نشریه دانشگاه علوم پزشکی بیرجند
سال هجدهم شماره 2 (پیاپی 47، تابستان 1390)

Airways responses during extubation can lead to coughing, laryngospasm and hypertension. The aim of this study was to compare the effects of intratracheal and intravenous lidocaine on airway responses and cardiovascular effects during extubation. This clinical trail was preformed on sixty 15-60 year old patients undergoing general or gynecological surgery, who were class I and II based on the classification of the American Society of Anesthesiology. Three minutes before the end of surgery and at the same time stopping the anesthetic gases, lidocaine was administered 1.5mg/kg intravenous or intratracheal. The number of bucking and coughs till extubation, number of cough till 30 minuets after extubation, the interval between stopping the anesthetic gases and extubation and also heart rate and blood pressures were recorded. Data were analyzed by SPSS version 16 using chi-square and t-tests at the significant level of P<0.05. The mean times for extubation in intravenous and intratracheal lidocaine group were 11.3±3.6 and 11.7±4 minuets, respectively (P=0.71). There were no significant differences in numbers of bucking (P=0.19) and numbers of cough (P=0.97) between the two groups. No significant differences were observed in cardiovascular variables between the two groups. The effects of intravenous or intratracheal administration of lidocaine on the rate of bucking, cough and the time for extubation at the end of general anesthesia were similar.

Blood donation causes changes in physical and physiological characteristics. The purpose of this study was to investigate the effects of blood donation on the exercise performance and some of hematologic parameters in physically active and non-active women.

In this experimental study, 14 active women with history of physical exercises more than 6 months and 16 non-active women, ranging form 20 to 30 years old, were participated voluntarily. Hemoglobin, hematocrit, serum iron and exercise performance parameters (including maximal oxygen uptake and anaerobic power) were measured 24 hours before, 2 days and 4 weeks after blood donation. Data were analyzed by means of SPSS (version 16) at the significant level of P<0.05.

Serum hematocrit and hemoglobin in both groups were significantly decreased 2 days and 4 weeks after blood donation (P<0.001 vs the day before donation) and were significantly increased 4 weeks comparing 2 days after blood donation (P<0.001). Maximal oxygen uptake was increased significantly only in non-active women, 4 weeks after donation comparing with 2 day after and the day before donation (P<0.001 for both). Peak anaerobic power was increased significantly only in active women, 4 weeks after compared to the day before donation (P=0.03).

Although compensation mechanisms for hematocrit and hemoglobin are similar in both active and non-active donors, they are different for maximal oxygen uptake and anaerobic peak power and may response independent of hematocrit and hemoglobin levels.

Gestational trophoblastic disease (GTD) is one of complications of pregnancy and has different subtypes (complete mole, partial mole and choriocarcinoma). Macrophage derived factor or CCL22 is a member of chemokines that produced by macrophages, dendritic cells and tumors cells. It has an important role in the recruitment of T regulatory cells and T helper2 lymphocytes to the site of tumor. This chemokine has several polymorphisms which the most important is at position 16C/A. This study was aimed to evaluate the polymorphism of this gene and its relationship with GTD. In this case-control study, the peripheral blood of 110 patients with GTD and 120 healthy pregnant women were used for DNA extraction. The polymorphism of the CCL22 gene was investigated with Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP) method and analyzed by means of Epi Info 2000 and SPSS (version 11.5) at the significant level of P<0.05. No significant difference was observed in the polymorphism of CCL22 (including genotypes CC, CA and AA) and the frequency of its alleles between the case and control groups. Moreover, there was not a significant association between CCL22 polymorphism and subtypes of GTD. It seems that genetic alteration of CCL22 is not associated with GTD,therefor, investigation of other chemokines gene polymorphisms is suggested in future studies.

Migraine headaches, start since adolescence, are often severe and lead to dysfunction in patients. This study was performed to determine the prevalence of migraine and its relationship with educational disability in adolescents of Birjand city in 2010.

In this descriptive- analytical study, 723 adolescents were selected by cluster sampling method and have been investigated by headache international criteria for diagnosing common migraine; the degree of educational disability has been determined by the fifth version of Migraine Disability Assessment Questionnaire. Data analysis was performed by SPSS (version 15)using statistical tests of Mann Whitney, Chi square, Fisher and correlation coefficient at the significant level of P<0.05.

The mean age of studied subjects was 15.8±1.02 years and the prevalence of headache was 68.5%. Prevalence of migraine was 6.4% in boys and 7.6% in girls. The mean length of headache attacks was 8.15±4.97 hours, the number of attacks during the last 3 months was 7.1±6.69 and attacks interval was 14.11±8.03 days. The average score of migraine derived disability was 11.59±13.71 (average disability) and headache score was 4.93±2.77 (average headache). The educational disability was significantly associated with intensity, frequency and interval of headache attacks (P<0.001).

Regarding to the high prevalence of headache and various complications, it is recommended to identify the affected students and introduce them to the specialized centers for identifying the precipitating factors, instructing the families and teachers and preventive measures to reduce the attacks and improving the efficacy of people.

Major beta thalassemia is the most common hereditary anemia in our country, especially in the shores of Caspian Sea, Oman and the Persian Gulf. Hearing impairment is one of its complications. This study was aimed to evaluate the hearing impairment in thalassemic patients in South Khorasan province.

This descriptive-analytic and cross sectional study was performed on the 32 major thalassemic patients in South Khorasan province in year 2007. Personal and clinical data were collected from the patient's file in the certain disease department of Valiasser Hospital. Clinical examination and hearing tests were done by an odiometrist and ENT specialist to evaluate the hearing status of the patients. Data were analyzed by means of SSPS (version 15)using independent Student-t test at the significant level of P<0.05.

The mean age of the studied patients was 9.3±1.4 years (range: 2-17.5 years). Fourteen patients were female. Abnormal audiogram, tympanogram and otoscopy were observed in 10.9%, 31.2% and 18.7% of the examined ears, respectively. Normal hearing, sensory neural hearing loss and conductive hearing loss were observed in 81.2%, 9.4% and 9.4% of patients, respectively. Overall, the prevalence of hearing impairment in this study was approximately 20%.

In order to prevent and to treat the hearing complications of thalassemia earlier regular and periodical monitoring of auditory function in all thalassemic patients is recommended.

Depression is one of the most common emotional phenomenon in the current century and its prevalence among the students is 20-61%. Initiation of education in university is a critical period of every student's life. The aim of this study was to determine the prevalence of depression among new admitted students in Birjand University of Medical Sciences.

In this cross-sectional descriptive-analytic study, all of the students that were admitted and registered in the academic year in 2009-2010, were enrolled with census method. Data were collected by a questionnaire with two parts. Demographic information was recorded in the first part and the students responded the 21 questions of depression Beck test in the second part. Data were analyzed by means of SPSS version 11.5 at the significant level of P<0.05.

Totally, 231 questionnaires were completed. Twenty eight students (12.1%) had experienced some degree of depression. Of these, 23 people (10%) had mild and 5 students (2.1%) had moderate depression. No case of severe depression was found. A significant correlation was observed between the prevalence of depression among students and the level of family income (P=0.02) and jobs of mothers (P=0.03).

In spite of the low prevalence of depression among the new registered students in Birjand University of Medical Sciences, and the observed depression in students of families with low incomes, decreasing economic problems and counseling may prevent possible progress of depression during the education period.

Evidence Based Medicine (EBM) emphasizes on proper usage of the results of scientific research in the bedside for patients. This study evaluated the levels of clinical evidence in published articles in Iranian scientific medical journals over a fifteen-year period (1994-2008).

In this descriptive study, the years 1997, 2002 and 2007 were selected using systematic random sampling method and all of the clinical articles published in odd numbers of Iranian medical journals in these 3-year were analyzed. These articles were categorized according to the Oxford Centre for EBM from level I (highest) to IV (the lowest). Data were analyzed by means of SPSS (version 11.5), using chi-square test at the significant level of P<0.05.

Out of 4497 published articles in the selected 3-year, 2860 clinical articles were determined and evaluated. The total number of articles with levels I- III increased from 19.9% in year 1997 to 30.1% in year 2002 which indicate a significant growing of clinical evidence over the time (P=0.001). The median level of clinical evidence rating improved from 3 to 2 during the study period. The majority of clinical articles (59.7%) were classified as non-evidence.

The level of evidence of clinical articles in Iranian scientific medical journals has improved significantly during the studied period. Therefore, it seems the quality of clinical research in Iran has been improved according to standards of EBM.

Psychological well-being is defined as the development of real talents of each individual. Personality traits are considered as important variables for explanation of behavior. This study was aimed to investigate the role of five big personality factors (adaptability, loyalty, neuroticism, acceptation and extraversion) in predicting components of psychological well-being (self-acceptance, environmental mastery, positive relations with other purpose in life, personal growth and autonomy).

In this correlational-descriptive study, 436 students (232 female and 204 male) were selected based on cluster sampling method from all Birjand's high schools. Data were collected by means of the five big personality factors and the psychological well-being scales. Data were analyzed by SPSS (version 15) using Linear Regression at the significant level of P<0.05.

Adoptability trait predicted the positive relationships with others and self-acceptance. Loyalty trait predicted autonomy. Neuroticism trait, predicted autonomy, positive relationships with others, personal growth and purpose in life. Acceptation trait predicted environmental mastery, autonomy, personal growth, purpose in life and self-acceptance. Beta coefficient showed that six components of psychological well-being can be predicted by extraversion trait.

Regarding the important role of personality traits in predicting components of psychological well-being, more attention to the role of educational statues in development of personality is essential.

Performance measurement is one of the important issues in management. In the health sector, evaluation of productivity; using resources and facilities, of hospitals is inevitable. This study was aimed to determine the related factors of effectiveness of Performance Measurement System (PMS) in teaching hospitals and to provide a model to optimize and predict the effectiveness. In this descriptive study, which was done in the first 8 months of 2010, 32 teaching hospitals of Tehran were selected by means of census method and 60 questionnaires were sent. Independent variables including design, implementation and applications and their relation with effectiveness as dependent variable were investigated. Data were analyzed by SPSS (version 18) using descriptive statistic tests, Pearson correlation and linear regression at the significant level of P<0.05. The models of quality management, international organization for standardization (ISO) and balance scored card were the models with the highest usage in performance management. The studied independent variables were moderately considered. Significant relationships were observed between the components and the effectiveness. Linear regression test indicated the importance of strategy, users and the applications of performance measurement systems. The design and application are two basic steps in effectiveness of the PMS. Moreover, strategic planning, the users and the manner of using the results, have role in effectiveness of PMS.

Entamoeba histolytica is a common parasitic infection in children that causes ameboebic colitis. This infection is more common in the tropical areas with low socioeconomic levels. Extra intestinal complications such as liver abscess are fatal in children. It is very rarely reported in the neonatal period. In this report, a 25-day-old newborn suffering from amoebic dysentery is presented without known predisposing factors. The patient was successfully treated with Metronidazol. Physical examination and laboratory tests revealed no abnormal finding in later follow up and the infant had normal growth and development.