نشریه دانشگاه علوم پزشکی خراسان شمالی
سال سوم شماره 3 (پاییز 1390)

The rate of nosocomial infections is a remarkable index that can be used to evaluate the quality and type of health care provided in hospitals. On the other hand, infection of control in hospitals has a direct correlation with the identification of the infectious agents. The aim of this study was to evaluate the level of microbial contamination of operation rooms in Amir-Al-momenin Hospital in Zabol. In this cross-sectional descriptive-analytic study, 380 samples were taken from different operating rooms of Hospital. After laboratory analysis, the results were considered with sampling location, sampling time (before or after disinfecting), type of disinfectant and its dilution level. Statistical analysis was done with SPSS soft ware and Pearson chi-square test. The Microbial contamination was 27.6% in the operation rooms of the hospital. Contamination was due to bacterial (18.2%), fungal (7.6%), and bacterial + fungal infections (1.8 %).The most prevalent contaminating agents were Staphylococcus epidermidis (22.5 %), Klebsiella spp (14.2 %) and Aspergillus spp (10.8 %). The most contaminated locations were the floors and walls, the beds and anesthetic masks. The least contaminated area was the air. The microbial contamination rate in Amir-Al-Momenin Hospital of Zabol was not significantly different from other hospitals in the country. It was however, a far cry from world standards (5%). There is a dire need to plan suitable strategies to decrease the microbial contamination rate in the operation rooms of the hospital.

Oligohydramnios is a deficiency in the amount of amniotic fluid, lower than expected for the pregnancy age concerned. In severe cases this may lead to fetal morbidity and mortality. The purpose of this study was to determine the effect of oral and intravenous hypotonic liquid on the amniotic fluid index in pregnant women. This clinical trial study was done in 60 pregnant women in their 35th to 38th weeks of pregnancy with amniotic fluid indices of 5 to 10 cm. The amniotic sacs in all these women were intact and sonograms showed no abnomalies in their fetuses. They were divided into 3 groups: The first group did not receive any treatment and was designated as the control group. The second group was treated by oral hydration (2lit/2h) and the third group was treated by intravenous (Ringer) Isotonic liquid (2lit/2h). A sonography was administered and the amniotic fluid index was calculated prior to and 1 hour after treatment. In the control group, the difference of the mean of amniotic fluid index prior to and after treatment was 0.39±1.74 cm (P-Value=0.33). In the second group the difference of index before and after treatment was -1.32±1.82 cm (P-Value=0/004). In the third group the difference of the mean of the amniotic fluid index before treatment and after treatment was -1.85±1.85cm (P-Value=0.001). The differences in the amniotic fluid index was significant (p=0.001). The results of our study showed that the administration of oral and intravenous maternal hydration is a suitable procedure for the short-term increase of the amniotic fluid index. This increase was higher in treated group.

AIDS is continuesly one of the most complex health problems of the 21st century. The aim of this study was to assess the knowledge, attitudes, beliefs and preventive measures taken by high school students in Mazandaran. This was a descriptive cross-sectional study. Using a multistage area sampling method. A random sample of 4400 high school students were studied in Mazandaran in 2007-9. Students who agreed to participate were given a four-page, self–administered questionnaire. Data analyzed by K Squer test using SPSS version 16. All 4400 eligible participants completed the questionnaire. The mean age was 15.91 ± 1.04 years ranging from 15 to 18. Half of the participants were male. The findings indicated that the respondents had average to fairly good knowledge about AIDS. The correct answers ranged from 8.2% to 91.3%; Despite the presence of myths among students concerning the disease and ways of contracting it, most students possessed a positive attitude towards the disease. The results also showed that the majority of the respondents (82.1%) strongly agreed or agreed with the statement that people with AIDS should have social rights to study or work. Although high school students are a high risk group, unfortunately, no efficient preventive program is available for HIV infection and AIDS in Mazandaran.

Research shows there is a relationship between body weight consisting of fat mass (FM) and lean body mass (LBM) and bone mineral density. The purpose of this study was to analyze the relationship between fat mass and lean body mass with lumbar spine bone mineral density. The present study was a descriptive correlation study on 24 active and non-active postmenopausal women. The active group (n=12) had exercised by walking for one hour, three times a week, for a minimum of three years on a regular basis. The non-active group (n=12) lacked physical activity and they were similar with the active group in the onset of their menopause. Fat mass and lean body mass and bone mineral density of lumbar spine of subjects were measured by DEXA machine. The collected data were analyzed by Pearson correlation test by SPSS 16 software. Results showed that there is a significant relationship between lean body mass and lumbar spine bone mineral density in both the active and non-active postmenopausal women, except for the second lumbar spine bone in non-active postmenopausal women. Lean body mass can be considered as a predicting index for lumbar spine bone mineral density in active and non-active postmenopausal women.

Despite medical progress, tuberculosis continues to be one of the most important factors in human morbidity and mortality. The aim the present study was to investigate the epidemiology of tuberculosis as well as other factors related to this disease in the province of North Khorasan. This study was a descriptive-analytic study conducted in patients with diagnosed tuberculosis in the years 2005-2010. Data related to patients suffering from tuberculosis (pulmonary and extrapulmonary) was provided by the Tuberculosis Office, Department of Diseases control, Province of North Khorasan. Data were analyzed using SPSS 16 software. 669 cases of tuberculosis have been reported in North Khorasan during the years analyzed. 90.6% of the patients were newly diagnosed cases. The prevalence of the disease in the years studied was 10.6, 9.6, 13.1,7.2, 8.14 and 17.14 respectively. Despite the decline in the prevalence of tuberculosis in North Khorasan in recent years, there has been an increase in the spread of bacillus tuberculosis from patients to the healthy population of the province. In this province it takes an average of 6 months from the onset of symptoms to diagnosis. This can play an important role in the spread of the disease, highlighting the importance of early diagnosis.

Pain is a complicated phenomenon that has been ignored in the newborn in the past. Massage and touch therapy have effects on CNS and facilitate the release of internal opiates such as beta-endorphins and enkephalins which can be effective on pain. The purpose of this study was to investigate the effect of massage on alleviating the intensity of pain due to vaccination experienced by the newborn infants that were delivered at Bentolhoda Hospital in the city of Bojnurd, North Khorasan, Iran, in 2007. In this single blind randomized clinical trial (RCT), 60 healthy full-term newborns were studied. These were then randomly allocated into two groups; experimental group (massage) (n=30) and control group (n=30). The experimental group received 30 minutes of direct massage applied by the mother and supervised by the researcher. A reasonably firm and rhythmic effelurage massage was applied to the whole body and petressage massage was applied to the extremities. The control group was placed in the cot beside their mothers’ beds without any massage techniques. After 30 minutes, the two groups were injected with Vaccina (Hepatitis, BCG) by a vaccinator in the center. In the two groups, behavioral changes of the newborns was observed and evaluated before vaccination, immediately after 30-minute intervention, and 5 minutes after the intervention by a researcher who was blind to the group the infant was allocated to. The intensity of pain was measured using the (NIPS) Neonatal Infant Pain Scale. Data were analyzed using descriptive statistics, t-test and chi-square test. after 30 minutes intervention, the mean of pain intensity in experimental group was lower than control group (p=0.004). The findings of the present study indicates that massage reduces the intensity of pain experienced by the newborns, being a non- invasive method for the reduction of pain, therefore it can be used in the promotion of the infants’ health.

Urinary tract infections (UTIs) are one of the most frequent diseases which if misdiagnosed can lead to complications such as renal scars. To prevent this complication, it is necessary to identify all the children who are at high risk for renal scars following UTI for treatment and follow them up seriously. The aim of this study was to investigate the probable relationship between factors such as age, sex, fever, microorganism involved, vesicoureteral reflux and its severity and number of recurrence episodes of UTI with occurrence of persistant renal scar in children suffering from UTI. This descriptive- analytic study was done on 50 children aged 37 days to 15 years with UTI who referred to Dr. Sheykh Hospital Mashhad-Iran. The study was judgmental non-probability sampling. Urinary tract sonography during the treatment and voiding cystourethrogram (after U/Cs turned out to be negative) were performed in all cases. DMSA scan was done 6 months after diagnosis of UTI to demonstrate renal scar. Renal scars were seen in 22 out of 50 patients. Of the 50 patients, 9 were boys and 41 girls; 66% of cases had fever. The etiologic germ was E. coli in 84% of cases and the recurrence pathogen was also E. coli in 71.9% of cases.VUR occurred in 55.6% of patients and dilated reflux (grade III and more) was 44.4%. The mean number of recurrence in patients who developed renal scar was 3.9 and in the others without scar it was 1.93. Finally, the association between the male sex and unusual microorganisms (non E. coli) in recurrence of UTI and relation of VUR, dilated reflux and recurrence episodes with renal Scar was statistically confirmed (P<0.05). According to our data from this study, the risk factors for renal scar followed by UTI are male sex, non E coli pathogens, VUR, VUR grade III and higher and the number of UTI recurrences.

The time interval between arterial blood sampling and analysis may lead to some changes in the composition of blood gases due to ongoing anaerobic and aerobic reactions. The aim of this study was to determine the effects of time lag and ambient temperature on parameters of arterial blood gas in patients after open heart surgery admitted to Kurdkuy hospital, located in Golestan Province, Iran, in 2011. In this study samples were collected in glass tubes and kept in ice or kept in room temperature the stability of the blood gas parameters (Pao2, Pco2, pH, Hco3) for 61 samples were measured and compared at 5, 15,30 and 60 minutes after sampling. Parametric and non-parametric tests were used to analyze the data. SPSS version 16 software was used and P<0.05 was considered significant. Pao2 concentration in the samples kept in ice were significantly different from the samples in room temperature (103.86 vs. 97.48). While PacO2 did not change over time for the samples on ice, the PacO2 decreased over time for the samples in room temperature. Hco3 changes in both groups were not significant. According to our findings, the time lag and temperature shifts can affect blood gas parameters. It is necessary to consider time lag and temperature when analyzing arterial blood gases.

Every year, about 4 million lives are lost due to diabetes. Control of blood glucose may delay the onset and progress of the disease. The present study aimed at evaluating the quality of care given to diabetic patients with medical records in the health homes in the Malekan region. This was a cross-sectional study where 624 patients at ages of 18 to 75 years were chosen through simple random sampling. Patients’ data collection was through questionnaires, records with the family physician, and measurements taken such as height, weight, and blood biochemical factors. Data were analyzed by descriptive statistics using SPSS 17. The mean glycohemoglobin level of the patients was 9.4±4.2%. 57.7% of the patients had a glycohemoglobin level over 7.5%. 76.8% of the patients used orally administered drugs while 4.6% of them used IV administered drugs. 80.6% of the patients had at least one visit at the physician’s in the past year. 33% of the patients had a systolic blood pressure over 140 mmHg and 26% had a diastolic pressure over 90 mmHg. 67.7% had a cholesterol level over 200 mg/dl and 59.4% had a triglyceride level over 200 mg/dl. In 27.9% of the patients, HDL level was less than 40 mg/dl and in 9.4% of them, LDL level was over 130 mg/dl. 59% of the patients had a body mass index over 27 kg/m2. The quality of the diabetic patients’ health care in the present study was much lower than standard criteria.

Injuries caused by contact with sharp instruments and exposure to contaminated blood of patients with infectious diseases are among the most threatening occupational hazards in the health sector. Considering the high incidence of injuries among medical personnel, this study aimed to determine and interpret such experiences. a descriptive-qualitative method called phenomenology was used in this study. The data were collected through semi- organized interviews with 6 personnel working in different levels of the health care system. Sampling was purpose- oriented and the data were analysed using collizi thematic method. The main themes raised from participants’ experience were carelessness, foreboding, and lack of support, follow-ups, and scandal. Most participants in the study found that the most reason for needle-stick injuries and contamination to infectious excretions was lack of standard precautions. Also, lack of concentration while giving care and lack of staff were cited as other important factors causing injuries. The results of this study highlighted the lack of a correct follow-up procedure for occupational injuries. Most participants complained about the lack of support by authorities, as well as their negligence and denial of this great health risk. This results in loss of hope and motivation to follow up the case seriously. Nonetheless, personal efforts for survival prevailed. These findings offer a new insight to health authorities and help them to realize the great potential dangers.

Nonalcoholic Steatohepatitis (NASH) is as a part of a broad spectrum of nonalcoholic fatty liver disease, and its prevalence is increasing in parallel with the increasing prevalence of obesity. The purpose of this study was to examine the effect of restricted diet with or without aerobic training program on cardio respiratory fitness and anthropometric indices in patients with NASH. Twenty-three NASH patients aged 25 to 50 were randomly divided into two groups: restricted diet accompanied by aerobic exercise (n=12) and diet alone (n=12). The caloric intake in both groups included 500 Kcal less than the estimated daily energy requirement. In addition to the diet the first group participated in an aerobic exercise program for a period of 8 weeks, 3 days a week with a 55–60% heart rate reserve. Anthropometric indices and peak oxygen consumption (VO2peak) were measured before and after eight weeks of intervention. Data were analyzed by Paired Samples and Independent-Samples T Test; The different with P<0.05 were considered significant. Results showed a significant decrease in anthropometric measurements and a significant increase in peak oxygen consumption in both groups. There was, however, a significant difference between the two groups in Waist Circumference, Waist to Hip Ratio, Waist to Height Ratio and VO2peak. Results from this study showed that the combined program of aerobic exercise with diet was more effective than diet alone on reducing central obesity and visceral adiposity and improving cardio respiratory fitness in patients with NASH.

Leishmaniasis is a parasitic infectious disease caused by a protozoan parasite from the trypanosomatidae family with a wide spectrum in tropical and sub tropical areas. Cutaneous leishmaniasis(CL) is found endemically in some parts of North Khorasan province. The purpose of this study was to define the status of the disease in this province in the years 2009-2011. The demographic information of 485 patients with CL was collected from March 2009 to March 2011. Demographic information including age, gender, and occupation and also information about the number of lesions were collected through questionnaires given to these patients in health centers of the province. Statistical analysis was performed in SPSS 15 software using descriptive chi-square test. Among 485 patients, 60.2% were male and 39.8% were female. Lesions were found on the face (23.4%), hand (40.6%), leg (25.5%), trunk (5.2%), neck and head (5.3%). The patients suffered from one lesion (42.1%), two lesions (21%), and three or more lesions (36.9%). The highest incidence of CL was found in Esfarayen with 198 cases (40.8%) and Jajarm with 160 cases (33%). Considering the number of cases reported and the consequent mental effect of the lesions left by the disease, the implementation of prophylactic and control measures is recommended.