مجله مطالعات علوم پزشکی
سال بیست و سوم شماره 1 (فروردین و اردیبهشت 1391)

Asthma is the most common chronic disease in childhood. Various results were found linking breastfeeding and childhood asthma. The aim of this study was to investigate the association between duration of breastfeeding and risk of asthma in children at age 2-8 years in Urmia district.

This case-control study was conducted on 200 cases that were selected from asthmatic patients. The control groups (n=400) with two controls per case were selected from other patient with irrelevant allergic disease and healthy children and were matched according to their age and gender. Information related to duration of breastfeeding and other affected factors were collected using ISSAC phase II risk factor questionnaire in interview with patient’s relatives. The associations between breastfeeding pattern with risk of asthma were analyzed by multiple logistic regressions after adjust for affected variables using STATA 10 software.

Duration of breast-feeding for two first years of life was associated with a reduced risk of asthma. However, continuing it for higher than two years was significantly associated with an increased risk. Exclusive breast-feeding for less than 6 months and using artificial feeding before 6 months increased risk of asthma among 2-8 year old children. But it wasn’t significant statistically.

Lasting of breastfeeding for first two year of life does not increase risk of asthma and exclusive breast-feeding for first 6 months of life has protective effect against asthma at 2-8 years.

Enhanced external counterpulsation (EECP) is a non-invasive outpatient treatment used for angina pectoris. In patients with intractable angina who were symptomatic after medical and invasive strategies, several novel techniques are considered including EECP. In patients with refractory angina due to coronary anatomy specific information, CABG or PCI are also up despite anti-ischemic drug therapy are still symptomatic, other treatments including EECP is used. EECP produces an acute hemodynamic effect that is presumed to be similar to that produced by the invasive intra-aortic balloon pump. By applying a series of compressive cuffs sequentially from the calves to the thigh muscles upon diastole and rapidly deflating the cuffs in early systole, an increase in diastolic and decrease in systolic pressure is created. The purpose of this study was finding relationship between the therapeutic effects of enhanced external counterpulsation on refractory angina in patients, unsuitable for invasive interventions. In an Intermediary study, 50 consecutive patients (34 male, 16 female) were treated with EECP and followed for one year post treatment. Canadian cardiovascular society (CCS) class was analyzed, and medication and adverse clinical events were assessed prior to EECP, at the end of the treatment, and at 1 and 12 months thereafter. Any differences in background factors were recorded and analyzed. The mean age of the 50 patients of this study was 62.18±8.67 years. A significant difference was found in score of life quality questionnaire between pre and after EECP treatment (p=0.010). Differences between EF pre and after treatment were significant (p=0.038). Differences between angina severity (CCS Score) pre and after EECP treatment were significant (p<0.001). Differences between Ischemia severity pre and after treatment were significant (p=0.044). Nitroglycerin usage pre and after treatment had no significant changes. Exercise duration significantly increased after treatment duration (p=0.001). LVEDD and LVESD also significantly reduced (p=0.031, p=0.032). Exercise test duration of one month after treatment than before treatment, and was significantly increased (p<0.001). However, the rate of improvement in the above parameters significantly after one year than a month after that story you did not treat the effects of relative stability is above. Amount of nitrates and other medications used before and after treatment statistically no significant difference in terms of study. This study demonstrated that EECP a useful method, while effective and safe for patients with severe refractory angina pectoris resistant to drug therapy and aggressive measures such as PCI and CABG are not suitable.

This study was done in hem dialysis patients who referred to Imam Khomeini hospital of Urmia for insertion of arterial -venous fistula with Gore-tex, in whom there was not possibility of natural fistula. Objectives were assessment and comparison of complications and patency of arterial-venous fistulas was done with 6 and 8 mm Gore-tex graft in the upper limb and comparison of them with the 8 mm Gore-tex graft in lower extremities in a year after the operation. A follow-up study was done on 65 hemodialysis patients referred to the Imam Khomeini hospital of Urmia for insertion of arterial-venous fistulas with Gore-tex. Considering that the patient's situation and the best move for them would determine the appropriate size and position of graft, there was not possibility of making randomized groups for study. So in 32 (49/2%) cases 6 mm Gore-tex and 33 (50/8%) cases 8 mm Gore-tex was used. Anterior-venous fistulas with Gore-tex in the upper limb of 48 (73/8%) cases and in the lower limb of 17 (26/2%) were inserted. After collecting all information, data analysis was done using SPSS software. In order to analyze data and graphs survival distribution with Kaplan-Miere method was used; and to assess the significant differences in the distribution of graft patency between the size of grafts and position of insertion depending on data distribution and status in a group Cox regression and Log rank tests were used. According to the results of this study no significant differences in the one year patency and complications between graft size and or location of insertion were seen. The graft can be inserted based on clinical situation and the vascular status of patients. Although this point should be noted that our study sample size and duration of follow-up is low and these recommendations should be used with caution.

Patient satisfaction is an important indicator of quality of care and service delivery. Assessment of patients’ satisfaction with their emergency department (ED) experience can have an effective role in improvement of emergency department services.

This study was carried out in one week and during all shifts, by trained researchers using standard Press Ganey questionnaire. The study questionnaire included 30 questions, based on Likert scale, and comprised of four sections namely: identification and waiting time, registration process, physical comfort and nursing and physician care, and overall satisfaction of emergency department. The data were analyzed descriptively.

303 patients were included in this study. The highest satisfaction rates were observed in the items of courtesy of physicians (86.6%) and courtesy of nurses (85%). The patients rated high dissatisfaction with these items: cleanliness of emergency room (21.4%), care provider's efforts to include patient in decisions about treatment (19.8%) and to give information about medications (19.7%) and waiting time before first visit by the care provider (16.4%). The mean waiting time for first visit of physician was 14.1 minutes. Sixty two percent (CI: 55.1, 68.99) of the patients rated their general satisfaction with emergency setting as good or very good.

The key elements of the patient satisfaction were courtesy of nurses, physicians and waiting time for first visit. The study findings indicate that satisfaction rate is relatively acceptable in the emergency care services, such as: medical care, nursing care, Courtesy of staff, physical comfort and waiting time. Efforts should focus on shortening waiting intervals and improving patient's perceptions about waiting in ED and also improving the overall cleanliness of emergency room.

Aluminum has many harmful effects on biochemical and physiological structures even behavioral disorders. The rabbits were classified into treatment and control groups. 12.5mg/kg aluminum chloride was injected to treatment group animals and simultaneously the same dose of deionized water to control group animals in anesthesia state for 7 weeks, intraperitoneally. Tissue preparation for ultrastructural, morphologic and morphometric studies was carried out on the basis of standard methods. The microscopic photomicrographs were studied morphologically and morphometrically. Finally the morphometric results were analyzed by statistical tests. Tubular dilation, severe lymphocytic infiltration and fibrotic changes of renal tissue (morphologically); significant damage in glomerular basement membrane, thickness increase of glomerular basement membrane and sedimentation of electron dense particles in it, decrease of microvilli and cytoplasmic vacuolation of proximal tubular cells (ultrastucturally); significant increase of average diameter of renal tissue components (p<0.05) and average thickness of glomerular basement membrane components (p<0.05) (morphometrically) were obtained. Previous studies have revealed the effect of aluminum on different cellular organelles of tissues was distinct. Present study showed aluminum-induced changes was in glomerular basement membrane components, microvilli, nuclear membrane, mitochondria and tubular-cells cytoplasm. It seems these changes are the results of free radicals production, cell membrane lipoperoxidation and even nuclear DNA changes.

Iron deficiency is the most common nutritional deficiency in children. Iron supplements are recommended for controlling iron deficiency in infants in developing countries. The aim of this survey was to study the prevalence and related factors of non-consumption and irregular consumption of iron drop in infants aged 7-24 months in Urmia. This cross-sectional study was done in all health centers of Urmia city in 2009. 400 questionnaires were completed by females whose babies were between 7-24 months old. The cases were selected by systematic random method. The data were analyzed by SPSS, Chi square test, Fisher exact test, and T-test. According to the results of this study, 14% of children did not consume iron drops, and among consumers %14.24 consumed regularly and %85.76 consume irregularly. Most important causes in non-consumers was child refusal, child vomiting (after use) and most important causes in irregular consume was parent's forgetting the medication or child refusal. We observed significant relationship between iron drop consumption and mother educational level (p<0.001). The prevalence rate of irregular consumption in Urmia infants is in high level and the prevalence rate of none-consumption is in considerable level that most important causes are parental forget, child refusal to eat iron drop and child vomiting (after use).

Lymphedema is a common and troublesome condition that follows breast cancer treatment. The aim of this study was to compare two treatment methods after breast operation: standard treatment and complete decongestive therapy in the treatment of post mastectomy lymphedema In this experimental trail study, 10 women with post-mastectomy lymphoedema were treated in two groups: the control group included 5 patients with standard treatment (intermittent pneumatic compression, elevation, bandage and exercise) and the experimental group included five patients with complete decongestive therapy (manual lymphatic drainage, multilayer bandage and exercise). Measuring parameters were edema volume, limb circumference, range of motion and pain. The patients’ conditions were assessed at the first, fifth, tenth, and fifteenth session and one month after the last session for follow up.The primary outcome parameter was volume reduction of the affected arm after treatment. The comparison of two groups showed that limb circumference on elbow and shoulder levels and edema volume more decreased in the experimental group versus control group (P<0.05). The results of this study will provide information on the effectiveness of manual lymphatic drainage and its impact on the quality of their life and physical limitations of the patients. Keywords:

Diabetes mellitus, as the most common metabolic disorder in the world with increasing incidence, is associated with advanced atherosclerotic changes in cardiac, cerebral and peripheral vasculature. Atherosclerosis by making some changes is related to the cardiac and cerebral vasculature. Establishment of peripheral vascular complication leads to early diagnosis, prevention and treatment of cardiovascular complication. Measurement of Ankle Brachial Index (ABI) with Colour Doppler ultrasonography was down as a screening test for assessment of atherosclerotic change in 206 patients with type 2 diabetes Mellitus through a cross sectional study. ABI Index less than 0.9 was defined as a predictive norm for atherosclerosis. Ki- square and ANOVA tests were used for data analysis. 84 male and 122 female with type 2 diabetes mellitus were evaluated. The mean age was 54.08 ± 9.2 and 41 patients, 17 males (41. 5%) and 24 female (58. 5%), had ABI less than 0.9. The meaningful correlation was between abnormal ABI and duration of disease (P=0. 04), cardiovascular event and CCU admission (P=0. 001), hypertension (P=0. 01) and dyslipidemia (P=0. 01). ABI is a non invasive and reliable assay for detection of peripheral and cardiovascular disease in diabetic patients. In patients with abnormal ABI, long term follow up for earlier detection and prevention of high risk cardiovascular complication is helpful.

Dental materials have had a great role in reconstruction of dental structure. One of the complications of using metallic filling in mouth is galvanic symptom. When two or several non-homogenous dental materials with different electric potentials lie near, the side effects are metallic taste feeling, irritated feeling in membrane, erythematous region, and gingivitis desquamate. The aim of this study was to assess the presence of symptoms of electro galvanic in Iranian samples. This descriptive study was conducted on two groups of 150 patients, 189 female (63%) and 111 male (37%). Assessment was done by oral examinations and filling the questionnaires for records of probable of electro galvanic symptoms. Statistic analysis was done by SPSS. The results indicated that the presence of galvanic phenomena in the case and control group was 82% and 5.3%, respectively. Among them, the most prevalent symptom was metallic taste feelings and the rarest clinical manifestation was erythematic in buccal and lingual mucosa surfaces. According to the results of this study, direct contacts of metallic filling lying side by side or face to face in proximity of electrolysis solution (saliva) is effective in occurring of galvanic phenomena.

Throughout life, stem cells make new cells in various tissues. Bulge region of hair follicle indicated as sources of stem cells for along times but little studies done in vitro to characterize rat bulge hair follicle stem cells. In this study bulge cells of rat hair follicle were isolated and were cultured, then morphological features of differentiated cells were studied. Also, rat hair follicle cells were assessed one and three weeks after cultivation. The result showed that two days after cell attachment to floor of plates, the cells initiate to proliferation and migration. Growth curve showed that the rate of cell proliferation at day 8 reaches its maximum level. After a week of cell culture, they had good power but after detachment were limited reproduced. Most cells in high cell density conditions and NT- 3 treated media differentiated to neural and glial lineage. Results showed that cultivated rat bulge cells, have high proliferative potential, and also could change to neural and glial like cells.

Stents are used to drain urinary colleting system due to the trust of drainage and kidney activity during the operation. Although they are very useful, they have early and late complications such as pain, irritative symptoms, hematuria, infection, migration, calcification, and ureterovascuar fistula. We report a 40 years old man who had a history of TUL three years ago and complained of urgency and frequency and work up showed that he had missed double J stent with vanishing of stent midshaft and semiopaque stones over the coil parts of stent in UPJ and bladder.

Aden carcinomas account for less than 2% of primary bladder cancers. In some situations, bladder tumors especially aden carcinomas has got unusual clinical presentations. A 76 year old female with diabetes mellitus was presented to the emergency room because of fever, abdominal pain and erithem of suprapubic region and after physical examination abdominal wall abscess was suspected and the patient underwent surgery. After drainage of abscess, the surgeon noted extending of abcess to pelvic cavity with involvement of bladder wall and adjacent organs. Urologic consultation was performed and frozen sections were obtained from involving portions of the bladder that revealed malignancy. Thus eventually, radical cystectomy and anterior pelvic exentration and bilateral ureterosigmoidostomy were performed. The patient was discharged after ten days with good general condition. Definitive pathological and immunohistochemistry result was reported as primary bladder adenocarcinoma with invasion to abdominal muscles. To date, the case of bladder adenocarcinoma with initial presentation of abdominal wall abcess has not been reported and our patient is thoroughly exclusive and significant case because of its unusual presentation and type of performed procedure in unprepared bowel preoperatively.

When medical therapy is ineffective or does not exist for a particular adrenal disease, surgery becomes necessary. The introduction of laparoscopic adrenalectomy has revolutionized adrenal surgery and largely supplanted the open approach. In this series we introduced three cases of aldosterone producing adenoma and pheochromocytoma which underwent laparascopic adrenalectomy. To the best of our knowledge, this surgical procedure was done for the first time in our educational center in west Azarbayjan. We describe three cases and procedural details of a minimally invasive laparoscopic adrenalectomy- two patients with pheochromocytoma and one patient with primary hyperaldostronism- that was performed at Imam Khomaini hospital in Urmia. The procedure required specifically trained, advanced laparoscopic surgery team and showed remarkable advantages in comparison with open procedure in terms of blood loss, shorter hospital stay, rapid healing and return to normal function. We believe that such minimally invasive laparoscopic procedures should be carried out in other health care centers throughout this country so that patients may benefit from this proven role in patient care.