نشریه دانشگاه علوم پزشکی بیرجند
سال نوزدهم شماره 1 (پیاپی 50، بهار 1391)

Nausea and vomiting are the most common side effects of chemotherapy. The aim of the current study was to assess the effect of ice massage applied to the pericardium 6 (P6 or Neigaun) acupuncture point on nausea– vomiting due to chemotherapy in cancer patient. In a randomized clinical trial one- blind, 114 patients were randomly divided into three groups. Ice massage group were massaged gently on the skin around P6 point of the hand with ice cube into a wet gauze pad for 7 minutes twice a day with 12-hours interval for 24 hours by the patient. Placebo group were massaged with wooden cube and the control group received no interventions. Nausea and vomiting in three groups rated by Morrow Assessment of Nausea and Emesis (MANE) Questionnaire in 4 periods of time in 24 hours was used for the assessment of nausea and vomiting. There were significant decreases in the frequency of nausea (P<0.01) and vomiting (P<0.03) and a decrease in the intensity of nausea (P=0.63) and vomiting (P=0.34) in the case group. Frequency of nausea was significantly lower among placebo group than the control group (P<0.02). Ice massage on Neigaun point is effective on reducing the frequency of chemotherapy induced nausea and vomiting in cancer patients. Placebos, patient-practitioner relationship, suggestion, and the patient's view on nausea and vomiting and the role of interaction between the therapist and the patient is effective to some extent.

Diabetes mellitus causes enhanced oxidative stress due to increased production of oxygen free radicals and decreased activity of antioxidant defense system. Flavonolignan Silymarin has an antidiabetic effect. This study was conducted to evaluate the effect of its chronic administration on serum levels of aspartate and alanine aminotranferase; and the heart and liver level of malondialdehyde. In this experimental study, 40 male Wistar rats were divided into 5 equal groups, i.e. control, Silymarin -treated control (100 mg/kg), diabetic, and two Silymarin- treated diabetic groups (50 and 100 mg/kg). Silymarin was daily administered (i.p.) to each of the group members ten days after streptozotocin injection for 4 weeks. Serum levels of aspartate and alanine aminotranferase were measured both before and at the end of the study. In addition, level of malondialdehyde (MDA) was measured in the liver and the heart tissues on the basis of the reaction of thiobarbituric acid. Serum glucose level in high dose Silymarin-treated diabetic group was significantly lower as compared to diabetics in the sixth week (P=0.007).Moreover, diabetic rats showed a significant increase in their aspartate serum level (P=0.028) and alanine aminotranferase (P=0.008) and Silymarin treatment only significantly reduced serum level of alanine aminotranferase (P=0.034). In addition, diabetes was followed by increased level of MDA in the liver (P=0.008) and the heart (P=0.009) tissues and high-dose Silymarin treatment significantly reduced MDA level only in the liver tissues (P=0.026). Long-term treatment with silymarin at a dose of 100 mg/kg can attenuate serum level of alanine aminotranferase and hepatic MDA level and does not have any significant effects on serum level of aspartate aminotranferase and cardiac tissue level of MDA in the administered doses

Giardia lamblia, Giardiasis causative protozoa, is one of the most common etiologic agents of diarrhea throughout the world especially in Iran. Asafoetida, an oleo-gum-resin (called Anjodan in Farsi) obtained from an Iranian endemic herb, Ferula Assa-foetida has been used in treating of different diseases, particularly parasitic ones. The aim of this study was in-vitro evaluating of the effect of Asafoetida aqueous and alcoholic extracts on Giardia lamblia cysts. 500 µl of each of 1.25, 2.5, 5 and 20 mg/ml concentrtions of asafoetida aqueous and ethanol extracts was added to 500 µl of purified Giardia cysts,respectively. The mixtures were kept at 4, 24 and 37°C. The Giardicidal activity of the extracts was measured 1, 2, 3, 4 and 5 hour (s) after exposure through 0.1% eosin dye staining and microscopic enumeration method. The gathered data was analyzed by means of one- way variance, Pearson's correlation coefficient and Independent T-test. The highest Giardicidal effect of Asafoetida ethanol extract was 100% at 37°C, belonging to 20 mg/ml and in the 4th hour after experiment, while the maximum Giardicidal effect of Asafoetida aqueous extract was 57.23% at the same temperature and with the same concentration, in the 5th hour. There was a significant difference between Giardicidal effect of ethanol and water extracts with all concentrations and at different whiles and temperatures (P<0.005). Giardicidal effect of both extracts significantly increased due to rising the concentration, time and temperature (P<0.0001). Ethanol and aqueous extracts of asafetida have in-vitro Giardicidal effect on Giardia lamblia cysts. Ethanol extract has more Giardicidal effect.

Culture and specific staining (including Zeil-Nelson and fluorescent methods) are standard measures for the diagnosis of tuberculosis (TB).Because these methods are time-consuming and, sometimes, due to their low accuracy faster and more accurate methods are necessitated. Methods, which can substitute invasive procedures, when obtaining smear samples and culture is not possible; and in addition to being simple and fast, they have an acceptable diagnostic accuracy. The aim of the present study was to verify the diagnostic value of blood PCR in pulmonary TB. This case-control study included 64 proven pulmonary TB cases (according to The National TB Protocol) and 28 subjects who were completely healthy. 4.5ml of blood was derived from each participant and then mixed with 0.5ml EDTA. Finally, DNA extraction and PCR testing using SI 6110 primers was performed for all blood samples. Mean age of the cases and controls was 49.8±18.6 and 48.2±18.5, respectively. 49.2% of the cases and 25% of controls were male. Blood PCR in 23 patients with TB was positive, but none of the controls had a positive PCR (thus, sensitivity of 35.7% and specificity of 100%). With regard to specificity of 100% in PCR method (despite its low sensitivity), in conditions where there is no access to an appropriate specimen, a positive blood PCR can obviate invasive procedures and rapid and definitive diagnosis of the disorder and timely treatment of the patient, his life is saved.

Tuberculosis is a chronic lung infection that has contaminated 1/3 of men worldwide and nowadays causes 2 million deaths and 9 million diseases. One of the can be can be assisted tests, in addition to smear, in the diagnosis of pulmonary tuberculosis is lung radiography. In tuberculosis patients radiography of negative smear samples, which is often diagnosed with delay, can be assisted. In the present study, radiographic changes of tuberculosis patients with positive smear and those with negative smear have been compared. In this descriptive, retrospective, and analytical study, out of 376 patients who had exactly been diagnosed as tuberculosis ones and had been referred to Birjand health center during 2001-2006. One hundred patients whose smear tests were positive, according to WHO's standards, were selected. Then, among negative smear patients 100 individuals who were demographically compatible with positive smear ones were chosen. All of them had x-rays from their lungs, which were then interpreted by a radiologist. Moreover, all patient's sputum tests were done in the reference lab of the Health Center under a technician. The obtained data was analyzed by means of frequency distribution table and descriptive statistics using SPSS (version 15); and Chi-square statistical test. Except reticulunoduler infiltration, relative frequency of other radiographic findings in positive smear patients was more than negative smear ones; and only in the variables calcification, adenopathy of the lungs hilum, mediastinal widening, and patchy infiltration the difference was statistically significant P<0.05. Regarding the results of the study, although radiographic changes are not decisive in the diagnosis of pulmonary tuberculosis if they are accompanied by clinical symptoms and sputum smear, they can be assisted.

In order to best use from traditional medicine, world health organization suggested hygiene in making products and traditional healing method. Considering the great importance of different types of drug distillates and different uses of traditional & industrial, the amount of fungal and bacteria pollution in sweat chicory, Tp and forty traditional essences was studied in Birjand shops. In this method 30 sample of traditional and industrial sweat chicory, Tp and forty traditional was selected from Birjand city for bacterial (total coli form, fecal coli forms) and fungal pollution and was transferred to laboratory and were analyzed according 7725-1 and 997 number standard of Iran. Based on the results, in 1 case of TP and forty traditional essences fungus penicillium and sweat chicory aspergillus and penicillium fungi were isolated. In 80% TP and forty traditional essences & sweat chicory samples microbial pollution were detected and from these samples 20% sweat chicory and TP had coli form pollution & 20% TP and sweat chicory & forty traditional essences had fecal coli form pollution. 80% industrial samples of sweat chicory had microbial pollution and from these 100% had coli form pollution. According to the results, surveillance should be done more in various stages of preparation and distribution of these essences.

Recycling of sewage in our country can be one of the ways to overcome the problem of water shortage. The aim of this paper is Evaluation of Valli-e-asr hospital effluent for irrigation of the green. During the 12 months of the project since January 2009, twelve samples of the hospital water were selected. 35 samples were taken both from raw sewage and refined effluent with the average frequency of two samples every month. Various physical, chemical, and biological factors were measured on the basis of the standard method book (AWWA). The gathered data was statistically analyzed using SPSS software (version 15) and paired T test at the significant level. The percentages of separating some parameters such as BOD, TSS, COD, and MPS in the exiting effluent were 63.56%, 44.9%, 42.9%, and 89.97% respectively and those of the parameters PH, Mg, SO4, and SAR were 7.52mg/l, 66.82 mg/l, 382.14 mg/l, and 0.54 mg/l respectively. The amount of parameters BOD, COD, TSS, MPN, EC, CL, TDS, and NA% were 165.14mg/l, 887.657mg/l, 784.4286mg/l, 1856857 MPN, 4137.97µs/cm, 999mg/l, 2866.57mg/l, and 75.11% respectively. The sewage refinery of Valli-e-asr hospital does not produce a favorable outcome and some of the parameters of the effluent such as PH, Mg, SO4, and SAR are in accord with the standards of reusing in agriculture and irrigation; but many of the necessary parameters do not correspond with the necessary standards for this task.

Nowadays, regarding the increased human and geological activities, concentrations of toxic and carcinogenic disinfectant by-products– like Trihalomethanes -which have an organic base, in drinking water sources, has worryingly increased. Thus, the present study aimed at surveying the amount of dissolved organic carbon (doc) removed from aqueous solution by Fenton process. In this descriptive study, the outcome of removing dissolved organic carbon derived from natural water with initial concentrations 2, 4, and 8 mg/l using one-liter water containers by means of Fenton Process at PHs 2, 3, 4, and 5 due to adding 20, 40, 60, and 80 mg/l of H2O2 and Ferrous ions with 4, 8, 12, and 16 mg/l concentrations at oxidation time 5, 10, 20, and 40 minutes was calculated. Finally, the outcome of carbon removal was assessed by means of TOC analyzer. It was found that the most outcome of dissolved organic carbon removal (about 97%) belonged to 10/1 H2O2 and Ferrous ion, while dissolved organic carbon PH was 3 and its initial concentration was 2mg/l and oxidation time was 40 minutes. Generally speaking, it was confirmed that the improved Fenton Oxidation Process can efficiently be used to refine water containing dissolved organic carbon. The method was found to be highly and relatively fast compared to conventional existing techniques and also, it can be concluded that the Fenton process has the potential to be utilized for the cost-effective removal of DOC from water and wastewater.

Prevalence of mental disorders is growing worldwide so that, according to WHO's statistics, more than 0.5 million of the world population suffer from mild or acute mental diseases. Regarding the increasing feature of such diseases, it is obviously necessary to carry out a new study aiming at determining the prevalence of mental disorders in Birjand. This descriptive-analytical study, which employed multiple randomized cluster sampling, was conducted on 582 over 15 year olds in Birjand. For data collection, SCL-90-R questionnaire was used. The questionnaire was filled out two experts of the Health Center of the province, in addition to a researcher. The questioners/interviewers completed the questionnaires by referring to the residences of the individuals after obtaining their conscious written consents and justifying the aims of the project. The obtained data was fed into SPSS software (version 15) and analysed. 7.1% of the studied individuals had serious mental disorders and 47.9% had significant mental problems. Prevalence of various mental disorders was as follows: obsessive– compulsive disorders 5.5%, paranoid disorders 5.5%, depression disorders 6%, somatoform disorders 3.7%, inter-personal sensitivity disorders 1.7%, psychotics disorders 1.2%, anxiety disorders 2.6% and phobic disorders 1.3%.M ental disorders were significantly higher in women compared to men. Considering the above results it is concluded that mental disorders have a relatively high prevalence in Birjand.

Urinary tract infection (UTI) in children is among the prevalent infections of childhood, which occurs due to growth of bacteria in the urinary tract. The aim of this study was to evaluate the usefulness of procalcitonin (PCT) as a reliable marker for distinguishing urinary tract infection (UTI) with or without renal parenchyma (cystitis). Eighty children, who were suspicious of having UTI and had been referred to Ali Ibne Abitaleb hospital (in Zahedan) or pediatric clinics (June 2007- Oct 2009) were included in the study after their urine culture revealed their infection. Besides, their clinical and lab symptoms including erythrocyte sedimentation rate (ESR), C– reactive protein (CRP), serum WBC, and serum procalcitonin (PCT) were recorded. The patients were divided into two groups based on their lab clinical symptoms and radio-isotope scans, namely acute pyelonephritis and acute cystitis (lower UTI). Serum procalcitonin was measured in these cases in a semi-quantitative manner. Fifty children with mean age of 4.89±3.50 years were compared with 30 children with mean age of 5.20±3.07 years. ESR, WBC, and PCT were significantly higher in patients with upper UTI (P<0.001), but CRP was not significantly different in the two groups. PCT, which was semi-quantitatively measured, when lower than 0.5 had a relationship with sensitivity, specificity, positive predictive value, and negative value of 72%, 83.3%, 87.8%, and 64.1% respectively. When PCT was more than 2, the relationship with the mentioned features was 50%, 96.6%, 96.2%, and 53.7%, respectively. The relationships in these two domains can both be assistant in differentiating pyelonephritis from cystitis. PCT was more sensitive and specific for the diagnosis of upper versus lower UTI compared with CRP, and it can be a better marker than CRP for early prediction of febrile pyelonephritis in children.

Lead and cadmium are as main environment pollutants, and even in low concentrations have harmful effects on human health. Baby teeth are efficient indicators of environmental exposure of children to heavy metals. The aim of the present study is to determine the concentration of lead and cadmium in deciduous teeth of 5-12 year old girls and boys in Birjand in 2010.

In this applied research, teeth samples of children were collected from different clinics of Birjand. The samples were prepared by means of acidolysis method and metal levels were measured using graphite furnace atomic absorption spectrophotometer. Data analysis was conducted thanks to SPSS software (version 16) and P<0.05 was taken as the significant level.

Mean amount of lead and cadmium in teeth samples was 1.96±1.62 and 0.2±0.17 µg/g, respectively. The highest levels of lead was found in children’s molar teeth, while children’s incisor teeth had a higher level of cadmium. Besides, the amount of lead and cadmium was more in the boy's samples rather than the girls'. However, the difference between the two genders was not significant.

Deciduous teeth are suitable bio indicators to monitor for environmental pollution with heavy metals. The metal levels of lead and cadmium in the teeth of boys are more than girls'. The main reason is the presence of these metals in the environment and the boy's long-term exposure to these pollutants. Keywords: Deciduous tooth, Bio indicator, Lead, Cadmium,

The assessment of the Central Library member's use and Knowledge is an important step in a comprehensive planning to improve their awareness of the available facilities and services. This Study was performed to determine knowledge, and use of library services and facilities of the information section by the members of the Central Library. In This descriptive– analytical study, among 558 participants, 344 students were selected through systematic sampling and the rest (254) by means of census. A self-designed questionnaire considering the aim of the study was used to evaluate some of the facilities offered by the information section. The gathered data was analyzed by means of Mann- Whitney and Kruskal-Wallis Tests using SPSS Software (version 15) and P≤0.05 was taken as the significant level. Among 558 participants, 57%, 18%, 20% and 5% were students, staff, faculty members, and free members, respectively. 93/4% were aware of the library working hours and 16.6% were not satisfied with it. The most and the least familiarity with databases involved Irandoc and Ovid Bank (66/8%, 54%), respectively. Among the Computer Softwares, Microsoft Word was the most applicable one. Mean score (from the total of 116) of using library services and facilities was 21.719.1. There was a Significant relationship between the level of knowledge and library usage of the studied library members (P<0.001). The results showed that there is a relationship between member's Knowledge and their use of, the services and facilities of the central library.

In order to maximize the elderly's activities and keep them at an optimized level health-promoting behaviors and being conscious of them have significant role. The present study aimed at the evaluation of health-promoting behavior's education and their effects on the knowledge of the elderly in the geriatric nursing residences in Tehran in 2009 This semi-experimental and interventional study was carried out on 87 elderly residents in the geriatric nursing residences in Tehran selected through simple random sampling. Data gathering means was a self-designed questionnaire consisting of 62 questions covering demographic data (8 questions) and knowledge (54 questions) in six different fields including responsibility to individual health, physical activity, diet, attention to spiritual growth, interpersonal communication, and stress management. The questionnaire was completed in every nursing residence by means of interview before the education and two weeks after the last educational session. Two education sessions, each lasting 45 mins, were held in two consecutive days. The education was conducted in a group setting data was analyzed by means of SPSS software using paired t-test or Wilcoxon test. P value less than 0.05 was considered statistically significant. Mean of total awareness as well as knowledge in different fields significantly increased after education. Mean score of total awareness was 62.5±9.1 vs. 85.8±8.6 in pre- and post- education evaluation, respectively (P<0.001). It is confirmed that the education of health-promoting behaviors influences the awareness of the elderly in geriatric nursing residences.

Serum Carbohydrate Antigen, CA19-9, is a carbohydrate antigen whose usage -as a tumor marker- in pancreatic and bile ducts malignancies is commonly increasing. Sensitivity and specificity of this antigen in the diagnosis of malignancies is 70-90% and 68-91%, respectively. CA19-9 can also rise in other disorders and in few of benign conditions including cholangitis, due to other causes, e.g. choledocholithiasis. However, in such cases the increase is not significant and it is usually below 1000 u/ml. Values more than 10000 u/ml are limited to few case reports in articles. The case under study was a 66 year old man hospitalized because of epigastric and right upper quadrant pain, fever, jaundice, acholic stool, weight loss of about 6 kg, and hyperchromic urine. Physical examination revealed that the case was icteric and febrile with a mild RUQ tenderness on percussion. Laboratory tests showed marked elevation of bilirubin and CA19-9 (Total bilirubin: 36 mg/dl, Direct: 19.5 mg/dl; CA19-9: 44777u/ml, Normal: 0-40 u/ml), but the enzymes of the liver and alkaline phosphatase only increased to two times the normal level. Sonography showed dilated common bile duct with four stones within it. Four weeks after stones extraction and renewal of bile current CA19-9 fell to 60 u/ml and returned to normal range (0-40) 2 months later; and during this period the patient was totally asymptomatic. As a result, in patients with biliary obstruction, a diagnosis of malignancy cannot be made solely on the basis of increased concentration of CA19-9, even in case of high clinical suspicion and the interpretation of this increase must be done with more caution and after lab follow-up following removal of the obstruction.