مجله مطالعات علوم پزشکی
سال بیست و سوم شماره 5 (آذر و دی 1391)

Techniques like APACHE IV (Acute Physiology and Chronic Health Evaluation IV) are used extensively for predicting mortality rate of patients with different diagnosis in the intensive care unit who are admitted. These indexes are also considered as a standard tool for studying of hospitalized duration، quality evaluation of care provided and classification of illness severity. The purpose of this study was to determine the predicted mortality rate and duration of hospital stay in-patient admission in intensive care unit with APACHE IV technique.

This cross sectional study was conducted to evaluate patients during six months of 2010 of different sections of ICU wards in two health care centers. The study population had a utility profile and demographic and APACHE IV were used.

From 240 patients admitted in ICU، 159 patients (66. 3%) remained alive. The mean APACHE IV patients were 50. 62 ± 19. 07 (minimum 13 and maximum 98). The predicted mortality rate using APACHE IV، 11. 18 % and the observed mortality rate was 33. 7%. APACHE IV score in survived patients were 44. 94 and died patients were 66. 77% (P = 0. 000، t: 7. 10).

The result of the present research showed that the APACHE IV can predict mortality of hospitalized patients in the intensive care unit precisely. So، by using these indicators and other instruments we can classify severity of diseases and expected course of treatment before patients hospitalization in ICU. Evidently further studies in this field should be done.

Leech biting in human and animals is accompanied by nasal bleeding، vaginal bleeding، rectal bleeding، hematemesis، and hemoptesis and cause indication the anemia. In this experimental study the anti limnatis nilotica effects of differens doses of levamisole، albendazole and niclosamide on leeches was investigated with anti leech assay. The data were analyzed with SPSS software and variants analysis (M±SD). The results shown that the average time death of leech for separate doses of levamisole with dose of 100، 200 and 300 mg 10. 22±2. 22، 8. 33±1. 93 and 6. 77±2. 22 minutes، respectively، and for niclosamide with doses of 100، 200 and 300 mg 32. 22±6. 03، 26. 33±9. 19 and 20. 22±5. 82 minutes killed the leeches. The treatments of 100، 200 and 300 mg of albendazole and 100 ml of distilled water hadn’t any effects on leeches. Levamisole and niclosamide had the high effects on leeches and can be effective in leech contamination.

Diabetes is a metabolic disorder which affects whole systems in body including female reproductive system. Moreover، diabetes is an effective cause to infertility. Metformin is of the most common drugs using to control of hyperglycemia in patients. The aim of this study was surveillance of ultrastructural changes of ovarian follicles in diabetic rats and evaluation of Metformin efficiency. Thirty-six adult Sprague-Dawley female rats (170-210g) were studied in 3 groups (Control، diabetic and diabetic treated by metformin). In second and third groups، rats were induced diabetes by streptozotocin and the third group were treated by metformin monohydrochloride. At the end of experience period، rats were euthanized and their right ovary -after preparation- were observed by Transmission Electron Microscope (TEM) to survey objective factors. In comparison with control group، shape shrinking and size decreasing in granulosa cells، nucleus disorder and shrinking، decline in nucleus activity (increasing of dark chromatin)، reduction in number of cytoplasmic organelles and their unnatural appearance، accumulation of lipid droplets in cytoplasm، gaps among corona radiata cells and their spacing from zona plucida were observed in diabetic group. Mitochondrial homogenization and decreasing in number، ballooning in cristae in some mitochondria، swelling of rough and smooth endoplasmic reticulum are of the most obvious organellar changes in diabetic group. Diabetes causes ultrastructural changes of apoptosis to granulosa cells and leads to atresia in growing follicles. Treatment with metformin can cause better conditions to mentioned cases in diabetic patients.

Measles، rubella and mumps vaccination prevented the viral diseases threatening children during the recent decades. The incidences of these diseases in countries with high vaccination coverage have reduced significantly. Initial vaccination was as a single dose and then two dose vaccination was introduced. This change in the vaccination schedule still is renewed but the level of immunity، protection، production and stability of antibodies in the body is unknown. The aim of this study was the comparison of antibody levels among the children who received single or double doses of MMR vaccination. In this study، 200 children were classified as 100 patients with single dose vaccination (at age 12 months) and 100 with a double vaccination (at age 18 months). There was no relation between the serum level of antibody and gender of children. The positive serum level of IgM antibody against measles in single and double vaccination groups was 33% and 39% respectively with no significant difference. The positive serum level of IgG antibody against measles in single and double vaccination groups was 76% and 99% respectively with significant difference. The positive serum level of IgM antibody against mumps in single and double vaccination groups was 84% and 99% respectively with significant difference. The positive serum level of IgG antibody against mumps in single and double vaccination groups was 97% and 99% respectively with no significant difference. The positive serum level of IgM antibody against rubella in single and double vaccination groups was 21% and 14% respectively with no significant difference. The positive serum level of IgG antibody against rubella in single and double vaccination groups was 84% and 97% respectively with significant difference. The quantitative amounts of IgM and IgG against three diseases measles، mumps and rubella in children with second vaccination were more than once administration significantly. Finally، two time vaccination schedule in 12 and 18 months of age can immunize better than other vaccination programs and is more effective.

The highest interest is a beautiful act of psychological problems for the patient. This study compared the personality disorders clusters B، C among cosmetic surgery applicants and ordinary people. The present study was a comparative survey. The participants were 124 people، applicants (62) and non-applicants (62) in Urmia. The cosmetic surgery applicants were chosen by sampling and the non-applicants were chosen by matching age، sex، job، and literary level among the relatives of the applicants. Also، the applicants had referred to cosmetic surgery centers in Urmia during the last three months. The data were gathered by MCMI-III questionnaire، and the data were analyzed using descriptive statistics، MANOVA. Among personality disorders of clusters B and C، there was a significant difference between the two groups except for borderline personality disorder and avoidant personality disorder. It should be noted that all people are not a good candidate for cosmetic surgery، especially those that do not have the necessary mental health and personality. Therefore، personality characteristics assessed before surgery and medical intervention by a psychiatrist and psychologist is important.

Psoriasis is a genetically common disease and skin inflammatory chronic prolifrative that affects on patients body، but also on their life quality. This disease goes on until death. Vitiligo is skin pigmentation disorder with bad effects on an individual´s personal and social life، leads to his social performance disorder. The purpose of this study is to survey life quality of patients suffering from psoriasis and vitiligo، finally life quality of these two groups is compared. Materials & M ethods: In this comparative-descriptive study، 115 patients suffering from psoriasis and 115 from vitiligo (age up to 20 and minimum 6 months of patience duration) w ere investigated by continuous sampling way. The study was don e by researcher-made questionnaire and the d ata analysis was done by descriptive statistics and by SPSS17. Average score of psoriasis patients was 64. 52±18. 5 in somatic scope، that figure for vitiligo group was 72. 78±18. 25 (p=0. 001). Average score for psoriasis patients in psychological-spiritual scope was 35. 2±19. 9 and 40. 7±24. 6 for vitiligo group (p=0. 065). That figure for group one in economical-social scope was 60. 81 ± 24. 61 and 52. 99±22. 5 in vitiligo group (p=0. 022). Comparing quality of life of these two groups did not show any meaningful statistical difference (p=0. 541). This study indicates that vitiligo and psoriasis have deep effects on the suffering patients life quality. And these two groups experienced the same amount of difficulty due to the signs and therapies of the diseases.

The comparison of clinical effect of tamsulosin and nifedipine in medical expulsive therapy of lower ureteral stones. 57 patients with distal uretral stone (size 3- 6 mm) were randomly divided in two groups. Group 1 (29 patient) recivedtamsulosin 0. 4 mg daily and group 2 received ifedipine 30 mg / daily / TDS. Two group receive water 2 lit/ day and supp Indomethacin 100 mg/ Prn. All patients were questioned about the episode of ureteral colic، dose of Indomethacin، rate and time of spontaneous passage of stone. Patients were followed for 28 day. Tamsulosin group passed stones at 6. 29 day and nifedipine group passed stone at 6. 38 day (P= 0. 947). Five patients of Tamsulosin group and four patients of nifedipine g roup haven’t spontaneous passage of stone after 28 day (P= 1). Tamsulosin group use 6. 28 Indomethacin and nifedipine group use 5. 21 Indomethacin in follow - up p e riod (P=0. 403). In Tamsulosin group 3 patients and in nifedipine group 2 patients have drug complication. (P=1). None of differences were statistically significant. Tamsulosin and nifidipine have same effect on distal Ureteral stone. Both are safe and effective in distal Ureteral stone and have low complication. (both dectease analgesic use and time of passage).

Odontogenic cysts are derived from odontogenic epithelium and lined by odontogenic epithelium. All three odontogenic cysts (Dentigerous cyst،Odontogenic keratocyst cyst and Radicular cyst) can develop tumoral transformation. The least tumoral transformation rate is related to OKC. Epithelial cell proliferation rate is important in the prognosis. The best marker is HER2/neu. In this study 70 samples diagnosed as 3 odontogenic cysts (29 cases of Dentigerous cyst،24 cases of odontogenic keratocyst cyst and 17 cases of Radicular cyst) were selected from archive of Oral Pathology Department of Detal Faculty. The samples were prepared for IHC staining method. Data were collected and analyzed by using Fisher Exact test and SPSS version 17. Staining rate of tumoral cells were scored from 0-3. Scores 2 and 3 were considered as overexpression. Three cases of OKC and 7 case of Dentigerous cyst were negative in staining but all cases of radicular cysts were positive. Fisher Exact test showed significant difference between the scores and type of cyst (P=0. 005). Overexpression was found in 41. 7% of OKC،48. 3% of DC and 88. 2% of RC. In conclusion،RC had the highest rate of staining (88. 2%) which reveals the highest proliferation rate in this cyst. It can be explanation for higher rate of carcinimatous change in RC and residual periapical cyst.

The purpose of this study was to investigate the effectiveness of cognitive therapy for reducing weight on obese or overweight and depressed people. Present study is a quasi-experimental study with pretest and post test that was performed on 30 female students by completing MMPI questionnaire and Beck depression test، body mass index. The data were analyzed through analysis of covariance and t-test. The findings showed that، in the experimental group، Lower body mass index and depression is more after treatment than control group. It can be concluded that cognitive therapy can help reduce weight and its complications and be beneficial in the long run.

Gunshot trauma is a major problem from worlds war until today and its mortality is increased with progress in military industry. According to strategic position of west Azarbaijan province and residue of implanted mines in through the POV our hospital is faced with a lot of gunshot victims. This study aimed to study epidemiologic variable of gunshot victims from October 2002 to October 2007. Materials & M ethods: T his retrospective cross-sectional study was conducted on 138 patients admitted from October 2002 to October 2007 to Imam hospital. A questionnaire including survey variables was made and was according to m edical records and the data were anal yzed. 93 patient (67%) were in 10-29 age group. 126 (9/03%) of them was men. Average hospitalization time was 5. 9 day. Trauma was due to gunshot in 64 (46. 3%)، shotgun in 37 (26. 8%) and explosion in 37 (26-8%). The most involved region was the h ead and neck in 46 victim s (28. 8%) and lower limb in 40 (2. 6%). The most involved organ was the l ung and pleura chest wall in 21 (23. 7%) and vasculature of limbs in 18 (19. 78%). The m ortality ra te was 8. 6% and disability occurred in 6. %. According to high volume gunshot trauma in west Azerbaijan province، this problem must be considered more seriously.

Presence of medical students in orthopedic operation room can be useful for orthopedic learning. It could be a learning model based on small groups learning scheme. This study was designed to evaluate the impact of attendance of medical students in operation room on their ward and global scores. Material s & M ethods: Forty medical students were enrolled in two groups. Group A was attended in operation room for three days a week and the other group was conducted to be present in opd clinic. Wards and comprehensive scores of two groups were compared using the SPSS software for means and statistical significances were with Mann-Whitney test. A questionnaire was developed for study purposes and completed by members of both groups. Its results were analyzed and described. Average scores of group A was17/55 and group B was16/25. Statistical analysis revealed significant differences between the two groups in terms of means. Average score for skill exam was 17. 5 (SD= 0. 99 and CI= 95%) in group A and it was 15. 05 (SD= 1. 1 and CI= 95%) in group B. In comprehensive exam، overall percentage of questions answered correctly byGroup A was 79. 5% and in GroupBwas62%. Statistical analysis was in favor of strong difference between two groups (p value=0. 002). In response to questionnaire 16 student of group A and 8 student of group B believed that presence of medical students in operating room as an observer is obligatory. 50% of each groups believed that this attendance has useful effects on their future role playing. Medical student participation in the operating room not only increases scores on ward exams but also has significant effect on comprehensive examination

obesity and particular upper body obesity are important risk factors for diseases. One of the main causes of obesity is hormonal agents. The aim of this study was to investigate the relationship between cortisol and testosterone hormones and anthropometric parameters and liver enzymes and blood glucose in men. In this study 30 healthy adult males ranging in age from 29 ±7/2 years were randomly chosen and the anthropometric parameters (waist circumference”WC”، waist to hip ratio”WHR” BMI) blood levels of cortisol and testosterone SGOT SGPT alkaline phosphatase”AP”، glucose”FBS” were measured. cortisol had negative relationship with testosterone (P<0/05) and Positive relationship with waist circumference، WHR BMI، FBS (P<0/05) and also Positive relationship with alkaline phosphatase (P<0/01) but testosterone had negative relationship with BMI and waist circumference and WHR (P<0/05). FBS level was positively correlated with AP (P<0. O5) and BMI، WHR، WC had positive relationship with each other (p<0. 01). Mean ± SD cortisol and testosterone levels in overweight subjects and obese were significant higher than normal weight subjects and lower than normal weight subjects (P<0/05)، respectively. men with upper body obesity (WHR≥. /9) had significant higher levels of cortisol and lower level of testosterone than men with low WHR (WHR ˂. /9) (P<0/05). Other variables were not significantly associated with each other. The results indicate that cortisol level had a negative correlation with testosterone and elevated serum cortisol and low testosterone were associated with high BMI، upper body fat distribution that are important risk factors for diseases such as Cardiovascular Disease، Diabetes Mellitus، O steoporosis.

Breast cancer is the most common malignant tumor in women. In our country (Iran) based on the study of the “Institute of cancer”، breast cancer accounts for 10. 8% of all newly diagnosed cancers. Because of different clinical course of breast cancer in sufferers، identifying the factors that directly or indirectly predict the ultimate outcome of patients is useful for clinical management and determining the prognosis. In recent years much attention has been paid to the use of biomarkers in predicting treatment response and prognosis. All the mastectomy specimens with the diagnosis of “breast invasive ductal carcinoma” in in Imam Khomeini Hospital were selected between 2004 to 2008. Five slides of each paraffin block were prepared، one of which stained for H&E، and the rests stained for Cyclin-D1، P27، and ER/PR according to Dakocytomation system. Slides stained by Haematoxylin and Eosin were assessed to determine tumor histologic grade based on the Nottingham modification of the Bloom-Richardson grading system. Regarding the expression of estrogen receptors، 14 cases (36. 8%) were ER positive and 24 patients (63. 2%) were ER negative، and for expression of progesterone receptors، 14 cases expressed PR (36. 8%) but 24 patients (63. 2%) were PR negative. 18 patients were positive for P27 and 9 patients expressed Cyclin-D1 positively (23. 7%). According to the obtained results، no significant correlation were not seen between P27 and/or Cyclin-D1 expression and clinicopathological parameters of breast carcinoma such as patient’s age، number of the involved axillary lymph nodes، histologic type or grade of the tumor، tumor size and steroid receptors expression. Finally، we suggest further investigation on relationship between these biomarkers and other prognostic factors in a larger group.