نشریه دانشگاه علوم پزشکی خراسان شمالی
سال چهارم شماره 4 (زمستان 1391)

Background& Objectivs: Indicators of hospital are the most important factors to show the performance of the hospitals. They are a tool for comparing the amount of services، evaluating services and comparing services with standards or comparing with previous years. The aim of this study was to investigate the performance of educational hospital of North Khorasan University of Medical Sciences and comparing to country indicators This project is an analytical study which describes and compares the performance of educational hospital of North Khorasan University of Medical Sciences in year 2011 and 2012. The data were collected by referring to statistical unit of health deputy and analyzed using Excel software and Pabon Lasso chart The indicator of bed of occupancy in 2011 was 81% and in 2012 was 74%. The indicator of average length of stay in both years was 3. 2 unchangeably and the indicator of bed turnover interval was 1. 2 in both years which was in a good status in compare to standards. Also by using Pabon lasso chart was determined that 3 hospitals were in zone 3، 2 hospitals were zone2 and one hospital was in zone 4. performance indicators in educational hospitals of North Khorasan Universities of Medical Sciences was in a good condition in Comparison to the standards. The educational hospitals had high performance according to Pabon lasso chart، 50%.

Methylene blue (MB) is the most commonly used substance for dying cotton، wood and silk. On inhalation it can cause difficult breathing، while on the direct contact it may cause permanent injury of the eyes of human and animals، burning sensations، nausea، vomiting، profuse sweating، mental confusion and methemoglobinemia. In the present study، Salvadora persica stem ash was used as a low cost adsorbent for the successful removal of Methylene blue (MB) dye from aqueous solutions. This research is an experimental study that was performed to survey efficiency of the Salvadora persica stem ash on removal of methylene blue from aqueous solutions. The effect of various operating parameters such as initial concentration of dye (20-200 mg L-1)، contact time (5-270 min)، adsorbent dosage (0. 2-10 g L-1) and pH (2-13) was investigated. The findings of this study were showed that the Salvadora persica stem ash was able to remove up to 97% of MB dye (156. 22 mg/g) from solutions with various initial dye concentrations at initial pH 13. Also، the equilibrium data were also fitted to the Langmuir and Freundlich equilibrium isotherm models. It was found that the data fitted to Freundlich (R2=0. 9314) better than Langmuir (R2=0. 8836) model. Finally it was concluded that the Salvadora Persica stem ash can be used for textile industry wastewater treatment.

Marginal restorations are appropriate places for plaque accumulation and bacterial reproduction causing periodontal disease or tooth loss. the present study was conducted to compare the periodontal status in patients with correct marginal restorations and their controls referred to department of Oral Medicine and Operative Dentistry of Mashhad Dental School. Fifty patients with one or more marginal restorations as well as their controls were studied in a randomized clinical trial study. Gingival bleeding and plaque indices were evaluated in both groups for the purpose Willcaxon test was used comparing the results in both groups. 50 percent of cases had plaque index of 0 as the rate was 60 per cent in control samples. Considering gingival index، the percentage of patients with 0 gingival index was 58 and 74 in case and control groups respectively. Bleeding index of 0 was reported to be 38 and 72 per cent in case and control groups. Probing depth was more in case group than those of control. Statistical analysis showed significant difference between the two groups considering four measured variables (P < 05/0). According to the results of this study، even the correct marginal restoration may have effect on periodontal status

Suicide as a major health problem is a priority in health system، caused by different risk factors that differ in each society. Base on definition of world health organization suicide is a conscious act that the person try to end his/her life with lethal action. Since suicide is the most important psychological emergency، this study aimed to assess the suicide trend and its related factor in Bojnurd. study population consisted of all attempted suicide who admitted to the Emam reza hospital (2748-person) from 2006 until 2011. We used data from the hospital records and a check list was filled for each case. Descriptive statistics and chi square test were calculated using SPSS version 16. mean age of the study population was 23. 44 ± 8. 66. Suicide rate were 67. 1 and 38. 3 percent in women and men respectively. Most suicide was done by pills (87. 5%) and after that by poison (7. 4%). Most suicide was occurred in unemployed people (50. 4%) and fewer rates were observed in civil servants (2%). In regard to season، the lowest has occurred in spring and the highest in autumn. Sex، marital status، and education were significantly correlated with suicide (P-value<0. 05). since the suicide was high among youth and women the precise training program should be designed for families by health policy makers to solve the problem of this group of people.

Dependency on opiate drugs is one of the major health problems in Iran and most patients with substance dependency disorder are also co morbid with mental disorders. The present study compared the psychological profiles of patients on methadone maintenance treatment and substance dependent persons. In this descriptive-analytic study، 142 substance dependents male patients and 146 male under methadone maintenance treatment who referred to MMT clinics in Bojnurd were compared. Data were collected by using SCL-90 – R. All data were analyzed by SPSS16 software and presented with chi-square and T tests in 95% confidence level. Variables affect the two groups (age، education، marital status، time and kind of drugs) were similar. Score of Overall psychological profile of drug-dependent group (2/1 ± 0/56) and the methadone group (1/58±0/62) were significantly different (p<0/0001). Also all subgroups scales in SCL90 were significantly different (p<0/0001) and were in favor of methadone group. patients in methadone maintenance program had lower psychological problems than substance users and methadone maintenance treatment could improve both physical and psychological profiles of these patients.

keratectasia is a sight-threatening complication that may occur after LASIK. The purpose of this study was to evaluate the effects corneal crosslinking with riboflavin and UVA for treatment of this complication. Twenty-three eyes of 12 patients in Non-Randomize Cohort study (referred to Navididegan Clinic) were selected for corneal crosslinking. Standard examinations like: UCVA-BCVA-slit lamp examination، topography were performed preoperatively and 1، 3، 6، 12 and 18 months after the procedure. The mean UCVA was 0. 54±0. 37 LogMAR preoperatively that changed to 0. 41±0. 33، 0. 42±o. 33 and 0. 5±0. 36 LogMAR in 6، 12 and18 months postoperation respectively (p=0. 011). Mean simk was 43. 49±3. 72 preoperatively and changed to 42. 68± 3. 75، 42. 62± 3. 8 and42. 78± 3. 84 in 6، 12 and 18 months postoperative respectively. Crosslinking seems to be a safe procedure for stabilizing the progression of ectasia with stabilizing and improvement of UCVA and k-readings.

This research aimed to study the mental disorders and resiliency in parents of normal and exceptional children. In this cross-sectional study is that، among all couples in which the first child 7 to 12 years old of normal and exceptional in Faruj studying in primary schools were selected by random sample of 426 subjects (213 couples) parents of normal and exceptional students after attending school، SCL-90 questionnaire and resiliency scale (CD-RISC) were performed. Data Analyze use by mean، standard deviation، Kruskal-Wallis، t-test and correlation. There are significant differences (P<0/05) in levels of subscales of mental disorders between two group of parents. There is a significant difference (P<0/05) between parents'' mental disorders and resiliency with variables (age، socioeconomic status، number of children، education، age differences، addiction، mental disorders in family and a history of separation from his wife). There is a significant difference (P<0/05) between GSI in parents of normally and exceptional students. There is a significant difference (P<0/05) between resiliency among scores of parents (both normal and exceptional children). There is a significant correlation (P<0/01) between GSI and resiliency in the total subjects (r = 0/61). 20 percent of the sample group had a mental disorder. Because the parents of exceptional children and women have higher scores in GSI and have lower scores in resiliency than men، more serious attention and is planned by the authorities.

Since NMDA receptors have been introduced as a therapeutic target، the effect of MK-801، a non-competitive NMDA receptor antagonist، was evaluated on motor deficits following ischemia induced by middle cerebral artery occlusion (MCAO). In this experimental study، thirty male Wistar rats (300-350g) were randomly divided into 5 groups (n=6 in each): intact control، sham-operated، ischemia and two ischemic groups treated daily with MK-801 at doses of 0. 5 and 1 mg/kg for 3 consecutive days. Ischemia was induced by transient middle cerebral artery occlusion (MCAO) for 15 minutes. Motor deficits in experimental groups were evaluated using rotarod and incline board tests for 3 consecutive days. According to results، MCAO induced sensory motor deficits in ischemic group، as rotarod time and incline board angles were decreased in ischemic group compared to sham operated group (P<0. 001). The administration of MK-801 for 3 days at doses of 0. 5 and 1 mg/kg increased rotarod time and incline board angle in treated groups compared to ischemic group (P<0. 001). Our study revealed that MK-801 could improve motor deficits induced in ischemic rats. Thus، it may be suggested that MK-801 might have a therapeutic value for the treatment of stroke

Urinary tract infection is a common problem and reflux is the most common urologic abnormalities in pediatric. This study aimed to determine the prevalence of urinary tract infection and urinary reflux in children 1 month to 12 years، early diagnosis، appropriate treatment and prevention were done in 2010 in bojnurd This cross-sectional study was done in 2010 at Imam Reza hospital Bojnurd. Participants in the study included all hospitalized children from 1 month to 12 years who were diagnosed with febrile urinary tract infection. Non-probability samples of 196 subjects were selected. Urine tests (U / A and U / C)، demographic questionnaire and laboratory results were completed by a trained nurse. Data were analyzed using SPSS18software and presented with Chi-square test. The studied samples included 73. 5% female and 23. 5 percent male. Chi-square test showed a significant relationship between the age and urine culture (p=0. 004). Accordingly the maximum number of positive urine culture was seen in the age group of 2 to 3 years old. Urinary reflux prevalence in this age group were also significantly higher than other age groups (p=0. 02) This study revealed that urinary tract infections are more common in children 2 to 3 years، and given that the reflux increases the risk of urinary tract infection، paying attention to health tips and necessity of training to prevent of urinary tract infection in children is recommended.

Given the importance of aquatic arthropods as vector in medical and bioindicator in life sciences and information on the composition of such animals، this study was conducted during 2010 in the city of Kashan. Descriptive study and sampling at 13 locations and over 39 times in 2303 on the number of larvae، nymphs، Pupa and adults were collected from Lentic and Lotic waters. The collected Samples were transferred to the laboratory and identified by using a stereo microscope and morphological keys. Total 2303 samples over 39 times the sampling of the class insecta 1724 (74. 8%) crustaceans، with 579 samples (25. 2%)، were collected. from insect: Order Diptera، with 1،287 cases (55. 8%)، Order Trichoptera with 158 samples (6. 9%)، Order Ephemeroptera 153 samples (6. 7%)، Order Odonata with 61 samples (2. 6%)، Order Heteroptera with 26 samples (1. 1%)، Order Coleoptera with 26 samples (1. 1%)، Order Plecoptera with 13 sample (0. 6) were identified. From Crustacea Class، Amphipoda 414 samples (18%) from Lotic water، Ostracoda 139 samples (6. 1%)، Copepoda 26 samples (1. 1%)، from the Lentic waters was collected. For the first time، from Crustacea class، subclass of Ostracoda and from Diptera order، Ceratopogonidae، Eryphidae، Dixidae families were reported in Kashan. Therefore it can be concluded that the aquatic arthropods Fauna are very rich in Kasha..

Obesity is the most important nutritional problem among teenagers in developed countries and its resulted handicaps is the main nutritional and health issues. The aim of this study was to determine the prevalence of overweight and obesity and their related factors among high school students aged 14-17 years old in North Khorasan province. This cross-sectional study was carried out on 450 high school students who were in first، second and third stage. Samples were selected by random cluster sampling. Overweight and Obesity were determined according to body mass index (BMI) more than 85 percentile for corresponding with sex and age. Data were analyzed by SPSS version 16. The mean BMI were significantly higher among female students. The prevalence of overweigh and obesity was two times higher in females in three age categories. Mean height of males in three age categories was higher the 50 percentile of CDC chart، and mean height of female only in 14-year category was correspond with 50 percentile. There was a statistical significant relation between BMI with sex، job، family income، hours working with computer and fathers’ BMI. appropriate nutritional intervention and educational program to increase the knowledge of families about the proper nutrition، especially in mothers are the best way to prevent and control obesity among children

One of the most common parasitic diseases of humans and animals is hydatid cyst which is caused by larval stage of the parasite Echinococcus granulosus. The adult worm of this parasite lives in the intestine of dogs and canine، as an ultimate hosts and grazings have the major intermediate hosts'' role. Humans as accidental mediator hosts are infected by eating and drinking foods contaminated with parasite eggs or through direct contact with infected dogs. This is a cross-sectional study. Data were collected by census method. The collected data were recorded in a check list according to the patients'' medical records. The data included demographic information (sex، age، occupation، place of residence) and related hydatidosis disease (affected limb and the number of cyst). Data were analyzed by SPSS software A total of24 patients with hydatid cyst operated in Northern Khorasan province hospital during2010 to2011. 10 cases (41/7%) were male and14 (58/3%) were female. Most hydatid cysts were observed in the age group of 31-40 years (25%) and in the age group of below 10years (20/8%) respectively. The members involved in13 cases (54/2%) in the liver،10 cases (41/7%) in the lung and one case (4/2%) had cysts in liver and lung، respectively. Due to the abundance of stray dogs and animal husbandry in north khorasan province، training the ways of disease transmission، fighting stray dogs and cattle dogs ''treatment is recommended.

Hippocampus area contains a high concentration of zinc which plays a role in synaptic transmission and probably plasticity andippocampus development. This study aimed to assess zinc level in the hippocampal formation of rat embryos by using Timm method and its relation with volume changes of subregions of hippocampus before and after birth. In this study، wistar rats'' embryos on days 11، 21 and postnatal days of 7 and 14 were used. Samples were stained by Timm method and the degree of staining was quantified by Mat lab7. 5 software، The volume of hippcampal sub regions were estimated by cavalieri’s method. The results were analyzed in Mat lab software7. 5. Timm staining on embryonic days of 21 and 11 before birth and first and second weeks after the birth were negative. The quantified results of Timm staining showed no significant level of difference (p>0. 05). The volume difference of dentate gyrus،CA3 and CA1 regions showed no meaningful difference till seventh day postnally (p>0. 05). while the volume changes of the day 14 after birth showed significant level of difference in comparison with the postnatal day of 7 and embryonic days of 11 and 21 (p<0. 05). It seems zinc dose not play a role during morphometric development of hippocampus and hippocampus attains its final shape from postnatal Second week.

Yoghurt is a fermented dairy produced by starter culture and consumed around the world. This food may become contaminated with aflatoxin M1 that caused threats to the health of consumers، especially young children and adults. So detoxification with biological methods is the best solution in milk and fermented dairy products. The aim of this study was to evaluate the effect of starter bacteria and lactobacillus casei in the reduction of aflatoxin M1 in Yoghurt. Milk contaminated artificially with aflatoxin M1 (AFM1) at levels of 0. 05، 0. 1، 0. 5، and 0. 75 (ppb). Then starter was added and incubated at 42°C. In next step the cold yoghurt was centrifuged and the amount of aflatoxin M1 residue in the supernatant was measured by ELISA method. Finally، the results were analyzed with the SPSS 16. The analysis of yoghurts during manufacturing with starter YC-280، L. casei-431 showed that the mean percentages of absorbance were 94. 35% and 94. 15% respectively. Starter culture of yoghurt and probiotic strain L. casei-431 are safe methods that can be used for detoxification without losing nutritional value.

One of the most important parameter in water quality is the amount of fluoride in water. Fluoride can cause bad effects on human body in high concentration. The most important of these is dental and skeletal fluorosis. According to the WHO guideline، fluoride concentration in drinking water should be limited in 1. 5 mg/l. According to the recent study، in some parts of Iran fluoride concentration is more than this standard. At present time، membrane technologies have a lot of advantages; therefore get improved in water industry. The aim of this study is investigation of membrane processes efficiency to product water with suitable quality of fluoride concentration in permeates. In this study، the efficiency of nanofiltaration membrane (NF33، 1812-50، FILMTEC) to remove fluoride from water was investigated. The effect of some chemical (initial amount of fluoride، sulfate and electrical conductivity (EC) and the effects of associated cation with fluoride ion) and physical (flow rate) parameters to remove fluoride were studied. Obtained results showed that the fluoride removal efficiency decreased with increasing in initial amounts of fluoride، sulfate and EC in feed water and increasing in flow rate. Moreover، this efficiency for CaF2 was higher than NaF. Compare with standard، fluoride concentration in all samples was in standard range and fluoride removal efficiency for this membrane was over 85%.

Heamodialysis is one of the most common replacement treatment of renal transplantation. Effective and adequate heamodialysis could improve the quality of life of patients. Inadequite heamodialysis can lead to multiple uremic complications. The aim of this study was to determine dialysis adequacy of hemodialytic patients based on urea kinetic modeling in hemodialysis center in Bojnourd. This descriptive study was carried out on 63 patients who were under dialysis treatment (at least 3 month and once a week) in Imam Ali hospital،Bojnurd. Hemoglobin، hematocrit، cholesterol and BUN were measured before and after heamodialysis. Adequacy of dialysis was calculated by Daugirddas II. Data were analyzed by SPSS software 15 and presented with chi square، independent a paired t-test، ANOVA. Our results showed that %36. 1 of individuals have URR>65% and %47. 7 individuals have KT/V >1. 2. After dialysis mean blood pressure،weight،BUN showed meaningfull reduction. There was a significant difference between mean of BUN post dialysis and KT/V and URR. There wasn’t significant between KT/V URR and Hb Hct،Alt،cratinen،Chlostrol. According to this study the adequacy of dialysis in patients was lower than those of same reported studies. we suggest more study in order to determine the underlying reasons for dialysis inadequacy in these patients.

Background and Using predictive Criteria of bedsore could be helpful for early diagnosis and prevention of this complication. The aim of this study was to analysis of blood flow changes in tissue under pressure in order to achieve a specific pattern in the formation of bedsore. Blood flow changes in different layers were recorded by an optical system. Blood flow signals were recorded at different ages and time-frequency signals changes were evaluated in pressure -free conditions and also using pressures of 30 and 60 mm Hg in the heel area. Signal analysis was performed by using MATLAB and a significance level of 0. 05 was considered. 15 volunteers (9 men and 6 women) with a mean age of 54 years were evaluated. Based on the records of blood flow، it was noticed that by increasing pressure، the pattern of time- frequency of blood flow changed significantly. Additionally the pattern of time- frequency of blood flow changes showed meaningful changes in relation to the depth of tissue (p<0. 05). Amplitude and frequency of signal content of more than 30 mm Hg of pressure were different compared to the reference case and also to the change in patterns caused by impaired perfusion in the area. A model for the formation of bedsore can be identified by measuring and analyzing of blood flow changes in different layers of tissue and accordingly a new approach to evaluate the behavior of under pressure tissue can be suggested.

The contamination of water by organic pollutant viz. phenolic compounds is a worldwide environmental problem due to their highly toxic nature. Biosorption has been attracted as a new technique to remove these contaminants from water and wastewater. The purpose of this study was to introduce an indigenous and inexpensive adsorbent، brown algae، for removal of phenolic compounds Phenol، 2-chlorophenol and 4-chlorophenol adsorption on Cystoseira indica has been investigated using HPLC، High Performance Liquid Chromatography. Pre-treatment، protonation and chemical cross-linking with CaCl2، have been done in order to improve the stability as well as the adsorption capacity of the algal biomass. The effect of various parameters like adsorbent dose، pH، contact time and initial phenolic concentration were studied for their optimization. The equilibrium binding has been described in terms of Langmuir or Freundlich isotherms and kinetic models. Data indicated that biosorption process was equilibrated for 2 hours and then desorption surpassed absorption process. Phenol showed lower elimination rate than 4-chlorophenol and 2-chlorophenol and 2-chlorophenol had most elimination. The rate of adsorption of phenol، 2-chlorophenol and 4-chlorophenol were found to be maximum at neutral pH. Equilibrium adsorption data for phenol، 2-chlorophenol and 4-chlorophenol were fitted by using Langmuir، Freundlich and Freundlich adsorption isotherms model respectively. Also it has been found that adsorption kinetics can be described according to the Pseudo-second order model، from which the R2 and the normalized standard deviation (NSD)، were determined. The results showed reasonable adsorption capacity of Cystoseira indica brown algae and can be used as a native alternative to phenolic compounds removal from aqueous environments.

Because most patients with back pain wish to treat themselves by noninvasive techniques، the purpose of this study was to compare the exercise therapy and foot reflexology on chronic low back pain was reduced. In this semi-empirical and applied study 36 male patients with criteria and diagnosis of chronic low back pain were selected for entry into the study. The subjects were randomly divided into three equal groups and controls namely as exercise therapy and reflexology. Pain intensity as the pre-test and post-test measured using the VAS. Exercise and reflexology treatment protocol during 30 sessions (3 sessions per week for 10 weeks and 30 minutes) was performed simultaneously on the subjects. In this period، the control group did not perform any treatment. Data were analyzed by spss software 18 and presented with t -tet،one way ANOVA and LSD Both selected program of exercise therapy and foot reflexology had meaningful effects on reducing low back pain (P<0. 001). There was no significant difference between their impacts on reducing chronic low back pain، (P<0. 001). Both exercise therapy and reflexology treatments can be equally effective for reducing chronic low back pain.

clinical education is one of the crucial aspects of teaching that leads to acquiring clinical qualification. Clinical education is affected by variety of factors which made us to conduct this systematic review on these factors. published articles since 1992 till 2011 were systematically reviewed based on systematic search، screening، quality evaluation، collecting and analyzing data from databases such as Pubmed، Irandoc، Iranmedex، SID، Magiran، INLM، Scholar google، Med lib، and Iranian journals. The searching was done using keywords clinical education، viewpoint، Midwifery، Nursing، Student. Based on results the effective factors included educational goals and plans، instructors performance، clinical environment، facilities، and students'' personal characteristics. Totally there were no significant differences between instructors'' and students'' views on the effect of clinical education but the effect of clinical environment was mentioned more by instructors and effect of instructors'' performance by students. due to need for more precise assessment of each factor and present condition، more efficient strategies should be sought with the help of instructors، students and other stake holders.

Appendicitis is one of the most common surgical diseases that is currently treated by two surgical approaches، open and laparoscopic methods. One of the postoperative complications of appendectomy is stump appendicitis which has been reported in various forms. This report is dealing with an admitted case with lower right quadrant pain after laparoscopic appendectomy. After clinical and laboratory examination، the patient was candidate to diagnostic operation and finally the stump appendicitis was removed

HIV positive patients have incubation period which is usually after infection and during the primary stage (acute retroviral syndrome). HIV positive patients are often unaware of their infections and early clinical manifestation of this infection is associated with an infection resulted from immuno suppression. Neurologic complications of HIV include spinal cord and cranial nerves diseases. Vacuolar myelopathy is a neurologic complication with 20% prevalence in AIDS stage. Here a 20 years old HIV positive case، without definite HIV risk factors and early clinical manifestation of quadriparesis resulted from vacuolar myelopathy is being reported. The goal of this report is to remind the importance and attention of assymptomatic HIV carriers and variety of contagious transmission and correct management of these complications to health community and authorities.