مجله دانشگاه علوم پزشکی مازندران
پیاپی 105 (مهر 1392)

Background and EEG is used as a diagnostic tool in the diagnosis and prognosis of disease spread. Among the psychiatric illnesses that can utilize EEG to measure response to treatment، schizophrenia can be noted. Many investigations on the application of data EEG as a predictor of treatment response in patients with schizophrenia refractory to clozapine has been done in order to resolve contradictions and the limitations of previous studies. We studied the response to treatment with clozapine، with the PANSS greater number of samples making them prior studies have examined. In a cross-sectional study، 70 patients with schizophrenia resistant to treatment with candidates receiving clozapine were selected from those EEG and PANSS baseline was patient during twelve weeks of treatment with clozapine were again patients PANSS was used and EEG raw patients with a good response to treatment and disease with poor response to treatment were compared with each other. After data collection، descriptive statistics software SPSS17 square test was used for the analysis of EEG data from a linear regression to examine the relationship between the indicators of response to clozapine treatment. The results showed that there is coherence of EEG and the treatment response to clozapine significant correlation was (P= 0. 00). The results showed that there is presence of asymmetry in EEG and the treatment response to clozapine significant correlation was (P= 0. 8). The EEG abnormalities include coherence of EEG in predicting response to treatment in patients with treatment-resistant schizophrenia to clozapine which is effective.

Background and Non-alcoholic fatty liver disease (NAFLD) is the most common type of liver disease. Using functional food such as microalgae is a new approach for improvement of metabolic disorders and oxidative stress in these patients. This study aimed at assessing the effect of microalgae Chlorella vulgaris (C. Vulgaris) supplementation on lipid profile and lipid peroxidation in NAFLD patients. This double-blind randomized placebo-controlled clinical trial was conducted in 70 patients with NAFLD (whose diseas was confirmed by ultrasonograohy). The subjects were randomly allocated into 2 groups of intervention (n=35) who received 400 mg/day vitamin E plus four 300 mg tablets of C. vulgaris before breakfast and the placebo who were given 400 mg/day vitamin E and four placebo tablets per day for eight weeks. Anthropometric measurements and biochemical parameters including total cholesterol (TC)، low-density lipoprotein cholesterol (LDL-c)، high-density lipoprotein cholesterol (HDL-c)، Triglyceride (TG(، Malondialdehyde (MDA)، Alanine aminotransferase (ALT)، Aspartate aminotransferase (AST)، and Alkaline phosphatase (ALP)، were assessed at baseline and end of week eight. In both groups after eight weeks the weight، TC، LDL-c، TG، ALT، ALP، and MDA decreased significantly (P<0. 001)، but HDL-c increased significantly (P=0. 04). AST significantly declined in intervention group (P<0. 001). The mean changes in weight، MDA and ALP between the two groups reached statistically significant levels (P<0. 05). The results of this trial indicate C. vulgaris supplementation could decrease weight، MDA and improve lipid profile as well as liver function in patients with NAFLD.

Background and Due to the emergence of antibiotic resistance bacteria، treatment of urinary tract infection is becoming more problematic. Integrons are mobile genetic elements that play an important role in dissemination and accumulation of resistance genes of multidrug resistance in bacteria. The aim of the present study was to determine the antibiotic resistant profile، frequency of integron genes (Classes 1،2،3) and investigate the role of integrons in the development of antibiotic resistance among Escheria coli and Klebsiella pneumoniae isolated from urinary tract infections. 50 E. coli and 50 K. pneumoniae isolated from the urine samples of patients who referred to Valiasr Hospital، Arak، Iran were subjected to this study. All the isolated samples were confirmed by standard biochemical tests. Isolates were tested for susceptibility to 16 antimicrobial drugs by using disk diffusion method and the distribution of different integron classes was determined by polymerase chain reaction (PCR). The highest rate of antibiotic resistance in K. pneumoniae isolates was found in rifampin (90%)، erythromycin (90%)، ceftriaxone (76%)، amoxicillin-Clavulonic acid (76%)، cotrimoxazole (70%)، cefotaxime (70%) ceftazidime (66%) and for E. coli isolates in cotrimoxazole (88%)، ceftriaxone (76%)، amoxicillin-Clavulonic acid (74%)، ceftazidime (72%) and cefotaxime (72%). All the E. coli isolates were susceptible to Imipenem، while only three (6%) of K. pneumoniae isolates were resistant to this antibiotic. Ninety percent of K. pneumoniae and 86% of E. coli isolates carried class 1 integrons، whereas class 2 integrons were found in 8% and 2% of E. coli and K. pneumoniae isolates، respectively. Class 3 integrons were not found. The high frequency of Class 1 integron in E. coli and k. pneumoniae isolates associated with the high rate of antibiotic resistant indicate that may be integrons play an important role in facilitating the spread of antimicrobial resistance in this region.

Background and

Diabetes mellitus is the most common endocrinologic disease in children and adolescents. Type 1 diabetes mellitus (T1DM) is frequently associated with autoimmune thyroid disease. It is believed that the prevalence of thyroid disease in T1DM patients is higher than normal population. Various studies reported the incidence of hypothyroidism as 2-32% in T1DM. This study investigated the frequency of hypothyroidism in children with T1DM.

In this retrospective study 85 patients with T1DM attending the Endocrine Clinic، 17-Shahrivar Hospital affiliated to Guilan University were recruited. The study was done in 2008-2011. Thyroid function tests including thyroid stimulating hormone (TSH) and thyroxine (T4) were performed. The data including the patients’ age، sex، results of TSH and T4 tests، and duration of disease were obtained.

The patients were 40 male (47. 1%) and 45 female (52. 9%) with the mean age of 9. 24±3. 57. They were aged 1-15 years old and the mean duration of disease was 18. 75±27. 36 months. Among the patients seven cases (8. 2%) were hypothyroidism (subclinical hypothyroidism). There was no significant association between age، sex، duration of diabetes and hypothyroidism in T1DM patients.

Our results demonstrated a high frequency (8. 2%) of hypothyroidism in T1DM patients. We suggest regular and annual thyroid function testing in T1DM patients.

Background and Primary cytomegalovirus (CMV) infection occurs in 0. 15-2. 0% of all pregnancies and might causes abortion. Actually CMV infections are most common in females and rate of infection increases with age. In pregnant women it usually occurs in ages below 30 years old. Aim of the present study was investigating on the seropositivity rate of CMV in pregnant women to determine the rates of infections (primary، reinfection، and reactivated) in them and to find the rates of abortion due to these infections The present study 360 pregnant women were screened for CMV-IgG ELISA to reveal seroprevalence rate in them. Type of CMV infection (primary، reinfection، reactivated and incidious infection) were investigated in them by using CMV-IgM، CMV-IgG، and CMV-IgG Avidity tests. All cases were followed to the end of pregnancy. CMV-IgG seroprevalence in studied women was 77. 3% and high rate seropositivity was 50. 4%. Frequency of primary، reinfection and reactivated infections was 0. 8%، 0. 6%، and 21. 1% respectively. Insidious infection rate was 54. 7%. About 22. 8% of studied women had not exposured with CMV before screening. Abortion occurred in about 66. 7% of primary infections and 100. 0% of reinfections and these two factors presented significant relationship with spontaneous abortion. Results of the present study showed seropositivity for CMV-IgG is not a valuable measure for CMV active infection even with high titers، so screening with CMV-IgG in pregnancy in not valuable without CMV-IgG avidity test but regarding to significant relationship of primary and reinfection with abortion، It seems that follow up of pregnant women for these infections with IgM-CMV ELISA might be more worthy.

Background and Threshold contrast sensitivity could be considered as an important indicator of visual function in thalassemic patients. In this study the threshold of contrast sensitivity was investigated in patients with major and minor thalassemia and normal individuals. This cross-sectional study was conducted in 30 patients of thalassemia major (Desferal dependent)، 30 patients of thalassemia minor and 30 healthy individuals as control group. After determining the best-corrected vision، contrast sensitivity was measured using Freiburg Vision Test at frequencies of 1، 5، 15 cpd at distance of 4 meters. The results were then analyzed using SPSS. Contrast sensitivity was higher in patients with thalassemia major at all spatial frequencies (P<0. 001)، however، there was no significant difference between minor and healthy subjects. We found no correlation between transfusion duration، dose of chelator and Ferritin with contrast sensitivity. Patients with thalassemia develop visual disorders that could result in reduction of contrast sensitivity. Therefore، contrast sensitivity testing could be of great benefit in detecting early changes in the visual function of beta-thalassemic patients.

Nurses are the largest group of professionals in the health care systems whose the most important aim is enhancing patients’ quality of life، but nurses’ own quality of life and health promoting behaviors are the issues that have not been dealt with sufficiently. The present study was performed to measure the amount of health promoting behaviors of nurses working in educational hospitals of Sari affiliated to Mazandaran University of Medical sciences 2013. The present research is a descriptive cross- sectional study which was done through using stratified random sampling in 226 working nurses in four educational hospitals in Sari city in 2013. Data were gathered using a two-section questionnaire including demographic characteristics and 52 likert-type (from 0 to 4 score) questions which was based on Health Promoting Lifestyle Profile-HPLP- II and its validity and reliability were confirmed. Data analysis was performed using T-test and One-way ANOVA tests. The mean score of HPLP- II was 135. 33±18. 55 (the total score is 208). The highest score was in the area of nutrition (25. 53±4. 37) and the least score was in the area of physical activity (16. 85±5. 05). The total score of HPLP- II and all its area except nutrition were higher in the male nurses than that of female nurses، but the significant difference was observed in the area of physical activity (p=0. 001). Nurses should obey health promoting behaviors in a high level and this study is a beginning of increasing researchers and hospital managers’ knowledge to implement health promoting plans among the working nurses in the hospitals to achieve a desirable level of health promoting behaviors especially in the physical activity domain.

Background and Misabortion is a disorder resultant of numerous causes such as infections. It is clear that bacterial infections due to genital mycoplasma، Listeria and brucella can cause septic abortion. A right time diagnosis of these infections can improve women fertility. This study was conducted to survey the efficiency of PCR in detecting the specimens with negative culture results in women suffering from septic abortion. We also did this by considering individual variables. In this analytical and descriptive study، appropriate samples were collected from a total of 87 women with septic abortion who referred to Karaj’s hospitals. The samples were cultured into mycoplasma، Listeria and brucella specific media. Then، the bacterial genus was verified by different biochemical tests. PCR test is performed on negative culture cases and SPSS-18 software is used for the statistical analysis of data. From the total of 87 blood samples، 37 samples (42. 5 %) were positive for mycoplasma and ureaplasma (25 cases) and Listeria monosytogenes (12 cases) with both culture and PCR method. Our result showed no positive cases for brucella. From the total cultured specimens، 12 cases (13. 8%) were positive and 75 cases (86. 2%) were negative. We performed PCR test for negative cultured results. With PCR method، 25 cases (33. 33 %) showed positive results and 50 cases (66. 67%) showed negative results. The results also showed a significant statistical relation between PCR test results with recurrent abortion and level of education (P< 0. 05). The results show that PCR is a more sensitive، easier and faster method in comparison to culture for detecting bacterial cause septic abortion. It is obvious that quick diagnostic and starting antimicrobial therapy at the right time can prevent and decrease abortion’s complications، so it recommended then that using PCR in detecting this bacterial cause septic abortion can be more effective.

Background and Difficult laryngoscopy and tracheal intubation is a major cause of morbidity and mortality during anesthesia. Its prediction is important for the anesthesiologists. Upper Lip Bite Test (ULBT) has been recently used. We aimed to evaluate ULBT، Interincisor distance (IID) and three fingers accuracy and their possible correlation to predicting difficulty in laryngoscopy and intubation. In a prospective diagnostic study، 410 patients who were scheduled for elective surgery were enrolled in the study. Before the induction of general anesthesia، the airways were assessed، and ULBT، IID and TF evaluated. The larangoscopic view according to the Cormack- Lehane grading was evaluated after anesthesia and grades 3، 4 were defined as “difficult laryngoscopy and intubation”. We used ROC analysis for the best cut-off points. Sensivity، specifity، positive predictive value (PPV)، negative predictive value (NPV) and likelihood ratio of these tests were calculated The prevalence of difficult laryngoscopy was 7. 1 % (n=29). CI 95 %: (0. 068-0،072). The results showed that 92. 9% of patients had an easy or relatively easy laryngoscopy and intubation. 6. 8% (n= 28) were on the third grade of Cormack-Lehane and 0. 3% (one person) on the fourth grade. Sensitivity and specificity of ULBT were significantly higher than IID an TF، (59%، 75% versus 55 %، 64%)، respectively. There is a significant difference in mean weight، age، height، BMI and TF of the patients who have or have had difficult intubation. But the IID as well as the age of the patients in both groups had significant difference (P=0. 001). ULBT for all the patients in the region with regard to the geography and ethnic sari and Mazandaran، is recommended. ULBT is a better test than IID and TF. Age test with a cut-off of 36 years of age for future studies are recommended

Background and Decreasing of motion is one of the characteristics of aging that caused the decrease of quality of life and generative problems of others. The objective of this study was to compare the effect of an exercise program on kinematic analysis of gait of elderly men and women who are residents in a sanatorium. From the sanatorium elderly residents، 15 men and 15 women between 65 to 80 years old were studied. Berg questionnaire was used to evaluate falling risk، cadence (the number of steps in one minute) and a digital camera (Sony DCR-HC54) was used to measure kinematic variables of gait (speed and joints angles (ankle، knee and hip)). All measurements were repeated after a 24-session physical training program including walking، strength training، balance and endurance training. Independent and paired sample t-test were used for the statistical analysis (P<0. 05). The falling risk was reduced about 20% in elderly women and 12% in elderly men (P=0. 000) and cadence was improved about 20% and 10% in elderly women and men، respectively (P=0. 01). Walking speed was increased about 19% (P=0. 000) in elderly men and 45% (P=0. 002) in elderly women after exercise. The exercise program has improved the joint angles (ankle and knee) approximately 2 degrees that was not significant (P=0. 01) but it has improved the hip angle approximately 3 degrees (P=0. 01). Exercise (walking with weight) will improve their gait performance and reduce the risk of fall more specially in women. The exercise program in this research is performed in elderly sanatorium simplicity that it can improve walking speed. We suggest that in future studies، the effect of exercise programs investigate on kinetic variables of gait of old people.

Background and Proper and efficient management of hospital wastes because of its infection potential and possession of dangerous wastes is inevitable and this goal can be achieved only when we have a good understanding of the quality and quantity of hospital wastes and enough available information about separation، collection، treatment and disposal of hospital wastes. The aim of this study was to determine the health status and the quality and quantity characteristics of Tabriz hospitals that could help policy makers in the health sector to improve the quality of comprehensive planning and health services. This is a cross-sectional study and was conducted by completing the questionnaire، interviewing hospital health experts and visiting 10 hospitals out of the 11 hospitals of Tabriz University of Medical Sciences. Total occupied beds in ten investigated hospitals were 2383 beds، which produced 8779 kg/d of solid wastes and capita waste generation was calculated 3/79 kg/d. Also، the average production rate of general wastes، infectious and chemical wastes، sharp wastes and pathological wastes were calculated respectively، 2. 75، 0. 875، 0. 128 and 0. 043 kg/d per bed. Unfortunately، the average capita waste generation per bed in Tabriz has a high rate of production in comparison to other cities of Iran. This research is a warning to the concerned authorities to remove this problem immediately by doing the best practices، taking the most appropriate decisions and the costs that are not too high.

Background and Nowadays، the accumulation of toxins in food، water، land and air، is one of the most important arguments regarding human health and environment. The important feature is the chronic toxicity of pesticides; they can accumulate in the body. The accumulation of toxins in the body occurs directly through exposure due to contact or indirectly through food، inhalation or absorption through the skin. The aim of this research was to evaluate the amount of residue “Diazinon” in orange products of citrus gardens in Sari. The extraction of this toxin was done using the organic solvent “n- hexane” from the samples of orange from the different regions in Sari. In this study، the evaluation the Diazinon amount was taken cared of by using gas chromatography which was equipped with mass spectrometry detector (MS). In this research، the sensitivity is set to ppb to determine the amount of toxin. All the results were statistically analyzed using one way-ANOVA and student t-test. Then Tukey-posttest was applied to compare the pesticides residue levels found in the samples (P< 0. 05). All results obtained from the different areas were in the normal range. Normal range for Diazinon residues in citrus fruits، according to the WHO is 0. 7 Ppm. According to the results of this study، Diazinon was found in all samples. All values are normalized based on global standards.

Backgound and Recent rise in elderly population points to the need for social support، and focusing on these people’s relationships and quality of life. Social support acts as a mechanism to tackle isolation and loneliness، and high level of quality of life results in more joy، satisfaction، healthy life، economic prosperity، educational opportunities and creativity. This study aimed at assessing the quality of life of the elderly attending rehabilitation centers considering demographic variables such as the elderly’s marital status، sex، educational background and the type of rehabilitation center being admitted to. This descriptive study was performed in 281 individuals referring to rehabilitation centers in Mazandaran province. A researcher made questionnaire was used to assess the status of social support and to investigate the elderly’s quality of life the standardized questionnaire (36-SF) was used. The results indicate a significant difference between the mean scores of social support and its components and the mean score of the test. The overall qualities of life for elderly were higher than average. We also observed a significant correlation between social support and the elderly’s marital status، educational background، and the type of rehabilitation center. According to the services offered by studied rehabilitation centers the quality of life of elderly was in satisfactory condition. There was no significant difference between quality of life، marital status، and educational background. However، we found a significant relationship between the type of rehabilitation center and quality of life of elderly.

Background and Infection is still 30% of deaths in the elderly. The increase risk of infection in this age group is probably due to the physiological changes of the aging process. The aim of this study was done to determine the infection leading to admission in elderly and non-elderly groups in a referral teaching hospital in the Southwest of Iran. This cross-sectional study was performed on hospital data. All patients admitted in the second half of 2012 in the Infection Ward of Razi Hospital in Ahvaz (referral teaching hospital in the Southwest of Iran) were studied in two age groups that include: elderly (greater than or equal to 60 years) and adult (under 60 years) groups. The final diagnosis is based on symptoms and clinical infectious disease by a specialist. Other variables such as gender and final status، transfer or death were also recorded. The Data were analyzed by statistical software SPSS 17 and Chi-square and Fisher s exact tests. Finally، 111 cases (32. 7%) were in the elderly group and 228 patients (67. 3%) in the adult. In the elderly group، 62. 2% were males and in adult group، 69. 3% were males (P=0. 219). The risk of infection in elderly in comparison with patients below 60 years was 1. 3 for the bone and soft tissue infections، 0. 3 for meningitis، 0. 8 for TB، 0. 7 for fever of unknown origin، 0. 4 for hepatitis، 9. 6 for sepsis، 2. 1 for upper respiratory tract infection and 0. 9 for genitourinary tract infections. The percentage of deaths in the elderly group (7%) was more than the adult patients (3%) patients (P=0. 042). The result shows that the risk of some infections such as sepsis، upper respiratory tract infection and bone and soft tissue infections is high in elderly patients in comparison with the adult group and more attention must be considered to care these patients in the elderly group.

Smallpox is a serious infectious disease to have ever afflicted mankind. Smallpox is caused by variola virus، which belongs to a family of viruses known as poxviridae. Pox viruses are large DNA viruses which are 200-400 nm. The smallpox prodrome is characterized by the sudden on-set of high fever (38. 5°C-40. 5°C) and malaise 10 to 14 days after exposure. As populations grew and migrated، the disease spread across the globe، killing millions of people and shaping the course of history. Since 1978، no cases of smallpox have been reported to the World Health Organization from anywhere in the world، the last case had an onset of rash in 1977 in Somalia. However، a total of 2 years of effective surveillance must elapse before this last endemic area can be confirmed to be smallpox-free. The objective of this study was to describe a public-health response to smallpox as using for bioterrorism. In this study، we use Google Scholar، Med line، CDC، site of Ministry of Health and Medical Education and World Health Organization. Smallpox has a high mortality rate and can spread through aerosols and because the population is highly susceptible to the infection. The severity of variola، which includes variola major and variola minor، is related to the virulence of the infecting strains. The case fatality is about 1% for the minor form and up to 45% for the major that two less common clinical forms are the hemorrhagic and flat-type. Smallpox has a high mortality rate and can spread through aerosols، and immunity in the population is low. An outbreak of smallpox will be controlled through surveillance، containment، vaccination، and isolation of cases. Smallpox was eradicated before the development of modern antiviral drugs. Treatment is supportive as to the attention to treatment of bacterial super infection. Death from smallpox is usually the result of severe toxemia، septic shock or disseminated intravascular coagulation. There is great concern that smallpox is an excellent candidate for use as a terrorist weapon.