مجله علوم پزشکی رازی
سال بیستم شماره 9 (پیاپی 114، آذر 1392)

Vesicourethral anastomotic stricture (VUAS) is a relatively common complication after Radical Retropubic Prostatectomy (RRP). We reported our experience in treatment of VUAS especially with transurethral resection of fibrosis. In a multicentric retrospective cross-sectional study conducted between March 2006 and August 2011، 683 (RRPs) performed by two uro-oncologists، were studied. Patients with VUAS were included in the study based on subjective urinary symptoms and direct cystourethroscopy. VUAS was managed by Urethral Dilatation (UD)، Transurethral Incision of Stricture (TUI)، Transurethral Resection of scar (TUR) and open reconstruction. Type of treatment and its outcome were recorded and analyzed. Data analysis was performed by SPSS version 18. Of the 683 (RRPs)، VUAS Occurred in 58 (8. 9%) patients. Mean time interval between Foley catheter removal and diagnosis of VUAS was 3. 9 months، and mean time of follow up was 36. 8 months. Twenty-five patients (43. 1 %) with urethral dilatation did not require further treatment. Eighteen patients (31. 03%) improved with use of transurethral incision of stricture with or without urethral dilatation. TUR of fibrosis had a good response in 14 (24. 13%) who had not responded to UD or TUI. One patient، who did not responded to multiple previous procedures، underwent open reconstruction. The patient was became incontinent after surgery. Following endoscopic treatment، incontinence was not observed in any patients. Although VUAS is a bothersome complication after RRP it responds to usual endoscopic treatments. In our experience TUR of fibrosis can be performed safely without increased risk of incontinence.

With the advancement in technology، internet addiction has become an issue which adversely affects the healthy life style. The aim of this study was to investigate the relations between internet addiction and health promoting lifestyle of the students and determine the effects of internet addiction on the health of students and to collect basic data to plan for preventing internet addiction and to improve students’ life style. This descriptive and analytical study was done on 250 cases (140 females and 110 males) living in the dormitories of Tehran University of Medical Sciences in 2012. Stratified Random Sampling was used for selecting students، participation in the study was voluntary، tools of collecting data for this study was self-reported questionnaire consisting of three parts، the first part contained demographic information including age، sex، marital status، employment status، educational level، and educational status (grade point average); the second part was health promoting lifestyle (HPLP) questionnaire (52 questions) of Walker and colleagues and the third section of the questionnaire was “Young''s Internet Addiction”. In order to analyze the data SPSS V. 19 was used and results at the level of p<0/05 was considered significant. According to the findings of the study there is a significant relationship between internet addiction and promoting healthy lifestyles (p<0/001)، and addicts to the internet are in adverse situation as compared to the internet users in terms of promoting healthy lifestyles. People addicted to the internet received significantly lower scores in spiritual growth (p<0/001)، health responsibility (p<0/001)، interpersonal relationships (p<0/001)، stress management (p<0/001)، physical activity (p<0/001)، and nutrition (p<0/001) compared to ordinary users. This study shows that internet addicts gain lower score in health promoting lifestyle and reveals necessity of interventions to correct methods of internet using and training students to improve their lifestyle.

Determining the etiologic agents of septic arthritis is very important. The aim of the present study was to determine group A streptococcal polysaccharide antigens in synovial fluid of patients with arthritis. A cross sectional study was conducted upon 52 cases with acute mono arthritis in Hazrat-e-Rasool Akram hospital in Tehran، Iran (2010-2012). Gram staining، culture and rapid antigen tests were performed (LPA) for H. influenza، S. pneumonia، group B streptococci، N. meningitidis، E. coli and; Group A streptococcal polysaccharide antigens (Cusabio company; Austria liscence، China، ELISA) was searched in synovial samples (negative smear and culture). p value <0. 05 was considered valuable. Septic arthitis was diagnosed in 34. 5%; that included positive culture or gram staining in 15%، positive rapid antigen test (LPA) in 5. 7%، positive group A streptococcal polysaccharide antigens in 3. 8% of cases with negative results for other tests. Septic arthitis was diagnosed in 34. 6% of cases. Only 15% of cases had positive culture or gram stain (mainly S. aureus، S. pneumonis)، 5. 7% were diagnosed by rapid antigenic tests (LPA) and group A streptococcal polysaccharide antigens (ELISA) test was positive in 3. 8% of the remaining cases (negative smear and culture). By addingthenew diagnostic methods to the conventional culture tests for detecting common bacterial antigens (especially streptococcus)، the role of infectious organisms in evolution of acute arthitis would be elucidated better. Streptococcal polysaccharide antigens in synovial fluid are not defined by the immune system. The irreversible cardiac، renal، and neurologic complications are probable. Optimal treatment of proved streptococcal cases is recommended.

Heart disease is the most common cause of death that has increased in developing countries. Coronary Artery Bypass Graft (CABG) surgery is one of the treatment methods in these patients that have been used widely over the past decade. This study was performed with aim of resolving the issues related to lack of patients'' familiarity with anesthesia and surgery and inattention to their training needs due to anxiety and dysfunction of hemodynamic statue. In this semi-experimental study، 124 patients who were candidates for CABG were randomly assigned to either the test or control groups. Patients'' anxiety was evaluated by Amsterdam questioner and checklist was used for recording hemodynamic variables. The collected data were analyzed using the paired، independent t test and ANOVA in the SPSS. There were no significant differences between demographic variables in two groups. There were no significant differences between patients'' anxiety، hemodynamic status، educational needs at admission time and before surgery in control group but in the intervention group، anxiety of patients decreased after the intervention (p<0. 001). Hemodynamic variables in two groups changed before surgery (p<0. 05). There was significant relationship between gender، level of education and patients'' anxiety (p<0. 05). Considering the benefits of education on patient’s anxiety and hemodynamic status، more attention should be given by health care providers to patient education.

Oxidative stress contributes to dopamine cell degeneration in Parkinson’s disease (PD). This study was performed with the aim of studying the protective effects of Eriobotrya japonica flower extract (EJFE) on intraventricular 6-hydroxydopamine-induced lesion in male rats. In this laboratory experimental study، twenty seven rats were divided into three groups: control، lesioned and extract treated lesioned. Lesion was induced with injection of 250 mg/kg of intraventricullar 6-hydroxydopamine (i. c. v. 6-OHDA). Lesioned and extract treated lesioned groups received saline and extract (200 mg/kg) three times per week for 12 weeks، intraperitoneally. Five days after i. c. v. 6-OHDA injection، tyrosine hydroxylase and dopamine levels in the striatum were measured by ELISA method. Data was analyzed using one-way analysis of variance (ANOVA). Results show that consuming the extract significantly prevented the decrease in dopamine levels in Parkinson rats (p= 0. 001)، but tyrosine hydroxylase level did not change in the extract group (p= 0. 86). The results of this research showed that pre-treatment with hydro alcoholic extraction of Eriobotrya japonica protected the dopaminergic neurons against 6-OHDA lesion and may have protective role against Parkinson disease.

Neonatal jaundice is a common problem which is of particular importance because of the serious complications such as kernicterus. Identification of predisposing factors can cause rapid diagnosis and treatment of jaundice. This study was conducted to determine the prevalence of jaundice in the perinatal period. In this cross-sectional study of 170 infants born in 2011 in 22 Bahman Hospital Gonabad، non- probability sampling was used. Demographic details such as age and gender were collected. Results were analyzed by SPSS 19 software. The incidence of neonatal jaundice was 53. 5 % (91/170). There were 48 male (52. 7%) and 43 (47. 3%) female infants. Most babies had mild jaundice (47. 8%) and 15. 2% with severe jaundice. Most infants with jaundice were born in a vaginal delivery. Age of mothers of newborns with jaundice، in most cases (65. 9%) were more than 25 years and most of them had blood group O (34. 1%)، positive RH (89%) and second pregnancy (61. 5%). No significant statistical association was found between the demographic characteristics of mothers and jaundice (p<0. 05). Also RH negative mothers with RH positive husbands had correlation with jaundice (p<0. 05). According to the high prevalence of jaundice in Gonabad further studies with a large sample size must be recommended in order to obtain accurate statistics on the prevalence of jaundice in high-risk infants.

The purpose of this study was to identify the effects of external loads on balance control during upright stance in Chronic Low Back Pain (CLBP) patients and healthy adults. This study was a qausi-experimental design. External loads were applied to 23 young، healthy participants and 21 low back pain subjects، and effects on balance control were characterized by Center-of-Pressure (COP) based measures. Center COP data were used to calculate standard deviation of amplitude، standard deviation of velocity in anterior-posterior and medial-lateral directions، mean total velocity and phase plane parameters. We used two way ANOVA to explore the pre/post applying external load and the between groups difference. The results showed that applying external load had a significant main effect on the standard deviation of amplitude in anterior-posterior and medio-lateral direction and parameters. There was no interaction of load and group in this study. Also there was no difference between two groups at the beginning of the test. These data show that wearing 10 kg of external weight in a waistcoat increases the postural sway of subjects، which may in turn increase the likelihood of falls and injury.

As any decision making for improving the quality of clinical education depends on recognition of the present problems، as well as the inadequacies and faults from the stakeholders` points of view، this study was conducted to evaluate all the stakeholders in educational process comprehensively and estimate their satisfaction from the present system in order to illustrate a general framework of strengths and weaknesses of Shiraz University of Medical Sciences. This was a cross sectional descriptive analytic study conducted in 2011. Three separate teacher-made questionnaires were designed according to the study purpose. The first questionnaire was related to interns and residents (under and post graduate students)، the second one for clinical teachers and the third belonged to the head nurses. Expert views were used in order to assess the content and face validity and test-re-test was applied for reliability checking. SPSS version 17 was used for descriptive statistics and relevant tests of t-test and Anova at the significant level of 0. 05. Findings showed that residents، interns and head nurses attending this study agreed more with fixed professors in only one educational center rather than the view of the professors whom had equal perspectives toward fixed or rotation status. As the present educational framework in Iranian educational theraputic centers can not meet the demands of the new needs and provide standard educational environment، and also according to the results of the present case in regard to the status of clinical education in Shiraz University of Medical Sciences، it seems that along with attention to the recommendations of the present study change in the present system could improve the quality of education، research and therapy status in various university centers.

Social capital، as one the social determinant of health has an effective impact on decreasing mortality in a community. This study was conducted with the aim of determining the relationship between quality of life and social capital among health workers in medical and health network of Rey city. This study was a cross sectional design conducted in 2012. Sample size was 140 individuals selected through stratified sampling. In this study، a questionnaire was designed that included three parts; socio demographic (6 items)، standard SF 36 quality of life questionnaire (36 items) and Bullen’s instrument (36 items). Data was collected and analyzed by SPSS software version 18 with using with T-Test، ANOVA، and Pearson correlation. Mean age of the participants was 34. 28±7. 44 years. There were significant associations between social capital and physical function، general health، social functioning، mental health، and vitality domains (p<0. 05) while there were no significant associations between social capital and role limitations due to emotional problems and physical pain (p<0. 05). According to the results، the increase of social capital in a community can lead to development of quality of life among health network staff. It seems by using strategies such as social networking enhancement، security establishment، strengthen interpersonal trust، expansion of social relationship and cooperation are effective for improving quality of life among staff.

Today opioids are used to control and relieve acute and chronic pain. However، the incidence of both tolerance and dependence phenomena are the two major problems in the people who take these drugs. So، in this study the combination effect of haloperidol and methadone on the acquisition and expression of morphine dependence and tolerance have been examined. In this experimental study ninety-eight NMRI male mice were randomly divided into acquisition and expression groups. Each group was divided into seven sub-groups: control، sham (saline)، methadone، haloperidol، haloperidol + methadone، methadone + haloperidol ratio of 2 to 1 and methadone + haloperidol ratio of 1 to 2. All groups were addicted with gradually increasing doses of morphine for 7 consecutive days. All drugs، in the acquisition group were injected 30 minutes before morphine injection for 7 days and in the expression group 30 minutes before morphine injection on the 8th day (test day). Morphine tolerance was measured by tail immersion test for 30 minutes before and after administration of morphine on the test day. To assess the dependence، mice were administered with naloxone and then withdrawal behaviors were observed for 30 minutes. Then data were analyzed using one-way ANOVA by sigma stat software. Chronic morphine injections induced tolerance and dependence in mice. Percentage of Maximal Possible Effect (MPE) as a tolerance index was significantly increased in acquisition and expression groups which received drugs combination methadone 1 + haloperidol 2 as compared to control groups. About the dependence، the marked decrease was shown in withdrawal behaviors in the combination therapy groups. However، our results have shown that probably methadone and haloperidol combination treatment، especially in the ratio of 1 to 2 could reduce tolerance and dependence more than single drug treatment animal groups.