مجله دانشگاه علوم پزشکی اراک
سال هفدهم شماره 1 (پیاپی 82، فروردین 1393)

One of the amendments made in Iran's Health System was family physician program were introduced in 2004. This study aimed to describe the experiences of physician and other health team members about general interest of this program. This study is a qualitative and data collection method was in-depth interviews (semi-structured). Groups participants including 15 physicians, 15 midwives and 25 healthworker declare their experiences about of general advantage in this program. In total, 55 interviews were carried out in population. Purposive sampling fand content analysis with comparative of the methods were used. In this study, after continuous analysis of data 376 initial codes were obtained. After integration of theses codes 30 the secondary cods come out which consist of public or general interest and economic benefit, respectively. Moreover 4 sub-categories (improve of index of public health and care, health folder, insurance for rural, low referral to expert of physican), were created. Based on the results the use of electronic folders instead of traditional folder and accelerate to acsess of information patient for promotion of care and finally delivery some facilitate for health team worker recommended.

In recent years, studies have been conducted on the role of coenzyme Q10 in improvement of sport performance and also cardiovascular health. The present study investigate effect of coenzyme Q10 supplementation combined with swimming aerobic exercises at-4week on Heart Rate Deflection Point (HRDP) and VO2max in active women. A number of 32 trained women with the average age of 21/25 ± 0.86 years and Body Mass Index (BMI) of 20/127± 1.06 kg/square meter were selected randomly and were divided into eight -member each groups: Control, Supplement, Supplement – Exercise and Exercise. The subjects participated in four-week consumption of coenzyme Q10 and swimming exercises (three sessions in a week).The consumption rate of coenzyme Q10 100 mg/kg/d was in the form of capsule that subjects took it during lunchtime. Before and after a four-week period, the subjects performed an incremental exhaustive test on treadmill, using respiratory gas analyzer to determine HRDP and VO2max. It should be noted that data analysis was conducted using One-Way Variance Analysis Test (ANOVA) in P<0.05 significant level. Based on paired T-Test results, despite HRDP had increased in each four groups but the significant increase was observed only among groups in VO2max (P=0.008) based on ANOVA Test (P<0.05). Although positive changes were observed inside the group after passage of four weeks, coenzyme Q10 supplementation combined with swimming aerobic exercise had not any significant effect on HRDP only increased VO2max.

Abstract Comprehending of suicidal ideation and related factors has valuable clinical outcomes in domains of prevention and crisis intervention. The aim of the present study was to explore the predictive role of psychological, demographical and socio-economic factors in suicidal ideation. In a cross-sectional descriptive study, 671 persons among general population of Semnan City were selected by voluntary sampling. Data collected with NEO-Five Factor Personality Inventory, Symptom Check-List Revised, The Defense Style Questionnaire, The Beck Scale for suicide Ideation, The Beck Hopelessness Scale, The Social Support Questionnaire and demographical questionnaire, then analyzed by correlation and Logistic Regression with SPSS. Literacy level (OR=1/237;P<0/014), Family relationships (OR=1/873;P<0/010), Outcome (OR=4/211;P<0/003), Job status (OR=3/149;P<0/008), History of psychiatric disorders (OR=5/754;P<0/003), Hospitalization in psychiatric ward (OR=2/003;P<0/011), Neuroticism (OR=6/136;P<0/001), Extraversion (OR=3/612;P<0/005), Neurotic defense style (OR=2/468;P<0/005), Mature Defense Style (OR=4/107;P<0/002), Immature Defense Style (OR=3/059;P<0/003), Social Support (OR=7/609;P<0/001), and Hopelessness (OR=9/834;P<0/001) significantly differentiated persons with suicidal ideation from persons without suicidal ideation (P<0/001). These variables totally could correctly predict 97.4% of suicidal ideation. In this model, risky psychological, demographical and socio-economic factors increase the odds ratio of suicidal ideation. These findings have importance for designing of preventive interventions and interventional programs for self-harm behaviors.

Allergic rhinitis affects 40% of general population and has an increasing prevalence. Sleep disturbance is an important problem in individuals with allergic rhinitis. Recent studies have shown that 68% of cases with perennial rhinitis and 48% with seasonal rhinitis have impaired sleep. In this case-report study, 33 children with allergic rhinitis aging 6-18 years entered the study. Thirty five children without allergic rhinitis entered the study as control group. A questionnaire containing demographic data and types of sleep disorders filled for every child. Except respiratory disorder, there was no other significant difference between groups in any sleep disorder. Sixteen children (48.5%) in case group has respiratory disorder while none of control children were involved (P=0.0). Nasal congestion is the main factor involved in sleep impairment in children with allergic rhinitis. Therefore, it seems that it is the first symptom to be treated.

Sudden visual loss is one of the emergent problems that it may be a sign of a life-threatening disease. It should be quickly evaluated and identified the treatable causes. Case report: A young man without any history of certain disease was referred to the emergency department with complaints of sudden blindness. He was presented with fever, coriza symptoms and progressive blurring of vision that ultimately led to his visual loss. After carefully evaluation, finally suspected diagnosis of acute fulminant multiple sclerosis was made. Multiple sclerosis is a chronic inflammatory disease that is associated with acute attacks of neurological dysfunction. Some of these attacks are an emergent situation and need to early detection and treatment. There is a variant of Multiple sclerosis that called Acute Fulminant Multiple sclerosis which can cause sudden visual loss.

There have been reports showing the protective role of inducible Heat-shock protein (HSP) 70 in gastric epithelial cells. HSP70-2 gene is located in the class-III region of the MHC on the short arm of chromosome 6. The HSP70-2 gene has a pst1 site due to an A to G transition at the 1267 position and different genotypes of the HSP70-2 gene have been shown to be associated with a different level of HSP70 mRNA expression. This study was performed to investigate relations between polymorphism of the HSP70-2 gene and risk of peptic ulcer diseases. In this descriptive analytical study, the studied population comprised 100 subjects, attending the Endoscopy Center of Hafez Hospital in Shiraz on 2012. All subjects underwent upper gastroscopy. Genomic DNA was extracted from bioptic tissues. Genotypes were determined in patients and controls using PCR-RFLP. In the non-ulcer subjects, the HSP70-2 genotype distribution was 20 AA (40%), 26 AG (52%), and 4 GG (8%). Meanwhile, the HSP70-2 genotype distribution in peptic ulcer patients were 5 AA (10%), 44 AG (88%) and 1 GG (2%). The results showed that 1267G/A HSP70-2 Gene polymorphism is associated with peptic ulcer. It appears that polymorphism of HSP70-2 gene is associated with the susceptibility to peptic ulcer diseases. The analysis showed that the AG genotype increased the risk of peptic ulcer (OR=6.76, 95%CI=2.26-20.20, p=0.0006).

Abstract Selenium is a unique trace element which is benefit on inflammatory underlining diseases. MAPK (Mitogen-activated protein kinase) pathways regulate several cellular functions including inflammation, cell differentiation, migration, and apoptosis. This study aimed to find out the pathway(s) by which Selenium modifies inflammatory events in oxidative or thrombotic induced stress in platelet. This is a basic -experimental study on Human platelets obtained from 30 healthy individuals (age 35±12). The phosphorylation rate of P38MAPK, c –JNK (c-Jun N-terminal Kinase), and ERK1/2(Extracellular signal-regulated kinases1/2) as three important proteins in MAPK family and P-selectin were measured in presence or absence of selenium by ELISA(solid phase sandwich Enzyme Linked-ImmunoSorbent Assay). Pharmacological inhibition is done by inhibitors of P38MAPK, ERK1/2 and c- JNK in order to compare with selenium effects. The percentage of ratio of phosphorylated to total protein was used for normalizing the phospho protein contents of platelets. Selenium significantly reduced P-selectin expression (p<0.05), P38MAPK (p<0.05) and c- JNK phosphorylation (p<0.05) induced by cu2+oxidized LDL in platelets but Se couldn’t significantly reduce Thrombin induced P-selectin despite of decreasing in mentioned phospho-proeins. Our results indicated that Selenium can reduce inflammation via suppression of p38MAPK-dependent signaling pathway. These results may provide insights related to development of novel Selenium therapies in atherosclerosis.

Pain is a complex medical problem creating which inadequate control pain results adverse effects on the patients physiological, metabolic and mental conditions.The aim of this study was comparison effect of Ketamin-propofol with Alfentanil-propofol on creating analgesia and sedation during cystoscopy and comparing the side effects of two drugs and patient and physician satissfaction. In this double- blind clinical trial 140 person who were candidate for cystoscopy were randomly divided into two groups The first group received 1mcg/kg alfentanil with 1mg/kg propofol and the second group received 0.5 mg/kg ketamin with 1mg/kg propofol. Sedation score, pain score, time of cystoscopy and hemodynamic changes determined and data were analyzed by SPSS. The mean of sedation in alfetanil group was significantly more than ketamin group(p=0.001). The mean of pain score in alfetanil group was significantly less than ketamin group(p=0.001). The time of cystoscopy in cystoscopy in alfetanil group was significantly less than ketamin group (p=0.001). Results showed that alfentanil-propofol compare to ketamin-propofol reduced pain score and increased time of sedation with less side effects during cystoscopy. So this study supports the preference alfentanil compare to ketamin.

Paints are composed of an extensive variety of hazardous substances, such as organic solvents and heavy metals. Occupational exposure to paint increases oxidative stress, hematological disorders and DNA injury. A study was performed to explore beneficial effects of Silivit on the paint workers by measuring total antioxidant capacity, lipid peroxidation, and blood parameters as main oxidative stress biomarkers. The study was conducted on 25 male workers who worked in the paint factory. In the serum, total antioxidant capacity (TAC), lipid peroxidation (LPO) and hematological parameters before and after using Silivit were measured. For the analysis the data paired t-test and Pearson correlation analysis were applied. Results showed that after using the silivit a increase in TAC and a decrease in LPO were observed but these different were not significant. Also, aspartate transaninase after the using Silivit significantly decrease and high density lipoprotein significantly increased. Silivit due to antioxidant capacity result in improve hematological parameters in paint workers.

Intrathecal morphine side effect is Nausea & Vomiting after surgery. aim of This clinical study was to evaluate the effect of intrathecal atropine on PONV in patients receiving intrathecal morphine in lower limb surgeries In this clinical trial, 120 patients undergoing lower limb surgery were randomly divided into 2 groups. Experimental group received0/1 mg (cc1) Intrathecal atropine and control group received 1cc saline 0/9%. PONV during the first 24 hours and hemodynamic changes in minute 3, 5, 10 and 15 after surgery in both groups were measured. Data were analyzed using SPSS software (verision14). independent t-test, repeated measures manova,and chi-square were used to compare comparison of variables. Hemodynamic cheanges before injection and 3, 5, 10 and 15 after injection in two groups was not significant (P>0/05). None of the patients in the intervention group were PONV, but 17 patients in the control group had PONV that this difference was statistically significant (p =0/000). Pain in the control group was great than intervention group while 26 patients in the control group and 14 patients in the intervention group had vas greater than 3 that this difference was statistically significant(P = 0/04). Intrathecal atropine without interfering Hemodynamic and pain relief prevent nausea and vomiting caused by Intrathecal morphine in patients undergoing surgery to the lower limbs.