مجله دانشگاه علوم پزشکی گیلان
پیاپی 90 (تابستان 1393)

Abstract Human Immunodeficiency Virus (HIV) can cause some of the symptoms and diseases in ENT field. However, there are a few reports from developing countries and there is not any report on this issue. On the other hand, the prevalence of HIV positive (symptomatic or asymptomatic) patients is increasing across the nation. Awareness of these complications of hearing system can result in early intervention and improve patient's quality of life. Determining the otologic and audiologic findings in HIV positive patients A descriptive, cross-sectional study was performed on the 30 HIV positive patients referred from number-10 medical-therapeutic center of Rasht to Amiralmomenin hospital from April 2011 to March 2012. The senior resident of ENT- HNS took a comprehensive medical history and performed full clinical examination in the auditory system. In all patients, audiometric tests including tympanometry, pure tone audiometry, transient otoacoustic emissions (TOAEs) and auditory brainstem response (ABR) were done. Of the 30 HIV -positive patients, 21 were male and 9 were female. Of these, 2 patients were in the AIDS phase. The mean age of patients was 36.27 ± 9.71 years (range 24-56), and 8 patients complained of otic symptoms: dizziness (7 cases), tinnitus (4 cases), otalgia and fullness (each 3 cases). In audiometry, we found hearing loss in 8 of 60 ears (6 patients). The conductive and sensorineural hearing losses were found in 4 and 4 ears, respectively. As revealed, 21 out of 30 patients (70%) had abnormal TOAE. Also, in 9 out of 30 patients (30%), we observed ABR abnormality, with increased interpeak of wave I-III (14 ears)being the most frequent. Given the high prevalence of TOAEs abnormality in these patients and increased interpeak of waves I-III in ABR, it seems that the locus of ear damage is the outer hair cells of cochlea and distal part of the central auditory pathway and TOAEs is more sensitive than PTA and with ABR test it can help early detection of hearing loss in such patients.

Abstract

Tuberculosis is one of the most important health problems in developing countries like Iran, where Tuberculosis drug resistance is going to be a challenge.

We evaluated the results of TB treatment in patients with Tuberculosis, 2001-2010 in Rasht. Materials and Methodos: In this descriptive study, data including demographic information and questionnaire of tuberculosis were completed from TB software and files in patients with relapse, failure and multi-drug resistance.

In total, 98 patients were evaluated, consisting of 88 (89.8%) male and 10 (10.2%) female. As revealed, 86 patients (78.8%) had pulmonary TB and 12 non-pulmonary TB (12.2%). There was a significant relationship between being prisoner and the result of treatment (P=0.01) and also the kind of disease (P=0.001).

Complete and accurate registration of information and suitable programming considering the results of this study can be useful in decreasing the related health costs in Rasht and reducing factors associated with drug resistance. For better results, it is recommended that a general study be held in Guilan province before and after starting treatment, in order to determine the primary and secondary resistance.

Abstract Satisfaction has been a concept of high importance in today's health care services and is considered as one of the criteria in evaluating the quality of services. The present study has been conducted to evaluate the satisfaction level of patients with rural insurance in terms of the first and second levels of health services presentation in northern provinces of Iran. This cross-sectional study was conducted in the second half of the year (2012); 139 centers (25%) implementing rural insurance and family physician program were selected through systematic random sampling as the research samples and 6 out of 8 patients with insurance, who received required services after being referred to the second level by FPs, were evaluated. Data-collecting instrument was a researcher-made questionnaire, and the validity and reliability were confirmed. Data were analyzed by SPSS17 statistical software at the significance level of p<0.05. From the 955 patients who received services after referral to the first and second levels, 752 patients (78.7%) were female. The mean age of patients was 40.2±15.6 years and the mean referral of patients during the 9 months of (2012) was found to be 8±8.4 to home health and 6.4±6.6 to healthcare centers. Out of the 5 scores for level of patients satisfaction, 4.5±0.5, 4±0.7 and 4±0.8 were allocated to home health, healthcare centers, and second level hospitals and specialists, respectively. There was an inverse relationship between the overall satisfaction and education level and a direct relationship between satisfaction and age, number of referral to home health and healthcare centers (P<0.05). A significant difference was observed in the mean level of patients′ satisfaction with second level hospitals and clinics in northern provinces of Iran (P<0.05). However, no significant difference was found in the patients’ satisfaction level between home health and healthcare centers (P>0.05). The results showed a high level of satisfaction in patients with rural insurance. While maintaining and improving the existing condition, it is proposed that satisfaction levels of patients with other health insurances be compared and evaluated.

Abstract Diabetes mellitus (DM) is a multisystem disease that is characterized by persistent hyperglycemia resulting in both acute and chronic biochemical and anatomical sequel. The prevalence of connective tissue disorders in the diabetic patients has increased in recent years, affecting significantly their quality of life To evaluate the prevalence of musculoskeletal disorders in upper limbs of diabetic patients in Razi hospital and finding the association between the sex, gender, duration of DM, HBA1C level and vascular complication of DM Totally, 535 diabetic patients referred to Razi hospital (rasht) have been examined for limited joint mobility (LJM), shoulder adhesive capsulitis (SAC), carpal tunnel syndrome (CTS), Dupuytren’s contracture (DC), and trigger finger (TF). We recorded information about age, gender, HBAIC, duration of the DM and its complications The samples were 124 men and 411 women with mean age 56.75 and 53/65 years, respectively. Prevalence of LJM, SAC, CTS, DC and TF in women was 31.9%, 17.3%, 25.1%, 4.4%, 3.2% and in men was 24.2%, 17.7%, 8.9%, 2.4%, 1.6%, respectively. Prevalence of these complications in patients over sixty years old was 42.18%,29.63%,29.96%,5.18%,3.7% and in Hba1c >7was 35.1,18.6%,22.9%,3.7%, and in patients with over 10 years of DM duration was 46%,25.7%,31.6%,6.8%and 4.6%, respectively. As revealed, there was a high prevalence of musculoskeletal complications in diabetic patients, which was higher in patients over sixty years old, those with more than 10 year duration and those with HBA1C level more than seven.

Abstract Infertility problem has become as a major concern in the world today, and is associated with a stressful or exciting and potentially failing for the respective couples, followed by different social, psychic, physical and financial stresses One of the methods of infertility treatment is IVF-ICSI and this study aims to investigate female anxiety changes under therapy who were referred to Guilan's Clinics, northern Iran. This study is cross sectional and has been conducted as repeated measure. The population includes all women with infertility under treatment of IVF-ICSI in the infertility clinics of Guilan during one year. The selected sample consisted of 74 women with infertility who tried to use this method from April to August 2012 to treat infertility and were satisfied to participate in this study. They completed questionnaire of demographic, Positive and Negative Affect Scale (PANAS), Spill Burger Anxiety State Inventory information through 3 stages. The average age of the sample was 32.38 years (± 5.80) in this study. In reviewing the differences, the positive affect, negative affect and anxiety in the subgroup was significantly reduced through increasing positive affect age. Also, the positive affect in females with primer infertility is more than those females who had secondary infertility (P<0.05, t=2.11). In other variables, there was significance among subgroups. Using ANOVA test, we found significant differences between the positive affect (P<0.05, F=4.14), negative affect (P<0.01, F=23.69), anxiety state (P<0.05, F=3.80) in females, before treatment with IVF-ICSI and following it. Considering the anxiety and depression associated with treatment by IVF-ICSI, it is suggested to have consulting and psychotherapy intervention based on infertility treatment and levels of anxiety and emotion in respective women.

Abstract Identifying the exact causes of infant mortality in developing countries is very important. Infants’ mortality rate is a useful indicator for assessing the quality of health care in community. To detect the relative frequency of neonates and children’s mortality causes in 17 Shahrivar Training Hospital of Rasht, from Jun 2009 to Sep 2010 This was a cross sectional – descriptive study. The only exclusion criterion of the study was incomplete required information in the records. We designed a questionnaire which consisted of questions on age, gender, weight, living place, past medical history, the time between disease and hospitalization, diagnosis, positive culture and the cause of death. Having gathered the data, we used SPSS 16 software and chi-square test to analyze and compare the major causes of mortality and morbidity in the above-mentioned hospital. Data on 216 died patients were enrolled in the study. Their mean age was 3 years (minimum 1 month and maximum 7 years) and 133 (61.6%) of the cases were male and 83 (38.4%) were female. The main causes of mortality in this study were: pneumonia, respiratory distress syndrome, sepsis and liver failure. The causes of death among different age groups showed a significant difference (Chi-Square test, P.value<0.01). The leading causes of death in infants were respiratory distress syndrome (30.1%), pneumonia (20.3%), sepsis (14%) and prematurity (9.1%), and in children were pneumonia (26.3%), liver failure (17.7%), malignancy (12.5%) and sepsis (8.8%). With increase in our knowledge about prevalence and causes of death of diseases and related risk factors, we can have better planning to improve the quality of health and decrease mortality rate in our country.

Abstract Cerebrovascular disease is the second leading cause of death worldwide. Data on epidemiology of stroke, its pattern and risk factors, are scarce. Seasonal variation in the incidence of stroke and role of meteorological factors in its occurrence, have been investigated in several studies. These studies show that there were different patterns in stroke incidence across different areas. To investigate the seasonal pattern of stroke incidence and the association between daily stroke occurrences and meteorological factors among the patients admitted to the Poursina Hospital, northern Iran, in (2012). This cross sectional study was conducted in the Poursina Hospital in Rasht. All the patients with acute onset of neurological symptoms during (2012), after performing imaging studies and confirmation of the diagnosis of stroke, were enrolled. Age, sex, history of diabetes and hypertension, and date of stroke occurrence were recorded for all patients. The number of stroke episodes, temperature and humidity were recorded on all days of the year. Distribution of stroke cases among seasons according to study variables, was analyzed using chi-square test. To compare the average number of strokes per day among different seasons, kruskal-wallis test was used. The relationship between the number of strokes per day and meteorological variables was analyzed using Spearman's correlation coefficient. During the study period, 869 patients with diagnosis of stroke were admitted. Significant seasonal differences in the mean of ischemic stroke occurrence per day and mean of intracerebral hemorrhage occurrence per day, with peak rates in autumn, were observed. In the study of meteorological variables based on multiple linear regression with step-wise method, minimum temperature was inverse linear predictor of both overall stroke occurrence per day and ischemic stroke occurrence per day. For intracerebral hemorrhage occurrence per day, maximum temperature was inverse linear predictor and maximum humidity was direct linear predictor. This study suggests a seasonal pattern in the incidence of stroke and a possible role of meteorological factors in the incidence of stroke in this area. Attention to this seasonal pattern can be useful for medical centers to provide better services to their patients

Abstract

After elective surgery of head and neck region, one of the complaints of patients is unsteadiness and dizziness. This complaint was seen more in some surgeries in clinical experiences, one of which is rhinoplasty. Given the community's increasing trend to rhinoplasty, considering this complaint of patients is important for appropriate prevention or treatment

To evaluate dizziness occurrence in patients undergoing rhinoplasty, Amiralmomenin Hospital of Rasht

In this case-control study, 63 patients in case group (Rhinoplasty) and 50 patients in control group (Functional Endoscopic Sinus Surgery), were evaluated for dizziness. The two groups were matched for possible confounding factors. All the patients were evaluated for dizziness 1week, 1and 3 months after surgery. Also, in rhinoplastic patients, lateral osteotomy approach was considered as a possible factor. Using SPSS 19, data were analyzed with t and χ2 tests and P<0.05 was considered significant.

Fifty patients of case group and 45 patients of control group were followed for 3 months. Female patients comprised 80 and 44.4% of case and control groups, respectively. The frequency of dizziness in patients of case group was 17, 3 and 2, respectively. Only one case was due to benign paroxysmal positional vertigo and others were due to orthostatic hypotension. In control group, frequency of dizziness was 11, 1 and 1, respectively. The cause of all cases was orthostatic hypotension. The rhinoplastic patients with external and internal lateral osteotomy approach complained of dizziness in 58.6 and 11.5%, respectively. This difference was significant statistically (P<0.0001).

This study showed that the most frequent cause of dizziness in both groups is pseudo vertigo and due to orthostatic hypotension. It seems that true vertigo is not associated with operation types (including rhinoplastic and nasal endoscopy). We advised more detailed investigations with larger sample size in this area.

Abstract

In recent years, investigations on various species of the genus Centaurea have shown that its extract or secondary metabolites has various pharmacological effects including anti-inflammatory, antinociception, Cytotoxic and etc.

The aim of this study was to investigate the antinociception, and anti-inflammatory effects of Ethyl acetate fraction of fruit plants Badavard (Centaurea bruguierana ssp.blangerana) on male rats.

Different parts of the plant Badavrd were collected from Bushehr, then, powdered and solved by ethanol and then, Ethanol extract was Fractioned. Antinociceptive effects of ethyl acetate fraction was examined by formalin test and tail immersion test and anti-inflammatory effects of xylene test in male rats of NMRI. The rats were divided into 6 groups of 8, including negative control, positive control, and 4 experimental groups. Experimental groups were injected intraperitoneally by 100, 200, 400 and 800 mg/kg of Ethyl acetate fraction. Normal data were analyzed using Anova and post hoc TUKEY test and non-normal data, were analyzed using Kolmogrov-smirnov and Mann-whitney test.

In the formalin test, ethylacetate fraction showed a significant difference (P<.001) in the control group at all doses. The hot water tail immersion test, ethylacetate fraction at dose 100 at times t0, t1, t2 indicated significant differences (P<0.05) and at time t3 showed significant differences (P<0.01), at doses 200 and800 at time t0 significant differences (P<0.01) and s at times t1, t2, t3 significant differences (P<0.001) in the control group at all doses, at dose 400 at times t0,t1 significant differences (P<0.05) were observed and at times t3, t4 significant differences (P<0.05) in the control group. at all doses were seen Test, xylene, ethyl acetate fraction showed a significant difference (P<0.01) or the control group at all doses. Naloxone inhibited the antinociceptive effects of ethyl acetate fraction in the acute phase, but had no effect on chronic phase.

Analgesic and anti-inflammatory effects of ethyl acetate fraction can be attributed to the Sesquiterpenelacton and flavonoids. These compounds relieve nociception and inflammation by inhibition of inflammatory mediators.

Abstract The autonomy is a new system of hospital governance. in this system hospital administration is based on its own revenue and not to the general budget of the government. Survey of Personnel's attitude about relation of autonomous and hospital performance in Guilan University of Medical Sciences. In this descriptive- correlative we collected data from April till September of 2012. The study population was 48 of 55 accounting staff, managers and physicians of hospitals of Guilin University of Medical Sciences. Sample Size Determinate by Using Morgan Table. A questionnaire was used to collect data. Cronbach's alpha for autonomous and performance in the 0.76 and 0.75, respectively. To analyze the data, regression analysis tests was used. Results show major effects of the autonomous on performance of public hospitals. Also, the dimensions of autonomy (the right to decide on strategic management, the right to decide on managing physical resources, dealing with sale market and services) and financial performance According to staff's attitude autonomous have impact on hospital performance.