مجله علوم پزشکی رازی
سال بیست و یکم شماره 4 (پیاپی 121، تیر 1393)

Effects of lower limb muscles fatigue on foot plantar distribution during walking has not been documented clearly in the literature. The purpose of this study was to determine the effect of quadriceps femoris muscle fatigue on alteration of the center of pressure and plantar pressure distribution during stance phase of walking. Twenty-two males (age: 23. 5±3. 17 years، weight: 78. 8±3. 21 kg، height: 179. 2±4. 64 cm) participated in the study. Leg extension machine was used to induce quadriceps fatigue with 50% of one-repetition maximum. Peak plantar pressure distribution was collected using a foot scan pressure system during stance phase of walking. Paired t-test was used for data analyses. Peak plantar pressure at the hallux; first، third، fourth and fifth metatarsal bones and lateral part of heel was significantly increased (respectively: p=0. 001، p=0. 011، p=0. 001، p=0. 019، p=0. 013، p=0. 001)، while peak pressure was decreased at the medial part of heel (p=0. 001) and toes 2-5 area (p=0. 001) after fatigue protocol. The center of pressure location was significantly shifted toward the lateral side of the foot (p=0. 003) at contact phase، while it shifted toward the medial side at loading response phase (p=0. 001) after fatigue. Results of this study showed that quadriceps muscle fatigue could increase foot plantar pressure characteristics، consequently influence pain and lower limb injuries.

Adolescence is sensitive period that form normal and abnormal habits for all of life. The aim of this study was determination of health and spiritual health responsibility and interpersonal relations and predictive factors based on the theory of planned behavior in high school girl students in Tabriz. In this cross - sectional study، 340 students were selected thorough conventional sampling. A self-made questionnaire based on standard questionnaires of Health Promotion and Lifestyle II (HPLPII)، spiritual health standards and components of the theory of planned behavior (attitudes، subjective norms، perceived behavioral control، and behavioral intention) was used for data collection (Palutzian& Ellison). The questionnaire was validated in a pilot study. Data were analyzed white SPSS v. 15 by using descriptive and analytic tests. Mean score for responsibility for health، spiritual health and interpersonal relationships and structures of theory of planned behavior were moderate among the students. There were significant positive correlations between elements of the theory (p<0. 001). Attitude and perceived behavioral control constructs was able to predict 35percent intention of behavioral change (p<0. 001، F=62. 03 and R2=0. 35). Constructs of attitude، subjective norms، and perceived behavioral control was able to predict 74 percent for behavioral change in accountability for health (p<0. 0001، F=319. 82 and R2= 0. 74)، 56 percent for behavioral change in spiritual health (p<0. 0001، F=144. 14 and R2=0. 56) and 63 percent for behavioral change in interpersonal relationship (p<0. 0001، F= 192. 02 and R2=0. 56). Generally state of health responsibility، interpersonal relationship، and spiritual health of students were intermediate. Thus behavioral intention and its determinants such as attitudes and perceived behavioral control interventions must be noted.

Results improvement of Patients treatment results and reduction of costs to achieve results are one of major challenges to healthcare systems. Recently، these themes are developed into value in health care theme، and some models for the value measurement are provided. Value increase in these models is based on care delivery value chain. Increasing share of diabetes in health care expenditure and death rate clarifies necessity for focusing on diabetes. How to construct a care delivery value chain for diabetes is the question of this study. Through a case study in Hamedan Beheshti hospital a care delivery value chain for diabetes was constructed. The case data were collected using an internal medicine text book and interviewing internists. Reliability and validity of the care delivery value chain were improved by different sources، questionnaires and personal interviews. A care delivery value chain for diabetes was constructed. although the care delivery value chain constructed for diabetes is restricted to certain conditions، it addressees treatment activities in great detail. This value chain can relate results and costs to treatment activities. Identifying costs and results measures of treatment these activities can lay the ground for value measurement of health care provided. This measurement is the first step toward value improvement through comparison.

Chronic obstructive pulmonary disease (COPD) causes significant mortality and morbidity. The role of infectious agents has been determined in pathogenesis of the disease. Pneumocystis jirovecii is a fungus that causes pneumonia in immune deficient patients. The organism has been detected in the respiratory tracts of asymptomatic patients in low levels، which is called colonization. Several studies have determined the association of this organism with COPD. Our study aim to evaluate the prevalence of pneumpcystis jirovecii colonization in patients with COPD.

60 patients with COPD، went under bronchoscopy and BAL was performed. The disease severity was determined with BODE index. Colonization with pneumocystis jirovecii was evaluated with PCR in the BAL fluid.

The prevalence of pneumocystis jirovecii colonization in COPD patients in our study was 5%.

The prevalence of pneumocystis colonization is lower than the published studies in developed world، which could be due to ecologic differences.

The concept of lifestyle as an important variable has been found in texts of Nursing and has been closely associated with public health. So this study was performed to explanation of problems to promotion their life style & peresentation of practical solution. This is a descriptive and analytical study with Problem solving procedure. We studied 116 nurses who are working in public hospitals. Instruments for gathering information included demographic data، lifestyle & nurses problems questionnaire & analyzed by using SPSS software (16 ver). in total lifestyle of 9. 5 % of nurses were in adverse condition، 52. 6 % were in moderately good، 37. 9 % were in good condition. Most undesirable behaviors was in the health responsibility dimension & the most desirable behavior was in smoking dimension. most nurses problems on promoting healthy lifestyle were related to executive& managerial scope «excessive working hours» with a score of 1. 72، environmental equipmental scope ​​ «inappropriate workplace conditions» with a score of 1. 47، in educational scope «Lack of access to educational counsel regarding personal health issues،» with an average of 1. 37 & in individual & motivational scope «inadequate salary» with an average 1. 77. According to the most Identifed problems، the best solutions based on data، text study، the htinking of research team was presented. among of these solutions according to the rules «Training courses as workshop and seminar for nurses about the importance of promoting a healthy lifestyle» Was scored the highest. Though to cover the rest of the solutions، formation «the Promoting healthy lifestyle committee for nurses» was proposed.

Post anesthetic shivering is a common and unpleasant postoperative complication. The aim of this study was to compare the efficacy of ondansetron with meperidine in preventing postoperative shivering. A randomized controlled trial was carried out on 60 patients with ASA class I-II undergoing general anesthesia. General anesthesia was performed with fentanyl، midazolam، sodium thiopental and atracurium. The patients were randomly allocated to receive ondansetrone and meperidine intravenously at the beginning of wound closure. Occurrence and severity of shivering was evaluated for 30 min in the recovery room. Also، side effects were assessed in recovery room. In the postoperative period incidences of shivering in ondansetron group was 6. 7%. Patients in meperidine group have not shivering (p=0. 49). Nausea and vomiting occurred in 26. 7% of the meperidine group but none in the patients receiving Ondansetron (p=0. 005). The prophylactic use of ondansetron and meperidine were found to be effective in preventing postoperative shivering.

Caring of elderly with Alzheimer''s disease and communicate with them، is a chronic stressful process that have negative effect on caregiver''s physical and mental health. The aim of this study was to determine the effect of communication skills training on perceived stress of caregivers of elderly with Alzheimer disease in 2012.

This study was a quasi-experimental type. In this study، 91 caregivers of Alzheimer''s patients referral to the Iranian Alzheimer Association، Tehran، Iran were selected and assigned into a control in the two groups (intervention (n=49) and control (n=49)) by using block randomization. Then، two groups were completed two questionnaires of demographic variables and perceived stress before the intervention. Educational program was designed according of pre-test results and conducted to the intervention gr oup. Two groups were followed-up one-month after the intervention. Seven participants in the intervention group refused to take part in the study. Statistical analysis of data was performed with SPSS software (Version 16) and Student’s paired-samples t test and Independent-samples t test. In this study، p<0. 05 was considered significant.

The mean age of the caregivers in the intervention and control group was 52. 23 (± 11) and 52. 26 (± 13) yr old، respectively. In the control group، 85. 7% were women and 81. 6 % men. No significant differences were found in the demographic characteristics and the mean score of percieved stress (p=0. 06) between the two groups before the intervention. Following the intervention، there is significant reductions in the mean score of perceived stress in the intervention group compared with the control group (p = 0. 001).

It is suggested that methods of verbal and non-verbal communication would be trained to caregivers of elderly patients with Alzheimer''s disease in the Iranian Alzheimer Association and other related institues. This can lead to improve both caregiver''s health and also their quality of care of elderly with Alzheimer''s disease.

Mechanical obstruction is the most common surgical disease of the small intestine، which can be potentially fatal. However appendicitis is very rare cause of intestinal obstruction and is usually. In rare cases of appendicitis، symptoms of small intestine obstruction can be more predominant than the appendicitis symptoms. This may lead to delayed diagnosis of appendicitis and further complications such as intestinal strangulation appendix perforation. A 20 -year-old male patient، presented with bowel obstruction symptoms since 5-day ago. There was all mechanical bowel obstruction symptoms include frequent nausea and vomiting، severe abdominal distention، fever and inability to gas or stool pass there. Serial abdominal X-rays showed multiple air -fluid levels and CT scan was demonstrating obstruction at terminal ileum and cecum. In Laparotomy with midline incision، there was severe dilation of the small intestine caused by pressure effect on bowel wall due to gangrenous appendicitis after appendectomy، all symptoms was relieved Early diagnosis and intervention is very important in strangulation of bowel. Whenever features of intestinal obstruction predominate، we should think about appendicitis as a rare cause of obstruction. Especially in cases with elevation in markers of inflammation.

NEC (Necrotizing Enterocolitis) is an increasing clinical burden to patients، families، and the neonatology health care team. Although the diagnosis is straightforward، the morbidity and mortality associated with the disease are not improving. Risk factors of prematurity، formula feeding، intestinal ischemia/hypoxia، and bacterial colonization accentuate the imbalance toward mucosal stress with impaired host defense، in some cases leading to uncontrolled intestinal inflammation and necrosis. The premature infant differs from term infants and older patients in multiple ways، including enteral feeding characteristics، bacterial colonization patterns، autoregulation of splanchnic blood flow host defense، and the regulation of the inflammatory cascade. Although several strategies to prevent NEC have been tested in humans and animals، most have had limited success. Recent results from studies using probiotic supplementation have been exciting، and following additional investigation، this novel approach may significantly impact the incidence، morbidity، and mortality associated with neonatal NEC.

Febrile convulsion (FC) is one of the most common seizure disorders in childhood period. Some trace elements such as magnesium may contribute in pathogenesis of FC. The aim of our study was to compare serum level of magnesium in children with FC and febrile patients without seizure. This prospective، case – control study included two groups of patients with 6-60 month of age with FC and fever without seizure respectively. Forty – seven cases were enrolled in each groups. The serum levels of magnesium were measured by spectrophotometery. Data were analyzed by T-test and Chi-square. Mean age of cases with FC and febrile patients without seizure were 26. 3±18. 99 and 23. 28±19. 11 months respectively. There were 24 male and 23 female in FC group، 26 male and 21 female in another group. The mean age and sex distribution were similar in these two groups. Mean levels of magnesium were 1. 96±0. 28 mg/dl and 2. 15±0. 24mg/dl in cases with FC and febrile patients without seizure respectively and there was a significant difference (p= 0. 001). The magnesium level was significantly lower in FC patients. In our study Serum level of magnesium was lower in FC group in comparison with patients with fever but without seizure.. Magnesium may play an important role in producing seizure in febrile children. In future the use of supplemental magnesium may prevent febrile seizure.