مجله علوم پزشکی رازی
سال بیست و یکم شماره 5 (پیاپی 122، امرداد 1393)

The defining characteristic of a longitudinal study is that subjects are measured repeatedly through time. Longitudinal studies are in contrast to cross-sectional studies, in which a single outcome is measured for each individual. The primary objective of this study is to use copulas to model the within-subject dependencies over time.

In this longitudinal study, we used the hospital records of patients with type 2 diabetes in Lolagar hospital, Tehran. Information of patients who visited the hospital at least twice during the years 2006-11 were recorded. Factors affecting fasting blood sugar were determined by regression model and the use of copula functions. We used the Residuals pp plot of copula function for selecting copula. Fitting model was done with R software.

In this study, only three explanatory variables were statistically significant. Smoking (p<0.001), family history (p<0.001), and duration of illness (p<0.001) were the positively significant variables. The coefficient estimate of duration of illness was 0.003, meaning that other variables remained the same, as duration of illness increases by one unit, the expected value of fasting blood sugar will increase.

In addition to identifying risk factors of fasting blood sugar, it was shown that use of copula function is an appropriate method for longitudinal data analysis and modeling correlations between data.

Regular physical activity has a positive effect on physical, mental, and social aspects both individually and community health. This study aimed to determine the effect of educational intervention on physical activity using BASNEF model among female university students Shahre Qods Branch in 2012 –2013. In this prospective experimental study, after selection of students girls that had the study conditions from four colleges, educational intervention was performed for 6 weeks that included discussions and lectures, education package, pamphlets and CD. Forty five students were randomly assigned for case group and forty five were randomly assigned to experimental group. Data gathering tool was a three part - questionnaire including demographic questions, BAZNEF model questions (included information related to the knowledge and attitude, physical activity and enabling factor, intention about physical, normative beliefs and subjective norms), and third part that included IPAQ questionnaire (International Physical Activity Questionnaire). After pre-test, the educational intervention was done for the experimental group. Post-tests were conducted in case and control group students’ immediately after training and three month after training. SMS was sent for case group and then collecting data was analyzed using statistical software SPSS. Level of significance was set at >0.05. There were no significant differences in intervention and comparison groups at baseline in terms of knowledge, attitudes, enabling factors, physical activity intention and subjective norms (p<0.05). After the intervention, the intervention group showed significant differences in terms of knowledge (p<0.001), attitudes (p<0.001), enabling factors (p<0.001), physical activity intention (p<0.001) and subjective norms regarding physical activity (p< 0.04). After 3 months with SMS awareness, knowledge (p=0.002), attitudes (p<0.001), enabling factors (p<0.001), planned physical activity and subjective norms (p<0.001) still had high average score. The results indicate the effectiveness of the educational intervention based on BASNEF model, resulting in greater knowledge, attitudes, enabling factors, planned physical activity and subjective norms. For a continuous physical activity, the provision of sports facilities suitable for students who have access can easily lead to the promotion of physical activity among students.

Silver nanoparticles have a wide range of applications in medical sciences which their effects depend on their size. Besides, there is an ever-growing need to develop environmentally benign nanoparticles synthesis processes which created an interesting area for the researchers studying in this field. So, attempts have been made to find new microorganisms that fabricate the nanoparticles in smaller size. This study aimed to evaluate a green process for production of silver (Ag) nanoparticles synthesized using Penicillium chrysogenum (PTCC 5037 = ATCC 10003).

The standard colonies of Penicillium chrysogenum were cultured in Czapek dox broth. The supernatant of the broth was examined for the ability to produce silver nanoparticles. For that, 100mL of silver nitrate solution at a concentration of 3mM was added to 100mL of the supernatant and incubated for 24 hours at 28°C. Then, the formation of nanoparticles were confirmed by alteration of culture from yellow to brown. The synthesized silver nanoparticles were characterized by UV-visible spectroscopy, Dynamic Light Scattering (DLS), Zeta potential, Polydispersity Index (PDI), Scanning Electron Microscopy (SEM) and Atomic Force Microscopy (AFM) for particle size and shape. The synthesized nanoparticles were centrifuged at 20,000rpm by ultracentrifuge for 5 minutes to separate nano-silvers from the solution.

Addition of Penicillium citrinum supernatant to aqueous AgNO3 solution led to the appearance of brown color in solution after 24h of reaction, indicating the formation of silver nanoparticles. The UV-Vis spectrum exhibit an absorption band at around 420nm suggesting the formation of silver nanoparticles. Hence, the secreted proteins and enzymes are responsible for reduction of silver ions to convert them to silver nanoparticles. SEM and AFM photographs showed that the silver nanoparticles formed were fairly uniform in size with a spherical shape and average diameter of 40nm.

The study showed that the standard fungus of Penicillium chrysogenum has the ability of cationic silver ions to produce silver nanoparticles. Moreover, as nanoparticles formed extracellularly, they are pure and free of cellular particles which help them to be used straightly for various applications

Considering this fact that in necessary conditions physicians should breaking bad NEWS to their patients and families, they have to obtain essential behavioral skills during their educations. That’s why these behavioral skills play important roles in definition of professionalism in World Health Organization while the most important aspect is its efficacy. This is a descriptive analytic study which has been conducted in Iran to standardize the validity and reliability of Spike questionnaire about breaking bad NEWS to the patients. At first the questionnaire was translated from English to Persian and then it was coordinated with national scales and again translated into English to confirm its external validity. To evaluate its structural validity it was distributed among 100 medical residents and finally the data was analyzed with statistical software. The results were discussed by expert professions. Its reliability was also assessed by Cronbach's Alpha and also Test - retest methods and considering the results, the final questionnaire on this issue was designed. Due to our results, validity and reliability of the questionnaire was confirmed. Cronbach's Alpha test showed its internal solidarity more than 0.7 and ICC was measured as.903 that all confirmed the questionnaire reliability. Spike questionnaire can be a valid and reliable method to evaluate the awareness of physicians in breaking bad NEWS to the patients and their family members. As not many studies have evaluated this issue it seems necessary to conduct a national educational program for all medical students in universities

It seems that the prevalence of Musculoskeletal Disorder (MSD) in laptop users is high although relatively few studies had focus in this group. The aim of this study was to investigate the prevalence of discomfort and pain in laptop user subjects and identifying the common adopted posture during usage of laptop. This descriptive cross sectional study was targeted at a group of 300 students aged between 20 and 30 who use laptop at work or at school in Tehran, Iran. A questionnaire was used for data gathering. Descriptive analytic methods were used to show prevalence rate of musculoskeletal pain. The results showed 77.3% of users reported at least one musculoskeletal complaint after using laptop. Among these neck trouble was the most prevalent MSD (60.3%), followed by wrist (27.3%) and right shoulder trouble (26%). Nearly 45% of subjects adopted kyphotic posture during laptop usage. The most common places where laptop was placed on were on the lap 28.7% and 24% on the office desk. On the base of Visual Analog scale the grade 4 was the most pain that was reported. The study has demonstrated that laptop usage causes musculoskeletal pains among students at work and in school and it is associated with the duration of use and adopted postures.

Yearly thousands workers throughout the world, particularly in developing country are involved in work-related accidents resulting work force disability and eventually, costing a lot for industries. Recent researches show that transition into and out of DST (Day Light Saving Time) plan causes imbalance circadian rhythm and may lead to sleep disorders. Sleep deprivation may have negative consequences on motivation, accuracy, consciousness and it is likely that the transition into and out of DST leads to increase the number of accidents. Therefore, this study was conducted for the reason that Iran is one of the countries in which the DST plan is implemented and so far, there is not any study in this case. Study type was a descriptive and analytic one. Using the database of Iranian Mines & Mining Industries Development and Renovation Organization, in this study we analyzed the total number of occupational accidents during 9 years from 2003 to 2011 in the months before and after change time. The results showed that the number of accidents did not increase significantly and considerably in the months before and after the implement of change time. In addition, most accidents occurring in the months before and after DST were related to the age range of 30-39 years old workers. Most accidents occurred among workers who had less than 5 years work history and the most injured location in the months before and after DST was related to lower and upper extremities. It seems that the sleep deprivation after DST transition does not affect considerably on the occupational accidents rate among the workers of Iranian Mines & Mining Industries Development and Renovation Organization.

Diet therapy in gastrointestinal (GI) surgeries is influenced by site of surgery and its complications. Some GI surgeries are rare so diet therapy becomes complicated. The aim of this report is informed the appropriate nutritional management in wide and rare GI surgeries. Case report: The case is a patient by colon interposition and partial gastrectomy surgery. Complications such as dumping syndrome, acute respiratory distress syndrome and sepsis appeared in this patient. Inappropriate nutritional support before and after surgery was the cause of complications. The results were prolonged and complicated course of treatment and apparent malnutrition in patient. Nutritional evaluating of patient and consult by an expert dietitian before GI surgery is important in considering the appropriate route of feeding to accelerate healing With an emphasis on preventing malnutrition and prevention of secondary complications of the disease.

Anesthesiologists, more than any other specialists, face lawsuits. As that there was no complete report on the reasons of lawsuit and condemnation of these specialists in Fars province, this study presents the results related to the frequency and reasons of lawsuit from anesthesiologists in the above province. This was a descriptive cross sectional study conducted on all of the dossiers on anesthesiologists condemnation referred to Shiraz Forensic Medicine commissions during 2006-2011. Collected data contained demographic characteristics of complainants, medical status of patients, types and degrees of medical faults and the final opinion of the medical commission. Among all the studied dossiers, 35 cases were related to anesthesiologists’ complaints, most of complaints were from patients aged between 40-50 years old, 71.43% of whom were males and others (28.57%) were females. Totally, 82.86% of the cases resulted in death and 17.14% had impairment among which 50% were related to brain injury. Most important cause of death in 24.14% of cases was respiratory problems. According to the present findings, most cases of complaints from anesthesiologists were related to middle age patients without any background of illness. So lack of anesthesiology services to high risk and old patients because of the fear of medical faults is not acceptable. At the same time it is necessary to insure anesthesiologists not to be afraid of patients’ complaints.

There is always difficulty and inaccuracy in measurement of blood pressure by conventional method in children. Technical errors, human errors, and incompliance of child during measurements are the main disadvantage. Nowadays, 24- hour ambulatory blood pressure measurements (ABPM) are introduced to apply for children. The aim of this review is to update our understanding on the accuracy, validity and application in children. All original articles from 2009 to 2014 in EBSCO, Scholar.google, Pubmed, Cochrane were searched. Review articles, pharmaceutical clinical trials, case reports, and those articles related to adults were deleted. According to literature studies, ABPM has correlation with the severity of end organ damage, morbidity and mortality. The accuracy and reproducibility of it has been assessed frequently. It is very important and useful to detect hypertension especially in children suffering from chronic disease such as diabetes mellitus, reflux nephropathy, renal transplantation. It helps to discriminate among true hypertension, white coat hypertension and masked hypertension and to detect those with non- dipper statues. All children with underlying renal disease, diabetes, heart disease, children with history of stroke, myocardial infarction or hypertension in their family members, high office blood pressure, on hypertensive medication and those of dialysis will benefit from regularly assessment by ABPM.

Lead is a common environmental contaminant element without useful biologic role in human body. Exposure to lead is an important public health problem especially for children. It may have toxic effect on many organs among central nervous system. The aim of our study was to determine cerebro-spinal fluid levels of lead in healthy children in Tehran. This prospective study included one group of healthy children with 2 -84 months of age. Thirty cases were enrolled. The cerebro-spinal fluid levels of lead were measured by atomic absorption. Data were analyzed by T-test and Chi-square. Mean age of cases was 25.46± 20.56 months. There were 15 males and 15 females. Median levels of lead was1.65 μg/dl (min= 0.5, max=14.2). There was no relationship between age and sex and cerebro-spinal fluid lead levels. In our study cerebro-spinal fluid lead levels was measured. It is recommended to compare our finding with cases with neurologic disorders.