مجله دانشگاه علوم پزشکی اردبیل
پیاپی 54 (زمستان 1393)

Deviation of the nasal septum is a common cause of unilateral or bilateral nasal airway obstruction and may follow nasal and midface trauma. Patient complaints of airway obstruction that are consistent with intranasal physical findings often lead to septoplasty and turbinate surgery. Severe nasal septal deviation leads to complete nasal obstruction and disturbs air passage from nostrils، however the effect of septal deviation and nasal obstruction surgery (septoplasty) on Eustachian tube function and middle ear pressure is controversial and isn’t clear. Whereas many of surgeons do not believe the considerable effect of septoplasty on Eustachian tube function and middle ear pressure، so they do not recommend this procedure before middle ear surgery. On the other hand، some have an idea that septoplasty has significant effect on middle ear pressure suggesting this procedure before ear surgery like tympanoplasty. This prospective analytical-descriptive study was conducted on seventy patients from 18 to 65 years of age who underwent septoplasty due to severe septal deviation leading to nasal obstruction in Beesat Hospital during one year (2012-2013). Middle ear pressure and Eustachian tube function on the septal deviated side and contralateral side before and after septoplasty (3 to 6 months later) were measured through tympanometry and Eustachian tube function test (Toynbee test). The comparison between pre- and postoperative ETF tests and middle ear pressures was assessed using Paired –T test and p-value of less than 0. 05 was considered as statistically significant. This study revealed that comparison between mean values of pressure in the deviated and contralateral side has no significant statistical difference before and after septoplasty. Also comparison between Eustachian function in the deviated side and contralateral side showed no significant difference before and after septoplasty. The septoplasty didn’t have considerable effect on Eustachian tube function and middle ear pressure three to six months after surgery، and on the basis of pre- and post operative measurements it was stated that surgical correction of a nasal septal deviation before ear surgery such as tympanoplasty is not justified.

Infertility is a global problem affecting millions of men and women in developed and developing countries. In this regard, in-vitro fertilization (IVF) plays an important role in improving the quality of life in infertile patients. However, studies have shown that the implantation failure in IVF is the main challenge of this procedure. Melatonin can increase the survival rate of embryos and IVF success rate through eliminating free radicals and removing reactive oxygen species. So, this study is conducted to investigate the effects of different concentrations of melatonin on the rate of newborns of mice following transfer oftwo-cell embryos. In this study, female mice with average age of six to eight weeks were superovulated by administering pregnant mares serum gonadotropin (PMSG) intraperitoneally (7.5 IU. ip), and followed after 48h by human chorionic gonadotropin (hCG) (7.5 IU. ip). Two-cell mouse embryos were obtained from female mice oviduct after 48 h. The embryos transferred bilaterally into pseudopregnant mice of the same strain through surgical procedure and 8-14 embryos were transferred to each tube. The study included 4 treatment groups and one control group (6 mice in each group). The treatment groups were exposed to subcutaneous injection of concentrations of 100 µm, 10 µm, 1 µm and 100 nm of melatonin. After the cesarean on 18th day of pregnancy, the percentage of live births was assessed. The outcomes of the live birth rate were as­sessed using the chi-square test and statistical analyses were carried out using SPSS version 16.0. Percentage of live birth was calculated and compared with the control group. A total of 701 two-cell mouse embryos were transferred into one control group and four experimental groups. The number and percentage of live births at concentrations of 100 µm and 10 µm of melatonin and the control groups were 21 (15.55%), 13 (9.15%) and 9 (6.47%), respectively. No infant was born at the concentrations of 1 µM and 100 nM of melatonin. The highest rate of live births was obtained at the concentration of 100 µM and showed a significant difference with the control group (p ≤ 0.01). There was no significant difference in live births at the concentration of 10 µm and control group. The results of this study indicated that subcutaneous injection of melatonin improves the two-cell mouse embryo growth and post implantation development of mice.

Chronic psychiatric patients not only become inactive members of community but also the heavy costs of their maintenance and rehabilitation burden on society and their family. According to importance of subject, this study aimed to investigate the role of percieved social support in predicting positive and negative syndrome in patients with schizophrenia. In this descriptive-correlational study, 124 patients have been selected among patients with schizophrenia hospitalized in Issar Psychiatric Hospital and Rehabilitation Centers in first 3 mounths of 2014 in Ardabil, Iran and completed Positive and Negative Syndrome Scale (PANSS), Multidimensional Scale of Perceived Social Support (MSPSS) and a researcher made demographic checklist. Data were analyzed by Pearson correlation coefficient and multivariate regression analysis on SPSS-16 software and P values less than 0.05 were considered statistically significant. The mean age of participants was 36.34±9.09 and their education level was mostly (58%) primary or illiterate. Results showed that there is a negative relationship between patients positive symptoms index and their family, some others and total social support (p<0.01) and also between negative symptoms index and patients friends, some others and total social support (p<0.05). Results of multivariate regression analysis showed that 11% of positive and negative symptom syndrome are explained by percieved social support in patients with schizophrenia (p<0.01). Percieved social support has relationship with positive and negative syndrome of patients with schizophrenia and measures to increase resources of social support and promotion of patients percieved social support can be used as an effective intervention by clinicians, patients and their family.

Addiction is one of the problems in world threating the social, economic and culture factors. It is essential to have an accurate knowledge about the characteristics of drug users in order to diminish the high-risk behaviors of intravenous drug addicts. This research has been done to assess relationship between individual characteristics and high risk behavior in intravenous drug addicts. In this descriptive-analytic research, 360 drug users were selected from different places in Ardabil city and interviewed by a prepared questionnaire. The data were analyzed using descriptive and analytical tests including t-test, Pearson correlation and ANOVA with SPSS statistical software. The results showed that the age, gender, material status, job position, age of addiction start, age of injection start, injection frequency, injection frequency per day, syringe supply place and the partner’s gender during recent few months had no significant difference compared to drug users with needle sharing and without needle sharing. The educational level of drug users with needle sharing was lower (P=0.037) and the number of new syringe usage per month was also lesser (P=0.001). They predicted to be more likely infected with AIDS (P=0.001) and had a less argument with their partner about using condom, also mostly have not used condom at their last sexual relationship (P=0.001). The average number of their partners during last three months was high (P=0.003) and there was a meaningful relationship between true sense of peril and using condom in drug users with needle sharing group (p=0.001). There is a significant relationship between the true sense of danger and the using condom. It is necessary to have an appropriate advertising to increase using condoms among injecting drug users.

Adult stem cells are undifferentiated cells that replace dead or injured cells. There are adult stem cells in some regions of human tissues and hair follicle is one of the tissues that have adult stem cell source and these cells have an important role in hair life cycle. In this study, we investigated the isolation of hair follicle stem cells (HFSCs) and expression of mesenchymal stem cell markers on the isolated cells. Human hair follicles obtained from men scalp tissue by micro punch technique. Hair follicles isolated and cultured in culture flasks in DMEM-F12 + FBS. After outgrowth of stem cells from hair bulges, they analyzed by flow cytometry for detection of stem cell markers. 23 to 27 days after isolation and culture of HFSCs in uncoated cell culture flasks, cell surface markers expression studied by flow cytometry. Flow cytometric analysis showed 25.26% Stro-1, 50.85% CD90, 45.24% CD105, 61.20% CD44, 8.20% CD45, 11.86% CD146, 2.72% CD106, 7.21% CD166 and 26.74% CD19 expression in HFSCs. In this study, isolated stem cells significantly expressed some of the mesenchymal stem cell markers higher than other markers. These markers give certain characteristics to HFSCs, and introduce the cells as an alternative option for cell therapy, tissue engineering and regenerative medicine.

Procalcitonin (PCT) is a precursor of calcitonin hormone, comprising 116 amino acids, which is produced in thyroid neuroendocrine cells. However, in conditions such as septic shock, metastatic cancers, bacterial and fungal infections PCT is secreted by lung neuroendocrine cells, liver cells, and leukocytes. PCT is involved in acute phase of inflammatory process as a reactant protein. Hence, in this study serum and pleural fluid PCT was evaluated in common types of pleural effusion. This is a cross-sectional case-series study carried out on 60 patients with pleural effusion. In this study, effusion cases due to tuberculosis, malignancy, effusion followed by pneumonia, and also transudate were investigated. Other cases of pleural effusion were excluded from this study. After collecting the samples, PCT levels in pleural fluid and serum of patients were measured and compared statistically with respect to the primary etiology of effusion. Sixty patients (10 patients with TB, 10 patients with malignancy, 10 patients with para-pneumonic, and 30 patients with transudative pleural effusion) participated in this study in which 61.7% were men and 38.3% women (p=0.204). The mean age of participants was 62.68 ±19.38 years. Results showed that mean of PCT in pleural fluid of patients with exudative effusion was 0.74 ng/ml (0.63 ng/ml in malignancy, 0.42 ng/ml in TB and 1.51 ng/ml in para-pneumonic) and in patients with transudative was 0.42 ng/ml. In addition, mean of PCT in the serum of patients with exudative pleural effusion was 0.74 ng/ml (0.65 ng/ml in malignancy, 0.40 ng/ml in TB and 1.20 ng/ml in para-pneumonic) and in patients with transudative was 0.43 ng/ml. The analyzed data showed that there was a significant difference in the pleural fluid (p=0.016) and serum PCT (p=0.009) of patients with pleural effusion transudate and exudates. After excluding patients with transudative, a significant difference was also observed among patients with exudative in such a way that in the para-pneumonic group the amount of PCT level in the serum and pleural fluid was more than tuberculosis and malignancy groups. Serum and pleural fluid PCT is increased as a marker in response to inflammation. Although its increase in patients with bacterial and pneumonia infection is significant, it can be increased in patients with secondary inflammation of tuberculosis or malignancy and consequently can be used as an inflammatory indicator in the evaluation of patients with pleural effusion.

Today, the concept of q uality of services is particularly important in health care and customer satisfaction can be defined by comparing the expectations of the services with perception of provided services. The aim of this study was to evaluate the quality of services provided for outpatients in clinic of Ardebil city based on the SERVQUAL model. This descriptive study was conducted on 650 patients referred to outpatient clinic since July to September 201 3 using a standardized SERVQUAL questionnaire (1988) with confirmed reliability and validity. The paired t-test and Friedman test were used for analysis of data by SPSS software. 56.1 % of respondents were male and 43.9 % of them were female. The mean age of patients was 33 ± 11.91, 68.9 % of patients were in Ardabil and 27.3 % of them had bachelor's or higher. The results showed that there is a significant difference between perceptions and expectations of the patients about five dimensions of the service quality (tangibility, reliability, assurance, responsiveness, and empathy) in the studied clinic (P< 0.001). The highest mean gap and minimum gap were related to empathy and assurance, respectively. Regarding to observed differences in quality, the managers and also planners have to evaluate their performance more accurately in order to have better planning for future actions. In fact, any efforts to reduce the gap between expectation and perception of patients result in greater satisfaction, loyalty and further visits to organizations.

At the present time, health care services have been increasingly transformed to a competitive issue and many factors influence usage of hospital services and selection of a hospital by the patients. This study has been performed for surveying effective factors on selecting a public or private hospital among non-emergent patients of Ardabil hospitals in 2012. This research was a cross-sectional descriptive-correlational study and the statistical population was non emergent patients of four public and two private hospitals of Ardabil in 2012. The samples (598 patients) were collected by stratified random sampling method. Data-gathering tool was a researcher-made questionnaire and data were analyzed by descriptive statistics, frequency [distribution] tables, and logistic regression analysis. The results depicted a direct interdependence between selecting a hospital (public or private) and the three factors of social elements, hospital services, and hospital facilities with a confidence coefficient of 92%. Based on logistic regression analysis and Exp(B) coefficient, the patients’ priorities for hospital choosing were hospital services, social elements, and hospital facilities with Exp(B) of 1.932, 1.332, and 0.338, respectively. The most important factor for choosing public hospitals was lower cost of services and for private hospitals was physician’s recommendation. The strong effects of these two factors have overshadowed other variables.

Childbirth is the most stressful event for the women both mentally and physically affecting their physiological and psychological indicators during labour. The aim of this study was to assess the effect of non-pharmacological methods of labor pain relief in mothers’ perceived stress conducted in Alavi hospital of Ardabil, 2013. In this double blind randomized controlled trial, 320 mothers were allocated into two groups by stratified block randomization. The intervention group (n=158) received continuous support throughout the labour process, positioning and movement, music, aromatherapy, showering andconsumption of a light diet or water.The control group received only a routine care. The perceived stress scale (PSS) was employed to collect data in three stages; at the beginning of the active phase, before the intervention, six hours after birth and then eight weeks postpartum. The two groupswere compared using General Linear Model with controlling the baseline scores. There were 14 participants loss to follow-up. The mean of perceived stress score in the intervention group was significantly lower than the control group at 6 hours [adjusted mean difference: -1.0 (95% confidence interval: -0.01 to -1.9]. However, there was no difference between two groups in terms of perceived stress score at 8 weeks postpartum (p=0.692). Non-pharmacological methods of labor pain relief are an effective intervention for reducing perceived stress level in mothers during labor and therefore use of this intervention is recommended.

Social phobia is one of the common anxiety disorders characterized by fear of social situations, shame and embarrassment in communicating with unfamiliar people. The aim of this study was to examine the effectiveness of acceptance and commitment therapy in reducing anxiety and depression in students with social phobia. An experimental pretest-posttest with control group design was used to conduct the study. The population consists of all female students in Ardabil city, 2013-2014 academic years. Using a multiple-stage cluster sampling method, a representative sample consists of 400 students was selected for the study. Then, among the students those with social phobia (based on the cut-off point), 34 participants were randomly selected and divided into two groups of 17 people (one experimental group and one control group). The participants in experimental group received acceptance and commitment therapy for 10 sessions of 90 minutes. The control group did not receive any intervention. Anxiety, depression and social phobia questionnaires were administered to the two groups before and after the intervention. Descriptive statistics and multivariate ANOVA (MANOVA) were used for data analysis. The results of data analysis showed that treatment based on acceptance and commitment therapy reduces anxiety, depression and social phobia of students in the experimental group compared with the control group (p<0.001). The present study showed that acceptance and commitment therapy for students with social phobia can be used as a psychological intervention along with other intervention mechanisms.

Primary Extra nodular non-Hodgkin lymphoma during pregnancy is rare with occurrence rate of 0.8 in 100000 pregnancy. In this report, the case of a 19-year-old woman during week 14 of her intrauterine pregnancy with primary extra nodular non-Hodgkin lymphoma is described. The staging consisted with thyroid open biopsy. After induced abortion the subject underwent chemotherapy with CHOP regimen (cyclophosphamide, doxorubicin, vincristine, and prednisolone) for 6 cycles.