مجله دانشگاه علوم پزشکی گیلان
پیاپی 81 (بهار 1391)

Improving pregnancy rate associated with the use of cryopreserved oocytes would be an important advancement in human Assisted Reproductive Technology (ART). Vitrification allows glasslike solidification of a solution, a physical process, without ice crystal formation in the living cells. The purpose of this study was to evaluate the viability of the oocytes, in vitro maturation and embryo development vitrified germinal vesicle oocytes after single and stepwise exposure to cryoprotectants. Germinal vesicle oocytes with or without cumulus cells were transferred to a verification solution composed of 30 % M sucrose (v/v) ethylene glycol, 18% (w/v) Ficoll-70, and 0.3 M sucrose either by single step or in a step-wise fashion. After verification and storage in liquid nitrogen, the oocytes were thawed and washed twice in the medium TCM119 and then subjected to in vitro maturation, fertilization and culture. The oocytes survival rates after vitrifying-warming, maturation rate, the capacity of fertilization and embryonic development to 2-cell were examined in vitro. The oocytes surviving, maturing to MII, fertilization developmental rate in the step-wise exposure were significantly higher (P<0/05), compared with the corresponding rate in single step procedure. The results of the present study indicated that oocytes vitrified with cumulus cells and stepwise procedure had a positive effect on the maturation and developmental rate than oocytes without cumulus cell and single step procedure.

Safety climate has shown its ability to predict important safety results, such as perceived risk, accidents and injuries. It is important to understand the psychometric properties of instruments used to measure safety climate before they are used in the setting of factories and workplaces. We explore the reliability and validity of safety climate questionnaire in Qazvin industries. Furthermore, correlations between accident rate and safety climate factors were explored. A study using a questionnaire was conducted on 380 employees in eight major companies in Qazvin, Iran. A 43-item safety climate questionnaire was developed after a scientific literature review and consultation with safety experts. Seventy five percent of the data gathered were subjected to principal component factor analysis with varimax rotation, using SPSS software. The remaining data (25%) applied for running confirmatory factor analysis using the AMOS 16.0 structural equation modeling program. Explanatory factor analysis displayed 8 factors which together explained 68.46% of the total variance. Cronbach Alpha (Internal consistency) across items in each of the 8 factors and that of the total scale were found acceptable. A 37-item questionnaire measuring safety climate was extracted from the original 43 items. Finding of confirmatory factor analysis was revealed to be a satisfactory fit index (CFI=0.91, TLI= 0.93, RMSEA= 0.044, =3.41). The safety climate scores calculated were found to have significant negative correlation with self-reported accident rates showing good predictive validity. One way ANOVA results display that the companies’ mean safety climate scores vary significantly from each other indicating that companies have different safety climate levels. The Safety Climate Questionnaire demonstrated good psychometric properties. This study has recognized Management commitment for safety and safety priority in workplace, employees knowledge and compliance from safety rules, employees attitude toward safety, workers participation and commitment to safety, safeness of work environment, and emergency preparedness in the organization, priority for safety over production and risk justification as the 8 safety climate factors in the Qazvin industries. This study provides benchmark scores for each safety climate factor with which organizations or even individual departments can be compared based on factor scores.

Adolescence is a critical period in any individual’s life, and puberty is the most important change within this period. Care for the girls’ health condition is very important because they play a crucial role in fertility and reproduction. Since today’s girls are tomorrow’s mothers and their health is so important. To investigate the junior school girls’ knowledge and attitude toward puberty sanitation in Lahijan, northern Iran, in 1388- 1389. For the purpose of this cross-sectional study, 384 female students in 3rd grade of junior school in Lahijan were selected through random cluster sampling in 1389. Questionnaire was used for data collection and the collected data were analyzed using SPSS software version 16, T test and Ch -square and Pearson correlation coefficient. The average age was 14.08 years and average age variable of menarch was12.3+1.04. Level of awareness was good in the majority (60.41%) and they had a positive attitude toward the puberty. Results showed a significant positive correlation between mothers’ levels of education and their daughters’ awareness (p<0.05) Based on the results of Pearson Correlation coefficient and p<0.05, we understood there was a meaningful relationship between source of awareness and attitude toward puberty sanitation. Also, there was a meaningful relationship between the level of awareness and attitude toward puberty sanitation area, too (p<0.05). The present results demonstrate an improvement in the level of awareness and attitude to psychological and somatic health in puberty period, compared to those during the last decade. Since the source of awareness has been the mothers in the majority of the studied cases, it could be suggested that mothers’ awareness should be promoted and students should be encouraged to consult their teachers, books, journals and the related materials in order to enhance their knowledge about physiologic, psychological and behavioral changes which occur during puberty and thereby to avoid the negative consequences and improve their awareness.

The importance of the mental processes and their role in people’s health and disease have been demonstrated by several studies. Although diverse factors affect people’s health, for the realization of their general health, and the role of personality factors that determine the individuals’ rules of conduct, further studies are required. Exploration and comparison of general health in adolescent girls and boys and its relationship with personality characteristics. We selected for this cross-sectional study, 4342 male and female students in high schools and pre-university across 11 provinces of Iran through multistage cluster sampling. General Health Questionnaire (GHQ) and Five-factor Personality Traits (NEO) were filled. In order to analyze the data, descriptive statistics parameters such as frequency, mean and standard deviation and for inferential analysis, Correlation Coefficient, Regression Analysis and multivariate analysis of variance (MANOVA) were used. According to the results, there was a significant difference between adolescent girls and boys in terms of general health. The results also showed that there was a significant positive correlation between neuroticism and general health and a significant negative correlation between extroversion, conscientiousness, and openness and general health (p<0/01). Also it was shown that neuroticism, extroversion, conscientiousness, and openness to experience can be considered respectively as the predictors for measuring the probability of adolescents’ general health status. Considering the results, it seems that by examining the personality characteristics of adolescents we can measure the likelihood of changes in various aspects of their general health conditions. Also, as the results demonstrated, we can conclude that the general health of the girls are more at risk than the boys.

The prevalence of low birth weight is one of the important sanitary indices in evaluating the prenatal care all over the world. So, recognition of risky factor related to low birth weight can help prevent the occurrence of being low birth weight. To determine the pravalence of low birth weight in Guilan and comparison of many biological characteristics of mothers of low birth weight babies with those of the mothers with normal weight babies. In this descriptive- analytical study, first, all newborn babies in 20 hospitals and maternity centers between Day (Jan.2008) and Azar (Nov.2009) were selected. Then, 168 low birth weight babies and 157 normal weight babies were randomly selected along with their mothers who filled the biological characteristics questionnaire with 0/85 validity. Variables in this research includes the condition of mother’s nourishment, smoking, suitable mobility and rest, high blood pressure, exposure to X-ray, and bleeding during pregnancy. Since the variables were classical, (nominal scale), the data were analyzed by qui statistical method and Phi coefficient in meaningful level (p≤0.01) with SPSS Software. The prevalence of low birth weight in Guilan was found to be 6/96 percent. Also, according to the obtained frequencies, there was a significant difference between the mothers of the two groups in terms of nourishment conditions (P=0.000), being exposed to radiation (p=0.002), vaginal bleeding (p=0.001), being exposed to smoke (p= 0.01), and ideal mobility and rest (p=0.000), during pregnancy. But there was no significant difference between them in terms of hypertension record (p= 0.89). As the results indicated, the prevalence of low birth weight in Guilan province was low and close to prevalence in Europe. Moreover, the recognition of some risky factors pertaining to the prevalence of low birth weight in Guilan province can help take preventive measures to reduce its rate.

Staphylococcus aureus is the main cause of surgical site infection, causing morbidity and mortality in patients undergoing surgery. Despite a lot of research on the best diagnostic method and Methicillin-Resistant Staphylococcus aureus (MRSA) screening in patients undergoing surgery, the most appropriate diagnostic method is still unknown. The question is whether Rapid Molecular (PCR) or the traditional microbial culture is the most suitable method?

This study aimed at systematic reviewing of articles to evaluate molecular method in MRSA diagnosis and the necessity of screening patients before and after surgery to prevent infections and its subsequent outcomes e.g. mortality.

Many searches in databases including the digital and medical inlm library and sites such as Science, JAMA, BMD, Springer were done since 2007 to August 2010. In total, 118 studies were selected regarding the following keywords; site surgical infection, Staphylococcus aureus, PCR, and culture. Two independent persons who selected the articles evaluated the designs of the studies and extracted the information using blinded method objectively. After a complete study of other articles, 50 articles were also eliminated, and 8 articles were finally entered the study. Data of culture diagnostic methods and PCR and the statistics of infection prevalence in surgical site were analyzed by Cumulative Pooled analysis.

Eight randomized clinical trials of culture methods and PCR had been studied in MRSA diagnosis and screening in different surgeries. The average duration of study was 11.6 months in all articles. The relative risk of site surgical infection was 7.3% with MRSA in all articles and CI was 95 % (0.696, 0.367). The conformity between culture and PCR was 91%, PCR sensitivity 99.2% and PCR specificity 82.2%. The rates of MRSA infection before (0.65 %) and after (0.35 %) surgery were significantly different with screening. When screening was applied, the rate of infection with 0.95% CI decreased to 28.9% - 31%.

Findings confirm the necessity of screening before surgery in order to determine the antibiotic prophylaxis preceding the surgery in those who carry MRSA. Thus, considering the specificity and sensitivity of PCR to microbial culture, molecular method is rapid and effective in diagnosis and screening of the patients who undergo surgery.

In recent years, application of radioactive materials is developed fast for diagnostic and therapeutic purposes in nuclear medicine. Meanwhile, each worker on the basis of his organizational post, receives different amount of radiation from various radioactive sources such as radiopharmaceuticals, radiopharmaceutical received patients, institute wastes like syringe, cotton soaked with polluted alcohol and so on. In this research work, the amount of absorbed dose of workers is measured in three nuclear medicine clinics in Guilan province. Among 35 workers investigated, 12 were chosen from clinic A, 13 from clinic B and 10 from clinic C. Worker's absorbed dose was measured using LiF:M,C,P thermo-luminescence dosimeter(TLD) made in special molds. These molds were fastened on their chest for two months. In order to minimize the uncertainty of outcoming results, three LiF dosimeters were used in each mold. This information is extracted using TLD reader and Win REMS software and finally the worker's average absorbed dose was calculated. The achieved results show that worker's absorbed dose is in the range of 0.94 to 14.6 mGy with the average of 2.2 mGy. The minimum absorbed dose was for the specialists of clinic C and the maximum absorbed dose was for the nurses in clinic A. The results also show that the maximum absorbed doses in all 3 clinics are received by nurses. In this study, the maximum amount of absorbed dose is related to nurses. This indicates that it is necessary to minimize the amount of patients exposure as well as worker's exposure, especially nurses, according to the basis of ALARA principle, via accomplishing the laws, rules and standards of radiation protection and the proper use of hand equipments.

In Iran, zoonotic cutaneous leishmaniasis (ZCL) is an endemic disease in many foci in the northeastern, southern, and central parts of the country. This disease goes through the geographical distributions along with dispersion in their reservoirs (gerbils) and their vectors (sandflies). Therefore, controlling the vectors or reservoirs has a significant role in prevention of Leishmania parasites which is transmitted by sandflies. Nowadays, because of vectors implications, the routine methods of controlling and spraying has no more useful effects on vectors and reservoirs. Consequently, in recent years maternally inherited intracellular Rickettsia like bacteria (Wolbachia) has been fascinated by many researchers. The aim of the present study was to improve our knowledge about detection of two species of Paraphlebotomus sandflies infected with W. pipientis which yet has not been reported in Iran and the world. The new surveys have been conducted in the case of Wolbachia detection in two mentioned ZCL vectors. In Turkemen Sahara within the ZCL focus, two species of Phlebotomus caucasicus and Phlebotomus mongolensis sandflies has been frequently collected from eighteen villages. Sticky papers and CDC traps were used to sampling sandflies in rural areas. In the laboratory, sandflies were identified to species by dissecting and mounting genitalia of each sandfly. DNA from sandflies (Thorax and abdomen) was extracted, the wsp gene confirmed for the presence of Wolbachia using wsp general primers (81F/691R). After sequencing, the data were analyzed by molecular software. We examined a total of 136 individuals (91 male and 45 female) from Phlebotomus caucasicus and Phlebotomus mongolensis species; 10 out of 44 positive (32.35%) samples had enough DNA to sequencing. Wolbachia infections have been found and verified for the first time in each of two Phlebotomus caucasicus and Phlebotomus mongolensis species in Iran and the world. In this procedure, 3 haplotypes (2 common Haplotypes and 1 unique Haplotype) of 2 species of Paraphlebotomus subgenus has been recognized in 10 sand flies of Iran. Paraphlebotomus sandflies are the secondary vectors of ZCL after Phlebotomus which play a decisive role in maintaining disease of their reservoirs. Wolbachia provide a starting point for inducing changes in host sex or sexuality. By manipulating Wolbachia as a transgene, it is hoped that these bacteria may be used as a controlling system for decreasing vector-borne-disease.

Rhinoplasty is one of the most popular plastic surgery in the world. Edema and ecchymosis are two expected consequences after any planned injuries such as surgery that extend recovery time and cause to distress for the patients and their families. Several drugs (e.g. corticosteroid and tranexamic acid) and herbal extracts (e.g. arnica) are suggested for resolving this problem but there is no comparison between them yet. This study was undertaken to compare the potential benefits of dexamethasone with tranexamic acid on postoperative edema and ecchymosis after rhinoplasty. Determination of dexamethasone and tranexamic acid efficacy on edema and ecchymosis after rhinoplasty. This was a clinical trial cross sectional double blind study. Seventy rhinoplasty candidates were randomized in two groups. In addition to routine management and cold compress after operation, one group received dexamethasone and another group received tranexamic acid injection for both groups 1 dose of drug before and 3 doses per 8 hours after rhinoplasty.. For measurement of edema and ecchymosis, we took digital photos from patients’ face third day of postoperation. Then three colleagues who were blinded to assigned groups, scored edema and ecchymosis level with using 0-4 point standard scale. The α < 0.05 is considered significant statistically. Nineteen men and fifty one women were enrolled. On postoperative day 3, there was no significant difference in the rating of preorbital ecchymosis among two intervention groups (p<0.15). Also there was no significant difference for the edema rating among two intervention groups (p<0.12). According to our results, no significant difference in postoperative edema and ecchymosis was detected among two groups. In regard to similar efficacy of both drugs to decrease edema and ecchymosis after rhinoplasty, we must select one of them according to the other effects of drugs.

Considering the side-effects of opiums and NSIADS drugs such as respiratory depression, apnea and GI effects, today it has been paid more attention to intra abdominal wall infiltration of local anesthetics for this purpose. The aim of this study is to determine the effect of intra abdominal wall infiltration with bupivacaine to reduce post operative diclofenac need in elective cesarean sections. In this double- blind, placebo-controlled trial, 60 healthy women with single term pregnancy underwent spinal anesthesia were randomized into two groups. Patients, then received a combination of 30cc of bupivacaine with 1.5cc of epinephrine as intra abdominal wall infiltration or equal volume of saline in cesarean section at the time of abdominal closure. Pain was assessed using a visual analogue scale 1, 2, 3, 4, 8 and 12 h after the operation.Also mean diclofenac consumption was assessed during 12 h after the operation. The final analysis was done with statistical tests by SPSS (P<0.05 was considered significant). Mean pain scores at 1 and 2 h after the operation was significantly lower in bupivacaine group than placebo(p<0.05). Mean diclofenac consumption was lesser in bupivacaine group than placebo (p<0.05). Also the time we prescribed diclofenac in bupivacaine group was later (p<0.05). Intra abdominal wall infiltration with 30cc of 0.25% bupivacaine leads to less pain and less diclofenac consumption at the first hours after cesarean section.

Neuronal migration disorders of the brain cortex are a diverse group of brain abnormalities with different etiologies and entities. They may present with various neurological and ocular abnormalities, while psychiatric presentation is very rarely reported. Here we described the first case of mania in a patient whit neuronal migration disorders. Case history: we report a 27 – year – old male with symptoms of mania with a prior history of occasional seizure attacks whose MRI showed neuronal migration disorder and his symptoms was controlled with sodium valproate. Association between neuronal migration disorders and mania was shown in this case. Besides, it raises the possibility that, as shown by other researchers, there may be common basis between mood disorder and neuronal migration disorders.