فصلنامه یافته
سال دهم شماره 2 (پیاپی 31، تابستان 1387)

Atherosclerosis is the most common cause of deaths in the developed countries and causes one million mortalities per year in the USA. Smoking, hypertension, diabetes, obesity, hyperlipidemia, stress, and low activity are known to be the causes of atherosclerosis. The objective of this study is to confirm the relationship between chlamydia pneumonia (Cpn), as well as helicobacter pylori (Hp) and atherosclerosis. In this analytical case-control study two groups of patients were studied. The first group including 30 patients over 30 years old with coronary artery disease were operated using coronary artery bypass graft. The control group included 30 persons assessed with angiography and having normal coronary arteries. The data were collected and analyzed using statistical methods. The two groups were similar in terms of IgA and IgG anti-Cpn, and IgG anti- Hp but they were statistically different concerning IgA anti-Hp which had more positive cases in the case group in comparison with the control group (p<0.003). Additionally, 6 and 8 positive findings in immunohistochemistry (IHC) of the aortic punch biopsy were observed in Cpn and Hp respectively. When the serologic and histological findings were compared, it was revealed that the two bacteria had different behaviors in local invasion and systemic reactions. This study confirmed that Hp could cause atherosclerosis by activating systemic reactions while Cpn could not cause it. Moreover, in 20% and 26.7% of the cases Cpn and Hp respectively revealed invasions to the aortic tissues which could result in atherosclerosis. It is recommended that this study must be repeated with large numbers of patients and control groups, and the control groups must be cadavers so that their aortic tissues can be biopsied.

Periodontitis is a common inflammatory and infectious disease which destroys the supporting structure of the teeth. Recent studies show that periodontal infection significantly increases the risk of some systemic diseases. It is generally accepted that bacterial species notably Porphyromonas gingivalis and Bacteroides forsythus are highly associated with periodontium. Molecular methods such as Multiplex PCR seem to be more sensitive and faster. Multiplex PCR alone can lower the limit of bacterial detection. Several pathogens can be detected simultaneously by this method. The Subgingival plaque samples from 61 patients including 34 women and 27 men in the age range of 24-69 years and an average age of 43 suffering from chronic periodontitis with probing depth of PD6, and from 40 periodontally healthy controls including 22 women and 18 men in the age range of 21-69 years and an average age of 41.35 were collected by sterile curette. In this study, two species-specific forward primers were used in combination with a single reverse primer. The sample's DNA was extracted and Multiplex PCR was administered. Porphyromonas gingivalis was detected in 51 samples (83.61%) and 16 samples (40%) of the chronic periodontitis patients and the healthy subjects respectively. Moreover, Bacteroides forsythus was detected in 32 samples (52.50%) of the chronic periodontitis patients but it was not detected in any of the samples from the healthy group. P. gingivalis and B. forsythus can be simultaneously detected using Multiplex PCR. The present data suggest that P. gingivalis is a more important factor in the etiology of chronic periodontitis. Further studies are needed to determine the spectrum of pathogenicity of the disease and effective management of diagnosis and treatment in order to decrease the risk of periodontal complications such as systemic infections.

Numerous studies indicate that diarrhea is more common in persons suffering from malnutrition, because malnutrition causes infection and infection leads to diarrhea which in turn it is a notorious defective cycle. Regarding the high prevalence of gastroenteritis, especially in less than 2 years old children, and relatively high prevalence of malnutrition in children in developing countries that cause impacted high expenses on government and families, because of long term hospitalization of children, this research was carried out to study relationship between nutritional status of children with gastroenteritis and their duration of hospitalization in Khorramabad Shahid Madani hospital in 2007. In this cross- sectional study, 100 children under 2 years old with gastroenteritis were investigated. They were divided into groups of 50 including "well nourished" and "mal nourished", then the duration of hospitalization in both groups was compared. Nutritional status of the children was measured by dividing their weight by their 50% of standard weight for their ages. Children with birth interval from previous child more than 2 years, birth weight over 2500 grams, mothers’ age range of 20-35 years, lack of hospitalization during the last 6 months were selected. Data were collected using questionnaire. The effect of the other likely interfering variables, with 95 percent of confidence interval, were determined. A significant relation between mean time of hospitalization (in terms of day)and nutritional status of the children was observed (P<0.001) mean time of hospitalization in well nourished group was 2.58 days, however in mal nourished group it was 3.86 days. Among interfering variables, only exclusive breast feeding showed a significant effect on the duration of hospitalization (P=0.001). Most of the children suffering from gastroenteritis were between 7-12 months of age. Mean age of mal nourished children was 8.96 months, while for well nourished children it was 10.18 months. According to our results, malnutrition leads to a significant increase in duration of hospitalization in children suffering from gastroenteritis disease.

High blood pressure (BP) is one of the most important modifiable risk factors of cardiovascular diseases. Furthermore, anthropometric indices such as body mass index (BMI), waist circumference and waist-to-hip ratio (WHR) can independently and sometimes more severely lead to BP changes. The objective of this study was to assess BP status and its relationship with anthropometric indices among women in rural areas of Kerman province, Iran. This cross-sectional study was performed on 370 women of reproductive age (20-45 years old). General information were gathered from each sample using questionnaire and face-to-face interview. Body weight, height, waist and hip circumferences were measured and BMI and WHR were calculated for each subject. Data were analyzed using one-way analysis of variance (ANOVA), independent t-test and Pearson’s correlation coefficient tests. 15.9% and 22.8% of subjects were obese and abdominal obese (WHR>0.8) respectively. 14.3% of subjects were also hypertensive. BP significantly increased with weight, BMI, WHR, waist circumference and number of pregnancy. Furthermore, BMI was positively associated with systolic blood pressure (SBP) and diastolic blood pressure (DBP) (r =0.26, p<0. 002 and r =0.32, p<0.0001 respectively).There was also a positive correlation between WHR with SBP (r =0.22, p<0.003) and DBP (r =0.24, p<0.002). In addition, waist circumference was positively correlated with DBP (r =0.18, p<0.05). Anthropometric indices have positive and significant correlation with blood pressure changes in women of reproductive age. It is generally recommended to consider weight control and body fitness for hypertension prevention in women.

Shoulder pain is the third most prevalent cause of musculoskeletal disorder after low back and cervical pains. Most of the shoulder symptoms are attributed to the rotator cuff. The objective of this study was to compare the effects of low-power laser therapy with ultrasound therapy on the patients with rotator cuff tendonitis. This clinical trial was performed in Zahedan university of medical sciences in 2006. Thirty patients with rotator cuff tendonitis were randomly assigned to either a low-power laser therapy group (15 patients) or an ultrasound therapy group (15 patients). Strength (kg) of shoulder abductor, and internal and external rotator muscles, as well as range (degree) of shoulder abduction, and internal and external rotation were measured before and after intervention using hand-held dynamometer and goniometer respectively. The pain was evaluated using the visual analogue scale. In the laser group, a low-level Ga-As laser was applied with a 100 mw point probe (average power), wave length of 905 nm, pulse duration of 200 ns, 6 J/cm2 dosage, 5 KHz frequency, and lasting 3 minutes. The ultrasound treatment was applied with a power of 1 W/cm2, a frequency of 1 MHz, pulse mode of 1:4, and lasting 10 minutes on each occasion. The treatment was carried out 3 times weekly for 10 days. The data were analyzed using independent sample t-test and paired t-test. The pain in the laser group was significantly decreased from 6.06±1.6 to 5±1.3 in abduction, from 5.3±1.5 to 4.7±1.3 in internal rotation, and from 5.06±1.4 to 4.3±1.44 in external rotation (p<0.05). On the other hand, the pain in the ultrasound therapy group was decreased from 6.3±1.06 to 6.2±1.01 in abduction, from 6.07±0.9 to 5.9±0.84 in internal rotation, and from 5.87±0.92 to 5.8±0.96 in external rotation (p>0.05). A significant improvement after treatment was observed in the laser group in measures of shoulder abductor, internal rotator and external rotator muscles strength compared to those of the ultrasound therapy group (p<0.05). The pain level was also significantly decreased after the treatment in the laser group compared to the ultrasound therapy group in each of the three movements (p<0.05). In rotator cuff tendonitis, the results support the effectiveness of Gallium-arsenide low power laser therapy in order to decrease pain, and subsequently the occurrence of muscle strength. A period of low power laser therapy is more efficient than ultrasound therapy.

Medication errors are the most common avoidable causes of iatrogenic injuries in patients. One out of every three medication errors occurs when a nurse prescribes drug to a patient. Since medication instructions are among the most important parts in the patient's treatment process, their inappropriate application can lead to many serious consequences such as incomplete or incorrect therapy, as well as legal problems. The present study was carried out to verify the knowledge and attitude of nurses regarding medication error, and its prophylactic ways in educational and therapeutic hospitals of Khorramabad in 2005. The samples of this descriptive cross-sectional study included 86 randomly selected nurses who worked in educational and therapeutic hospitals of Khorramabad in 2005. Data collection instruments were a questionnaire and the structured interview. The collected data were analyzed using SPSS software (version 13), Chi-square and descriptive statistic test. Analyzing the data indicated that the nurses stated the moot important causes of medication errors as follows: inadequate number of nurses (100%), night and repeated long shifts (83.7%), personal problems of the nurses (79.9%), presence of the patients’ attendants and crowded wards (79.9%), and inappropriate environmental conditions of the wards (73.3%). Fear of receiving reprimands and punishment (88.4%), triviality of errors (57%), and unsupportive attitude of the nursing officials (50%) were the most frequently cited reasons for not reporting the medication errors. Moreover, adequate nurse to patient ratio (98.8%), staff continuing education (96.5%), and adequate information about medications (69.8%) were reported as the most important ways to prevent medication errors. Also 62.8% of the cases had moderate knowledge regarding medication error and its prophylactic ways. The data analysis showed that from the nurse's viewpoints, some interventions including increasing adequate nurse to patient ratio, improving environmental conditions of work, reducing environmental distractions such as interruptions and stressors, increasing staffs’ information about medications, increasing the role of clinical pharmacologists, creating medication error reporting systems, supportive attitude of nursing officials, focusing on causes of errors, and improving controlling and supervising systems can have remarkable effects on reducing medication errors. Moreover, both individuals and systems have to be taken into consideration when rules and regulations concerning medication error reporting and prevention are made.

Neonates expose to painful procedures even when come to birth healthy. Pain reduction is a definite right for each living creature during medical intervention. It has bee proved by many studies that painful experiences during babyhood, besides the early complications such as tachycardia, tachypnea and increase of body metabolic needs, can intensify individual’s physiologic and behavioral responses to pain in next stages of life. The purpose of this study is to examine the efficacy of supine, prone and kangaroo care (KC) positions on diminishing the pain response of term neonates during acute pain of venopuncture. In this clinical trial study, 50 healthy neonates between 39 to 40 weeks of gestational age with physiologic icter requiring bilirubin estimation were assigned to receive a venous puncture and assessed for their responses to the pain of venopuncture performed in a standard manner. Blood sampling was performed by an expert nurse in charge of each neonate in three positions including supine, kangaroo care (KC) at a 24-hour interval during 3 days. The place and condition of sampling were equal for all neonates. Pain responses were assessed using DAN scale, then the gathered data were analyzed using SPSS software and statistical tests. According to the obtained results there was no significant differences between pain score in supine and prone positions. Limb movements score in supine position was significantly higher than two other positions (P<0.001) and vocal expression score in KC position was significantly higher than two other positions. In supine position, pain profile score was significantly lower in subjects with higher weight and there was same result in KC position. Based on the results, KC position seems to effectively decrease pain during venopuncture and other painful procedures, but it is suggested to do similar studies to complete the outcome of the present study.

The primary ectopic goiters of mediastinum, specially of posterior mediastinum is rare and estimated on 1% of the goiters of retro sternal and mediastinum and their blood supplies is from intra thoracic vessels.

We introduce a patient who referred with the complain of a huge mass in the anterior medistinum. His complain presented by dyspnea breathlessness and chronic cough at first. This mass was removed easily through collar incision and partial strernotomy. Throught surgery we found that blood supply of mass arised from thoracic vessels and inominate artery, with drainage to inominate vien. Following mass removal, all the symptoms of the patient were resolved.

we presented an uncommon true primary ectopic mediastinal goiter resected through a median strnotomy with complete excision and relief of all symptoms.