فصلنامه یافته
سال چهاردهم شماره 1 (پیاپی 47، بهار 1391)

Graft versus host disease (GVHD) is among major complications of allogeneic hematopoietic stem cells transplantation, and also is an important factor affecting the outcome of transplantation. An increased incidence of GVHD has been suggested following allogeneic peripheral blood stem cells (PBSC) transplantation, however, how this affects survival is not yet well clear. In this study, our aim was to assess the impact of acute GVHD (aGVHD) and chronic GVHD (cGVHD) on overall survival (OS), disease-free survival (DFS) and relapse following non-T-cell depleted HLA-identical sibling peripheral blood stem cells transplantation (PBSCT). Data of 78 patients, including 40 patients with acute myeloid leukemia (AML) and 38 patients with acute lymphoblastic leukemia (ALL), undergoing non-T-cell depleted HLA-identical sibling allogeneic PBSCT,were analyzed. All patients were received a uniform myeloablative conditioning regimen and prophylaxis for GVHD. We studied the incidence of aGVHD and cGVHD and their effects on survival and relapse in these patients. The overall incidence of aGVHD and chronic GVHD was 82.5% and 42.5% in the AML patients and 84.2% and 26.3% in the ALL patients. The occurrence of aGVHD had no effect on OS, DFS and relapse in AML and ALL patients receiving transplants. Although incidence of 2-year OS and DFS were significantly higher in the AML Patients with cGVHD compared to patients without cGVHD (P=0.024 and P=0.033, respectively), this difference was not due to the low incidence of relapse. These data indicate that the occurrence of cGVHD is an important predictor of outcome of non-T-cell depleted HLA-identical sibling allogeneic PBSCT, in those AML patients who develope cGVHD have a high chance of survival.

In order to offer better services in health care centers, awareness of perception and expectations of services recipients in these centers, and determination of existing gap between these two components, have a substantial role. This study was performed to assess the quality of health care services provided in health care centers of Khorramabad city using SERVQUAL model in 2010. In this descriptive cross-sectional study, 650 clients of health care centers of Khorramabad city were selected by stratified and random sampling method. The standard SERVQUAL questionnaire was used for data collection. Data were analyzed by SPSS 16 using descriptive statistics and Wilcoxon, Mann-Whitney, Kruskal-Wallis tests and Spearman correlation coefficient. In all 5 dimensions of offering services (including tangibility, reliability, responsiveness, assurance, and empathy), negative quality gaps were observed. The highest quality gap average was in empathy dimension and the lowest quality gap average was in reliability dimension. Between age of clients and quality gap score, reverse association was observed (P=0.026). There was no statistically significant relationship between the quality gap with sex and education level of clients. Expectations of the clients in all aspects of offering services are beyond than their perceptions, and needed to improve the quality of offering services in these centers in all the dimensions especially empathy dimension. It is recommended that the quality of the offering services be assessed periodically in these centers and intervene to improve the delivering of health services.

Children's diarrhea is one of the major health problems worldwide, especially in developing countries, accounting for nearly 4-5 million deaths per year.Campylobacter jejuni is a common human bacterial pathogen, which plays at least the same leading role to Salmonella and Shigella as the causative agent of infectious diarrhea. Regarding limited studies on different epidemiologic aspects of this bacterium in Iran, this research carried out to determine infectious enteritis caused by Campylobacter Jejuni in children with diarrhea in Khorramabad city. In this study the descriptive survey of the diarrhea caused by Campylobacter jejuni in children less than 12 years of age in Khorramabad city was conducted between September 2004 and September 2005. Stool specimens were collected from patients referred to medical laboratory of Shahid Madani children’s hospital and the correspondent laboratories with clinical symptoms of acute diarrhea. The specimens were transferred to microbiological laboratory of the veterinary faculty of Lorestan university in an attempt to isolate and identify Campylobacter jejuni species. One hundred-thirty out of the total 321 collected specimens (40.5%) were concerned to the female and 191 specimens (59.5%) to the male patients. Campylobacter jejuni species were isolated from 19 (5.92%) of the total collected specimens from which 11(3.43%) and 8 (2.49%) were associated to the female and the male children, respectively. Maximum of the positive cases were reported in the children aged less than 1 year (1.87%) and 1-3 years old (1.87%) that difference based on age groups was significant. According to the findings of the present investigation, the prevalence rate of Campylobacter enteritis in children less than 12 in Khorramabad in 2007 was 5.92 % which is same as the findings of similar studies in Zahedan (6%), Tehran (5%), Sari (4.8%) and Shiraz (5%).

Anemia is one of the most common health problems in Iran and the world. Moreover, iron deficiency anemia is the most prevalent nutritional anemia in the world. Considering the high prevalence of iron deficiency anemia and the relationship between their severity and cultural-economic condition in an area, this study was conducted to obtain the prevalence and plan the treatment of diseases. This cross-sectional study was conducted using a census method. All the adult patients with anemia signs and symptoms referred to the internal clinic of Shohada Ashayer were examined for CBC and RBC indices. The patients whose hemoglobin amounts fell in the anemia definition range were included. Iron level, serum ferritin, and TIBC assessments were performed and a questionnaire was completed for each patient. Then data were analyzed statistically. Out of all the anemic patients, 44.4% suffered from iron deficiency anemia. The prevalence of iron deficiency anemia was 52.3% in women and 22.6% of the men. 60.9% of the patients in 15-49 age group and 24.5% of those aged over 49 had iron deficiency anemia. A significant relationship was found between age, sex, and iron deficiency anemia. No significant relationship was found between history of NSAIDs consumption and the incidence of iron deficiency anemia. Since the prevalence of iron deficiency anemia in the studied population is high, considering improving and preventive interventions and comprehensive training programs in this regard seem to be necessary.

Hymen examination has divers individual, family, social and legal effects. Thus epidemiology of hymen for physicians and obstetricians is important. In an analytical cross-sectional study of women referred to women's forensic medical examination part of Shiraz from 2008 to 2009 were examined. A total of 823 samples with a mean age of 21.78±2.98 years and 16-20 years old were the most frequent age group among the cases. 53.58% of hymens were dilated circular and 46.17% of them were non dilated circular and 2 had no hole.From view point of anatomical type, 86.99% were in dilated circular hymens with smooth edges and the most frequent time of defloration of 80.33% of the cases was 3 weeks before examination. A significant relationship was observed between age and health status of the hymen. Also the relationship between age and time of defloration was significant. There is a variety in anatomical shape of hymen, and distinguishing normal findings from abnormal findings in the examination of hymen is a matter of importance.

Aquaporin1 (AQP1) protoin channels that expressed in the Choroid plexuses of brain ventricles, have an important role in cerebrospinal fluid (CSF) production. Some pathophysiological conditions such as intracranial hypertension, systemic hyponatremia and hydrocephalus followed by overproduction of CSF. Studies indicated that Curcumin can inhibit ionic channels. So the aim of this study was to determine that Curcumin can reduce the AQP1 protein in Choroid plexus cells. In this study Choroidal epithelial cells of lateral ventricle were isolated from Wistar rats brain and grown in DMEM supplement. 20Μm, 30μM of Curcumin were added to cell culture medium after 24hs and also 10 μM and 15 μM of this component were added to medium after 48 hours. Effect of Curcumin on viability of these cells examined by MTT assay. Also the effect of Curcumin on the level of AQP1 protein was investigate by flow cytometry assay. Based on MTT assay results, Curcumin inhibited Choroid plexus cells growth with IC50 value of 40μM and 22μM after 24 and 48 hours respectively. Flow cytomerty results indicated that Curcumin causes 50% decrease of AQP1 level in choroidal epithelial cells on dose and time-dependent manner. According to this study Curcumin can reduce the AQP1 protein in CP cells and this substance as a herbal medicene maybe able to be effective in treatment of some diseases such as intracranial hypertension, systemic hyponatremia and hydrocephalus by decrease CSF production.

Healthy Life for Cardiovascular Patients(HLCP), one of the ten projects included in Isfahan Healthy Heart Program, was designed and performed based on high-risk and secondary prevention strategies and aimed to reduce cardiac recurrences, along with the risk factors, morbidity and mortality among cardiovascular patients. In this study we investigate the trend of changes of frequency of coronary patients’ medicine intake, aswell as the results of process evaluation.

Five main strategies were designed to meet the project's goals. These interventions were designed based on education, legislation, and attracting inter-division and public cooperation. Process evaluation was performed in order to determine the project's successfulness. Prior to the project, the morbidity and medicine intake among the patients were also studied. These indices were again measured during the interventions and also after the project were completed.

Amongst all the interventions, educating the patients during the hospitalization period, at the time of release and also post-release educations were successful. Another success of the project in merging secondary prevention programs in the society was to attract public coordination and to establish a Non-Governmental Organization. The results also show an increase in the amount of aspirin, beta blockers, Angiotensin Converting Enzyme (ACE) Inhibitors, and statins taken by cardiovascular patients during the project.

The results suggest that secondary prevention and cardiovascular patient care promotion interventions can be performed using available facilities.

Since employees spend more than 60 percent of their awakening time at work place, this environment plays an important role in promoting their health. Nowadays, in many organizations, stress is experienced with various levels. One of the immediate consequences of the stress is the job burnout phenomenon. On the other hand, one of the most important factors of causing job burnout is the leadership style which is adopted by managers. This descriptive-correlational research was carried out to study the relationship between the leadership style of managers and the job burnout among the staff employees of Lorestan university of medical sciences. The sampling method in this study was random-hierarchical and the sample size was determined based on the Morgan tables and comprised of 182 employees and 45 managers. The instruments used to collect the data consisted of two standardized questionnaires: 1. Fiedler's Least Preferred Coworker Questionnaire (LPC) 2. Maslach Burnout Inventory which covers three aspects of job burnout: emotional exhaustion, a sense of personal accomplishment, and depersonalization. Using Cronbach's alpha, the reliability of the questionnaires was calculated as 84% for the Maslach Burnout Inventory and 81% for LPC. The statistical data were analyzedby by SPSS software. Among the employees, 64.3% low burnout levels, 35.2% moderate burnout levels and less than 1% high burnout levels were observed. 93% of the managers in this university in the staff section were shown to use a task-oriented style, 4.4% utilized a human relations oriented style, and 2.2% used a mixed style. There is also a significant relationship between the leadership style of managers and job burnout among the employees of the Lorestan university of medical sciences. The presence of a relationship between the leadership style of managers and job burnout among the employees demonstrates that there is an urgent need that managers use scientific methods of management in dealing with the personnel.

One of the emotional factors involved in major depressive disorder is recognition of facial expression of emotion. The aim of present study was to compare the recognition of facial expression of emotion in patients with major depressive disorder and normal people. 20 patients with major depression and 20 normal people were selected using available sampling method and responded to Ekman and Frisen (1976) recognition of facial expression of emotion test (α=0.71). The Method of this project was case- control; and multivariate analysis of variance was used for data analysis. The findings showed that there was a significant difference between normal (M= 26.95, SD= 2.68) and depressed (M= 22.65, SD= 3.97) subjects in terms of recognition of facial expression of emotion (P<.05), so normal people was better than people with major depressive disorder in terms of this variable. The defect in recognition of facial expression of emotion is a construction which can have a significant role in deterioration of major depression symptoms.

mechanical, thermal or chemical homeostasis is required to stop bleeding during surgery.The purpose of this study is to compare two method of hemostasis in bleeding rate during surgery of soft tissuie upper limb. In this case - control study 80 patients with inclusion criteria(age under50,without abdominal trauma,BMI less than30 and without soft tissue damage)that were operated by a surgen with available sampling (regarding to inclusion criteria, age and sex) non randomly divided into two groups of case and control and intervention in case group was base on causing hemostasis with electrocautery and tourniquet, but in control group, on electrocautery to cause homeostasis from beginning of operating tourniquet was used.Volume of lost blood was based on the number of used gases and suction was not used for any cases. Data collected by questionnaire and were analyzed by SPSS software and descriptive- analytic statistics. Mean age of case group was 31.62± 8/54 years and control group was 29.9±8.05 year. There was not a significant age difference between two groups(p=0.6). 63.8% of samples were men and and 36.2% were women. Most of surgical cases was related to repairing of ruptured flexor tendons of forearm (37.5%).The least was related to cyst and foreign bodies (12.5%). Tourniquet Mean time in case and control groups were 27.87±4.3 and 29.4±6.6 respectively and mean lost blood volume in case and control group were 16.3±5.3 and 17.2±4.7 respectively but there was no significant statistical difference in two groups(p=0.1). Tissue necrosis is a serious complication of Electro-cautery, so it is better to limit the use of Electro-cautery in soft tissue operations. But more researches are needed to confirm these results.

Teratomas are classified as congenital germ-cell tumors. These tumors are composed of ectopic tissue from 2or 3 layers,including mature, immature or malignant components and usually occur along the midline of the body. These tumors commonly occur in ovaries,testes, retroperitoneum and the sacro-coccygeal region.Anterior mediastinal teratomas account for 8-13% of the tumors in this region. the majority of these teratomas are located in the anterior mediastinum with only 3-8% arising from posterior mediastinum. Cases Report: The first case:A 65 years old man referred with complain of chest pain and dysphagia. A very large benign cystic tumor in posterior mediastinum in patient’s CT scan was detected and the patient underwent surgical resection. The final diagnosis was reported cystic teratoma. patient's symptoms were disappeared with surgical resection. The second case:A 55 years old woman with benign teratoma in anterior mediastinum tumor was discovered with assessment after chest trauma and she was treated with surgical resection.A30 month follow up was done, none of the patients had any complain. These slow growing tumors are often asymptomatic and are often detected incidentally on chest radiographs and or because of complications such as atelectasis,adhesion or compression of adjacent structures rupture and secondary infection. Surgical intervention is the only curative treatment and is advisable even when patient is asymptomatic because of the potential of complications.