مجله دانشگاه علوم پزشکی گرگان
سال نهم شماره 2 (پیاپی 22، تابستان 1386)

Pain, in particular post-operative pains, can produce numerous complications including a delay in healing of wounds in patients. For pain relief in patients postoperatively, different drugs are used, opioids like pethidine and NSAIDs. This study was carried out to compare the effects of the IM pethidine and suppository Diclofenac for pain relief after laminectomy following lumbar disc hernia.

this is a randomized control clinical trial study, 100 patients presenting for laminectomy with diagnosis of lumbar disc hernia and eligible for participation in the study, after recieving their informed consent for inclusion in the study non probability convenience sampling were selected by a convenience sampling method and then divided into two groups of Pethidine (P) and Diclofenac (D). Patients’ pain scores were measured by Visual Analogue Scale (VAS). Finally, the data obtained were analyzed by statistical software of SPSS.10, F test, T test and? ² P<0.05 was considered significant.

Mean pain scores within 24 hours after operation were calculated in group P as 2.8±2.02 and in group D as 4.46±2.30. There was a statistically significant difference between the reduction of the pain score after surgery in both groups (p<0.05). Nausea was the greatest side effect observed in group P (23%) and epigastric pain was the most common pain found in group D (18%). However, no statistically significant difference was found between the two groups in terms of the drug adverse effects.

A statistically significant difference was observed between pethidine ampule and Diclofenac suppository regarding the pain reduction after laminectomy. In the other words, Diclofenac suppository has less impact on pain killing in comparision with Pethidine ampule. In other to confirm these results, it is suggested that another study in terms of age and sex and after orthopedical procedures in a large scale-and if possible double blind- to be carried out.

The papanicolaou (pap) smear has been used to screen women for cervical cancer since 1940. Unsatisfactory results induce anxiety in patients and doctors. Recently, a number of new technologies have been developed to improve the detection of cervical cancer. Increase the early detection of meaningful pap smear abnormalities, reduce the number of unsatisfactory smears and false negative results and provide fewer ambiguous results one of these method is the new test, include liquid-based to improve the quality and quantity of the cervical pap smear. The aim of this study is to evaluate rate of unsatisfactory smear of cervical cytology in two methods, conventional pap smear (CP) and liquid-Based (L.B). A comparison cross – sectional study was performed from 2004-2005 on 1500 patients referred to the Ghaem hospital and private clinic. From all patients cervical cytology was taken randomly via two methods CP and L.B. Subsequently frequency unsatisfactory cervical cytology in tow methods evaluated. Statistical analysis using the SPSS soft ware was done and t-test and? 2 used for comparative evaluation. Considering the incidence of unsatisfactory cervical cytology in CP method %0.3 was and in LB method %1 was. Sensitivity of the C.P method was 68.8% and that of the L.B method was 83.1%. In this study incidence unsatisfactory rate in L.B method was higher than C.P method.

Shiga-toxin producing E. coli (STEC) belonging to several different O serotypes are one of the etiological agent of diarrhea. The STEC strains are considered as an etiological agent for enteritis after non-typhoidal salmonellosis and Campylobacter. They have also been associated closely with the hemolytic uremic syndrome (HUS) and hemorrhagic colitis(HC). The aim of this study was to determine of the frequency of STEC in patients with hemorrhagic colitis referring to Tehran hospitals. From March to September 2004, 70 patients with hemorrhagic colitis (Case)an 70 patients with diarrhea (Control) were included in this study. The stx gene was detected by PCR and was used for the determination of STEC strains. Slide agglutination with specific antisera used to detect O serogroup. Polymerase chain reaction- restriction fragment length polymorphism (PCR-RFLP) analysis of the flagellin gene (fliC) was performed for determining their flagellar antigen (H). Two samples (2.9%) from Hemorrhagic colitis cases and 12 samples (17.1 %) from diarrheal cases were positive for STEC. There was no significant correlation between STEC and Hemorrhagic colitis but there was a significant correlation between STEC and diarrhea (p<0.05). STEC isolates O142:H48 serotype was from hemorrhagic colitis cases and O126:H47, O126:H6, O26:H4 and O111:H23 serotypes were from diarrheal cases. These serotypes were not reported in hemorrhagic colitis cases. Our data showed that there was no significant correlation between STEC and hemorrhagic colitis. This could be explained since serotype responsible for hemorrhagic colitis i.e. O157:H7 serotype is not present in Iran.

Hospital infection is one of the important determinants on lengthening hospitalization and increasing the costs and mortality rates in hospitals. Intensive Care Unit (ICU) is one of the wards that are most afflicted with the incidence of this morbidity. This study involves investigating the incidence of infection in one of the Intensive Care Units. This study was designed in the form of a prospective cohort which was implemented on patients who were hospitalized in the ICU of Khatamol Anbia Hospital from September 21st 2002 for at least 72 hours and didn’t reveal signs of infection. The status and duration of using tracheal tube, ventilator, urinary catheter, and venous catheter, the duration of hospitalization in ICU and the time infection appeared were all recorded. During the six months spent on this study, 234 patients were hospitalized in ICU, among which 50 patients were investigated. The group of these 50 patients cumulatively spent 528 days in ICU. During their hospitalization, 9 cases of infection occurred in these patients. The incidence of infection was 18% (with a 95% confidence interval of 7.35% to 28.65%). The incidence rate was 17 patients in 1000 person-year of hospitalization in ICU (with a 95% confidence interval of 8.8 to 106.3). Hospital infection is a relatively common complication among patients who have been hospitalized in ICU for at least 3 days. The frequency of infection reported in Iran is equal or more than the results of studies carried out in other parts of the world.

The present study was designed to investigate the outcome of pregnancy and delivery in pregnant Iranian women with low and high hematocrit. In a cohort control study, 609 pregnant women attending Yahyanejad Hospital for antenatal care and delivery from Dec 2001 to Dec 2003 were randomly selected. Women with hemoglobinopathies such as thalassemia were excluded from the study. Maternal characteristics including hematocrit values were recorded at the first antenatal care and 3 cc.blood was sent to the laboratory for CBC. The main outcome measures included birth weight, gestation at delivery, Apgar scone, mode of delivery,the admitted NICU and perinatal death. X2, T-test, Anova and logistic regression models were also applied to analyze the data. Anemia (hematocrit<34%) in the first trimester was associated with a significantly increased risk of low birth weight (<2500g) and preterm delievery (<37 week’s gestation). High hematocrit values (>40%) did not increase the risk of low birth weight or preterm delivery. The risk of low Apgar score, operative deliveries and admitted NICU was significantly increased in women with high and low hematocrit adjusting for maternal age, parity, weight gain, inter pregnancy, father and mother education and other confounding factors. Low and high maternal hematocrit in the first trimester can contribute to the adverse pregnancy outcomes, thus pregnant women with abnormal hematocrit are at high risk factor and necessary awareness should be given to them on how to prevent complication and adverse outcome by special clinical care.

The ways of prevention of wound infections are too much, and some references mentioned that one of those ways is dressing. Dressing can cause a sort of spiritual transquility for patients, too. In the other side, doing it causes some kinds of limitations such as preventing of taking a bath or spending expenses. So, we decided to consider the influence of continuation of dressing, on the rate of wound infection, after first 48 hours post operation. In this research, we studied on 150 patients who were under the same surgeries, So that in the half of them, after 48 hours dressing were removed, and in the half remaining, dressing were changed daily for one week. In both groups, in the third, seventh and thirtieth day after surgery were inspected and examined by surgeon, in the case for having or absence of symptoms and signs of infection. In subgrouping patients we considered some factors include age, sex, type of operation and predisposing diseases. The 30 th day post operation was the end of our study and information analyzed in the computer with SPSS software. The average age in the group of without dressing was 35.12±20.19 and in the group with full dressing was 37.61±18.78 years. There were 74 men and 76 women. There was Just one wound infection in our study, who had dressing for one week. The case was woman without serious disease, and a half day before surgery was admitted in the hospital. In the group without dressing, we did not have any wound infection. 5.3% were nervous in the no dressing group and the 17.3% of patients with dressing were anxious of having their bath with delay. According to the no impression of dressing on the rate of wound infection in the clean surgeries after first two days and also lack of considerable anxiety in the non dressing group, we recommend picking up the clean wounds dressing after 48 hours and make patients feel guaranteed.

Teacher’s mental health, due to its effect on the formation of attitude and mental health of students, play more important role than any other social-class. This research focuses on the extend of teacher’s mental health with various levels of education as its main objective. This is a descriptive cross-sectional research. Statistical population is comprised of all teachers in Golestan province who involved teaching at schools in the educational year of 1383-84. a sample of 535 teachers was obtained through multi-phase random cluster sampling. Symptom checklist questionnaire with a cut-point of 2.5 on each dimension and 1.3 cut-point for global symptom index (GSI) were considered in determining teacher’s mental disorder. Finding showed %81.1 of teachers are of sound mental health and %18.9 of them (%21.8 in female and %14.9 in mal) seem to suffer at least from one of the symptoms of mental disorder. The sequence of disorder symptom prevalence was as follow: somatization %7.3, paranoid ideation %5.8 and depression % 4.9. the highest mental disorder was seen among elementary school teachers(%21.6) and the lowest among senior high school teachers(%14.9). a significant correlation coefficient between teacher’s level of education and overtime work with global symptom index(GSI) was seen(P<0.05). Result of study showed that the prevalence of mental disorders among Golstan teachers are medium and this finding are indicative of lower mental disorder among the teachers in Golestan province in comparison to the finding of similar researches done in other provinces.

Ectopic pregnancy is a main cause of maternal death and is 10-15% of refered patint to first trimester emergency ward. Due to importance of early detection and prevention of excessive blood loss in Ectopic pregnancy this study designed that evaluated the correlation between vital signs and quantity of hemo-peritoneum and except of traditional vital sign another method with more sensivity can be used in detection of tubal rupture and nessersirily of Emergency surgary. This study is a analytic cross sectional design in 105 patients had diagnosis of ruptured ectopic pregnancy in fatemieh hospital. positive predictive value and sensitivity and specifity of pulse rate, BP and shock Index (SI) in correlation to ruptured Ectopic pregnancy and hemoperitoneum evaluated. Hundred five patients were studied (70 ruptured EP and 35 unruptured EP). Mean of shock index in unruptured and ruptured EP was 0.6±0.29 and 0.94±0.22 respectively that was nonsignificant. (p<0.05) Sensitivity of pulse rate, systolic pressure and shock Index (Pulse/SBP) was 17.6%±9%, 32.4 %±10% and 91.4%±6% respeictively. negative predictive value was 34.1%, 38.7 % and 50% respeictively.mean primary Hb had no difference in two group. Normal vital sign alone are poor predictors of ruptured ectopic pregnancy and shock Index (Pulse/SBP) Correlate best with the quantity of intaperitoneal hemorrhage.

To assess the effect of a lateral – wedge insole with subtalar supporting on the femorotibial angle in patients with varus defomrity of the knee. The efficacy of a wedged insole with subtalar supporting and that of traditional wedge insole shoe insert were compared. 20 outpatient with knee osteoarthritist were randomized to be treated with either the supported or traditional inserted insole. In both group, the baseline and 2 month koos scores for subjective knee pain and ADL and quality of live and symptoms were compared. At the baseline, there were no significant difference in the femorotibial angle and pain and ADL, quality of life and symptoms, the 10 subjects wearing the subtalar supporting demonstrated a significatly increase femoretibial angle and koos scores without pain compared with insole group, there were no significant difference between twe group in pain after treatment. These results suggest that an insole with a subtalar supporting maintained the valgus correction of the, femoretibial angle in patgle in patients with varus knee OA for 2 months.

Clinical findings effective on disability of stroke patients have importance due to their effects on prognosis and future recovery following rehabilitation. Consecutive stroke patients admitted in Valie-Asr hospital, Khorasan enrolled in a prospective study in 2005. Hemihyposthesia, hemianesthesia, hemineglect and homonymous hemianopsia were evaluated in the patients. Disability score was determined based on the Rankin scale at 72 hours post stroke. Mean of Rankin Disability Score (MRDS) was analysed by T and Fisher tests and p<0.05 declared as significant. 329 stroke patients were investigated. Hemihyposthesia, hemianesthesia, hemineglect and homonymous hemianopsia were found in 37.4%, 13.8%, 7.9% and 7.3% respectively. MRDS was significantly higher in patients with hemianesthesia than other stroke patients, p<0.05. MRDS of patients with each of hemihypoestheisa, hemineglect and homonyous hemianopsia was not signigicantly different than patients without these abnormalities respectively. Patients with triad of hemianesthesia, hemineglect and homonymous hemianopsia had significantly higher MRDS than others, p<0.05. Hemianesthesia is the most important clinical effector on MRDS of the stroke patients. Presence of above triad predicts the highest MRDS in these patients.

Pediatric renal tumors represent approximately 7% of all childhood cancers and are completely different from those occurring in adults. The aim of this study was to make an analysis of clinical and pathological characteristics of these tumors. In this descriptive study all of the pediatric patients diagnosed as having renal neoplasm in departments of pathology of Dr Sheikh children hospital and Imam Reza hospital from 1991-2006 were evaluated. 52 patients including 27 boys and 25 girls with mean age of 40.63 months were studied. Tumors involved each kidney in 24 (45.3%) and were bilateral in 5 (9.4%) patients. Abdominal mass was the commonest clinical symptom and sign. Congenital anomalies were presented in 6 (14.6%) patients. Histopathological examination showed Wilms tumor in 46 (86.8%), cystic partially differentiated nephroblastoma in 2 (3.8%), mesoblastic nephroma in 2 (3.8%) rhabdoid tumor of the kidney in 1 (1.9%), metanephric adenofiroma and low-grade tubulopapillary carcinoma in 1 (1.9%) and clear cell sarcoma of the kidney in 1 (1.9%) patient. 11 (20.8%) cases were in stage I, 16 (30.2%) stage II, 13 (24.5%) stage III, 8 (15.1%) stage IV and 5 (9.4%) stage V. Although Wilms tumor is the commonest renal neoplasm in childhood there are also recently described entities such as metanephirc tumors and juvenile renal carcinoma that must be considered in histopathological evaluation of a pediatric renal neoplasm. Role of molecular and cytogenetic methods is increasing for classification and treatment of childhood renal neoplasms.

The incidence of cesarean delivery has been increased during these years. Relations are reported between mother's educational level and knowledge about various delivery methods. This study was done to find the distribution of cesarean delivery in female doctors, dentists, nurses, midwives and specialists under 45-years-old had been working in Gorgan city, 2004. In this descriptive cross-sectional study, 187 women in medical fields were recruited. A questionnaire was filled for each of them which included demographic data, causes of the cesarean delivery, and causes of personal tendency to it. Data was entered in SPSS-10 and analyzed with X2. In our study 307 deliveries were occurred, and 49.8% was cesarean delivery. The most common cause of the personal tendency to cesarean delivery was feeling less pain. Cesarean percentage in doctors, midwives and specialist was significantly higher than nurses and dentists (P<0.05). Cesarean frequency was significantly higher in nulipars (P<0.05). These results showed that the frequency of cesarean delivery in health care workers is higher than the general population.

Thalassemia is an inherited and chronic hemolytic disorder. Like other diseases it can make psychological, social and financial problems for both patients and families. The necessity of this research is to teach the way of treating the psychosocial problems of this illness and to increase the quality of patients and families life. It is also a descriptive study to examine psychosocial and financial disorders and coping strategies among families with patients suffering major beta thalassemia

320 parents (229 of mothers and 91 of fathers) were included in this study. These families were those who were visited clinics associated with Gorgan's University. Data collection was done using a self structured questionnaire as well as Mc Cubin and Thompson scale for identifying coping strategies.

Findings revealed many problems, such as: stress for disease (82.8%) and the patient's vague future (81.8%). The mentioned problems were of psychological disorders. And about social problems: 33.8% of patients families were deprived of having picnics in their free times and helping the patient meddles the routine work of homes in 30.1% of families. The financial problems: the cost of traveling and providing the medicine (63.8%). In addition 97.5% of families had faith and reliance in God in order to help them and to believe their child's illness as a reality. It is apparent that families use different kinds of method in order to cope with psychological, social and financial problems and to face the disease.

Most of families have a strong belief in religion and as a result they believe that any kind of problems and especially disease is one of ways to reach God. This is the idea which helps them to face this disease stoutly.

Leptospirosis is one of the most common zoonosis in the world,fatality rate of the disease is sometimes high in endemic regions and is transmitted through direct or indirect contact with urine of animals that are carrier of leptospirosis. We studied incidence of leptospirosis in Golestan province in 2004. According to coordination with province health center, 20 suspicious patients for leptospirosis were diagnosed by general practioners and referred to 5th Azar hospital. Patients with at least 4 constitutional symptoms (fever, sever headache, conjunctival suffusion, myalgia, arthralgia, icter, malaise) and history of working ir rice farm, exposure to wild or domestic animals or stagnant water were included and MAT for leptospirosis were requested. other causes were ruled out with wright, widal, VDRL, peripheral blood smear. Out of 20 suspicious patients, 12 cases reported. All of them were farmer, had titer>1/100 in MAT. Fever chills, headache were found in nearly all of them. Conjunctival suffusion and increased CPK up to 2 fold than normal was seen in %75 and %66.4 respectively. They were treated by ampicillin or amoxicillin sussessfully. According to the results of this study we suggest to all physician of the area to be concentrated to the disease as an occupational disease in rice farmers. So early diagnosis can prevent many complications of the disease in this group of farmers.