نشریه دانشگاه علوم پزشکی خراسان شمالی
سال هشتم شماره 3 (پاییز 1395)

Stroke is the second leading cause of death worldwide and is one of the main causes of long-term disabilities. The aim of this study was to assess the effect of Melatonin and Progesterone on stroke complications.
Sixty four male wistar rats were enrolled in the present study. Common carotid arteries were closed for 20 minutes. Then the animals were treated with 8 mg/kg Progesterone and10 mg/kg Melatonin. Moriss water maze test was done after 2 weeks. Then the animals were sacrificed and histological examination was performed.
The results showed that Progesterone and Melatonin increased the number of pyramidal cells and improved spatial memory in comparison with the ischemic and solvent groups (p0.05)
It seems that the Progesterone and Melatonin usage have beneficial effects on improving spatial memory and behavioral functions after stroke.

Obesity is one of the most important problems of public health in the world. Prevalence of obesity complications during the pregnancy are increasing in our country. Therefore, evaluation of the obesity complications in this era is important. The aim of this study is evaluation of the relationship between obesity and pregnancy complications and childbirth in health centers.
Material and In this study, 180 cases who referred to the health centers of Daregaz city were enrolled. Based on the measured weight and calculated body mass index at the beginning of pregnancy, women were divided obese (BMI greater than 25) and non-obese (BMI less than 25). All of the women were normal and hadnt any disease. Demographic and pregnancy data were assessed and recorded in both groups. Data were analyzed by SPSS software and chi square test.
Generally, obese women were older and had more pregnancy in comparison with the non obese women. According to this analysis, there is a valuable correlation between obesity and pregnancy complications such as poisoning , diabetes and blood pressure (p˂0.001, p˂0.001, p˂0.002, respectively). Also there is a valuable relationship between obesity and underweight of baby and type of childbirth (p ˂0.05).
The results of this study showed that the obese women are at risk of abnormal childbirth, underweight baby, and pregnancy complications.

Breast feeding is the best feeding option for infants. The WHO recommends that infants should be exclusively breastfed for the first 6 months of life, but in recent years indices of exclusive breastfeeding in Iran has extremely dropped. Therefore, planning about this item is essential. This study evaluates the mother’s experiences on exclusive breastfeeding in the first six months of infant’s life.
Material & The phenomenological qualitative research method has been Collaizzi. Eight women, having children less than 2 years old who were referred to the health centers in Mashhad in 1393 were enrolled. The content of the interviews were recorded with the permission of the participants and were implemented immediately after the meetings and examined by seven -step method colaizzi thematic analysis.
Exclusive breast feeding reviewed around two main axes: Factors promoting breast feeding for 6 months and inhibiting breast feeding for 6 months. The main themes were identified in 6 factors: factors related to the child; to the mother; the role of health personnel; family and community supports; self-efficacy and the role of Islam.The greatest factors in strengthening self- efficacy are listed as the self-effort of the mother, the mother's confidence, and husband support. Most of the mothers believed that exclusive breastfeeding is enough for 4 to 5 months because of the pediatrician commanding.
Using the supportive resources, media advertisements are effective in improvement of mothers awareness and self-efficacy about the exclusive breastfeeding for 6 months before the delivery.

Health tourism is a form of tourism which is well known and common for many years between communities.The aims of current study was a comparative evaluation of the factors affecting promotion of health tourism in Mashhad from the perspective of foreign tourists and managers.
Material & This was an applied descriptive–survey. Area of the study was Mashhad metropolitan in the period between 2015-2016. The study population includes administrators and experts in related organizations who were 50 people of custodians, as well as 384 foreign tourists. The researcher-made questionnaire was provided in two categories for experts and tourists. In order to analyze the data, SPSS software, one-sample t-test and paired t-test were used. Also the mean ± standard deviation of six variables of Porter's diamond model in status quo and the impact were measured.
Results showed a relatively good condition of the status quo of Mashhad in terms of entry into the health tourism market from the perspective of managers and experts (average of 3.36). Whereas, foreign tourists have evaluated only two variables including government (3.11) and culture (3.33) above the average and total average was lower than the mediocre (2.85).
Results showed that the cultural factors have had a desirable status and high impact from the perspective of foreign tourists and executives. Moreover, governmental support in providing visa services and accommodation for tourists was an important criterion in choosing a tourist destination. Generally, it was suggested that the custodians of health tourism in order to attract more tourists and promote this industry should offer the competitive prices.

The central vestibular pathway has a close structural and functional relationship with auditory and sensory-motor system. In the other words, vestibular system plays an important role in motor learning and development. In this case-control study, we compared hand’s fine motor function of a group of hearing impaired children and normal hearing peers.
Material & Sixteen students with age ranged between 7-13 years were recruited from hearing impaired specific school in Sanandaj, Iran. Forty-one normal hearing students were selected as control group by cluster sampling method among normal schools in the city. Fine motor function of upper limb was investigated by Purdue pegboard test and compared between two groups using independent sample T-test and X2.
Two groups did not have any significant differences in age, sex and hand dominancy. Although, these two groups also didn’t show any significant differences in dominant, non-dominant, and both hand’s score, children with hearing loss showed a significant lower assembly score in comparison with the children with normal hearing (p=0.019).
Children with hearing loss, probably have lower hand’s fine motor skills in comparison with the normal peers.

Pregnancy is a good time to change the food habits. Nutrition education plays an important role in promotion of women and children health. Therefore, this study aimed to determine the effect of education based on Health Belief Model in improving nutritional behaviors of pregnant women who were referred to health centers in Mashhad in 1395.
The present study is an interventional study with a pretest /post-test control group in which 90 pregnant women (45 tests and 45 controls) who were randomly selected from Mashhad health centers were enrolled. HBM-based questionnaire was used after the validity-reliability to collect the data. The pre-test was done in two groups and then model-based training sessions were held in groups. SPSS 22 software and t test and chi-square were used for data analysis.
There wasn’t any significant correlation between two groups in terms of demographic variables, variables, and feeding behavior before intervention. But after education in the intervention group the mean structure model in particular is perceived susceptibility (16/55±1/15), behavior(31/31±3/05) and awareness(21/44±2/58) had increased significantly ( P Education based on Health Belief Model was effective on promotion of behaviors of pregnant women about nutrition, and educational interventions in this field are recommended.

Religious beliefs have a significant impact on all aspects of human life and strengthening of these beliefs increases the self-esteem, mental health, and decreases the addiction and anger. This study aimed to determine the relationship between self-esteem and religious attitudes of nursing students in North Khorasan University of Medical sciences between 1392-1393. This study considers the discipline, grade, residence or non-residence in the hostel, marital status, and ethnicity.
This descriptive study was done by participation of 120 nursing and midwifery student. Religious attitudes and self-assessment questionnaire was used to collect data which was approved in the case of reliability and validity. . Descriptive indicators (mean, standard deviation, percent) as well as independent t-test, ANOVA, Pearson correlation were used via the spss16 software to analyze the data.
According to the Pearson correlation coefficient values were 0.222 and 0.008. There was a direct significant correlation between these two variables.
There is a significant correlation between religious affiliation and self-esteem.

Children are the future of any society and ensuring their growth and health should be a major concern of every society. One of the related concepts to their health is health-related quality of life. The aim of current study was to examine the construct validity, internal consistency, and reliability along time for the Persian version of children's Health related quality of life.
Population included whole of employers (men and women) who had a child between 5-18 years old in Mashhad education system. Two hundred samples were selected by a stratified random sampling and data gathered by the health related quality of life questionnaire (28-items). Exploratory and confirmatory factor analysis, Cronbach's alpha, correlation coefficient, and goodness of fit indices were used for data analysis. SPSS and AMOS were used for analyzing.
According to the explanatory factor analysis, seven factors which explained 68% of life quality variation were found. Based on confirmatory factor analysis (construct validity), first (GFI=0.885, CFI=0.925, RMSEA=0.056) and second (GFI=0.869, CFI=0.907, RMSEA=0.06) order factors had an appropriate goodness of fit. Internal consistency (α=0.68-0.85) and reliability along time (r=0.721-0.566, p The 22-items health related quality of life questionnaire which was examined by Persian version, was valid and reliable. Therefore, researchers can use it with confidence to measure the Iranian Children health related quality of life, but it requires more studies for the sick children.

Osteoarthritis is considered as the most common chronic disease and cause of disability in the elderly. Self-management can be appropriate to relieve the symptoms of osteoarthritis as one of the most suitable approaches in people with chronic diseases. This study aimed to determine the effect of self-management education program on disability of elderly patients with knee osteoarthritis referring to the elderly care clinic of Imam Reza (AS) treatment center in Shiraz.
Material & Firstly, an on hand sampling was done in this quasi-experimental study on elderly patients with osteoarthritis of knee. Then they were randomly divided into two groups: intervention (41 patients) and control groups (41 cases). The questionnaire contained demographic information and WOMAK tool was used to determine the severity of disability, which was performed at before, immediately after, and eight weeks after the intervention for both groups. The intervention was consisted of six sessions of group education in self-management included information about the disease and treatment, medication management, symptom management, management of psychosocial consequences, lifestyle (including exercise), social support and so on. The control group received usual care. Data was analyzed using the SPSS20 and descriptive-analytical tests (the significance level was α = 0/05).
The two groups were matched in the case of age, sex, education level, marital status, disease severity, body mass index, and earnings based on chi-square tests and independent t-test (p> 0.5). Before the intervention, there was no significant difference in the mean score of disability between the intervention and control groups (p= 0.55). However, the mean score of disability was significantly less in the case group rather than the control one, after the intervention (22.76±14.71 vs. 42.50±17.43) (p The performance of self-management program can be useful in reducing morbidity of patients with knee osteoarthritis. Therefore, it can be used as an effective empowering method.

The effect of non-surgical periodontal treatment on periodontal condition and metabolic control is a controversial issue. Therefore, the present study was designed to compare the effects of non-surgical periodontal therapy with and without systemic doxycycline on glycemic status and clinical periodontal parameters in type II diabetic patients.
Methods and materials: In this double blind randomized controlled clinical trial, fifty diabetic patients were enrolled. The periodontal therapy involved scaling with ultrasonic curettes. The patients received 100 mg Doxycycline twice on the first day and once per day after that for two weeks in case group and placebo in control group. Plaque Index (PI), Clinical Attachment Level (CAL) and Probing Depth (PD) were recorded on baseline and 1, 2 and 3 months after treatment. FBS(Fasting Blood Sugar) and HbA1C were also recorded at baseline and 3 months after the treatment and analyzed by t and Paired t-Test.
Periodontal parameters such as PD (P Although both periodontal treatment regimens are effective in type II diabetics, the use of Doxycycline as an adjunct provided more significant improvement in periodontal and glycemic control

Toluene (C7H8) is obtained from crude oil and aromatic compounds refining which is mainly used as a raw material, supplement or solvent. According to its application in industry and toxic effects, its impact has been studied on blood and spleen tissues of NMRI Albino Male Mice in the present study
Material and Thirty mature Albino NMRI mice have been categorized in three groups of Shem, Group-A, which have been injected with the 0.1 cc Toluene solution (35% Toluene and 65% physiologic solution) with the purity of 1700 mg/kg for 25 days. Group-B with the similar mice and the same situation received the purity of 1000 mg/kg. After weighting, anesthesia, and taking blood samples, relative parameters of blood and spleen tissues were considered, measured, and studied in the scope of micro and macro.
In the Group-A increased number of red blood cells (%4.7), hematocrit (%18.7), plasma density (%12), and hemoglobin (%7.4) as well as reduce thickness of spleen capsule wall and becoming more fibrous (%10/1), increased thickness of central arteriole wall (%32)and the inner diameter of the central arteriole of white pulp(%35.6), reduced spleen weight (%7), and body weight (%10) were observed in comparison with the Sham group that were significant. Characteristics mentioned in group B (except for the blood parameters which were more than group A) showed less change but there were significant in comparison with the sham and A groups (p The significance of this relationship showed that Toluene causes the elevated blood parameters, parenchyma adhesion by stimulation of hematopoietic centers leading to the inflammation which brings decreased spleen and body weight. These impacts are related to the dosage of the Toluene in which the higher purity has shown much more damage (except blood parameters in group B).

Toxoplasmosis is a main parasitic disease and may cause significant damage to the developing fetus and is a life-threatening opportunistic infection in immunocompromised persons. There are definite drugs available for the treatment of T. gondii infections. These drugs regimen, however, can cause side effects, however the macrolide antibiotic spiramycin is also used as a drug against T. gondii. This study tried to study the effectiveness of spiramycin in the treatment of toxoplasmosis.
The experiments in the present study, fifteen rats received spiramycin 400mg/kg thrice, 15 rats received pyrimethamine-sulfadiazine 150mg/kg once treatment for only one week and 15 rats untreated any drug and were evaluated as the control group. The effectiveness of spiramycin for the treatment of rats experimentally infected with Toxoplasma gondii before and after treated, were analyzed by Real-time NASBA method.
Result of this study showed that spiramycin could be eliminating parasites after 5 days after initiation of treatment in infected rats.
Spiramycin is effectiveness drug in eliminating Toxoplasma gondii in rat's blood and use in pregnant woman.

Regarding the patient's vital conditions in Intensive Care Unit (ICU) for burns, preventing medicinal errors is of utmost importance. This study evaluates the processes of prescribing and consuming drugs in ICU for burns in Imam Reza Hospital of Mashhad by using the failure modes and effects analysis (FMEA).
This was a qualitative and quantitative study based on the 9-by-steps explanation of the failure modes and effects analysis (FMEA) and the criteria of National Center for Patient Safety. Brainstorming and cause and effect diagram, are the main used instruments in the procedure. We applied the standard scoring Table to determine the risk priority number (RPN). We used descriptive statistics and content analysis with consensus views of the team members, for quantitative and qualitative data analysis, respectively.
Sixty eight failure modes were identified in two processes of prescribing and consuming drugs in ICU for burns. From which, Twenty seven percentages were determined as high risk. Therefore, suggestions were proposed to reduce or eliminate these errors
This study showed the importance of FMEA in assessment of errors during the medication administration process. Moreover, it showed the role of employees in errors reduction in burns ICU.

Choosing the appropriate treatment options for the cancer patients is a very complicated matter which requires comprehensive knowledge. The physicians are the only persons who have enough information. Therefore, in present study we assessed the treatment options of physicians who were suffered from prostate and bladder cancers.
Material & A total of 183 urologists were enrolled in present study. The cases filled a questionnaire included demographic data and also treatment options they will probably choose in case of cancer in themselves or their own close relatives.
In early phases of prostate cancer, 43% of urologists preferred for active surveillance, whereas 37% of cases chose the radical prostatectomy. However, in advanced stages, 73% chose radical prostatectomy. In aggressive bladder cancer, 43% preferred radical cystectomy, while 31% of cases considered capsule sparing cystectomy as a reasonable option. Most of the faculty members preferred radical prostatectomy and capsule sparing cystectomy in early stages of prostate cancer and early stages of bladder cancer, respectively. On the other hand, urologists in private medical centers were mostly inclined toward checking PSA and active surveillance. Classical radical cystectomy in aggressive bladder cancer was mostly practiced in non-educational governmental hospitals, whereas, capsule sparing cystectomy was mostly prevalent in private medical centers. More years of clinical experience was correlated with choosing radiotherapy, whilst choosing "No Surveillance" was correlated with the less amount of clinical experience. In advanced prostate cancer, the most chosen modalities were radical prostatectomy, radiotherapy, and no surveillance, respectively, in all levels of clinical experiences.
In the present study, we observed that there was a correlation between treatment option and level of clinical experience and the institute that the surgeon works in which, radical prostatectomy and capsule sparing prostatectomy were more prevalent among the faculty members. Moreover, in the case of advanced stages of prostate cancer, there was a correlation between higher levels of clinical experience and selection of radiotherapy as the treatment option.

Lumbosacral Transitional Vertebrae (LSTV) (Bertolleti’s syndrome) is known as a congenital spinal anomaly in which abnormal transverse process of last lumbar vertebra fuses partially or completely with first sacral segment. Here we reported a case of 16 years old girl who referred with pain in the left supragluteal region. Standard AP radiograph showed an abnormal fusion between the transverse process of the left lumbar vertebra and sacral bone. The Bertolleti’s syndrome was diagnosed.

Uncorrected Tetralogy of Fallot (TOF) is a rare disease in adulthood in which only few patients survive to adulthood without surgical correction. TOF during the pregnancy is even rarer.
Case report: Here we reported a pregnant 31 years old woman with uncorrected Tetralogy of Fallot that had a successful outcome. Based on obstetric ultrasonography, patient was undergone the caesarean surgery under the general anesthesia. A normal baby was born with 2,600mg weight and Apgar 7-8. The mother hadn’t any post operation complications. Clinical examinations didn’t show any evidence of cardiac disease in neonate.
Optimal outcomes in pregnant women with uncorrected Tetralogy of Fallot, requires a multidisciplinary team work and intensive obstetrical and medical management.