مجله علمی دانشگاه علوم پزشکی کردستان
سال بیست و یکم شماره 5 (پیاپی 85، آذر و دی 1395)

Beta thalassemia is one of the most common single gene disorders in the world which occurs due to a defect in the beta globin chain synthesis. In general, the majority of the patients with thalassemia, are suffering from decreased bone density. Osteoporosis is characterized by low bone mass and disorder of osteogenesis resulting in reduced bone strength. Considering the serious consequences of osteoporosis, this study was performed to evaluate the prevalence of osteoporosis in the patients with beta thalassemia major.
This study included 46 beta thalassemia patients above 5 years of age who had been admitted to the oncology ward of Besat Hospital in Sanandaj. Chemical biomarkers were measured and the results of densitometry of the lumbar spine and femoral head were investigated for the presence of osteoporosis, osteopenia and normal findings. Using SPSS 20 software, we used one-way analysis of variance to assess the association between chemical biomarkers.
The mean (SD) age was 19.8 (7.7) years, 24 patients (52.2%) were women and 32 (69.6%) were above 15 years of age. In this study, the most frequent findings of densitometry were osteoporosis (34.8%) and normal lumbar spine (34.8%). Comparison between the chemical biomarkers and findings of the densitometry of the femoral head revealed different levels of ferritin in these patients (P = 0.011). This difference was observed in the patients who had osteoporosis and normal densitometry results (P = 0.009).
The results of this study showed no significant statistical relationship between chemical biomarkers and the densitometry results. Therefore, use of bisphosphonate is recommended for prevention of bone damage.

Cardiovascular disease can affect physical and mental conditions. The purpose of the present study was to investigate the effect of phase 1 and 2 of cardiac rehabilitation on physical and mental health components in the patients with acute coronary syndrome.
This clinical trial study included 50 patients with acute coronary syndrome admitted to the coronary care units of the hospitals of Isfahan University of Medical Sciences between 2013 and 2014. The participants were randomly assigned to control and experimental groups. The experimental group performed cardiac rehabilitation program and the control group received routine care. QOL-sf36 questioner was used before and one month after intervention to assess physical and mental health components. Using SPSS18 software, data were analyzed by T- test.
There were no significant differences in the demographic variables and cardiovascular risk factors between the experimental and control groups. The mean scores of physical component and mental component after intervention, were 40.9± 9.9 and 37.7 ±10.4 in the control group and 46.9±8.6 and 45.3±10.6 in the experimental group respectively . The results of T-test showed that the mean scores of physical (p=0.02) and mental (p=0.01) health components in the experimental group were significantly higher than those in the control group.
The results of this study showed that cardiac rehabilitation program can improve physical and mental health components in the patients with acute coronary syndrome.

Liver has a major role in protection of human against various toxins and drugs. Cholestasis can be defined as impairment of the bile flow which can lead to increased oxidant stress, hepatocyte damage and finally cirrhosis. Selegiline is commonly used in management of Parkinson's disease. It has neuroprotective, antiapoptic and antioxidant properties. The aim of this study was to evaluate the effect of selegiline on liver cholestasis induced by bile duct ligation (BDL) in the rats.
Material and 30 male Wistar rats were randomly divided into 5 groups (n= 6) including saline, sham saline, BDL saline, BDL Selegiline (0.15 mg/kg) and Selegiline (0.15 mg/kg). Under general anesthesia and sterile condition, laparatomy was done, and bile duct was ligated. After 14 days, liver function tests, serologic tests and serum TNF-α were performed for all groups after taking blood samples. The results were analyzed by one-way ANOVA.
The results of the this study showed that selegiline significantly increased Alb, AST, ALT and ALP in BDL selegiline group compared to BDL saline. Also, when compared to saline group, selegiline significantly increased PT.
Selegiline in cholestatic rat model did not show a protective effect on the liver cells and in some cases exacerbated the symptoms.

Vitamin D has metabolic functions in the cells, and its deficiency is considered a risk factor for many chronic diseases, such as type 2 diabetes. The present study aimed to determine the relationship of vitamin D intake from supplements and diet with fasting plasma glucose and HbA1C in the patients with type 2 diabetes.
Material and This cross-sectional study included 500 subjects aged above 18 years with type 2 diabetes. Data were collected using demographic and food frequency questionnaires through interviews with patients. The data analysis was performed by linear regression, chi-square test and independent T-test.
Among 500 patients in the study, 11 were excluded because of reports of high and low calorie values. Finally, 489 patients were entered into the study. 163 (33.3%) subjects were male and 326 (66.7%) were female. The mean age of the patients was 56.19±8.8. Vitamin D intake through supplements and diet was 5.82±3.5 mcg / day in the men and 6.30±3.4 mcg / day in the women. The mean fasting blood glucose and HbA1C levels were 144.06±33.8 mg/dl and 7.34±1.1% respectively. Linear regression analysis showed that vitamin D intake had a significant inverse association with fasting blood glucose (r= -0.26 and P=0.02) and HbA1C (r= -0.37 and P In this study total vitamin D intake through diet and supplements had a significant inverse relationship with fasting blood glucose and HbA1C, indicating the importance of vitamin D intake in blood glucose control in the patients with type 2 diabetes.

Formaldehyde is an air contaminant which has wide applications in industry and medicine and its destructive effects have been reported on the body systems.
The aim of this study was to investigate the influence of different doses of onion extract on biochemical parameters and histopathology of mice kidneys exposed to formaldehyde.
Material and 48 adult male mice were randomly divided into six groups. The control group did not receive any injection. The second group received formaldehyde 10 mg/kg for 14 days and the 3rd, 4th ,5th and 6th groups received 5,10,20 and 40 mg/kg/day of onion extract respectively in addition to intraperitoneal doses of formaldehyde. After 14 days, tissue preparation was done and using stereological technique, the sizes of the kidneys and glomeruli were measured. Also, serum urea and creatinine levels were measured. Data were analyzed by SPSS software.
We found significant decrease in the number of renal glomeruli in all of the groups that received onion and also decrease in the volume of glomeruli in the group which had received 10 mg onion/day, compared to those in the control group (P = 0.000). There were significant increase in the level of urea in the groups which had received doses of 10 and 20 mg of onion and in the creatinine levels of the groups which had received daily doses of 5, 20 and 40 mg of onion compared to those in the control group (P = 0.000). Formaldehyde caused renal damage and an increase in the levels of urea and creatinine as well as a decrease in the number and volume of the glomeruli of the kidneys.
Administration of daily doses of 40 mg hydro-alcoholic extract of onion for two weeks caused protective effect on kidney tissue exposed to the formaldehyde.

Nowadays, the importance of pathogenicity of non-tuberculosis mycobacteria is well known. Generally, this group, in addition to the respiratory system can cause lymph nodes, skin, soft tissue and bone disorders. Identification of Mycobacterium by culture and biochemical tests may take several weeks and may not be useful for definitive diagnosis. PCR-RFLP (PRA) technique of the hsp65 gene using HaeIII and BstEII enzymes is a precise method for species differentiation, in comparison to phenotypic methods. It is a quick and inexpensive method for detection of mycobacterial species. This study aimed to assess the prevalence of non-tuberculous mycobacteria isolated from the patients referring to tuberculosis center (TB) of Kashan University of Medical Sciences.
Material and The study included 106 patients who had been referring to TB Center of Kashan University of Medical Sciences, from 1391 to 1394. The samples were tested by biochemical diagnostic tests. At the same time identification of the strains was made by use of PRA. Amplification of 441-bp fragment was performed by PRA for detection of hsp65 gene. The PCR products were digested with HaeIII and BsteII enzymes and analysis was performed on the basis of electrophoresis.
Molecular analysis showed non-tuberculosis mycobacteria in 4(8.3%) sputum samples,i.e. one positive sample (o.9 %) for every one of the following strains: M. abscessus, M. senegalense, M. fortuitum and M.kansasii.
The results of this study showed that some cases of tuberculosis in Kashan are due to non-tuberculosis mycobacteria. Also use of PRA analysis of hsp65 gene for clinical specimens is a rapid and useful tool for identification of species of mycobacterium which is helpful for early diagnosis, treatment and control of tuberculosis.

Anemia is the most prevalent nutritional deficiency in the world, affecting almost 30% of people worldwide, especially the pregnant women. On the other hand preterm birth is responsible for 2/3 of the infant mortality rate; therefore we performed this study to find the relationship between hemoglobin level in the first trimester of pregnancy and preterm delivery.
Material and This descriptive-analytical study was performed in the years 1392 – 1393 in Qazvin Province. 3000 pregnant women (age range:18 - 40 years), with gestational age of less than 12 weeks were selected from 5 medical health centers. 284 participants were excluded because of IUFD, anomalies, abortion, lack of cooperation or referral to other centers for follow up or performance of lab. tests. The first trimester Hb was recorded in a questionaire for every subject and cases were observed for spontaneous preterm delivery (less than 37 weeks).Using SPSS16 software, data were analyzed by chi -square test, T- test and logestic regression.
In this study the prevalence rates of anemia and preterm birth were 22.2% and 19.9% (542 cases) respectively. Mean gestational age was 38.28 ± 3.56 and the rate of preterm birth in the subjects with normal Hb level was 19.3%, and 21.9% in the patients with anemia. which revealed a significant relationship between maternal anemia and preterm birth (p This study demonstrated the relationship between maternal anemia in the first trimester and preterm birth. Therefore, preconception evaluation and anemia treatment in the women of childbearing age is recommended.

Contamination of food with enterotoxins of Staphylococcus aureus is a risk factor for public health. Because of lack of information on the contamination of the processed meat products including sausage and hams with the enterotoxins of Staphylococcus aureus, the present study was conducted to assess the presence of these toxins in the aforementioned products in Iran.
Material and In this cross sectional study, 72 samples of sausage and ham were obtained from product storages of four active meat processing plants with different qualitative grades; including A, B, C and D in summer of 2015 in Isfahan Province, Iran. The qualitative grading of the meat processing plants was performed on the basis of the "pre requisite programs: PRPs" form approved by Food and Drug Administration of Ministry of Health in Iran. The scores of hygienic factors including "hygiene of workers", "production and processing", "washing, disinfection, cleaning" and "hazard identification and verification" of the aforementioned meat processing plants were determined according to the PRPs form. The meat processing plant with qualitative grades of A, B, C and D had the scores of 924, 825, 754 and 614, respectively. The hygienic grades of meat processing plants were "desirable", based on the PRPs form. The ELISA kite was used to detect the enterotoxins of staphylococcus aureus.
The results showed lack of contamination of the processed meat products with enterotoxins of staphylococcus aureus in all sampls obtained from all of the factories with different qualitative grades.
The result of the current study showed that the implementation of suitable designs in relation to the hygienic principles and the continuous surveillance of food inspectors of the Department of Food and Drug of Isfahan University of medical sciences could have a positive role in prevention of contamination of sausage and hams with enterotoxins of Staphylococcus aureus.

Use of mobile phones by people, especially university students has dramatically increased in recent years. One of the important psychological and behavioral complications of this issue is sleep disorders or lack of sleep quality among students. Therefore, the purpose of this study was to investigate the effect of unsafe and excessive use of mobile phones on sleep quality in the students.
This cross sectional study included 230 students of Neyshabur University of Medical Science in 2014. To assess the sleep quality we used Pittsburgh Sleep Quality Index (PSQI) and Gennaro’s questionnaire was used for the assessment of unsafe and excessive use of mobile phone. Using SPSS 16 software, data were analyzed by Pearson correlation, independent T-test, ANOVA and multiple regression tests.
According to the results of this study 50.9% of the students had poor sleep quality.Only10.8% had limited and safe use of their mobile phones. Unsafe and excessive use of mobile phone had significant relationship with variables of study year, place of residence and nativeness, and PSQI showed a significant relationship with age, gender and place of residence (P Unsafe and excessive use of mobile phone can have negative effect on the quality of sleep and this consequently, could influence their educational performance and daily activities. Teaching the students about these complications, and the importance of the quality of sleep and its effect on the educational performance is recommended.

Insomnia is a common problem in general population. It is associated with negative consequences on daily living. Insomnia is an under recognized disease, and patients may seek treatment very late, which may lead to chronicity of the disorder and aggravation of its adverse consequences. Determination of the barriers to insomnia treatment may be helpful for early diagnosis and designing treatment plans for this disorder. The aim of study was to determine the barriers to insomnia treatment from patient's views.
Material and This qualitative study was performed by using conventional content analysis. Our participants were selected by purposive sampling with insomnia who had referred to Sleep Disorders Research Center of Kermanshah University of Medical Sciences from April to October 2015. Data collection was performed by semi- structure interview. The interviews were recorded by an audio tape recorder, and transcribed. Then, they were analyzed by qualitative methods.
Barriers to the treatment of insomnia included three main categories: "overlooking insomnia", "worries about insomnia treatment", and "janus faced nature of insomnia treatment". The subjects in the category of "overlooking insomnia" had lack of belief's about insomnia as an illness which should be treated. The patients in the second category, "worries about insomnia treatment", described their concerns about the treatment of insomnia. The subjects in the category of" janu faced nature of insomnia treatment" explained the inappropriate pattern of insomnia treatment in the study population.
According to the results, patient's views about insomnia, their worries about treatment, and the current pattern of insomnia treatment were the main barriers to the insomnia treatment. Barriers to the treatment of insomnia should be taken into consideration for the future treatment programs.

Adverse drug reactions (ADR) impose costs on the health care system and affect public health. Identification, assessment and prevention of adverse drug reactions are effective factors which can influence social health indices.
Material and In this cross-sectional study, 133 outpatient and inpatient reports of adverse drug reactions were investigated in Kurdistan Province hospitals between 2013 and 2014. The data included demographic characteristics, type, form, route of administration, type of drug side effects and final outcome. Data were analyzed by chi-square multi response test. P Our results showed that the most common complications were dermatologic and respiratory reactions due to injectable forms of the drugs and antibiotics were the most common drugs which caused adverse drug reactions. The frequency of adverse drug reactions was higher in the women and these reactions were more common between 40 and 50 years of age. Most cases of adverse drug reactions were reported from Sanandaj and Saqez Cites.
It seems that training programs about ADRs for healthcare workers and avoidance of unnecessary injections can lead to decreased incidence of ADRs.

Ectopic spleen is a rare condition in which the spleen is not in its original location. Simultaneous occurrence of thrombocytopenia, enlarged spleen (splenomegaly) and ectopic spleen is very rare.
Case Report: A 19 year- old married woman referred to Tohid Hospital with symptoms of pain, pressure and heaviness in the right upper quadrant (RUQ). On physical examination, a mass with firm consistency and a smooth wall in the right side of the abdomen around the navel, was palpated. Further investigations revealed, thrombocytopenia (Plt = 70000) and a large homogeneous mass with well defined wall, in the right upper quadrant (RUQ), in the anatomic site of left liver lobe. One week after splenectomy, platelet count increased to 250,000, and the symptoms disappeared.
Diagnosis of ectopic spleen or wandering spleen was considered for this patient. We found simultaneous occurrence of thrombocytopenia, splenomegaly and ectopic spleen in our patient which is a very rare condition.