مجله دانشگاه علوم پزشکی گرگان
سال پنجم شماره 2 (پیاپی 12، پاییز و زمستان 1382)

The pattern of cell types in vertebrate embryos depend on the function of organizing centers, specialized cell groups that direct the fate of nearby cells through the secretion of inductive factors. Our previous studies showed that during early neural tube formation, the notochord is essential for the induction of ectoderm and for the subsequent differentiations of the neuroepithelium. It is well known that glycoconjugates are developmentally regulated expression on the surfaces of early embryonic cells and could therefore be involved in many critical morphogenetic and histogenetic events during embryonic development. In the present study, histochemical studies were carried out to detect the presence and distribution of terminal sugars during development of precursors of motor neurons within the developing spinal cord in balb/c mice. Embryos from day 9 to 14 of gestation were fixed and processed for lectin histochemical studies by using horseradish peroxidase labeled WFA with binding specificity for terminal N-acetylgalactosamine. The first reaction was occurred weakly on the cells surface and extra cellular matrix just around the peripheral portion of floor plate on day 13 of gestation. It seems that these cells are developing premotor neurons, which will form the future motor neurons of the spinal cord. The reaction increased significantly and extended to the deep part of spinal floor plate by day 14. These data indicate that glycoconjugates containing N-acetylgalactosamine may play important roles in differentiation of the floor plate motor neuron and perhaps glia cells in final development of the ventral part of the spinal cord.

Transureteral lithotripsy is an effective procedure in lower ureteral stone. This study was done to evaluate lithotripsy method in pediatric ureteral stones in Mashhad’s Imam-Reza Hospital. In our institute 38 patients went under ureteroscopy and lithotripsy for ureteral stones. Mean age in our patients was 6.8 years (Range 2-13 years). 16 patients were male and 22 patients were female. The mean stone size was 7 mm (Range 6-16 mm). Ultrasonography and KUB or IVP was performed in all cases. After general anesthesia and cystoscopy guide wire introduced in ureter, ureteroscopy were performed for lithotripsy used ultrasound pneumatic or electrohydrolic. Stone were located in the distal ureter in 32 patients, in the midureter in 4 and in the proximal ureter in 2 cases. Ureteroscopy was successfully in 35 cases. Lithotripsy was used: Ultrasound, electrohydrolic or pneumatic. We were unable to introduce the ureteroscope into the ureter in 3 patients. In 3 patients stone migrated to the kidney after ureteroscopy. Then, they candidated for ESWL. Stone free was done in 32 cases (85%). A complication was 25% and treated with medical treatment. Our investigation demonstrates the high success rate ureteroscopy in pediatric group especially with a small caliber ureteroscope. Ureteroscopy should be considered the first choice for treatments of calculi in the distal ureter in children.

The rate of using contraceptive methods in an important criteria for evaluation the performance of family planning in women aged 15-49 years. The aim of this study is to determine the 7-year trend of contraceptive methods in population of rural area in Babol. This study was performed based on the existing data in family planning program charts in area under coverage of Gatab health center in Babol from 1994 to 2000. A sample of 400 women aged 15-49 years were selected using systematic sampling technique within each year based on the list of women who had husband aged 15-49 years in family planning books. In overall, 2800 women examined during 7 years of study. The data of type of contraceptive method and the calendar year were extracted from family planning charts. We used Z-test and Chi-square test in statistical analysis. The results showed that the rate of tobactomy increased significantly from 26.2% in 1994 to 36.7% in 2000 (P<0.05). The use of condom and IUD changed from 3% to 7.5% and from 5% to 8.5% respectively. The percentage of women did not use any contraceptive method decreased from 27.5% in 1994 to 4.7% in 2000 (P<0.05). While a significant changes neither were observed in using oral contraceptive nor withdrawal methods using 7 years. The rate of using confident methods of contraception increased significantly from 1994 to 2000. In spite of the relative high rate of withdrawal method and due to lack of its confidence, the more research and education for shifting its user to modern form of contraceptive is necessary.

The rate of using contraceptive methods in an important criteria for evaluation the performance of family planning in women aged 15-49 years. The aim of this study is to determine the 7-year trend of contraceptive methods in population of rural area in Babol. This study was performed based on the existing data in family planning program charts in area under coverage of Gatab health center in Babol from 1994 to 2000. A sample of 400 women aged 15-49 years were selected using systematic sampling technique within each year based on the list of women who had husband aged 15-49 years in family planning books. In overall, 2800 women examined during 7 years of study. The data of type of contraceptive method and the calendar year were extracted from family planning charts. We used Z-test and Chi-square test in statistical analysis. The results showed that the rate of tobactomy increased significantly from 26.2% in 1994 to 36.7% in 2000 (P<0.05). The use of condom and IUD changed from 3% to 7.5% and from 5% to 8.5% respectively. The percentage of women did not use any contraceptive method decreased from 27.5% in 1994 to 4.7% in 2000 (P<0.05). While a significant changes neither were observed in using oral contraceptive nor withdrawal methods using 7 years. The rate of using confident methods of contraception increased significantly from 1994 to 2000. In spite of the relative high rate of withdrawal method and due to lack of its confidence, the more research and education for shifting its user to modern form of contraceptive is necessary.

Fetal weight and gestational age are important factors in evaluation of neonatal safety and basic prediction factors in outcome of pregnancy and satisfactory criterion in decision of management in obstetrice and neonatalogy. Therefore finding a method for pridiction of fetal weight is critical. The present study employs, detect on value of Janson's formula in prediction of fetal weight. In this analytic study, 223 pregnant women who had a safe, live, singleton fetus, with cephalic presentation were admitted to labor ward at Dezyani hospital. Medical or obstetrical complication was excluded. Subjects selected by purposive sampling. For collecting data: First, using the same flexible tap measure calibrated in centimeters by using this tap, the fundul height was measured. The fundual height was also taken in Janson's formula and estimated weight was also calculated each cases. The actual weight of post delivery was measured immediately. Data analysis was done by correlation test paired T-test. This study shows mean estimated fetal weight (3730±546) were higher than the actual birth weight (3270±429). This study indicates that Janson's formula is not a good way to estimate fetal weight.

Neural tube defect is one of the most important malformations of the newborns. The aim of this study was to investigate the rates of NTD, anencephaly, spina-bifida cystica, encephalocele and the relation of these abnormalities with sex, ethnicity, mother’s age and consanguineous marriage in north of Iran (Gorgan). A cross-sectional study was done on 26280 birth in Dezyani Hospital in Gorgan during 1998-2001. This study has showed that, the NTD rate was 3.08, 2.78 and 3.38 per 1000 in total, males and females, respectively, female to male ratio was 1.31. The rate of spina-bifida, anecephaly and encephalocele were 1.48, 1.48, 0.11 per 1000, respectively. In regard to different races, the rate was 6.78/1000, 4.76/1000 and 2.41/1000 among Turkmans, Systani and native Fars, respectively (P<0.05). The rate of NTD in the mothers under 20 years was 2.29/1000, in 20-34 years was 3.37/1000 and over 35 years was 2.54/1000. Interstingly, 29.6% of parents with affected newborns had consanguineous marriage. We concluded that there is a higher rate of NTD in this, area, that it might be due to race-ethnicity variations.

Gastric cancer is the 2nd cause of cancer mortality after lung cancer. Approximately 12% of all cancer death are due to gastric cancer. Tumorgenesis is thought to be a multistep process involving a series of genetic changes in oncogenes and suppressor genes. The most common cancer-related genetic change known in human tumors is P53 mutation, particularly in gastric cancer. This study was done to determine P53 gene mutations in gastric cancer. This study was performed on 44 biopsy from patients with gastric cancer during 2002 in 3 hospitals in Tehran. For determination of P53 gene mutations was performed PCR-SSCP methods. The patients group comprised 31 males and 13 females (Average age, 60.8 years Ranging from 34 to 84 years). 36 cases (81.8%) intestinal type, 5 cases (11.4%) were diffuse type and 3 cases no defined. 44 gastric cancers of gastric tissues were screened for the mutations of P53 gene mutations in exons 5-8 using the PCR-SSCP analysis. After polyacrylamide gel electrophoresis, 9 patients (20.5%) showed an apparent electrophoretic mobility shift between the cancer and other normal samples. One mutation in exon 5 (11.1%), 2 were detected in exon 6 (22.2%), 3 were found in exon 7 (33.3%) and 3 were detected in exon 8 (33.3%). The mutation rate was 7 of 36 (21.2%) in intestinal type and 2 of (40%) in diffuse type. No significant correlation between P53 gene mutations and age and genus was found. This investigation showed the rate P53 gene mutation (20.5%) in gastric cancer in our society.

Hemodialysis patients quality of life is a significant subject. Style of coping or adjustment among hemodialysis patients is a complicated problem that affects the quality of life status. Responses domain to these problems are different from readjustment to suicide. The object of this study was to determine the relationship between quality of life and copings the problem, which were applied by hemodialysis patients. This is a descriptive analytical and correlational study. The study has been done in hospitals of Gorgan, Gonabad and Bandar Torkaman cities. The data were collected using a questionnaire with likert scale (From 1 to 5). Sample population was 167 patients. The results showed that 89 patients were male, 78 patients female, 25.74% between 35-44 years old and hemodialysis of duration of 114 patients was more than 4 years. The quality of life mean score and standard deviatior were respectively 89.58, 8.13. About 75.42% of patient’s quality of life were moderate. The emotional and problem focused strategies were used in moderate way by the hemodialysis patients. Statistic tests between quality of life and emotional focused coping was significant (P<0.05). In general there are relationship between quality of life and total coping (P<0.05). According to study, we conclude that emotional focused coping and total coping influence the quality of life of hemodialysis patients. Therefore hemodialysis patients must be educated and supported, to cope with the problems.

In all of world, a portion of household income expends on health care cost. Amount and distribution of the proportion indicate financial burden of health care in the societies. WHO believes that one of the main determinants in health system efficiency is fairness of financial contribution. This study aimed distribution pattern of urban households’ income, health expenditure by cost types and measuring of equality on health care costs in the Gorgan district. In order to establish the population laboratory, this cross-sectional study assessed 1014 household in the Gorgan health posts (No 4 and 8) on January 2003. health insurance status, monthly household income and monthly health care cost gathered through interviewing with the husbandmans. Health insurance coverage was 67% in highest and 44% in lowest income deciles (P<0.05). Median and mean of assessed households’ income and household health care cost were 1200000 Rls, (1669669±187300 Rls) and 80000 Rls, (281530±95124 Rls) respectively. Mean of median of out of pocket proportion health care cost per households’ income was 0.57±0.03 and 0.66 respectively. 13% of total income expended health care cost through out of pocket. This proportion in highest and lowest income decile was 7% and 28% (P<0.05). Gini coefficient of health care cost and out of pocket cost per total household income were 0.22 and 0.18 respectively. Low income households expended almost 40% of their income in order to purchasing of health care, in comparison to richest households, they spent 9% of total income. Instead of, additive development of health insurance systems and complementary insurance mechanisms, a half of health care cost in the population spend by out of pocket. According to WHO standards of health system performance, revising health insurance system and payment mechanisms are mandatory.

Due to volatile property of monomer from Methylmethacrylate and its well known toxic side effects, in case of absorption via skin or respiratory system. Also, due to allergic reactions of it, consideration of suitable ventilation systems and using protective methods is very important. To decrease direct contact with it, the capabilities of technician and improves his health and work place, we investigate relationship between Methanol level and exposure to Methylmethacrylate. In a case-control (In vivo) study of 32 dental laboratory technicians in Babol and Sari before and after working and 32 normal subjects, urine samples were collected. Urine Methanol levels were analyzed by paper and gas chromatography. Mean concentration of Methanol in case group (1.2 micro mol/l) was significantly more than control group (0.78 micro mol/l). Also, Methanol level was significantly higher after work (1.45 micro mol/l) when compared to before work (1.27 micro mol/l), (P<0.05). No relation between work history and urine Methanol level was observed. Due to significant increase of Methanol concentration during work in work place, the use of protective methods such as suitable ventilation, wearing mask and gloves, also, using vapor absorbing tubes can be useful in increasing dental laboratory workplace safety.

Urinary tract infections (UTI) are regarded as one of the most common infectious diseases. A remarkable percent of urinary tract infections are asymptomatic. In some cases of urinary tract infections, significant bacteriuria is not present. One the etiologic agents of culture negative genitourinary tract infections, which can be transmitted through intercourse, is Chlamydia Trachomatis. On the basis of high incidence of negative results of urine culture (Up to 60%) in patients suffering from UTI referring to Bou-Ali infectious hospital and taking into consideration the importance of genitourinary Chlamydial infections, we decided to study prevalence of Chlamydia Trachomatis in urine sample of patients with UTI referring to this hospital. This research was a descriptive study on the 320 patients referring to Bou-Ali infectious hospital in Zahedan, which were chosen by non-randomized sampling. One early morning urine sample was taken from these patients. After centrifugation, sediment of samples was used as antigen for Chlamy-check-I ELISA kits. Out of 320 urinary specimens, 95 specimens (29.69%) were positive and 225 specimen (70.31%) were negative for Chlamydia Trachomatis. From 95 positive samples, 43 person (45.2%) were male and 52 person (54.73) were female. In both sexes the highest percent was related to 20-29 years old group. In accordance with above reported prevalence rate and bearing in mind the consequences of inappropriate treatment of Chlamydial infections (PID, infertility, extra uterus pregnancy, epididiomitis) the importance of precise treatment of Chlamydial infection and necessity of providing laboratory facilities for accurate and rapid diagnosis of Chlamydial infections in the area with high incidence of culture negative urine specimens is recommended.

One of the most current aggressive methods to access to blood vessels intravenous peripheral catheters that contains excess complications and prevention of it is one of important medical goals. Therefore, this study was done to determining influence dressing with gauze sterile using in complication appearance rate of side effects patients in CCU and having venous catheter.

This clinical trial accomplished on 64 patient’s hospitalization in CCU and post CCU of Malayer Hospital. 32 of patients in the experimental group (Use of dressing with gaze sterile) and 32 of patients shelled in the control group (Routine) randomly. For data collecting was used checklist and laboratory reports, the method was according to following. Form: In beginning, questionnaire which contained demographic information completed and then venous catheter was enclosed sterility in patient’s hand by one person, after the catheter was replaced, placed the gauze sterile on catheter site for the experimental group (Routine) then every 12 hours considered the place in aspect of phlebitis and infection to 72 hours duration, since phlebitis appearing and or finished 72 hours, the angiocat plastical tip detached from trunck by sterile bisturi and transferred to laboratory tube containing nutritive materials and sent the laboratory during minumm time possible time it was cultured in a culture environment growing 15 colony number on every platelet was considered as positive.

65% of 2 groups are among 61-70 years old 53.1% of both group are illiterate. The majority of both groups (59.4%) had myocardial ischemic heart disease. Catheter situation in the experimental group 53.7% was in the left hand and the control group 63.1% was in the right hand in aspect of type of used drug 44.1% individuals of the 2 groups used 2 drugs heparin and vasodilators. Study’s result about phlebitis with (P<0.05) showed that the gauze sterile dressing has effected in preventing of it’s appearance, therefore statistical fisher test showed that gauze sterile dressing is not effected in preventing of venous catheter’s local infection.

The use of the sterile gauze dressing can effect in preventing of phlebitis and colonization.

One of the most important principles in education is adopting a teaching method in concordance with objectives, contents and learners. Teaching and learning clinical skills is a challenging aspect of education in field of medicine and allied health profession. Some of the new researchers have shown that video-based instruction has many advantages in comparative to others. But in the domain of the psychomotor learning there is not enough evidence to show that video-based instruction is an effective teaching method. The current study has compared students learning in video-based and demonstration methods. An experimental study was conducted on 40 first year nursing and midwifery students. The students were randomly assigned to case (N=20) and control (N=20) groups based on the their course. The data were collected from a pre-test, a post-test and a questionnaire for demographic information. Pre-test was given 24 hours prior to the presentation sessions. Then each group has received one skill with video-based and another skill with demonstration. Skills included the dressing changing and surgical hand washing. After 24 hours post-test was taken with previous criteria. The differences between the pre-test and post-test scores were considered as they are at learning level. The overall learning in the demonstration method was higher than the video-based method (P<0.05). However the scores of students in 2 methods was at acceptable level. The scores of students in the cognitive domain of hand washing by the demonstration were 16.20±1.5 and by the video-based method were 15.25±1. The scores of students in the psychomotor domain of hand washing by the demonstration was 16.85±1.4 and by the video-based method was 15.94±1.4 (P<0.05). The scores of students in the cognitive domain of dressing change by the demonstration was 25.60±1.8 and by the video-based method was 15.50±1. The scores of students in the psychomotor domain of dressing change by the demonstration was 16.78±1.3 and with the video-based was 16.12±1 (P<0.05). The results indicated that demonstration method is more effective in the students learning. However, both video-based and demonstration have led to the high level of cognitive and psychomotor learning. It could be concluded that video-based instruction can be an effective method for replacing the demonstration, especially when there is not access to demonstration, in addition according to the findings, video-based education is a effective methods for transporting knowledge, information and other topics in the cognitive domain. Therefore, considering the cost-effectiveness of video-based instruction and its ease of use, this method can facilitate education in where lack of experienced instructors and equipment is most pronounced.

Enuresis is a problem in children. In this research the success, rate and recurrence of Imipramine, Desmopresine and conditional therapy has been studied in enuresis treatment of children. This study was done on 84 enuresis child between 7-11 years old which were selected by screening at the schools. Patients divided randomly to 3 groups: The 1st group received 25 mg of Imipramine every night. The 2nd group was treated with 20 micg of Desmopresine intranasaly every night. The 3rd group used alarm for conditioning every night. All groups were treated for one month, and 2 weeks without enuresis meaned success. All physical finding and laboratory tests were normal in all patients (FBS, U/A, U/C, kidney and bladder sonography). Patients had in average 8.5 years old. 77.3% of cases were boys and 22.7% were girls. Success rate for therapy was 71.4%, 60% and 50% in-groups 1-3 respectively. Recurrence rate 6 months after therapy was 10%, 55.5% and 25% in-groups 1-3 respectively. Imipramine persists as cheep, available, well-tolerated and effective way of treating enuretic patients. Due to high recurrence rate, Desmopresine is just recommended as a temporary treatment.

Swimming pools are the most important sports field. The swimming effect on body and mental human health. The health, and disinfection of pools help to protect swimmers otherwise it can transfer agent of disease such as conjunctivitis-dermatit-athletes feet and parasitic in swimmers. The main purpose of this study is to survey the quality of health indicators in swimming pools and matching them with present standard in the Gorgan. This is a descriptive and cross-sectional study. It has performed on all of the swimming pool in summer season in Gorgan. In this study, general characteristics had determined by interview method and the parameters such as pH, turbidity, residual chlorine, Coliform bacteria, E.coli, Streptococcus Fecalis and Pseudomonas Aerogenosa determined in the laboratory. The sampling of water was performed every 10 days at 14-16 PM. The residual chlorine and pH determined in the field and the other parameters determined in the laboratory. This research showed that pH>8 in 66.6% of samples and the amount of Coliform, E.coli and Streptococcus Fecalis were not at upper limit of standard, but the Pseudomonas Aerogenosa is more than limit of standard in 58.3% of samples. The residual chlorine was more limit of standard in 61.1% of samples and the amount of residual chlorine was according to limit of standard in Kiani and women’s pools. The lack of chlorinator system-inadequate of water treatment system and lack of knowledge pool’s incumbent cause that pH and residual chlorine were undesirable at most of the time. Additionally bacterial pollution confirms above subjects. So it is recommend that extensive research to be done on relationship between bacterial pollution and prevalence of disease in swimming pools.

Cutaneous metastasis from carcinoma of the larynx are very rare. We observed a 75-year-old male patient with squamous cell carcinoma of the larynx who developed a subcutaneous nodule as an abscess presentation in the buttock. It was found to be a metastatic squamous cell carcinoma of the laryngeal cancer, histopathologically. The skin manifestations proceeded laryngeal metastases by 18 months after laryngectomy and radical neck dissection. After 3 months, the patient died. Cutaneous metastasis of laryngeal carcinoma should be considered in all patients with previous laryngeal carcinoma representing with cutaneous lesion.

Biosynthetic growth hormone is now available in virtually unlimited quantities. As a result because of its growth promoting and anabolic effects, it is widely used in various disorders in both children and adults. Growth hormone has been proven to be beneficial in a small number of diseases causing short stature in children, and in adults with severe growth hormone deficiency or acquired immunodeficiency syndrome (AIDS). The hormone is also used on an investigational basis in a variety of disorders causing short stature, as well as in the aged and in several catabolic conditions. It is likely that with time the indications for treatment with this hormone will be increased.