نشریه دانشگاه علوم پزشکی خراسان شمالی
سال سوم شماره 1 (بهار 1390)

Quality of life can be considered as a marker of the quality of health care and is a part of the patient's treatment plan. Its measurement in type 2 diabetic patients provides useful information to health authorities. This study is a descriptive- analytic cross – sectional study that has attempted to measure the quality of life in diabetic patients in Chaharmahal & Bakhteyari Province. The number of patients was 254 and they were selected randomly in two stages. Data were collected through questionnaires with acceptable validity and reliability measures. The data were analysed with software STATA 9 using independent t-test, ANOVA, Chi-square and multiple linear regression. The mean total score of quality of life was 122.8 out of 184 (SD: 1.1) in this study. 27.6% of the patients had favourable quality of life, 67.3% had rather favourable and 5.1% had unfavourable quality of life. The most important factors that determine quality of life in diabetic patients include satisfaction with health insurance, a history of hospitalization due to diabetes, a history of more than 10 years of diabetes, control of hypertension, micro- and macrovascular complications of diabetes, sight dimness and sleep disorder. Based on an accurate recognition of quality of life and its determinants in diabetic patients, a background has been provided for policymakers, planners, researchers, physicians and nurses working in a diabetic management tearn.

Medical records contain important and fundamental information about patient care in health centers and include sufficient information for identification of the patient, the diagnostic processing for the health care teams, justification of the treatment and the correct recording of the results. The present study is a semi-experimental study done through the completion of nine 3-option check-lists. It is a quantitative study of 9 major sheets of medical records of patients discharged from the university hospitals in Bojnord in 2009. This was done in two rounds, one before training and another 5 months after training. The training consisted two teaching courses titled "Correct procedures in documentation" for physicians and all others recording the documents (ie. nurses and paramedics). 355 records were classified using random sampling. Medical records were chosen from hospitals based on the number of in-patients in each hospital. Data analysis was through SPSS 15 software and using t-test, ANOVA, McNemarra and Tukey tests. The average state of the medical records after training in all the 9 sheets improved significantly (P<0.001) when compared whit before. An exception was the average laboratory test sheets which showed no significant difference. After training the Rate of complete medical records was 75% before training and 79% after training. In the evaluation of the 9 sheets under study, the highest level of completion after training was 93.55% in comparison whit before training (90.45%) the physican ΄s orders report sheet. The study shows a positive effect of training on the rate of medical records completeness. It seems that providing training programes for personnel will improve the quality of constant documentation of medical records.

Medical records contain important and fundamental information about patient care in health centers and include sufficient information for identification of the patient, the diagnostic processing for the health care teams, justification of the treatment and the correct recording of the results. The present study is a semi-experimental study done through the completion of nine 3-option check-lists. It is a quantitative study of 9 major sheets of medical records of patients discharged from the university hospitals in Bojnord in 2009. This was done in two rounds, one before training and another 5 months after training. The training consisted two teaching courses titled "Correct procedures in documentation" for physicians and all others recording the documents (ie. nurses and paramedics). 355 records were classified using random sampling. Medical records were chosen from hospitals based on the number of in-patients in each hospital. Data analysis was through SPSS 15 software and using t-test, ANOVA, McNemarra and Tukey tests. The average state of the medical records after training in all the 9 sheets improved significantly (P<0.001) when compared whit before. An exception was the average laboratory test sheets which showed no significant difference. After training the Rate of complete medical records was 75% before training and 79% after training. In the evaluation of the 9 sheets under study, the highest level of completion after training was 93.55% in comparison whit before training (90.45%) the physican ΄s orders report sheet. The study shows a positive effect of training on the rate of medical records completeness. It seems that providing training programes for personnel will improve the quality of constant documentation of medical records.

considering the growning population and the consequent increase in the amount and the varieties of wastes during land life in recent years, management of solid wastes is of great importance. The aim of this study was to present a suitable design for the hygienic disposal of wastes in the rural regions of Roudab, Sabzevar. In this research the quality and quantity of wastes, methods of collection, disposal and site selection for solid wastes from summer 2006 to spring 2007 for one year was investigated. In this study, suitable sites for the disposal of wastes were determined and eventually the site for waste disposal was designed on the basis of different standards using several models of information, including road maps with the guide Leopold matrix. Through field visits, two locations for comparison and evaluation through hierarchical analysis process were selected and studied throuthly. Giving appropriate weight to each of the locations, the final location was selected. The two selected sites were then assessed for their environmental impacts. Results showed that both sites were suitable for landfill solid wastes for the Roudab area. The needed area for the landfill site was 100000 m2 The current situation and method of collection and disposal of solid wastes in Roudab is not suitable. Therefore, considering the above results and in order to prevent invironmental pollution the establishment of a suitable management system for organization of solid wastes in the Roudab area is imperative.

Premature neonates, low birth weigth neonates weighing less than 2 kg or neonates with severe health problems kept at N.I.C.U are highly at risk of contracting nosocomial infections, in particular septicemia. Therefore, we decided to investigate the prevalence of bacteria in this ward. In this descriptive cross-sectional study, 100 hospitalized neonate in-patients in NICU were studied. Samples were taken from five parts of the neonate's body (rectum, skin, nose, pharynx and umbilicus) in three turns for microbiological analysis in the laboratory. Blood samples were also taken from neonates hospitalized with blood infection for microbiological analysis. Results of this study showed the bacteria identified in different parts of the neonate΄s body were Staphylococcus epidermidis, Klebsiella pneumonia and Escherichia coli in the amount of 484, 243 and 191 respectively. Also, 7 cases of septicemia caused by Staphylococcus epidermidis, Klebsiella pneumonia and Escherichia coli were observed, the number of cases being 4, 2 and 1 respectively. As the results of this research shows Staphylococcus epidermidis, Klebsiella pneumonia, Escherichia coli and Staphylococcus saprophyticus are the main cause of microbial colonization and septicemia in the neonates.

major portion of mental and physical development occurs in the first two years of life. Considering the importance of breast feeding and the vital effect of breast milk on the development of children, the aim of this study was to investigate various effective factors on duration of suckling in 24-month-old children in 2010, in the city of Farooj, North Khorasan, Iran. In this descriptive-analytic study, 250 nursing mothers who feed their childeran with breast milk for 2 years were selected, using simple random and stratified sampling methods. Data were collected using questionnaires and medical records available in health centers. Data were analyzed using SPSS 16 software using survival analysis with Cox Regression model. The median of breast feeding duration for children in the preset study was about 22 months the probability of weaning at 3, 6, 9, 12, 18, and 24 months was 0.80, 0.20, 0.30, 0.80, 0.126, and 0.875 respectively. The most important determing for duration of breast feeding factor was the mother’s employment status (OR= 2.32 and CI: 1.01-4.97). the results of presnt study showed that emploloymet of women is on important factor which affects the duration of breast feeding.

The present study was carried out to evaluate the antinociceptive effect of morphine in ovariectomized female rats in comparison with naïve and estradiole-treated ovariectomized rats. Matial and 30 female rats were divided into 3 groups: 1) Sham (control group) 2) OVX (ovarictomized) 3) OVX Est. (ovarictomized and estradiole treated). Estradiol valerate (2mg/kg/week, i.m.) was injected in the animals of OVX Est. The animals of Sham and OVX groups received 2ml/kg/week saline instead of estradiole. The hot plate test was carried out as a base record 15 min before injection of morphine (10 mg/kg; S.C.) and consequently it was repeated 5 times, every15 minutes after injection. The results were compared using one way and repeated-measure analysis of variance (ANOVA) followed by post-hoc Tukey’s test. Differences were considered statistically significant when P <0.05. The reaction times after injection of morphine in sham and OVX Est groups were significantly higher than basal reaction time (P <0.05 and P <0.001) but in OVX group there were no significant differences. However, the reaction times after injection of morphine in OVX, OVX Est and sham groups were not significantly different. It is concluded that ovarian hormones change analgesic effects of morphine in rats.

Amputation is one of the most common motor disabilities. Physical, behavioral and mental disorders following amputation are the most serious problems of amputee veterans. We assessed the quality of life in Iranian amputee veterans in Mazandaran province in 2010. This was a cross-sectional descriptive study. In this study the quality of life status of the participants was evaluated using a self-administered demographic questionnaire and a health survey questionnaire in the short form 36 (SF-36). 256 (44.52%) out of the 575 amputee veterans completed the questionnaire. The mean age of respondents was 46.44 ± 2.6 years ranging from 20 to 70. All participants were male. 94.9% were married and 78.8% had graduate diploma or were under diploma. According to the SF-36 the highest mean was related to mental health (54.35 ± 21) and the lowest mean was limitation in physical performance (36.42 ± 20.31). Only 4 out of 256 (1.6%) showed an excellent index for general health. It seems that the majority of the veterans lack an acceptable quality of life. This may be due to a shortage in receiving adequate rehabilitation and therapeutic services.

Sphygmomanometers are instruments nessesery for the basis of blood pressure measurement, it is well established that this device especially when is used in general practice may often be inaccurate and may cause errors in the measurement of accurate blood pressure. In this study we carried out an analysis of all aneroid and mercury sphygmomanometers currently in use in Sabzevar hospitals for their accuracy and physical condition. In this descriptive cross sectional study, all sphygmomanometers currently in use in Sabzevar hospitals were tested. A total 63 sphygmomanometers were compared with a standard mercury sphygmomanometer. Deviation of the hand of the aneroid sphygmomanometers and the mercury level of the mercury sphygmomanometers at rest were studied. The drop in pressure from 300mmHg was studied after one minute. SPSS 11.5 software and descriptive statistics were used to describe the data. 50 (79.4%) out of 63 sphygmomanometers were not level of reference zero at rest. 88.9% of the sphygmomanometers had a pressure loss of more than 15 mmHg in one minute, when the cuff was inflated to 300mmHg around a can – with a circumference of about 32 cm. the mean of difference between the sphygmomanometers and the standard sphygmomanometer in the 100 mm level was 6.67 mmHg. 54% of the sphygmomanometers showed a difference of more than 4 mmHg with the standard sphygmomanometer. Most in use sphygmomanometers were not accurate and must either be calibrated or must be out of use. We recommend that all hospitals need to have procedures in place for the regular calibration of their sphygmomanometers.

Cuneiform nucleus (CnF) is in midbrain area that has several functions including cardiovascular regulation. It is reported that the cardiovascular effect of CnF nucleus is mediated by rostral ventrolateral medulla (RVLM). However, direct projection from CnF to RVLM is sparse; therefore cardiovascular response of CnF nucleus may be relayed by other nuclei such as Kolliker—Fuse nucleus (KF). To test this hypothesis, KF was inactivated by cobalt chloride (CoCl2) and its effect on long cardiovascular response of glutamate in CnF was evaluated. Rats were anesthetized and arterially canuulated. Blood pressure (BP) and heart rate (HR) were recorded throughout the experiment. The drugs were microinjected into the nuclei and maximum change was compared with that prior to injection and with the control group using descriptive statistics and unpaired t-test for data analysis. Results were given as the mean±SEM. Microinjection of glutamate into the CnF nucleus caused a long term response (high blood pressure and tachycardia). Inactivation of KF nucleus significantly attenuated the blood pressure effect of long term response reaching 10.39±2.25 mmHg which is a significant decrease compared to glutamate (19.62±2.09 mmHg) (P<0.01). Maximum change in heart rate (16.33±4.8 bpm) showed no significant difference compared to glutamate (21.6±11.9 bpm). Our results showed that long term high blood pressure effect of CnF nucleus was mediated by KF nucleus. However, since inactivation of KF cannot completely block this response, another area may also be involved in relaying this effect. Tachycardia response was not affected by inactivation of KF nucleus. This finding indicates that the pathway of tachycardia response of CnF is probably independent of KF nucleus Cuneiform nucleus, Kolliker—Fuse nucleus, Glutamate, CoCl2, Blood pressure, Rat

Delivery of effective feedback is a remarkable criterion of effective teaching which is usually ignored in clinical teaching. This studywas conducted to determine the viewpoints of clinical students and educators about feedback delivery situation and related factors during their clinical experience. In this cross sectional descriptive analytic study, two self administered questionnaires were given to 148 students and 26 educators who were engaged in clinical experiences at least for one semester. The questionnaires consisted of three parts: Personal characteristics, a checklist for quality of feedback provision and related factors. The data were analized using SPSS version 16 with t-test, MannWithney, Spearmann and Kruskal–Wallis. There was a significant difference between the two viewpoints of the groups about feedback situation scores. All educators stated that they delivered feedback to their students while 23.65% of students stated that they didn’t receive any feedback. The majority of the two groups stated that feedback provision is necessary and expressed their willingness to increase its quantity.Moreover; there was a significant difference between scores given to oral and behavioral feedback delivery by two groups. Common feedback failiure as viewed by the two groups included: "too many students "and "different style of learning". The viewpoints of clinical students and educators about feedback delivery situation in clinical education were not the same.

Papillon Lefevre Syndrome (PLS) is a rare autosomal recessive disorder, which is characterized by palmar-plantar hyperkeratosis, periodontitis, and premature loss of dentition leading to loss of teeth by age 4–5 yr if untreated. This syndrome is recoginized by progressive pyogenic liver abscess Pyogenic liver abscess is an increasingly recognized complication and operation. Rapid diagnosis and immediate intervention are essential because any delay in diagnosis could increase mortality and irreversible complications. In this study we report two patients)two brothers aged 12 and 14) who presented with fever of unknown origin in whom pyogenic liver abscess was diagnosed. They had to undergo surgery and were shown to have PLS. immediately following diagnosis, suitable treatment procedures resulted in the patient's recovery and subsequent discharge. The aim of this report is to highlight the importance of paying attention to patients with fever of unknown origin as well as dental and skin lesions. Early diagnosis and suitable treatment procedures can prevent subsequent complications.

Preeclampcia (PE) is a complex multiorgan disorder with wide spread vasospasm. Endothelial dysfunction is central to the pathogenesis and several studies have demonesttated the association of hyperhemocysteinaemia for the endothelial damage in PE. Folic acid decreases blood hemocystein level by converting it to methionin. Therefore the aim of this research of the assessment of the relation between folic acid consumption and blood hemocystein concentration in women with and without Preeclampsia. This was a cross sectional case control study conducted among 60 singleton pregnant women in the third trimester admitted in selected hospitals affiliated to Mashad University of Medical Sciences. In the case group there were 30 women with blood Pressure equal to or higher than 140/90 mmHg and Proteinurea of higher than 300 mg in a 24 h urine collection. control group were 30 pregnant women with normal blood Pressure and without Proteinurea in the same trimester of pregnancy. They were matched in their ages, body mass index, socio-economic status, consumption of foods containing folic acid and supplements and other variables affecting Preeclampsia and were more homogeneous. Gestational age of onset, duration and dose of folic acid intake were evaluated by questionnaire and homocysteine levels were measured with a blood test. Data analysis was done using SPSS software, and using T-test, chi-square, two-way analysis of variance and correlation. The two groups showed no significant difference (P = 0.448) in terms of folic acid intake, pregnancy age at the start of folic acid intake and duration of folic acid intake during pregnancy. Blood levels of homocysteine was significantly different between two groups (P = 0.01). There was no significant difference between the duration of folic acid intake and the average blood hemocysteine. Moreover, the two-way ANOVA test showed no difference between two groups in terms of folic acid intake and blood hemocysteine level. Based on the results we conclude that there is no significant relation between the use of folic acid and blood hemocystein level (P=0.346). Folic Acid, Hemocysteine, Preeclampsia