مجله مطالعات علوم پزشکی
سال بیست و دوم شماره 6 (بهمن و اسفند 1390)

Growth disorders are one of the important health problems of children in the world, particularly in developing countries. This Study was aimed to evaluate risk factors of growth disorders in children less than one year old in Salmas. This historical cohort study was carried out on 473 children who were born in Salmas city that were selected and followed up until they were one year old. The data were collected with questionnaires in two time periods before six months old and end of one year. The influence of different factors on failure to thrive was evaluated with chi –square and multiple logistic regression tests. Out of 473 children, 219(46/3%) had growth disorder at least once a year. According to the findings of multivariate logistic regression, failure to thrive was associated with early onset complementary feeding, socioeco(mic condition, Child's disease after 6 months and, Maternal disease and birth weight, To illness but wasnt any associated with Parents age and literacy, birth length and Head circumference at birth, birth order, previous birth interval, parents smoking. According to results in this research, the growth disorder incidence rate in Salmas district has been high, training health workers and mothers of infants in the suitable child feeding and control of common infectious diseases in children under one year old particularly, among poor people can decrease these health problem.

Due to high neonatal mortality in developing countries and lack of knowledge about the relative importance of different causes of neonatal deaths, we carried out this study to evaluate the prevalence and causes of neonatal mortality in the population of Kerman Province. This cross-sectional study was conducted between 2008-2009. The population was all the neonates born in Kerman with the gestational age more than 20 weeks and died before the fourth week of their lives. The information was collected by trained research staff using forms; neonatal causes of death were assigned by a pediatrician on the basis of information extracted from medical records. The data were analyzed by SPSS v.15. Accordingly, 535 neonatal deaths were recorded. Final causes of death were classified as immaturity-related (36.4%), birth asphyxia (20.7%), sepsis (13.6%), congenital anomalies (13.8%), and undiagnosed causes (15.3%). Low birth weight, delivery characteristics including the educational level of birth attendant, presenting part and existing risk factors in pregnancy are mostly associated with different rates and causes of neonatal deaths. There was high prevalence of neonatal mortality in our study population. It is strongly suggested to improve health service quality in order to decrease neonatal mortality. Advancements in the care of premature infants and prevention of spontaneous preterm labor lead to a substantial decrease in neonatal mortality.

Critical illness polyneuropathy and myopathy (CIPNM) is a major complication of severe critical illness and management. CIPNM prolongs weaning from mechanical ventilation and physical rehabilitation since both limb and respiratory muscles can be affected. Many risk factors have been ever proposed for the CIPNM including sepsis, multiple organ failure, neuromuscular blocking agents etc. However, the data are heterogeneous and no consensus is present in this regard. This study aimed to evaluate possible risk factors in development of CIPNM in pediatric intensive care unit (PICU).Methods & Materials: In this observational study, 57 patients (aged 1 month to 14 years) in PICU and on mechanical ventilation (MV) for at least one week were recruited during a 24-month period in Tabriz Children Teaching Hospital. The CIPNM was diagnosed in 13 cases (22.8%) based on clinical and electrodiagnostic findings. Different variables including age, sex, PRISM score, duration of MV and PICU stay, accompanying pathologic conditions, medications and in-hospital outcome were compared between both groups with and without CIPNM. Sepsis and multiorgan dysfunction were significantly more frequent in the CIPNM group (6.8% vs. 38.5, p=0.01, OR=8.5 with 95%CI: 1.7-43.1 and 43.2% vs. 76.9, p=0.03, OR=4.4 with 95%CI: 1.1-18.2; respectively). Midazolam was administered more frequently in the non-CIPNM group (88.6% vs. 53.8, p=0.01, OR=0.2 with 95%CI: 0.0-0.6). There was no significant difference between the two groups regarding age, sex, PRISM score, duration of MV and PICU stay, other accompanying pathologic conditions (malnutrition, prolonged immobility) and other medications (pancuronium, steroids, aminoglycosides). The mortality rate was comparable between the two groups (4.5% in non-CIPNM group vs. 15.4% in the CIPNM group; p=0.22). In multivariate analysis, the sepsis and midazolam administration were the mere significant contributors to the CIPNM. Based on our findings, sepsis is a dependent risk factor for occurrence of CIPNM. On the other hand, midazolam seems to be an independent protector against this condition.

Non-communicable diseases account for 60% of deaths and 47% of the global burden of diseases. Seventy five percent of these deaths occur in developing countries. Most of these diseases have risk factors such as: hypercholesterolemia, physical inactivity, hypertension, diabetes mellitus, cigarette smoking, obesity and bad nutritional habits. The aim of this study was to compare the prevalence of risk factors of non-communicable diseases in the East- Azerbaijan province between 2004 and 2007. This cross-sectional study was carried out using cluster sampling method. Each cluster included 20 people (aged 15-64) from both genders and 5 age groups (15-24, 25-34, 35-44, and 45-54 and 55-64 years old). The samples were 3740 and 995 for years 2004 and 2007, respectively. The results were analyzed using SPSS software and a 95% confidence interval. The prevalence of the risk factors for years 2004 and 2007(respectively) were as follows: Hypecholesterolemia: 12. 1% & CI(6-18), 13% & CI(10-15). Physical activity (at least 10 min exercise in leisure time): 29. 6% & CI(21-39), 33. 6% & CI(30-36). Hypertension: 16. 3 & CI(9-23), 24. 1% & CI(21-27). Diabetes: 5. 5% & CI(1-10), 11. 4% & CI(10-14). Cigarette smoking: 10. 7% & CI(5-10), 14. 5& CI(12-17). Obesity:17% & CI(10-24), 23. 6% & CI(21-26). Fruit usage: 95% & CI (91-99), 95. 6% & CI (94-97). Vegetables usage: 83% & CI(76-90), 97% &CI(96-98). Fish usage: 29. 7% & CI(20-38)& 70. 7% & CI(68-73). Solid oil usage: 89. 9% & CI(84-96),68. 1 & CI(60-77). Liquid oil usage:7. 4% & CI(2-12), 28. 5 &CI (20-37). In this study we found no statistical difference between the prevalence of hypercholesterolemia, physical activity, hypertension, obesity, cigarette smoking and fruit usage, between years 2004 and 2007. The prevalence of diabetes however, increased and other nutritional habits improved in 2007.

Injuries to tendons are among the most common injuries to body. A repaired tendon needs to be immobilized for weeks until it has accrued enough strength to handle physiological loads. Tissue-engineered cell therapies offer many new treatment options for repair of diseased and damaged tissues. The present study aimed to investigate the effect of intratendinous injection of bMSCs on the rate and extent of early stages of tendon healing after primary repair in a rabbit model. Twenty seven skeletally mature New Zealand white rabbits weighing 1.8- 2.5 kg were used. Twenty rabbits were used as the experimental animals, and seven others were used as a source of allogenic bMSCs. Under general anesthesia an experimental tenotomy was made through the midsubstance of the DDF tendon. The transected tendon was immediately repaired with use of a locking-loop suture. No treatment was given to the control group. In the treatment group, bMSCs injected intartendinously at the repair site as well as externally around the repair site. The operated limbs were immobilized for two weeks post operatively. Samples from operated tendons were harvested at weeks of three of operation for biomechanical (tensile strength, yield point and stiffness) and immunohistochemical (type and extent of produced collagens) evaluations. Biomechanical findings revealed that there were significant improvements in biomechanical properties such as tensile strength and yield point (P<0.05). Immunohistochemical findings showed that three weeks after surgery production of collagen type Ι around the repair site in the bMSCs treated group was significantly denser and more regular than in the control group. Intratendinous application of bone marrow-derived mesenchymal stem cells following primary tendon repair can significantly improve the biomechanical and immunohistochemical parameters in the early stage of tendon healing. Early time period during tendon healing is crucial in the treatment of tendon injuries.

Disturbance of the experience, expression of emotions, difficulty in identifying and describing feelings (Alexithymia), negative affectivity, social inhibition (Type-D personality) may influence general health. The aim of the current study was to investigate the relationship and predictability general health through alexithymia and Type-D personality. This descriptive correlation study included 431 samples (193 boys, 238 girls) that were selected through random stratified sampling from Urmia University students and assessed by research instruments: General Health Questionnaire, Toronto Alexithymia Scale, and Type-D Personality Scale. Pearson correlation coefficient and regression analysis were used to analyze the data. The findings showed that there is a significant relationship between alexithymia and Type-D personality subscales: negative affectivity (r= 0.39, p<0.01), and social inhibition (r=0.44, p< 0.01). There was also significant positive relationship between alexithymia with subscals general health: somatic symptom (r= 0.27, p<0.01), anxiety (r=0.31, p<0.01), social dysfunction (r= 0.34, p<0.01), and depression (r=0.33, p<0.01). Of all research variables, negative affectivity and difficulty identifying feelings were able to predict 36 percent of the variance of general health. Results of the present study show that individuals with scoring high on alexithymia have poor general health. The relation between alexithymia with negative affectivity can be explained the observed alexithymia-health relationship.

Injectable contraceptives are safe and effective methods of reversible contraception for most women. Cyclofem, a once-a-month injectable contraceptive, was introduced in Iranian health delivery system since 2008. The main purpose of the study was to assess safety, efficacy, acceptability, and causes of discontinuation of cyclofem in the Iranian context. A total of 644 healthy women participated from rural and urban areas. Clients received Cyclofem based on a once-a-month regiment and were followed-up for up to 12 months. The data were evaluated by life table analysis. A total of 4144 women-months of treatment experience were accumulated during a one year period. Cyclofem proved its use-effectiveness (pregnancy rate of 0.00%) and its safety under routine service conditions of family planning facilities in Iran. The most common reason for method discontinuation was vaginal bleeding problems. The results of this study have once again demonstrated that Cyclofem is a highly effective method with an acceptable side effect profile. In addition, the study provided the elements for its approval by local health authorities and its inclusion into the Iranian National Family Planning Program.

The purpose of this study was to evaluate the role of fetal surgery in the formation of scar in the rat. Fourteen pregnant rats (420 ±20) were operated in this study. An incision made in upper lip via open fetal surgery approach and evaluated the scar formation clinically after labor. Operation was done on 16th to 18th day of gestation. One of the rats died and was excluded from the study. The findings of the study indicated formation of the scar was not clinically observable in in 11 rats (84.61%). In two rats (15.39%) a significant scar occurred. One of the best advantages of fetal surgery is lack of scar formation. There are other advantages such as alignment of the orbicularis oris muscle. Early intervention leads to better esthetic results in cleft lip, but it may increase the risk of abortion.

Dendritic cells (DCs) have high ability in antigen presentation. Their functional importance is in treatment of some diseases such as cancer and infection and autoimmune diseases, and prevention of allograft rejection. The aim of this study was to investigate maturation of Dendritic cells for tumor immunotherapy. DCs was produced in two stages. In the first stage monocyte cells were converted to immature dendritic cells in presence of GM-CSF and IL-4. In the second stage DCs became mature in presence of maturation factor of skin fibroblast cells (HSFPI3) and human umbilical vein endothelial cells (HUVEC) conditioned medium and Poly I-C, MCM. Extract of cancer cells (k562) was added as the antigen to the immature DCS. The generated DCs had appropriate phenotype, phagocytosis ability, and stimulate proliferation of T lymphocytes and were able to secrete high levels of IL-12 cytokine. The DCs generated in presence of endothelial and fibroblast cells had appropriate had the appropriate phenotype and functional and polarizated T lymphocytes type 1 (Th1) immuny response.

Drug addiction is one of the problems that affect the international community with regard to specific characteristics of each society. Addiction has serious and profound effects on health, family life, economy, security and cultural grow. Association of addiction with many infectious diseases such as hepatitis B, C, and AIDS has been proved by many reports. Given the growing trend of drug abuse in the country and the region and lack of published data, it was decided to study the prevalence of high risk behaviors in drug addict population referring to methadone treatment center in Urmia psychiatry hospital in 2010. In a cross - sectional study, 384 addicts referring to Methadon treatment center in Urmia psychiatric hospital were randomly selected in spring 2010. The survey tool was the questionnaire. Data collection was carried out by one researcher through interview within three months. Demographic information and risky behaviors of addicts including intravenous drug injection, tattooing, prison records etc were obtained and analyzed using SPSS software. Of 384 patients, 58 patients (15%) were IV drug abusers and 326 patients (85%) were non-intravenous drug users. Seventy five percent of drug users were married, the mean duration of addiction was 12 years, prison history was observed in 42%. With regard to drug use method, snuffing in 61%, injection of drug in 15%, and oral use in 24%) was observed. Considering other risk factors, history of alcohol use for more than 5 years in 26.6% percent, tattooing in 23%, shared use of syringes in only 1.6%, sharing razors in 5%, illegal sex (16.1%t). The most frequent drugs used were opium (50%) and heroin (33 %). Results from this study show that high-risk behaviors such as injecting drug, the use of shared needles and unsafe sexual contacts can be seen more prevalent among drug addicts. These behaviors predispose drug addicts to various diseases including blood borne infections. Considering the growing number of addicts, it would be essential in this vulnerable group to receive necessary health education and prevention services in rehabilitation centers.

Natural history of developmental dislocation of hip (DDH) is usually towards to length discrepancy, limping and finally bed ridden in fifth decade of life. Delay in diagnosis will result in compensatory anatomical changes and sophistication in treatment protocol. Ultimate results will be also affected by delayed diagnosis and treatment. We aimed to evaluate the etiology for delayed referring of patients in Imam Khomeini hospital. After research committee approval, 60 patients with developmental dislocation of hip with delayed presentation were evaluated. These patients delayed more than 3 months. A questionnaire was designed according to the study purposes and completed by review of charts and interview with parents. The data were gathered and statistical analysis was done using SPSS. Sixty patients had delayed diagnosis and 45 of them had delayed referring. Fifteen patients were referred immediately after delayed diagnosis. Fifty seven deliveries were performed in hospital. For all these patients screening for DDH was performed. The most common reason for referring was limping and the most common cause for delayed referring was economic problems. Mothers were the most common persons who noticed a problem regarding their babies. Despite of screening protocols for DDH, our patients were missed and after the diagnosis most of them do not refer because of financial problems.