Journal of Kermanshah University of Medical Sciences
Year:2006 | Volume:10 | Issue:1|Papers Count:10

Introduction: Laser therapy prevents complications of proliferative diabetic retinopathy (PDR), central retinal vein occlusion (CRVO) and branch retinal vein occlusion (BRVR), but its effect on visual acuity is controversial. This study evaluated the effect of laser on visual acuity in these patients.Materials and Methods: This interventional study conducted before-after treatment and evaluated 96 patients (133 eyes). After laser therapy the patients were followed for a period ranged between 3 weeks to six months and visual acuity based on Snellen chart was assessed. Results: 101 proliferative diabetic retinopathy, 16 branch retinal vein occlusion and 16 central retinal vein occlusion affected eyes were evaluated. This study evaluated 114 eyes of diabetic patients, 84 eyes of HTN patients and 46 eyes of hyperlipidemic patients. The means of corrected visual loss in PDR patients was 31.81+34.37 and 37.67+37.01 percent before and after laser therapy (p<0.05).Conclusion: It was concluded from this study that laser therapy in proliferative diabetic retinopathy patients does not cause visual improvement in short time.

Introduction: With regard to the importance of Life Quality (LQ) in patients with cancer, especially breast cancer, and research conflicts about quality and quantity of the effect of counseling on LQ promotion in such patients and for determining the effect of group counseling on symptom scales of LQ in patients with breast cancer treated by chemotherapy, this study was carried out at the at the Cancer Institute of Imam Khomeini Hospital in 2005 in Tehran.Materials and Methods: This is a randomized clinical trial in which 164 women aged between 25-55 years undergoing chemotherapy due to breast cancer and with mastectomy history. Subjects were divided into control (n= 82) and experimental (n=82) groups. The sample allocated method was employed randomly according to the latest number of patient cases in which odds located in control groups and evens in experimental group. Session of counseling was arranged for the experimental group. LQ of the patients were measured at the beginning and end of the study by two standard questionnaires (QLQ- Br 23, QLQ-C30).Results: Results showed that the mean age of the two groups were 40.84±7.7 and 41.72 ±8.4 in the control and experimental groups respectively. The mean of chemotherapy sessions in control group was 8.26±2.47 and in the experimental group was 8.3±2.66 with a range of 3-12. Nursing counseling cause LQ symptom scales promotion in the experimental group (P<0.001). General symptom scales such as insomnia, pain, nausea, vomiting, dyspnea, appetite loss, constipation and diarrhea and special symptom scales (arm symptoms, breast symptoms, systemic therapy side effect) were improved in the experimental group by means of counseling (P<0.001).Conclusion: According to the above results it is concluded that applying group counseling is an effective method in LQ promotion for such patients in their medical supportive centers.

Introduction: Following thoracic and abdominal surgery, all patients experience a decrease in pulmonary volumes and atelectasis. Different methods are suggested for improvement of pulmonary volumes and blood gas parameters in these patients. In this study the effects of spirometry on pulmonary volumes and blood gases parameters (ABG) in coronary artery bypass patients, were examined.Materials and Methods: This research is a clinical trial (self control) study. 110 consecutive male patients who candidated for coronary artery bypass surgery enrolled for study in 2000-2001. Data were collected through a questionnaire. Blood gases parameters and spirometry volumes were measured in three phases: before, first day of operation and after using incentive spirometry. Data were analyzed by descriptive and referential statistics.Results: In this study the mean of age was 52±8 years old LVEF was 50±7% and mean number of grafts was 2.4±0.7 The duration of mechanical ventilation was 7±4.5 hours in the intensive care unit. Comparison of ABGs before anesthesia and in the first day of surgery showed a significant decrease in systemic O2 saturation and arterial Po2 and an increase in arterial Pco2 (P<0.001). Comparison of the above parameters between the second and third phases showed no significant changes. Spirometry parameters showed a decrease of FEV1 and FVC after surgery (P<0.0001), but in comparison with pulmonary volumes after surgery by using incentive spirometery, no significant changes occurred.Conclusion: Using incentive spirometery in the first day of operation did not show significant improvement in pulmonary volumes and blood gases parameters.

Introduction: Acquired Immune Deficiency syndrome (AIDS) is a fatal nervous system disorder associated with infections caused by retro family known as Human Immune Virus (HIV). The present research was carried out with regard to the high prevalence of mental disorders among the HIV positive patients referred to Kermanshah Health care Center (KHCC).Materials & Methods: The present study is a descriptive, cross sectional one in which 132 HIV positive patients were studied (11 female, 121 male). All subjects were studied and assessed in two stages; a) by using cut-off point system (≥5) and self rating questionnaire (SRQ - 24) as a screening tool and b) clinical judgment forwarded by the psychiatrist on the basis of regulations.  The data were analysed by applying descriptive statistics.Results: The result revealed that 93.2% of the assessed patients were parallel to the diagnostic criteria of the mental disorders. 93.9 % (96.7% male, 63.6%female) with the drug dependency disorders, 43.2% (41.3% male, 63.6% female) with mood disorders, 18.9% (19% male, 18.2% female) with anxiety disorders and 11.4% (9.1% male, 36.4% female) with somatoform disorders. The above mentioned disorders were the most common disorders seen in each sample. Also, 74.2% of the total sample were shown to match the diagnostic criteria for personality disorders at axis II in which antisocial personality (31.8%) and borderline disorders (18.9%) were the most commonly dignosed respectively.Conclusion: Regarding the results obtained from the present research and the high rate of mental disorders in HIV positive patients, this group must be under special control for prevention.

Introduction: The most common manifestation of disturbed neurological function following stroke is motor weakness. Muscle weakness has been implicated as a factor underlying deficits in gait peliormance in subjects who have suffered strokes. The purpose of this study was to investigate the relationship between involved lower extremity isometric muscle strength and two functional tasks: gait ability and balance and motor skills in chronic stage of hemiparesis following stroke. Materials and Methods: This analytical cross sectional study was peiformed in Kahrizak Charity Foundation in 2004. 34 hemiparetic patients who had suffered strokes were chosen through a simple non-probability sampling. All patients were screened to ensure that their duration since the onset of the stroke was at least 12 months. The isometric strength of seven muscle groups was measured with a hand-held dynamometer. Two functional activities, gait ability and balance and motor skills were measured by using FAC and timed get up and go tests, respectively. Spearman's Correlations and Linear Regression were used to investigate the relationship and to estimate the results.Results: All muscle groups strength, except for hip extensors (r=0.16), were correlated significantly with the timed tet up and go scores (r=0.37 - 0.45). None of these muscle groups strength, except for hip abductors (r=0.34), were correlated with functional ambulation category test scores (r=-0.021- 0.2).Conclusion: The results showed that all muscles' strength, except for hip extensors, are valid estimators of balance and motor skills, and strength of hip abductors are valid estimators of gait ability. Also, this study is in support of using the involved lower extremity muscle strength measurements for evaluation of balance and motor skills and treatment of people in the chronic stage of rehabilitation following a stroke.

Introduction: Fever of unknown origin (FUO) is defined as the presence off ever for 8 or more days in a child in which a careful history and physical examination and preliminary laboratory results failed to reveal the probable cause of the fever. The causes of FUO are different in various geographical regions. The aim of this study was to evaluate the common causes of childhood FUO in our region.Materials and Methods: The medical records of all children (3 mo - 14 years) with final diagnosis of FUO who were admitted in two hospitals affiliated to Ahvaz Jondi-Shapour University of Medical Sciences were evaluated during 6years retrospectively.Results: 35 patients were included in this study. The causes of FUO in these patients were: infectious diseases, 12 cases (34.28%), collagen-vascular diseases, 8 (22.85%), neoplasms, 3 (8.57%), miscellaneous, 2 (5.73%) and undiagnosed, 10 (28.57%). The mortality occurred in 5 cases with a rate of 14.28%.Conclusion: The most common cause of FUO in our region was infectious diseases and Kala-azar was the main cause of FUO.

Introduction: Although low back pain (LBP) is a universal problem, local factors in different societies can affect it. This study was conducted to investigate risk factors of LBP among patients referred to Kermanshah hospitals.Materials and Methods: A validated questionnaire was used for collecting patients' characteristics and anthropometric data to identify risk factors. 604 people who referred to clinics with LBP were selected to take part and the same number complaining of other medical illness excluding LBP was matched as control group.Results: 53.7% of LBP and 52.7% of the control group were male. Mean age (y), height (cm), weight (kg), body mass index (kg/m2) in LBP and control groups were 42.6±14.63 & 42.57±14.54, 166.34±9.14 & 166.18±9.28, 68.54±21.71 & 67.96±12.34, 25.1±0.44 & 25.2±0.46 respectively.Most of the subjects in the both groups were housekeepers and illiterate.In LBP and control groups 91.3% & 91.5% bent over more than five times a day, 77.9% & 75.8% had more than one hour sedentary standing, 69.8% & 71.0% had been carrying heavy objects (more than 12 kg), 39.1% and 41.3% had been sitting more than 2 hours continuously, 13.4% & 14.4% had been driving more than one hour a day, 21.3%, 19.7% were smokers, 15.4% & 15.7% had a history of sport activities.Conclusion: Unlike some similar studies, in this study no significant association was found between these risk factors and LBP incidence. Further longitudinal studies are necessary to establish these risk factors.

Introduction: Continuous Nursing Education (CNE) is considered as a means of proper reply to the rapid changes in health care delivery and promoting professional standards of current practice among nurses. Professionals in CNE believe that CNE programs must be community-based but this need assessment had not been carrid out for nurses. This study was conducted to investigate the nurses' opinion about CNE, and to determine the educational resources as well as nurses' educational needs.Materials and Methods: This descriptive cross sectional study was conducted on the nursing units in Kermanshah in 2003. The members of target population were 100 nurses who provided direct patients care in their units. The data were collected by an approved questionnaire which consisted of demographic information and questions regarding the objectives of the study. The responses were measured by a single-item Likert Scale. The data were analyzed by using descriptive statistics.Results: 100 subjects were studied, in which 37% were male and 63% were female. They had at least ten years working experience with manage of 34.15±5.3 years. 36% of them were single and 64% were married. They spent not only more than 48 hours in continuous nursing education in the past two years, but also 5.9 hours monthly. 65% of them used textbooks, and 68% participated in conferences to meet the immediate learning needs.On the whole, the motivation for their participation, obstacles in continuous nursing education and need for these educational programmers were important from their viewpoints.Conclusion: Providing the best value for continuous nursing education is an important subject. In order to increase nurses' motivation and to minimize the obstacles, we should improve this educational programme by increasing their number in hospitals, decreasing the workload, participating in continuous nursing education programmers and giving special time for these programmes.

Introduction: Menopause is one of the critical stages in a woman's life that can influence their health during middle age. Taking into account the prevalence of depression as a psychological problem during menopausal period, this study was conducted to determine the prevalence of depression and its relative factors in different stages of menopause in women residing in Kermanshah city, 2003.Materials and Methods: This descriptive study was conducted on 460 women aged between 40-60. Individual and social characteristics and their depression were assessed by Beck Depression Inventory Scale. Individuals with BDI scores of more than 16 were considered as having clinical depression.Results: The mean age of subjects was 47.3±5.9. 39% of subjects were perimenopause, 33% were postmenopause and 28% were perimenopause. 32.2% were depressed, and the most prevalence of depression (39.3%) was seen in perimenopausal women and the least prevalence (21.6%) was seen in perimenopausal ones (p<0.001).Conclusion: The prevalence of depression in middle aged women in the perimenopausal period was more than of other stages and most of the variables of menopause had significant correlation with depression. With respect to the results of this research, depression is an important problem in middle aged women in this area and with regard to the effects of depression, researchers recommend an analytic study to determine the role of the most important factors and consequently an experimental study to reduce its prevalence.

Introduction: Heterotype pregnancy has been defined as coexistence of intrauterine and ectopic pregnancy. Coexistence of intrauterine and ovarian pregnancy is rare and often occurs in women who use Intra-Uterine Device (IUD) or women under assisted reproductive technology. We report a case who presented abdominal pain and an adenexal mass in ultrasound scanning. Post-operative diagnosis was coexistence of intrauterine and ovarian pregnancy.Case Report: The paitent was a 29 year old woman G4P3 who presented abdominal pain, nausea, vomiting and afour months history of menstrural cessassion and a two months history of spotting. On physical examination, her uterus was in approximatly the 18th week stage of pregnancy. There was obvious tenderness in LLQ. A firm mass estimated to be about 3 cm was palpable. In clinical and para clinical evaluations she had 17 week intrauterine pregnancy and a left adenexal mass with 7.5 week pregnancy sac without heart bit. Post-operative pathological examination revealed heterotype pregnancy with ovarian pregnancy.Discussion: Heterotype pregnancy is rare and the vast majority of cases are a coexistence of tubal and intra-uterine pregnancy. Coexistence of intrauterine and ovarian pregnancy is very rare. Probably, the predisposing factor in this patient was the use of IUD. Recently, this has been reported frequently in cases of ovarian heterotype pregnancy. In this patient, ovarian tissue was seen around the pregnancy sac. The most common symptom is abdominal pain followed by delay in menstruation cycle and spotting. Diagnosis of ovarian pregnancy accompanied by intra-uterine pregnancy is difficult. In this situation serial measurnient of hcG is not useful, since the intra-uterine pregnancy causes appropriate rise in hcG concentration. On the other hand, ultrasonography may show false negative results in the detection of ectopic pregnancy or make incorrect diagnosis of corpus louteum cyst.