Journal of Kermanshah University of Medical Sciences
Year:2009 | Volume:13 | Issue:2 (41)|Papers Count:15

Background: This study compares the efficacy of Fluoxetine (serotonin-selective reuptake inhibitors-SSRI) with Doxepin (tricyclic antidepressants –TCAs- antihistaminic) in treatment of irritable bowel syndrome (IBS).Methods: This randomized clinical trail recruited 200 patients who had referred to Kermanshah Imam Reza Hospital during the period 1385 -1386. All the patients had been diagnosed with IBS bases on Rome II criteria of IBS and were randomized into two groups. The patients were then received treatment with anti - depresants Fluoxetine (20mg /day) in one group and Doxepin (20mg/ day) in the other group for 12 weeks. In order to compare the quantitative variables, we used leven and t-test. Chi-2 test was used for qualitative variables.Results: There was no statistically significant difference between mean age in Fluoxetine group (37±98 years) and Doxipin group (37±02 years). The number of males in Fluoxitine and Doxipin groups was 40 and 42 respectively, which indicated no difference. Doxipin proved more effective on bloating, decreaing stool consistency, need for urgency and incomplete evacuation than Fluoxetine. On the other hand, the effect of Fluoxetin on abdominal pain and increasing of defecation was greater than Doxipin (p<0.05).The figure for positive response to improvement of 50% was 67% and 52% for Doxipin and Fluoxetine groups respectively (p<0.022).Conclusion: Our results indicated higher efficacy of Doxipin, the new TCA generation, in reducing most symptoms in patients with IBS, making it the recommended anti-depressant in treating IBS with no constipation.

Background: Intramuscular injection is one of the effective methods of drug administration. Yet the procedure is painful and avoided if at all possible. This study examines the effectiveness of simultaneous rhythmic breathing and Z – track method in prone position with foot internal rotation on reducing the pain of intramuscular injection.Methods: This quasi experimental (before and after) study included 100 patients who had intramuscular injection of Metocarbamol. Standard method was evaluated against the combination of rhythmic breathing and Z – track method in prone position with foot internal rotation. Pain intensity was measured before and after intervention using visual analog scale (VAS).Descriptive statistic was used for demographic information. Means were compared on paired T-test. Results: While before the intervention, 57% and 43% of the patients had severe and very severe pain respectively, after the intervention 24% of the patients experienced a mild pain with 67% reporting a moderate one. In addition, a statically significant difference was observed between the pain intensity means before and after intervention (p<0.0001).Conclusion: Based on the results, simultaneous rhythmic breathing and Z – track method in prone position with foot internal rotation could reduce the pain associated with intramuscular injection of Metacarbamol.

Background: Osteopenia is common problem in premature infants. Low - birth weight babies do not receive adequate amounts of calcium and phosphorus through breast feeding. This study examines the effect of calcium and phosphorus supplements on osteopenia in premature infants.Methods: This clinical trial included 42 premature infants hospitalized at Razi Hospital in Kermanshah. All the babies had a birth weight of less than 1800 grams. They were assigned into two groups of control and case. While babies in the control group received only breast milk, calcium (80mg/kg/day) and phosphorus (40mg/kg/day) were added to the breast milk for the infants in the other group. All the infants received a daily supplement of 400 iu vitamin D. Anthropometric measurements, serum calcium, phosphorus, and alkaline phosphatase concentration were examined once at the beginning of the study and then every two weeks until week 6. At the end of the period, wrist x – ray was administered for all the infants. Data were then analyzed using t-student and chi square.Results: Radiographic criteria did not indicate any signs of osteopenia. Yet a significantly higher serum alkaline phosphatase concentration was revealed through biochemical analysis in control group (p=0.001). Anthropometric measurements showed improvements in height, weight and head circumference for the two groups.Conclusion: Treatment with calcium and phosphorus supplements was associated with a decrease in serum alkaline phosphatase concentration which is an indication of osteopenia. However the treatment did not reduce incidence of osteopenia in premature infants.

Background: oxytocin infusion is used for induction or augmentation of labor to prevent prolonged labor. A cheap and nonaggressive alternative which is effectively used for contraction stress test is nipple stimulation. However research regarding its efficacy and safety is still limited. This study aims to compare the effectiveness of nipple stimulation and oxytocin infusion on the duration of phases of labor.Methods: This randomized clinical trial included 132 low - risk pregnant women admitted to Asali Hospital in 2006-2007. Those having poor contractions in active phase of labor were randomly assigned into two groups of nipple stimulation and oxytocin infusion. Women in the nipple stimulation group had their nipples messaged by hands moving in circle and using lubricant gel. The oxytocin infusion was started at 0.25 mIU/min for the oxytocin infusion group. Data collection was carried out through observation, examination and interviews. Data were analyzed using statistical tests, repeated measure test, independent T test, and spss software SPSS.Results: The mean duration active phase of labor for the nipple stimulation group was 203.48±104.90 compared to 191.75±79.01 of the oxytocin infusion group, indicating no statistically significant difference (p=0.470) on this. The same thing applied to the second and the third stage of labor between the two groups (p=0.092, p=0.872).Conclusion: Our findings showed that nipple stimulation is a safe effective technique to induce or augment labor. Future studies are recommended for further investigations.

Background: Automobile manufacturing industries are considered among the main sites where accidents are likely to happen. From a cognitive point of view, stress can cause problems such as poor concentration, absent - mindedness, and hesitancy while making decisions. This study examines the relationship between job stress and occupational accidents in an automobile manufacturing company.Methods: For this descriptive – analytic study, the psychological stress of the occupational groups was measured using standard job stress questionnaire. Safety Behavior Sampling (SBS) technique was used to collect samples of dangerous behaviors. Data were then analyzed using descriptive statistic, ANOVA, Pearson Correlation Coefficient and logistic regression tests.Results: Based on our results 88% of the sample suffered from a high level of occupational stress. There was also a statistically significant correlation between level of stress and number of accidents experienced by an individual. (P<0.05).Conclusion: Having considered the relationship between occupational stress and work-related accidents, minimizing or eliminating risk factors needs to be carried out through developing occupational stress management programs as well as following safety measures through reinforcing principles of safe behavior at all levels of organization.

Background: With the ever increasing incidence of coronary artery disease, its detection in particular through visual system becomes important. This study examines the relationship between corneal arcus and coronary risk factors such as cholesterol, triglycerid and fasting blood sugar.Methods: For this cross - sectional study, 265 participants all aged over 30 years were randomly selected from the patients who referred to a clinic over the first three months of 2004. Cholesterol, triglycerid and fasting blood sugar level was tested. Severity of corneal arcus was determined. The data were then analyzed using ANOVA and chi square test with %95 confidence interval.Results: Our results showed that the frequency and severity of corneal arcus were positively correlated with age (P=0.041) and the condition was more prevalent in males (P=0.001). There was a statistically significant difference between mean of cholesterol and blood sugar level and how severe corneal arcus (cholesterol P=0.004, blood sugar P=0.04). But the condition was not related to the triglyceride level (P=0.268).Conclusion: Corneal arcus picked up in eye exams can aid detection of coronary artery disease as the condition is related to other health problems such as high cholesterol and high fasting blood sugar level.

Background: Annual report of Cutaneous Leishmaniasis (CL) is around 20-40 per 100000 and the numbers are on the rise. One of the areas where significant numbers of people are diagnosed with the condition is the Iranian province of Kermanshah. This is the result of the unique ecology of the region, having the endemic focus in its warm areas. We decided to examine the epidemiological factors of CL in this province.Methods: This is an analytic-descriptive study of CL patients who had medical records filed in different health centers in Kermanshah over the period 2001-2006. All sample slides were stained with Giemsa and examined by light microscope.Results: Overall 727 cases were studied. The prevalence came out at 0.0387 percent which was 2.12 times higher in males compared to females. Most patients were aged 20 to 29. The highest seasonal prevalence for the condition scored for the fall at 35%. 32.5% of the patients had a history of traveling to endemic areas. The majority of the patients (54.4%) had a single lesion.Conclusion: Our results showed that epidemiological factors such as age, sex, season and traveling to endemic areas had influenced the prevalence of cutaneous leishmaniasis in this province. The information not only reflects the current status of CL in Kermanshah but also can be used to develop and later assess preventional and treatment programs.

Background: There is no doubt that improving quality in medical education is based on analysis of the current situation. Medical students are considered one of the best resources whose viewpoints on the educational shortcomings can provide valuable information on where there is still work to be done. This study presents the students perspective on the eeducational problems in Medical School of Kermanshah University of Medical Sciences in 2007.Methods: This phenomenological qualitative study included 24 medical students who were at different stages of medical training. Group discussions were held and students were interviewed over several sessions. All the sessions were tape recorded and transcribed by the 3 assistants. Information was then categorized in terms of three areas of basic sciences, traineeship and internship.Results: The most important problems were cited under the categories of educational objectives, planning, management, ethics and evaluation by the students. Among subcategories, offering specialty and subspecialty materials, the gap between basic sciences and traineeship, lack of motivation and lack of supervision on education were rated as the most important factors causing concern among the students.Conclusion: The results of the study have revealed a series of problems that require measures at the national level including the shortage of high – quality academic staff. However, most issues can be addressed through careful planning on the part of university officials and academic staffs.

Background: Research has indicated that while regular participation in sport can be associated with enhanced physical and emotional well-being it could also result in psychological disorders. This study aimed to determine the status of psychological well-being of physical education students of Razi University of Keramnshah.Methods: For the purpose of this descriptive cross-sectional study, 176 students (102 males and 74 females) were randomly recruited from all the students of department of physical education. The data collection instrument was a questionnaire with two parts: A- demographic information. B- The general health questionnaire (GHQ) which contained 28 questions. The data was then analyzed using descriptive statistics (frequency, central tendency, and standard deviation) as well as referential statistics (independent t test).Results: Based on the results, 47.2 percent of those sampled were suspicious of having psychological disorders. Males and females were almost the same in terms of the intensity of the problems.Conclusion: Based on our results, we recommend that physical education students have the option of selecting fewer physically demanding units for a given semester provided the course outline is organized in a way to allow students to enjoy the less intense units at the same time. To reduce psychological pressure and improve their general well-being, students should be encouraged to get professional support from mental health facilities such as counseling services and participate in mental health workshops.

Background: Failure in the development of diaphragm leaves a posterolateral defect known as bochdalek hernia .This anomaly is observed on the left side in 80-90 percent of the cases. Incomplete development of the posterior diaphragm causes the abdominal viscera to move to the chest cavity, causing the lung to become hypoplastic at the affected side. Ectopic kidneys are mainly located within the pelvic. However rare cases of thoracic kidney have also been reported.Case report: The patient was a 2-month-old infant admitted to the pediatric ward in Kermanshah Imam Reza Hospital .Chest X-ray and chest sonography revealed a right – sided diaphragmatic hernia with ectopic kidney within the right thorax. The patient underwent a surgery. It was a success and the patient was released from the hospital.Conclusion: Although thoracic kidney is a rare condition specifically when it is with diaphragmatic hernia, it could be diagnosed with before and after surgery investigations. This condition can be fixed with necessary manoeuvres and mobilization of vascular pediculus when the defect of diaphragm is removed.