Journal of Shahid Sadoughi University of Medical Sciences
Year:2010 | Volume:18 | Issue:2 (70)|Papers Count:18

Introduction: Cerebrovascular disorders are the third leading cause of death in individuals over the age of 50; mental disorders of this origin are reported in up to 50 and even 78 percent of patients. The global goal of this study was to assess mental disorders of stroke patients. Methods: In a cross-sectional study, 100 consecutive stroke patients in the neurology clinic of Rasool hospital were evaluated by accidental sampling and use of Neuropsychotic Inventory (NPI). Data was analyzed using Chi square and t-test. Results: 37 men and 63 women with mean age of 62.5 years were assessed over 1 to 12 months after their stroke. The results of Chi square suggested men patients had higher frequency in subscales of delusion, aphaty, disinhibition and sleep disorders and women patients in subscale of anxiety. The results of t-test reported that there was a correlation between right hemisphere lesions and euphory. Conclusion: Depression, anxiety and aggression were the most common mental disorders after stroke, respectively.

Introduction: Corrosive gastroesophagitis is one of the major problems in surgery and though multidiciplinary approach is used in these patients, prognosis of such patient is poor. In this retrospective study we selected patients with corrosive gastroesophagitis who had referred to Loqman hospital in the last decade and the results of treatment were analyzed. Methods: We analyzed patients with corrosive gastroesophagitis who had referred to Loqman hospital in the last decade retrospectively. Factors included age, sex, grade, substance use, surgery option and results of endoscopy. Results: In this study, 88 patients were evaluated. Most of the patients were men (64%) in the 31-40 years age group and the most common substance involved was acid (42%), cleaning (25%) and alkaline (15%) solutions. Mortality on the base of grading was: grade I= 0%, grade II = 8.5% and grade III= 64%. Endoscopy results in operated group were as follows: 48% ulcer and 26% stricture, while in the non operated group 7% had ulcers and 46% strictures. Mortality was 59% in the operated group and 80% in the non operated group. But all grade III patients had dysphagia. Conclusion: In grade II corrosive esophagitis, gastritis surgery is the best option for decreasing morbidity, but in grade III patients, surgery has a very poor prognosis.

Introduction: Multiple sclerosis is a chronic, progressive and degenerative myelin sheath disease of the central nervous system. It frequently occurs in young people in the productive stage of life who are solicitous about their role and family responsibilities. One of the treatment and vigilance intervention index in improvement of chronic illness is quality of life. The objective of the implementation of this study was to assess the effect of Orem self- care program on physical quality of life in multiple sclerosis patients. Methods: This study was a quasi-experimental researches on 70 multiple sclerosis patients’ who were randomly allocated to experimental or control group (35 patients in each group). The experimental group was treated with self-care program based on Orem self-care frame work and compared with the control group. Data was analyzed using presumption statistics. Results: T test showed that there was no significant difference in the physical quality of life score before intervention in the two groups (P=0.33, T=-0.69), while after intervention, the same test indicated a significant difference between the two groups (P=0.001, T=14.42). Pair t test showed significant difference in experimental group before and after self care program (P=0.001, T=-14.20), whereas the same test showed no significant difference in the control group (P= 0.95, T= -0.06). Conclusion: According to the study result, self care program based on the Orem frame work can have an effect on the physical quality of life in multiple sclerosis patients. Therefore, if a program is designed on the basis of educational needs and the “Orem self- care model” approach, it can be effective for enhancing the multiple sclerosis patients physical quality of life, and it can be recommended as a nursing interventional program. This intervention is safe, inexpensive and complementary that can be used to support multiple sclerosis patients in treatment centers.

Introduction: Organization culture explains the characteristic of any organization. Organization culture includes values, standards and portrays behavior of members of that organization. Considering the pivotal role which is played by human resources and also the cost borne by these human sources, any kind of neglection on part of management can be drastic. Methods: This cross-sectional study included 95 employees of Yazd health care institutions. Data collection was through a questionnaire based on 10 dimensions and 44 indicators about organizational culture in EFQM environment. Results: The situation regarding organizational culture dimensions was not appropriate from viewpoint of EFQM in any of the health care institutions. Conclusions: Spurred by impressive results in other industries, this compelling and logical approach has begun to penetrate the thinking of health care accrediting agencies, business coalitions, private foundations and leading health care organizations. In this case, making some potential situations and using the study results of improvement of organizational culture can develop environmental situations for employee’s promotion and firm growth.

Introduction: Natural killer T (NKT) cells are a subset of lymphocytes that express some NK cells properties. NKT cells have a regulatory role in immune responses. Little is known about the potential role of NKT cells in human infectious diseases. The goal of the present study was determination of frequency of Va24Vb11 and CD3CD56 NKT cells in tuberculosis patients. Methods: According to our criteria, three groups were selected for our study: 30 healthy PPD positive skin test reactors, 30 healthy PPD negative skin test reactors, 30 new case active TB patients and 25 Multi-drug resistance Tuberculosis (MDRTB) patients. Frequency of Va24Vb11 and CD3CD56 NKT cells in fresh peripheral blood was determined by Flow cytometry. Results: Frequency of Va24Vb11 NKT cells in the new case TB and MDRTB patients as compared to PPD positive healthy donors was significantly decreased (P<0.05), whereas CD3CD56 NKT cell numbers were similar in all groups. Conclusion: According to our results decrease in frequency of Va24Vb11 NKT cells may be related to insufficient immune responses to mycobacterium tuberculosis infection, especially in MDRTB patients.

Introduction: Survivin is a new member of the Inhibitor Apotosis Protein family (IAP) which plays an important role in the regulation of both cell cycle and apoptosis. Its distinct expression in tumor cells as compared to normal adult cells introduces Survivin as the fourth transcriptom demonstrated in tumors. Breast cancer is the most common malignancy among women and scientist`s efforts to classify it has lead to various molecular subtypes and controversial results. Because of the high prevalence of these tumors and lack of suitable molecular markers for diagnosis and prognosis, there are ongoing efforts to find molecular markers which can distinguish nontumoral from tumor tissues. In this study we evaluate the potential usefulness of Survivin and its splice variants DEx3, 2b and 3b as molecular markers in breast cancer. Methods: We studied 18 tumor and 17 non tumor adjacent tissues. Transcription levels were measured by Semiquantitative Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR) and normalized by b2m as an internal control. Results: 1)Survivin and its splice variants; Dex3, 2b and 3b showed differentially higher expression levels in tumors than adjacent normal tissues. 2) The expression levels of Survivin, Survivin-DEx3 and Survivin-3b were significantly correlated with the type of tumors. 3) Survivin-2b was expressed in a few samples. 4) Survivin-3b was detected only in tumor samples. Also, our results showed that DEx3 variant can be introduced as a dominant expressed variant in breast cancer. Conclusion: Our data indicated that the expression of Survivin, Survivin DEx3 and especially, Survivin-3b were correlated with cancerous nature of tumors and Survivin-DEx3 was the most common expressed variant in breast carcinomas. These results besides confirming the potential usefulness of Survivin and its splice variants as molecular markers in breast cancer, demonstrated the role of the gene and its splice variants, especially 3b in these lesions that enables distinguishing normal from tumor tissues. Therefore, evaluation of the expression of Survivin and its splice variants might be used as markers to stratify breast cancer patients for more optimal treatment modalities or it could be a promising new target for therapy.

Introduction: Bone marrow transplantation is one of the treatment modalities in many hematologic disorders. In recent years, bone marrow transplantation is increasingly being delivered in the outpatient setting. Some studies suggest that outpatient transplantation has many advantages. The aim of this study was to compare the quality of life in outpatient and inpatient multiple myeloma patients after bone marrow transplantation. Methods: This research was a descriptive, comparative study. The quality of life of 35 multiple myeloma patients who had undergone bone marrow transplantation (20 outpatient and 15 inpatient) was assessed. An EORTC QLQ_C30 questionnaire was used for data collection. The questionnaire was completed on three occasions (before transplantation, 45 day after BMT and 90 day after BMT). Descriptive (mean, SD) and inferential statistics (Paired T Test, ANOVA Repeated Measures) were used for data analysis. Results: Comparison of quality of life between inpatient and outpatient settings indicated that quality of life of outpatient group was significantly better than inpatient group in certain aspects including all functional scales, all symptom scales, physical functioning, nausea and vomiting, fatigue, role functioning and appetite loss, and after a period of 90 days after transplantation, there was a significant increase in quality of life of the members of the inpatient group with regards to social functioning (p=0.001), dyspnoea (p=0.05), insomnia(p<0.001) and diarrhea (p=0.07). Conclusion: Although both transplantation methods have their own advantages, but considering the point that outpatient setting results in betterment of quality of life in certain aspects, it is advisable that patients should undergo bone marrow transplantation in an outpatient setting.

Introduction: The mitochondrial defects in Friedreich ataxia (FRDA) have been reported in many researches. Friedreich ataxia is an autosomal recessive neurodegenerative disorder caused by decreased expression of the Frataxin protein. Frataxin deficiency leads to excessive free radical production and dysfunction of respiratory chain complexes. Mitochondrial DNA (mtDNA) could be considered as a candidate modifier factor for FRDA disease. It prompted us to focus on the mtDNA and monitor the nucleotide changes of genome which are probably the cause of respiratory chain defects and reduced ATP generation. Methods: We searched the mitochondrial NADH dehydroganase I (ND1) gene by PCR-TTGE and DNA fragments showing abnormal banding patterns were sequenced for the identification of exact mutations. Results: In 20 patients, we detected 3 mtDNA mutations which is novel in Friedreich ataxia. T4216C mutation results in conversion of Tyrosine to Histidine in 313 amino acid locations in ND1 and bioinformatics studies show that ND1 protein loses sixth intramembrane α chain. Conclusion: Our results showed that ND1 gene mutations in FRDA samples are higher than normal controls (P<0.001). It is possible that mutations in mtDNA could constitute a predisposing factor in combination with environmental risk factors that could affect the age of onset and rate of disease progression.

Introduction: Epileptic patients have special mental profile and experience emotional and psychopathological problems. Some studies have reported that epilepsy and psychopathology occur together. The aim of this study was to evaluate the mental profile of Complex partial seizure (CPS) and Grandmal seizure (GMS) patients and compare them with the control group. Methods: This descriptive-analytical study was carried out in 2008 at the neurological clinics of Isfahan and included 40 Patients with CPS and GMS epilepsy selected conveniently and control group included relatives of the patients. Psychological and personality profile was measured with MMPI inventory. The obtained data was analyzed with SPSS software, mainly through the analysis of Chi Square and ANOVA. Results: The findings of this research showed that although the scores of clinical scales in MMPI are higher than control group, this psychopathology isn’t abnormal. Epileptic patients in hypochondria, depression and hysteria had more elevated levels in comparison with the control group, but this difference was significant only in CPS patients. Conclusion: The results showed that epileptic patients tend to have more psychological disorders than normal people. These findings emphasize the necessity for psychological treatment along with drug therapy.

Introduction: Clinical findings affecting disability in stroke patients are important as presence of these factors determines the prognosis and future course of these patients. Methods: Consecutive stroke patients admitted at Ghaem hospital, Mashhad were enrolled in this prospective study in 2008. Hemihyposthesia, hemianesthesia, hemineglect and homonymous hemianopsia was evaluated in these patients. Disability score was based on the Modified Ranking Disability Score (MRDS), 72 hours post stroke. Mean of MRDS was analyzed by T test and Fisher tests and p<0.05 was considered as significant. Results: A total of 329 stroke patients were investigated. Hemihyposthesia, hemianesthesia, hemineglect and homonymous hemianopsia was found in 37.4%, 13.8%, 7.9% and 7.3% of the patients, respectively. MRDS was significantly higher in patients with hemianesthesia as compared to other stroke patients, (p<0.001). MRDS of patients with hemihypoestheisa, hemineglect and homonyous hemianopsia was not significantly different than patients without these abnormalities (p=0.44, p=023 and p=0.83). Patients with triad of hemianesthesia, hemineglect and homonymous hemianopsia had significantly higher MRDS than others (p<0.001). Conclusion: Hemianesthesia is a clinical factor affecting sensory disability in cerebral stroke patients. Presence of the above triad could increase MRDS in these patients.

Introduction: Smoking approval by friends and teachers seems to increase the probability of smoking by the students. This study aimed to determine whether adolescent smoking is associated with teachers or other students smoking, after controlling for confounders. Methods: A sample of the 3rd grade students of Tehran's high schools were asked to complete a 21 item questionnaire, including demographic and smoking habits. The comparisons of adolescent smoking pattern between two sexes and also smoking frequency of the family members, best friends and teachers between the smoking and non-smoking students, were performed. Furthermore, the association between smoking behavior and exposure to teachers smoking were assessed by a multivariate logistic regression analysis, adjusted for sex, parental, best friends, and sibling smoking. Odds Ratios were estimated. Results: Among the 4591 students (aged 17-19, mean 17.53±0.59 years), including 2092 boys (45.6%) and girls, 250 boys (12.1%) and 131 girls (5.3%) were current smokers (p=0.001). The proportion of smoker and non-smoker students who have been exposed to teachers smoking inside the school building were 55.7% (209) and 29.3% (1191) respectively (p=0.001). The 220 (58.7%) exposed students to outdoors teachers smoking (on school premises) were smoker while 1205 (29.2%) were non-smoker (p=0.001). By adjustment of the parameters, adolescent exposure to best friend smoking and to teachers smoking on school premises was significantly associated with current smoking. Conclusion: Teachers smoking during school hours and best friend smoking are the two important determinants to be considered in any project aiming to establish tobacco-free schools.

Introduction: Cancer is a disease that is determined by unnatural deformation and differentiation of cells. Cancer patients face psychosocial and physical problems that may have an impact on the patient's quality of life .The purpose of this study was to investigate the relationship between mental health and quality of life in cancer patients. Methods: This study was a correlational research. In this study, 90patients referred to Shefa hospital in Ahvaz were selected through convenient sampling in 2008. Data was collected by General Health Questionnaire and short form quality of life questionnaire (Sf-36) and analyzed using Spearman's correlation, t-test and ANOVAs test. Results: The results showed that most domains in quality of life were correlated with mental health domains. General health perception and physical function domains were correlated significantly with 3 domains of mental health anxiety, social function and depression. Somatoform symptoms were correlated significantly with mental health domain of quality of life (P<0.02). Finally, social function was correlated significantly with social dysfunction domain of life quality (P<0.05). Also, anxiety and somatoform domains of mental health had a more significant relationship in women than men (P=0.006 and P=0.025). From the quality of life domain, physical function had a more significant relationship in men than women (P=0.03), while bodily pain had a more significant relationship in women than men (P=0.001). Conclusion: According to the findings, many quality of life domains were correlated with mental health domains and cancer had an effect on various aspects of patient's life.

Introduction: Annually, more than 14 million people are reported to be infected with Leishmaniasis all over the world. In Iran, this disease is seen in the form of cutaneous and visceral leishmaniasis, of which the cutaneous form is more wide spread. In recent years, cutaneous leishmaniaisis is diagnosed by PCR utilizing specific primers in order to amplify different parasite genes including ribosomal RNA genes, kinetoplast DNA or tandem repeating sequences. The aim of this research was to detect early stage cutaneous leishmaniasis using Multiplex-PCR technique. Methods: In this study, 67 samples were prepared from patients with cutaneous leishmaniasis. DNA was extracted with phenolchloroform. Each specimen was analyzed using two different pairs of PCR primers. The sensitivity of each PCR was optimized on pure Leishmania DNA prior to use for diagnosis. Two standard parasites L. major and L. tropica were used as positive control. Results: DNA amplification fragments were two 115 bp and 683 bp for AB and UL primers, respectively. The sensitivity of two primers was not equal for detection of L. major and L. tropica. The sensivity of PCR with AB primer was 35 cells, while that for UL primer was 40 cells. Conclusion: The results of this study indicate that PCR is a sensitive diagnostic assay for cutaneous leishmaniasis and could be employed as the new standard for routine diagnosis when species identification is not required. However, the ability to identify species is especially important in prognosis of the disease and in deciding appropriate therapy, especially in regions where more than one type of species and disease are seen by clinicians.