JOURNAL OF GUILAN UNIVERSITY OF MEDICAL SCIENCES
Year:2003 | Volume:12 | Issue:47|Papers Count:13

Introduction: Recurrent spontaneous abortion and fetal loss are common in obstetrics and gynecology (60% of pregnancy loss). Immunological factor probably have a major role in this problem. Recent studies suggested an association between Antiphospholipid antibodies, especially Anticardiolipin antibodies (aCL) with recurrent abortion. Different studies report different association (5-51%). Objective: we determine the prevalence af aCL in recurrent abortion in Sari during 2000-2003. Materials and methods: In a descriptive study, women with a history of at least two abortions without any known etiology like hormonal Imbalance, systemic hypertension, diabetes, infection, hyperthyroidism and, anatomical abnormality in genital tract were studied. 512 cases, serum were investigated for presence of aZL in serum.The patient sera were tested by Enzyme linked immunoadsorbent assay (ELISA) method. Commercial standard ELISA kit from GENESIS Company were used according to kit instruction manual (>13 m/ml aCL considered as positive and 11Results: 512 women with age range of 18-40 (28.02±5.66) were studied. aCL was detected in sera of 57 (11.1%) cases, with confidence interval of 2.7 (11.1±2.7). 447 (87/4%) cases were negative for aCL and in 8 (1.5%) were intermediate.49.1 of pregnancy loss with positive aCL were in first trimester of pregnancy and 50.9 in second and third trimester with odd ratio of 3.1.Conclusion: The prevalence of aCL in recurrent abortion and fetal loss in Sari- City are not high and it is mostly positive in second and third trimester.

Introduction: Peroxides is a glycoprotein that contains hem group and variable cationic and anionic is enzymes. This enzyme is used in laboratory diagnosis for determination of hormones and bacterial toxins with ELISA method, detection of tissue antigens and macrophage activation against tumoral cells. In addition, this enzyme is used for measurement of glucose, urea, uric acid and cholesterol. Although peroxides is widely seen in available sources of plants, this enzyme for meeting the consuming needs of our country is imported from abroad with high foreign currency costs.Objective: This experimental study was conducted for separation and purification of peroxides is enzymes from cultivated radish which is cheap and abundant in all seasons in Iran.Materials and Methods: Extraction was carried out by homogenization of plant roots and concentration of Ammonium sulfate. Then, purification method was followed by gel filtration, cationic exchange chromatography. Finally, separation of basic and acidic is enzymes were conducted by different and repeated column chromatography and SDS-PAGE.Results: As a result of these procedures, Purification degree obtained was 168.5 folds more than the raw extract and specific activity was comparable with commercial peroxides.Conclusion: As this enzyme is stable at wide range of PH and temperature, we can economize its purification methods to a great extent and achieve the maximum required foreign currency savings. It is hoped that with the use of wide and cheap sources, we can take an effective step toward large scale production of the enzyme in our country and avoid spending our financial resources in purchasing peroxides from foreign countries.

Introduction: Patients with chronic renal disease are faced with numerous problems and complications. And it affects all aspects of patients life and eventually the quality of it.Objective: This comparative - descriptive study was conducted to compare dialysis patients Quality of Life from patients and nurses perception admitted to Razi Educational Dialysis Center in 2002. Materials and Methods: The sample chosen by survey, consisted of 18 nurses and 126 patients undergoing hemodialysis. The data collection instrument included demographic characteristics and three scales of QOL (Contrils Self - Anchoring Striving Scale, Index of well-being, and Time - T Trade - Off Health State Utility Score). Descriptive - analytical statistics (Independent T - test, Analysis variance and Pearson s correlation test) were used for data analysis. Results: The results from patient's perception showed a significant relationship between their QOL and level of education and income in all three scales. In addition a significant relationship b/w their QOL and place of living (P<0.03) and occupation (P<0.005) in index of well- being scale and between age (P<0.003) and place of living (P<0.001) in Cantrells Self- anchoring striving scale was shown and it indicated that the independent variable of QOL is positively correlated with dependent variables of occupation, number of children, predisposing diseases.The results from nurses perceptions of patients QOL indicated a significant relationship with sex (IWB) and with marital status and work experience in hemodialysis wards (SASS). Overall in all three scales, there was a significant correlation between patients and nurses perceptions of QOL. T- test analyses showed a significant difference between the scores in both groups; in IWB (p<0.01) in SASS (P<0.02) an in TTO (p<0.005). Patients' perception of their QOL is lower than nurses' perception of patients QOL.Conclusion: Identifying the difference between nurses and patients perception on QOL is important in care planning and intervention and it also helps nursing managers to assess the quality of nursing care provided to these patients.

Introduction: The postoperative complications of a subcutaneous hematoma, seruma, or infection often delay hospital discharge and require interceptive techniques that include evacuation, debridement and restoration of damaged tissue. Closure of the dead space in subcutaneous tissues is one of the methods to minimize wound infection after cesarean delivery. Objective: The purpose of this study was to compare the role of subcutaneous tissue closure with its non- closure of wound in infection after cesarean delivery.Materials and Methods: The present study is a prospective randomized clinical trial. It assessed the risk of wound infection in females undergoing an elective or emergency cesarean section. Research population was 336 pregnant women who were divided randomly into two equal groups for closure or non- closure of subcutaneous tissue during the cesarean section. All women were given prophylactic antibiotics routinely. Outcome under study in present research was wound infection, which was diagnosed by emergence of signs such as discharge, swelling, tenderness, redness hardness of excision spots. Chi- square test and SPSS.9 software was used for assessment of the data. Results: Findings of this study indicated that there were no significant differences between the two groups in terms of demographic, obstetric and surgical characteristics. Extents of wound infection after the cesarean section were 11.3% (no=19) in the group with closed subcutaneous tissue and 6.5% (no=11) in the group of non- closed subcutaneous tissue.Conclusion: It appears that there is no significant benefit in using a subcutaneous stitch closure in comparison with non- closure of it in cesarean section.

Introduction: puberty is the most important process in each person's life which is characterized by physical, mental and socio-emotional developmental changes. One of the physiological changes is sexual adolescence which specially in girls is associated with clear changes.Objective: The main goal of this study was to survey the knowledge, attitude and health behavior in high school girls during adolescence period. Materials and Methods: In this descriptive cross-sectional study, 375 girls who were randomly chosen from different high schools in Some Sara, were asked by a questionnaire. In this questionnaire in addition to demographic characteristics, girls knowledge, attitude and health behavior about puberty period were also surveyed.Results: The results of this research showed that %65/3 of subjects had moderate knowledge, %16/3 had positive attitude and %54/1 had poor health behavior.Conclusion: Preparing proper educational project in order to increase knowledge, positive attitude formation and health behavior promotion about puberty period for girl students who are considered would- be mothers, causes health behavior improvement and promotes the level of general health in community.

Introduction: It is estimated that four out of every five women treated for ovulatory hyper- menorrhea have no anatomic pathology, and more than one third of hysterectomies are carried out for the same symptom. The use of various medical therapeutic options for these women has potential for elimination of large number of surgeries and complications associated with them. Objective: The Objective of this research is to determine efficacy of Mefenamic Acid and Tranexamic Acid on amount of menstrual bleeding of patients with hypermenorrhea presenting to Gynecologic Clinic of Booali Hospital.Materials and Methods: Fifty patients with hypermenorhea were selected. Randomly 25 patients were managed with Tranexamic Acid and another 25 patients were managed with Mefenamic Acid during first 5 days of menstruation. Age range of patients was between 25 to 45 years old and their parity was less than 5 and their contraceptives were not OCP or IUD.Gynecologic study such as endometrial biopsy and fractional D & C were performed, if needed, to rule out organic causes.Patients suffering from other diseases such as peptic ulcer, inflammatory bowel disease, thromboembolic disease and coagulation disorders were not included in study. Efficacy of management was determined with number of pads that were used before and after management with both drugs during first 5 days of menstruation. and results were evaluated with statistical t-test method.Results: In this study, one patient from both groups was excluded because of incomplete history and continuation of the treatment. From twenty four patients in each group, seven patients from mefenamic acid group and 13 patients from Tranxamic acid responded completely to medical management, because the number of daily pads decreased to <5 sixteen patients in Mefenamic Acid group and ten patients in Tranxamic Acid responded partially because the number of daily pads decreased to 5-7. One patient in each group didn't responds to medical treatment. Conclusion: This study showed that both the mefenamic acid and tranexamic acid are effective in decreasing the menstrual blood loss and effect of tranexamic acid in decreasing the menstrual blood loss is little more than that of mefenamic acid.

Introduction: Varicose veins are a common complication people who are forced to stay on their feet for a long time because of the kind of their jobs. The nurses who work on operating rooms have to stay on their feet for a long time and without movement so as a result, this situation makes them face the lower limbs varicose veins. Objective: This research is a descriptive study determining the views of the nurses working in operating rooms of the hospitals affiliated to Kerman University of Medical Sciences about preventive actions for lower limb varicose veins. Materials and Methods: The questionnaire contained 23 questions which drew up in two sections and in order to analyze the data, central tendency, dispersion, ANOVA and the T test were used. Results: The results of this research indicate that most of the answers of personnel about their views of the individual steps for preventing lower limb varicose veins and also about the steps of some organizations for preventing the lower limb varicose veins were 48.3% and 59% respectively. Examination of the connection between nurses views about the individual steps and the demographic characteristics of the "T" test between females and males indicated a significant difference (P<0.008). Other demographic characteristics didnt show any statistically significant difference. In a comparison between the average of scores of nurses views about the organizational preventive steps and demographic characteristics according to ANOVA test between educational documents and the position showed significant difference (P<0.01) respectively (P<0.005). Demographic characteristics no statistically significant difference were seen.Conclusion: Considering these results, the necessity for increasing the personnels knowledge of how to prevent the varicose veins and also the necessity for provision enough possibilities in this field are quite felt.

Introduction: Adolescence is a period of mental and physical maturation. It is a clear period of physiological, physical, behavioral and social changes. Unfortunately, there are a few researches on health and nutritional situation of adolescent girls and boys in Iran. Objective: The present study was carried out to determine the nutritional status of anthropometrics and BMI of high school girl adolescents in urban and rural areas in Astaneh Ashrafiyeh.2000. ‏Materials and Methods: This research was a cross - sectional study on 336 girls (168 urban, 168 rural) at the ages of 14-17 with simple random sampling method. Height, weight and TSF were measured to the nearest 0/5 cm, 0/5 kg and with caliper respectively. Body Mass Index (BMI) was compared with the National Health and Nutritional Examination Survey I (NHANESI). Independent t-test, Chi Square is the statistical methods were used for data analyses.Results: Data analysis showed that means of the height, weight, BMI and TSF in urban girls were 157.5 ± 5. 1 (cm), 54.22 ±10.09 (kg), 21.77±3.53 (kg / m2) and 13.75±6.48 (mm) respectively and in rural area: 156.97±4.7 (cm), 52.62±9.03 (kg), 20.99±3.25 (kg/m2) and 12.76±5.36 (mm). Weight for Age (W/A) indexes of urban and rural girls were %7.6 and %9 below 5th centile and %2 and %0.6 upper 95th centile of NCHS respectively. Height for Age (H/A) indexes were %13.2 and %11.9 below 5th centile and %0.5 and %0.6 upper 95th centile of NCHS respectively.Conclusion: With regard to Body Mass Index (BMI) and TSF, the results of the present study showed a good nutritional status of the urban and rural girls and there wasn't any significant difference between urban and rural areas. Stunting was prevalent among the rural and urban girls. It has been suggested that implementation of nutritional education program is necessary to increase the nutritional knowledge and food diversification in adolescent girls.

Introduction: Nowadays tubal ligation (TL) is a safe method for women that its acceptability is increasing. Several methods are suggested for TL. The two major methods include: minilaparotomy and laparoscopy. Objective: The goal of this study is to compare early and late complications of tubal ligation via laparoscopy and minilaparotomy.Materials and Methods: This study is a prospective (cohort) study with one-year follow- up of 118 patients who underwent tubal ligation (TL) in Mahdiye Hospital in 1994. Patients were randomly divided into two groups, 90 patients underwent TL via minilaparotomy and 60 patients underwent TL via laparoscopy. In this study, complications of two methods were evaluated and compared. At last, statistical analysis was carried out with spss.9 software and using chi-square test.Results: There was not any complication during operation in minilaparotomy group, but in laparoscopic group, mesosalpinx rupture and hematoma were seen in one patient (P>0.05). Serosanginous or purulent secretion of incision was observed in 3 cases in minilaparotomy group (4.1%), but this early complication was not observed in laparoscopy group (P>0.05). Menstrual disorders and pelvic pain (2 cases and 1 case respectively) were observed during one-year follow up in minilaparotomy group and these complications were not observed in laparoscopic group (P>0.05).Conclusion: Considering the lack of significant difference in complications of two mentioned groups and since minilaparotomy is a more expensive procedure than the other one, it is better to apply laparoscopy for TL at more extensive levels.

Introduction: The increase of medical knowledge and technology has opened new horizons in the field of patient treatments. In this instance, use of standard equipments and resources and also application of theories for quality care are necessary in all fields of patient treatment as well as operating rooms (Ors). Objective: This study was done by a descriptive and research method to determine the existing issues and problems in operating rooms in Iran from 2001 to 2002.Materials and Methods: Data collection tool consisted of a four part questionnaire which covered problems related to infection control, or personnel performance, equipments and resources related to safety in OR and profession needs (such as promotion).The sample consisted of 100 OR personnel from 20 provinces in Iran.Results: The majority of samples (98%) did not use special gowns during infectious surgical operations and only 32% of them admitted to using various disinfectants as a means of infection control.90% of samples said that cleaning and preparing surgery sets were done by unprofessional personnel. 92% of samples didn't communicate with their patients and 100% of samples did not use protective shields for their patients.86% of samples declared there were no safety facilities against X-rays and 90% said there was no standard air conditioning.In regard to profession needs, the results indicated that for 84% of samples even planning for holding medical conferences was not carried out by managers or heads of ORs.Conclusion: Research finding indicated that the most important problems in ORs in Iran included control infection, lack of safety or structural facilities and non- fulfillment of profession needs.

Introduction: Prevalence of strabismus in general population is 5% and 90% of that is horizontal. Esotropia accounts for more than half of it. According to different etiology of strabismus that is treatable with simple glasses, association with amblyopia, cosmetic and functional compliance. Objective: We tried to do a descriptive study about frequency of different types of horizontal strabismus. Materials and Methods: In our descriptive study, patients with following criteria were selected: patients presenting to special clinic in Rasht with horizontal strabismus and under the age of 14 between 1999-2000 and in first quarter of Iranian year 1381 (2nd quarter of 2001). Eye examinations included central visual acuity, cycloplegic refraction with atropine eye drop 0.5% (every 8hours for 3 days), measurement of deviation in far (6meters), near (o.33 meter) with alternate prism & cover test and fundoscopy. If needed, glasses was prescribed and in some cases, surgery done. Then data were surveyed with a descriptive study model.Results: Total cases were 291.Of all patients, 221 cases (76%) had esotropia and 70 cases (24%) exotropia. 56% of total cases, 57% of esotropia and 54% of exotropia are females and the rest are males. Female/male ratios in total cases of esotropia and exotropia are 1.31 and 1.16 respectively. The most common esotropia types are refractive accommodative (30%), partially accommodative (27.7%) & congenital (19.7%). The most common exotropia types are basic (47%), simulated divergence excess (17%) and sensory (12%). 11% of all cases had A, V pattern. 35% of esotropia and 25% of exotropia had amblyopia.Conclusion: This study indicated that refractive accommodative esotropia is the most common type and wearing glasses at low ages can reduce the amount of deviation and amblyopia.

Introduction: Health care services require nurses who are critical thinkers, with high-learning skills, who can solve problems for which there are no standard solutions. Therefore, a change in the way teachers teach merits considerations. Objective: With regard to above considerations, this research has been carried out to compare the effects of two teaching methods: Lecture and PBL on learning and retaining in nursing students in Shahid Beheshty Nursing and Midwifery Faculty in Rasht. Materials and Methods: The sample of this semi-experimental study consisted of 29 students that were randomly divided into two groups; control (students under lecture method) and experimental (students under PBL method). The data collection instrument was a questionnaire, which included (1) demographic data and (2) multiple choice questions for knowledge assessment. Results: The result of Paired T test showed that PBL strategy had positive effect on learning and retaining, but Lecture method had positive effect only on learning, without significant effect on retaining. There were no significant differences between the two methods on learning and retaining, however; there were more benefits in lecture group in terms of learning and in PBL group in terms of retaining. Conclusion: Observation of higher mean score in expremental group compared with Control group can be indicator of appropriateness of P.B.L as a good replacement for lecture method. However, we need more researches for selecting appropriate methods.