Journal of Guilan University of Medical Sciences
Year:2016 | Volume:25 | Issue:98|Papers Count:19

Introduction: Intracranial hemorrhage in infants is associated with several factors. This has allowed different studies to report different levels of it. Therefore, further studies are required in order to arrive at reliable and common risk factors.Objective: Evaluating the risk factors associated with cerebral hemorrhage in the newborns admitted to the neonatal and neonatal intensive care units.Materials and Methods: In this descriptive prospective study, hospitalized infants with ultrasound and CT brain indication, including all preterm infants and neonates with symptoms such as seizures, loss, unexplained anemia, hypoglycemia were enrolled. To diagnose intracranial hemorrhage, ultrasound and CT. Scan were used in the days 3, 7, 14, 28 (discharge days), based on doctor discretion. Follow up for 6 months was performed by a neurologist and data were analyzed by SPSS software version 17.Results: The percentage of cerebral hemorrhage was 1.13 and 30.51 in neonates less than 35 weeks of gestational age (P=0.001). Cerebral hemorrhage in delivery by NVD method was 8.8% and in delivery with C/S was 3.5% (P=0.001). Comparing distributions of the Apgar score, the percentage of cerebral hemorrhage in neonates with Apgar scores more than 7 was 1.8% and Apgar score below 3 was 66.7 (p<0.0001). In this study, birth weight (P=0.001) and head circumference (P=0.005) as well as the need for mechanical ventilation (p<0.0001) were risk factors and predictors of cerebral hemorrhage.Conclusion: The results showed that low birth weight, gestational age below 35 weeks, lower head circumference, and receiving mechanical ventilation in neonates can be significant risk factors for the occurrence of cerebral hemorrhage. Also, neonates who were born through NVD method, or needed to revive at birth, and have lower Apgar scores had significantly more prevalent brain hemorrhage.

Introduction: Scientometrics studies with Assessing priorities, perspectives and capacities help policymakers and managers of universities and heads of research centers in appropriation budget, balance between budget and cost, appointment, promotion researchers, leading to a better understanding of the strengths and weaknesses of their covered settings.Objective: this study investigates the scientific outputs of Guilan University of medical sciences (GUMS) indexed in Scopus database based on scientometrics indicators in 2014.Materials and Methods: this is a cross-sectional study in scientometric field that assesses GUMS Scientific outputs indexed in scopus database Since the establishment up to the end of 2014. Data from Scopus database and documents and citation from the time of establishment of this university were collected. scientometrics indicators in 3 domains of quantity, quality and hybrid were calculated.Results: overall, 845 scientific outputs with 3078 citations with the affiliation of this university were indexed in Scopus. Ratio of document to authors was 5.28, document to faculty members was 2.28 and ratio of citation of document was 3.64. H Index, g Index, e Index and M-Quotient of this university were respectively 23, 32, 18.11 and 1.35.Conclusion: The publication trend of GUMS scientific outputs is growing. In addition, almost half of scientific outputs of this university were without at least one citation and also combined indices don’t have the appropriate level due to the low citations. To increase scientific outputs, providing appropriate platform to facilitate research among different parts of university and improve qualitative performance with quantitative expansion of them, was recommended.

Introduction: Infectious mononucleosis is a clinical syndrome, particularly in children, adolescents and young adults. Since the clinical and laboratory characteristics of infectious mononucleosis are different according to geographical regions and age groups, studies in different regions can be crucial in improving the diagnosis and treatment of patients with infectious mononucleosis.Objective: This study aimed to investigate the frequency of demographic, clinical and laboratory characteristics of patients with infectious mononucleosis admitted to 17th shahrivar Hospital of Rasht since 2009 to 2013.Materials and Methods: In this descriptive retrospective study, medical records of all patients with a diagnosis of infectious mononucleosis admitted to 17th Shahrivar Hospital of Rasht between 2009 and 2013 were examined. Patents’ demographic, clinical and laboratory findings were collected and analyzed by descriptive statistics using SPSS software version 18.Results: In this study, 99 patients with infectious mononucleosis with an average age of 6.19±3.03 were assessed of which 55% were boys. The most common season was summer (35%), followed by spring (30%). The most common chief complaints were fever (88.8%), and pharyngitis (63.3%). The mean duration of disease was 6.19±3.41days. The most common clinical signs were tonsillopharyngitis (98.9%), cervical lymphadenopathy and fever (9.93%). Leukocytosis was seen in 73.7% of patients and also, lymphocytosis in 62.6%, atypical lymphocytosis in 29.3%, anemia in 13.1% and thrombocytopenia in 6.1%. The high ESR, increased liver enzymes, positive monotest and positive IgM-VCA test were detected in 54.1%, 46.5%, 11.1% and 9.92% of subjects, respectively. The most common complication was respiratory distress in 5 patients. One patient died with respiratory distress and bleeding.Conclusions: The most common chief complaints were fever and sore throat; and cervical lymphadenopathy, fever and tonsillopharyngitis were most common signs. It is recommended that differences in the clinical manifestations and their prevalence in our region, be considered in the diagnosis.

Introduction: The prevalence rate of Post-Ischemic Stroke Dementia (PISD) is remarkable, and this cerebrovascular disease may increase the risk of incident dementia. However, demographic parameters associated with the PISD are often not well understood.Objective: To determine the prevalence of PISD, and to calculate the risk ratio of each of the demographic factors in association with its occurrence in a hospital-based study (Guilan province).Materials and Methods: In a retrospective cohort study, 206 patients, approximately six months post stroke were selected by consecutive and nonprobability sampling method among 760 eligible patients who were discharged from Neurology Department Clinic of Poursina Hospital in Rasht city, from April 2012 to May 2014. All patients underwent a multi-dimensional neurological examination, CT scans and MRI findings inspection, evaluation of the current and premorbid cognitive status by IQCODE and ACE-III tests respectively and also structured clinical interview, based on DSM-5 criteria in order to diagnose the major vascular neurocognitive disorder.Results: Forty eight of the patients were diagnosed with PISD (prevalence 23.3%). Cox proportional hazards regression demonstrated that older age (hazard ratio [HR]=1.06, 95%CI:1.00-1.11, P=0.035), lower educational level (HR=0.64, 95%CI:0.44-0.94, P=0.021), more severe stroke (HR=1.21, 95%CI:1.06-1.37, P=0.004),which was measured by National Institutes of Health Stroke Scale (NIHSS) and more premorbid cognitive impairment (HR=6.09, 95%CI:2.34-15.87, P<0.0001) measured by Informant Questionnaire on Cognitive Decline in the elderly (IQCODE), prognosticates the risk of PISD diagnosis on an average of six-months after stroke.Conclusion: PISD prevalence is remarkable among patients discharged from a hospital on a six month post stroke period. Early recognition of demographic factors related to PISD is helpful in more effective treatment, and can help prevent further loss of performance in stroke patients.

Introduction: Irritable bowel syndrome is the most common gastrointestinal disorder with an estimated prevalence of 22 percent in general population. Its etiology remains unclear. But impact of psych on physiology of digestion system is undeniable.Objective: Considering the importance of psychological factors in this syndrome, the aim of the study is more accurate investigation of these factors with focus on personality characteristics in IBS patients and its types with Diarrhea dominant, Constipation dominant & Altering type.Materials and Methods: the research method is descriptive-comparative and the research sample consists of 170 subjects, including 85 patients (21 with Diarrhea dominant, 30 with Constipation dominant & 34 with Altering type) and 85 healthy subjects, selected in Razi state hospital in Rasht, using availability sampling method. Patients were diagnosed by a gastroenterologist using the ROME II criteria and clinical evaluation and endoscopy (in some cases). Having been diagnosed, patients were asked to complete personality inventory forms (NEOPI-R) designed by Mc Crue & Kosta (1992), containing five major personality factors (neuroticism, extraversion, openness, agreeableness & conscientiousness). The obtained data were analyzed by implementing independent sample T test and ANOVA. P value=0.05 was considered significant.Results: based on the obtained results, neuroticism was significantly higher (P£0.001) and extraversion was significantly lower (P£0.001) in patients, compared to those of healthy subjects.Conclusion: based on these results, it seems that in psychological treatment we need to pay more attention to personality characteristics of IBS patients

Introduction: Vitamin D deficiency is the most common nutritional deficiency as well as a basic factor for normal bone growth. Increasing evidence indicates that the vitamin D contributes to normal glucose homeostasis and its deficiency is associated with impaired insulin secretion, as demonstrated in some reported studies. However, very limited studies and some even with conflicting results have addressed the association between the level of 25-hydroxyvitamin D in circulation and the risk of gestational diabetes.Objectives: Investigating the association between vit D deficiency and gestational diabetes.Materials and Methods: This case-control study was conducted on 157 women aged 15-50 years, referred to Rasht alzahra Hospital. Demographic data and medical history were collected. In doing so, for evaluation of gestational diabetes, glucose challenge test was done. Also, vitamin D level measurement was performed using Diasorin kit and CLIA method and the obtained results were analyzed by SPSS version 16.Results: The mean age of the normal group was 26.75±4.96 and the mean age for those with gestational diabetese was 27.07±5.73. (p=0.7). BMI index was the same for both groups and the average vitamin D serum levels for normal and patient groups were 11.06±17.81 and 17.41±6.76 nmol/l, respectively. Using regression logistic model, we demonstrated that increasing vitamin D serum level can reduce the chance of gestational diabetese by 5%. OR=0.95 (CI=0.91-0.99)Conclusion: In conclusion, gestational diabetese and vitamin D level seem to be negatively correlated. (P=0.002)

Introduction: Hospitals are important social organizations, and play an important role in every country health standards, and we need to gather, and process the related data. Data should be ready at appropriate time and be used for decision making finally.Objective: the aim of this study is an investigation into the relationship between hospital information system and hospital performance whereby patient satisfaction is studied as the mediator.Materials and Methods: social statistical analysis of Rasht hospital staff that have management information system. Sample was 320. Data were gathered by questionnaire and analyzed by SEM.Results: There was a significant relationship between patient satisfaction and hospital performance. There was a significant relationship between hospital information system and hospital performance too.Conclusion: Existance of hospital information system and it’s subsets and therefore improve hospital performance.

Introduction: Acute postoperative pain in children increases by activation of physiological and biochemical stress responses and leads to several complications. Caudal block and infiltration of local anesthetic are two effective modalities for postoperative pain management in children.Objective: The aim of this study was to compare the effects of these two methods on postoperative pain control in children.Materials and Methods: In this double blind clinical trial, 110 children who underwent herniorhaphy and orchidopexy, were allocated to two groups of caudal block and wound infiltration using randomized fixed quadripartite blocks. The drug dosage in caudal block group was 1mg/kg of bupivacaine 0.125 % and it was 0.5mg/kg of bupivacaine 0.25% in wound infiltration group. Pain score , time to start of micturition and gas passing, parents’ satisfaction, time for the first dose of acetaminophen , number and total acetaminophen dosage in 24 hours, were noted at 1-6-12-24 hours after operation.Results: Pain score significantly diminished in caudal (0.0001) and infiltration (<0.0001) groups. There was no significant difference between the two groups in terms of pain score changes (0.8), time for the first dose of acetaminophen (p=0.77) , number of need for analgesia (p=0.81), total analgesic doses (p=0.9), the onset of intestinal activity (p=0.44) and micturation (p=0.66) during 24 hours after surgery. However, parents’ satisfaction was significantly more in infiltration group (p=0.002) Conclusion: It seems that both methods are effective for this purpose. However, considering the less time needed for the procedure, and more satisfaction of wound infiltration, it might be suggested as the preferred method.

Introduction: Various studies have indicated that emotional disorders are prevalent in IBS patients and they are related to onset and severity of symptoms. The aim of this study was to compare the difficulties in emotion regulation in patients with irritable bowel syndrome and normal people.Materials and Methods: The study was a descriptive-comparative type. Of the patients with irritable bowel syndrome referred to Isfahan Digestive Health Center, 30 patients by controlling emotional problems were selected. For comparison, 30 individuals without digestive problem (normal) were matched with the patient group according to the emotional problems and gender. Information was collected using the Difficulties in Emotion Regulation Scale (DERS) and the short form of Depression, Anxiety, Stress Scale (DASS-21).Results: Mann-Whitney Test results showed that despite controlling emotional problems (depression, anxiety and stress), there were significant differences between patients with irritable bowel syndrome and normal people in terms of difficulties in emotion regulation and its components, except emotional awareness component (P<0.01, P<0.05).|Conclusion: Patients with irritable bowel syndrome, due to lack of adaptive emotion regulation skills and existence of some emotional dysregulation factors, experience further and more severe negative emotions. Thus, it will cause that their emotion regulation faces more difficulty.

Introduction: Having depression is common in patients with headache, but research on this issue in Iran is limited.Objective: Investigating depression and Primary headache symptoms comorbidityMaterials and Methods: Study of depression and headache comorbidity and some influential factors such as age, gender and type of headache is the goal of this case-observation study. 131 client patients of nerves and mental clinic of Kermanshah Farabi Hospital, and 131 people as a control group were selected among general population of Kermanshah city randomly. Data were collected by clinical interview and based on criteria of International Headache Society (IHS) and with Beck Depression Inventory.Results: We found comorbidity of depression and headache in 58.8% of cases, with the average depression score larger than that in the control group (p<0.001). 3.8 times of depression raises the risk of primary headaches. The relationship between depression and headaches in all age groups except the 45-64 year age group was significant (p<0.05).Conclusion: Data analysis indicated a correlation between depression and headaches.

Introduction: High fat diet leads to liver apoptosis, steatosis and inflammation, elevated liver enzymes, lipid peroxidation and free radicals. Vinegars contribute to apoptosis pathway and can reduce steatosis, inflammation and lipid profiles. Balsamic vinegar has strong radical scavenging ability and a high polyphenol concentration.Objective: The aim of this study was to evaluate antiapoptotic and protective effects of balsamic vinegar on liver tissues and lipid profiles in rats under high fat diets.Materials and Methods: Male wistar rats (n=24) were divided into 3 groups (n=8): control, high fat diet (HFD), HFD & balsamic vinegar (BV). Control group received 16.6% Kcal per day, and the other two groups received high fat diet (HFD) 51.6% containing canola oil. After 4 month group 3 in addition to HFD received a balsamic vinegar (0.51 mg/kg) for 6 weeks orally through their water. In the end of experiment, bloodletting and liver biopsy were performed. Serum liver enzymes and lipid profiles level were evaluated using photometric method. Apoptosis evaluation was performed with immunohistochemistry TUNEL method, and steatosis, inflammation and fibrosis were evaluated with H&E and Tri Chrome Malory staining. The data were analyzed using ANOVA and Tuckey post hoc test. P value less than 0.05 was considered significant.Results: Vinegar makes a significant reduction in liver apoptosis, steatosis, inflammation and central vein fibrosis (p<0.001). Triglyceride levels decreased significantly in the group treated with vinegar (p<0.001). However, no significant difference in LDL and total cholesterol levels was observed between high-fat diet and balsamic vinegar. Serum levels of HDL in the group treated with vinegar, compared to high-fat diet group, showed a significant increase (p<0.01). Vinegar did not make a significant difference in liver enzyme levels.Conclusion: This study showed that daily use of balsamic vinegar in rats under high-fat diet for 6 weeks, had protective effects on the liver tissue, and can increase serum levels of HDL, decrease TG and liver tissue apoptosis and steatosis, but no effect on the level of liver enzymes.

Introduction: Although numerous studies in Western Europe and North America indicate the impact of type A behavior pattern on coronary artery atherosclerosis or coronary heart disease (CAD), few studies conducted in Asian countries indicate that type A behavior pattern had no effect on coronary artery atherosclerosis Objectives: The aim of this study was to determine the relationship between type A behavior pattern and coronary artery atherosclerosis among Iranian populations.Materials and Methods: This study was performed with a case-control design. Data were collected from 77 patients with coronary artery atherosclerosis, referred to Afshar Hospital Professional Heart Clinic in Yazd city, and 78 normal controls, in July and August 2013. These groups were selected by convenience sampling method. The two groups completed the Jenkins Activity Survey (JAS) to measure the type A behavior.Results: The results suggest that the two groups were significantly different regarding the type A behavior (p<0.01), and components of irritability/impatience (p<0.01), speed (p<0.01), and achievement striving (p<0.05).Conclusion: Results of this study, contrary to Asian data, confirmed the hypothesis that type A behavior pattern is associated with increased risk of coronary artery atherosclerosis in Iranian populations.

Introduction: Perioperative blood loss is thought to be associated with an increase in urinary fibrinolytic activity. Tranexamicacid (TXA) is a potent inhibitor of plasminogen and also urokinase activators.Objective: To determine the efficacy of preoperative treatment with tranexamic acid in the rate of perioperative transfusions in patients undergoing transurethral resection of the prostate (TURP).Materials and Methods: In a clinical trial, 80 patients were randomly divided into two groups: Tranexamic acid (TXA) and controls. After Spinal anesthesia with marcaine, in the Tranexamic acid group (TXA), the patients received intravenous infusion of tranexamic acid 15 mg/kg before surgery and the control group received no medication, and serum Hb concentration was measured 1 hour after beginning the surgery, in recovery room, and 6 hours and 24 hours after surgery. If the hemoglobin concentration was lower than 10 mg/dL, one or more units of allogeneic packed red blood cells were transfused to keep the concentration of hemoglobin above 10 mg/dL, finally the mean need for the erythrocyte transfusions was compared between two groups. We used statistical tests such as T-test, Repeated Measurement, ANCOVA Test and SPSS software 16. P values less than 0.05 were considered significant.Results: This study, showed that the mean perioperative blood transfusion 24 hours post operation, in TXA group was less than that in control group (0.2±0.6) vs (0.6±0.92). (P=0.026)Conclusion: preoperative treatment with tranexamic acid reduces the rate of perioperative blood transfusions in patients undergoing T.U.R-P.