مجله دانشگاه علوم پزشکی گیلان
سال:1392 | دوره:22 | شماره:85 |تعداد مقالات:27

Introduction: The absence of efficient sewage treatment plant in many cities of Iran and national discharge standards for hospital wastewater makes the hospital wastewater treatment a necessity. Hospital wastewater is loaded with microorganism, heavy metals, toxic chemicals and radioactive elements.Objective: It can be hypothesized that the efficiency of activated sludge from industrial wastewater treatment plant can be different from municipal wastewater plant. In this study, the efficiency of activated sludge from dairy industry has been compared with that of municipal activated sludge for hospital wastewater treatment.Materials and Methods: To assess the efficiency of activated sludge, 1day, 3day and 5day aeration methods have been used. Before and after each aeration step, BOD, COD and MLSS of wastewater and sludge were determined.Results: The most efficient method was found to be 5day aeration and the efficiencies of municipal activated sludge and dairy industry activated sludge were respectively 93.9%, 93.3% and 97.4%, 97.3% for COD and BOD. Nonparametric tests and paired t-test show that there is no significant difference between municipal and industrial activated sludge efficiencies for hospital wastewater treatment but a significant difference between time lengths of aeration (1day, 3dayes and 5days) was observed.Conclusion: Both the dairy industry and municipal activated sludge could have high efficiency for hospital wastewater treatment.

Introduction: Rheumatoid arthritis (RA), is the most common inflammatory rheumatic disease. It is a chronic, systemic and disabling condition. Comorbid depression and/or anxiety worsen the biological and psychological outcomes of the disease.Objectives: Determination of relative frequency of depression and anxiety in the patients with rheumatoid arthritis.Materials and Methods: In this cross-sectional study, during six months (September 22, 2011 - March 19, 2012), BECK-II and Zhung self-rating Anxiety Scale(SAS) questionnaires were completed for 180 randomly selected rheumatoid arthritis patients(based on 1987 ACR criteria), from Rheumatology clinic of Rheumatology Research Center of Guilan Medical University(during a week after rheumatologist visit). Based on the scoring system, if score of Beck -II questionnaire (21 items instrument to measure depression severity) is <= 10, the severity of depression is normal, patients with score 11-16 are classified in mild depression, 20-17 in borderline clinical depression, 21-30 in severe depression, and 31 and higher in extreme depression group. If score of SAS questionnaire (20 items instrument to measure anxiety severity) is <= 44, the severity of anxiety is normal, patients with score 45-59 are classified in mild to moderate depression, 74-60 in severe anxiety, 75 and higher in extreme anxiety group. Patients with brain organic syndromes, fibromyalgia, current users of more than 10 mg prednisolon per day, current users of antidepressant drugs, patients with previous history of mood disorders, any poor control medical conditions (including but not restricted to migraine headache and poor control diabetes mellitus,...) and patients in function class IV were excluded from the study.Results: In this study, the relative frequency of depression was: 8.9% (16 patients) mild, 7.8% (14 patients) need psychologist consultation, 23.3% (42 patients) moderate, 30.6% (55 patients) severe, and 22.2% (40 patients) extreme depression. As for the relative frequency of anxiety: 68.9% (126 patients) mild to moderate, and 13.3% (24 patients) were with severe anxiety. As shown, there was no anxious patient without depression. Also, a positive significant correlation was found between Beck-II and SAS scores (p=0.0001, r=0.787).Conclusion: High relative frequency of depression and anxiety indicates the need for a close cooperation between rheumatologists, psychologists and psychiatrists if the best rheumatoid arthritis management is to be achieved.

Introduction: It remains controversial if dairy product intake is associated with risk of stroke. Previous studies on this issue came from Western populations and developed countries, and no information is available from the understudied region in the Middle East.Objective: This case-control study was conducted to assess the relationship between dairy consumption and risk of stroke in an Iranian adult population.Materials and Methods: In this study, 195 stroke patients (recognized based on clinical findings and computed tomography scan) hospitalized in neurology ward of Alzahra University Hospital were enrolled. Sex- and age-matched controls (n=195) were selected with convenience non-random sampling procedure from other wards of the hospital. A validated food frequency questionnaire was used to assess participants' usual dietary intakes. Data on usual physical activity patterns, smoking and socioeconomic status and demographic features were collected using of questionnaires.Results: Patients with stroke were older, had lower weight and BMI and were more likely to be male and physically active and less likely to be obese. After adjustment for age, sex and total energy intake, individual with the highest consumption of low-fat dairy had 42% lower chance of having stroke (OR: 0.58; 95% CI:0.34-0.99 ) while those with the highest intake of high-fat dairy had 128% greater chance of it (OR: 2.28; 95% CI:1.29-4.00). Further adjustment for physical activity and smoking made the association of low-fat dairy intake with stroke marginally significant (P=0.07) but just slightly attenuated the association of high-fat dairy consumption and risk of stroke (2.19; 1.24-3.88). The association between high-fat dairy consumption and stroke even persisted after additional adjustments for dietary variables (OR for top vs. bottom tertile: 2.02; 95% CI: 1.02-4.02).Conclusion: We found evidence indicating a significant positive association between high-fat dairy consumption and risk of stroke. Further prospective studies are required to confirm this finding.

Introduction: Smoking is one of the major factors threatening the health of community, especially the young. It is a complex behavior associated with psycho-social, biochemical and economic factors. Health Belief Model tries to describe health behaviors focusing on beliefs and attitudes.Objective: This study aims to determine the relationship between four constructs of the Health Belief Model (HBM) (Perceived Severity, Perceived Susceptibility, Perceived Barriers and Perceived Benefits), and cigarette smoking among male students at Guilan University of Medical Sciences.Materials and Methods: This cross-sectional study was carried out on 222 male medical university students of Guilan in 2011. Data were collected using a two part questionnaire including items about demographic features (age, study major, number of children in family, …) and the four HBM constructs. Data analysis was performed using the Chi-square and Mann-Whitney U tests.Results: Mean age of the students was 22.3±3.2 years and 87.4% were single. In total, 51 students (23%) were current smoker. Results of Mann- Whitney test showed significant differences in perceived barriers (P=0.002) and perceived benefits (P=0.000) between male smokers and nonsmokers. Results of multivariable logistic regression analysis also indicated that having smoker friends (OR=16.68), age (OR=1.32), mother with high education level (OR=7.51), more perceived barriers (OR=2.195) and low perceived benefits toward non-smoking (OR=0.621) are closely related with smoking.Conclusion: The results suggest that constructs of HBM can be considered when examining the related Factors with cigarette smoking and developing smoking prevention programs.

Introduction: The side effects of first line anti TB drugs may lead to a huge waste of money and as a result the patients may refuse to continue the treatment and in some cases even leads to death.Objective: To find the side effects coming from such drugs among the patients admitted in Giulan Province, northern Iran.Materials and Methods: This is a cross-sectional study on the patients with tuberculosis who were hospitalized in Razi hospital from 2002 to 2008. The information contained in the respective medical files was extracted and entered into the questionnaire.Results: Results showed that 61% of the total 387 TB patients were male. The average age of the participants was 45.5±19.3 years and 56 cases (14.5%) were with complicated condition. As observed, %27.3 of the cases were with more than one complication. Of the patients with complications, 27 patients (48.2 %) were with liver disease (hepatitis drug), 1 patient (1.7 %) with ocular complications, 46 patients (82%) with gastrointestinal side effects (anorexia, nausea, vomiting, pain epigastric, ichter, diarrhea) and 3 patients (5.3 percent) had skin conditions. Also, treatment was discontinued for 1.8% of the total 387 patients with tuberculosis due to the drug side effects.Conclusion: Timely consideration and management of the side effects can help inhibit the progression and prevention of respective complications.

Introduction: One of the most important factors in driving is having a good visual acuity. It has been suggested that over 90% of the sensory information for driving is visual. Recent studies using alternative approaches, have demonstrated a relatively strong relationship between vision and driving performance measures.Objective: The present study was designed to evaluate the visual impairment in the drivers of car accidents referred to Amiralmomenin Hospital during the research period.Materials and Methods: In this descriptive Cross -Sectional Study, the participants were selected by census sampling model; its content validity was evaluated and approved. All the drivers with accidents within Sep 2010 and Des 2011 were entered into this study. After the initial eye examinations and specific test, a questionnaire consisting of demographic data and history of eye and systemic diseases was completed.Results: In total, 403 drivers entered into this study, 94% were male and average age was 36.17±11.38 years. Most accidents occurred on the road (65.8%) and in sunny weather (74.2%) and 96.3% of people had not any history of eye disease. Also, 96.3% of crashes happened for the drivers with normal visual acuity, visual field (1.7%), Stropsis 15.8% and abnormal color vision (5.9%). Besides, 33 drivers (2.8%) had a known eye disease with most of them-9 (2.2%) having Cataract disease.Conclusion: It seems that visual filed test and color vision must be added to ophthalmologic examination before issuing driving license for the applicants and diabetic patients must undergo specific eye examination. These considerations could reduce car accidents and injuries.

Introduction: Striae gravidarum occurs in 50-90% of pregnant women in the third trimester and never completely disappears, so it is a major aesthetic concern for most women.Objective: Survey of frequency of striae gravidarum and the associated factors in nulliparus pregnant women.Materials and Methods: A descriptive cross-sectional study was done on 200 women over 36 weeks pregnant primiparous qualify, referred to AL- Zahra hospital in 1388. Information including location and severity of the stria gravidarum, skin type and hair were examined clinically. Demographic features of the participants’ age, gravidity, gestational age, stria history of prior pregnancies, history of skin diseases, family history for stria, weight before pregnancy, BMI, weight gain during pregnancy, using corticosteroid and local creams or lotions, fetal sex, and PCO were gathered through interviews and questionnaires. Collected data were analyzed by SPSS version 11.5.Results: There were 149 cases (74.5%) with stria gravidarum and 51 cases (25.5%) without it. A significant difference was observed between steriae and the variables of maternal age, weight gain during pregnancy, BMI before pregnancy, educational level and family history.Conclusion: As revealed, the more weight gaining during pregnancy, the more risk was there for stria gravidarum formation. Positive family history of striae gravidarum seems to be an important associated factor and a greater chance of striae exists for younger mother.

Introduction: International studies show that the elderly population is increasing due to health promotion, yet this group encounters a lot of health problems that can threaten their mental health conditions.Objective: Determining the effect of reminiscence group therapy on the mental health of male elderly men in Anzali Cultural Center for the Retirees, northern Iran.Materials and Methods: The study is a pre-post semi-experimental trial carried out on all elderly and retired population, referred to the retirement center in Azali. Among them, 16 men were selected on the basis of clinical interviews conducted by the psychologist, who earned higher scores on the General Health Questionnaire. They were then randomly assigned to two groups of experimental and controls and tested. The experimental group received 10 sessions of reminiscence and the controls were left untreated. In the test phase, both groups were evaluated using the pretest instruments. Data were analyzed using multivariate analysis (MANCOVA).Results: Data analysis showed that reminiscence group therapy led to significant reduction in the components of physical signs P=0.02, anxiety, P=0.01, insufficient social activity P=0.001, P=0.000 and depression in the elderly group tested.Conclusion: The results show that reminiscence can improve mental health conditions in the elderly and can serve as an effective, affordable and available technique.

Introduction: While cardiovascular disease (CVD) is the most common cause of death worldwide, and early cardiac vessels occlusion begins from childhood, promoting the knowledge of children, their parents and teachers about CVD symptoms, risk factors and prevention seems to be an essential issue.Objective: Determining the effectiveness of education for cardiovascular on increasing the knowledge of preschool children, their teachers and parents in five preschool educational centers of Rasht about symptoms, risk factors and prevention of CVD.Materials and Methods: In this pre -post interventional study, 85 parents of preschool children from five preschool educational centers of Rasht, 4 principals and 10 teachers, participated in the pretests, educational treatment and then posttests about symptoms, risk factors and prevention of CVD.The knowledge levels of 101 preschool children at these centers were measured through illustrated pretests and then assessed and compared using posttests following theoretical and practical respective education.Results: In this study, the pretest mean scores of parents, principals, teachers and preschool children were 10.50, 10.75, 10.90, 12.95 and posttest mean scores were 15.52, 16.50, 19.30, 17.32, respectively and differences between pre and post conditions were significant. The level of knowledge about CVD increased in these groups by %52.84, %57.76, %92.3, and %59.3, respectively. As revealed, the knowledge levels of preschool children and their parents, principals and teachers about CVD were promoted and the necessity of public knowledge promotion about CVD symptoms, risk factors and preventive methods, planning proper children diets and childhood obesity prevention was indicated.

Introduction: Despite several improvements in cardiovascular interventional procedures, the limitation due to their complications has made the cardiologists doubtful about them and much interest has focused on the acute outcome and complications of such interventions. Few surveys have been done in Iran on the complications and outcomes of cardiovascular interventional procedures as substitutes for costly surgical managements.Objective: To investigate success rate and outcomes and intrahospital complications of the patients undergoing cardiovascular interventions in Eman-Khomaini Hospital in 2010-2011.Materials and Methods: In a descriptive retrospective survey, the medical files of 412 patients who underwent cardiovascular interventional procedures in Emam-Khomeili Hospital in 2010-2011, were studied and their clinical procedural and demographic data were derived. The respective laboratory data including Hb, HCT and CPK-MB before and after procedure and their post-procedural EKGs were assessed. Any major port-procedural major complications of the patients were registered.Results: The most common procedure was coronary artery angioplasty (352 patients), while other procedures were PTMC in 24 patients (5.8%), renal artery angioplasty in 14 patients (3.4%), ASD closure by Occluder in 7 (1.7%), lower limb vascular in and carotid artery angioplasties in 11 (2.66%) and 1 (0.24%) patients, and PS valvuplasty in 3 patients (0.7%). Among the patients who underwent coronary angioplasty, 8 (2.27%) showed asymptomatic rise of CK-MB without any significant change in EKG. One case of coronary artery perforation in CTO plasty was detected while two patients were complicated with no reflow during 18 months. In those who underwent PTMC, only one case (4.2%) of asymptomatic mild MR was detected. Totally, no mortality was reported and no other complications were detected in the patients.Conclusion: As the survey indicates, if the patients are chosen properly and the operators are competent and experienced, cardiovascular interventional procedures can be used with high efficacy, low risk and acceptable complication rate in the treatment of many cardiovascular disorders.

Introduction: Diabetes in long term is associated with learning and memory deficits. Given the Anti-diabetic and antioxidant activities of Tribulus terrestris (TT).Objective: to evaluate the effect of oral administration of Tribulus terrestris on learning and memory in diabetic rats.Materials and Methods: Thirty two Wistar rats were divided into control, TT-treated control, diabetic, and TT-treated diabetic groups. To evaluate their learning and memory, initial (IL) and step-through latencies (STL) were determined at the end of study using passive avoidance test and alternation behavior percentage was obtained using Y maze. Level of malondialdehyde in hippocampal homogenate was also measured at the end of the study.Results: STL significantly decreased in diabetic group (p<0.01) and TT-treated diabetic group showed a significantly higher STL (p<0.01), compared to the diabetic counterparts. Alternation percentage was significantly lower in the diabetic group relative to the controls (p<0.01) and treated diabetic group did show a significant difference in comparison with the diabetic group (p<0.05). Diabetic rats also exhibited a significant increase in tissue level of malondialdehyde (p<0.01) and TT treatment significantly reduced MDA level (p<0.01) in the diabetic group.Conclusion: TT treatment could enhance the capability of consolidation and recall in diabetic animals and could also improve spatial memory in them, partly via attenuation of lipid peroxidation in the hippocampus.

Introduction: Variations in anatomical structures are always important to basic and clinical specialists. The subclavian artery is a major constituent of the blood circulatory system. Its position in the root of the neck and its course through the interscalene triangle are significant.Case Report: Routine dissection of a male cadaver in the dissection room of medical faculty. This report is on important variations in branches of the subclavian artery in a singular cadaver. On the right side, no thyrocervical trunk was found. The two branches which normally originate from the thyrocervical trunk had a different origin. The inferior thyroid and vertebral arteries arose directly from the first part of subclavian artery and the transverse cervical, suprascapular and internal thoracic arteries arose originated from the other common trunk. This variation provides a short route for posterior scapular anastomoses.Conclusion: The anatomic and morphologic variations of the subclavian artery and its branches are significant in the neck. An awareness of this rare variation is important because this area is used for diagnostic and surgical procedures.

Introduction: Traumatic Arteriovenous Fistula (AVF) Called to an abnormal relationship between artery and vein which occurs in 10% of arterial traumas. If treatment of AVF due to trauma delayed, different outcomes including Heart failure, Varices and Varicose ulcers may accure. In case of chronic traumatic AVF, open surgery may lead to remarkable outcomes, Presence of many lateral veins and varicose veins in fistula, noticeably increases the risk of bleeding during surgery. Endovascular methods such as Fistula Embolization are appropriate alternates with fewer computations instead of open surgeries and easily done by local anesthesia.Case Repot: The patient was a 53-year-old man who was hit by shrapnel pieces in war. In CT angiography, AVF of lower limb was reported. He underwent right lower limb angiography and the fistula between peroneal artery and peroneal vein was amended by edndovascular method with embolization. Conclusion: Edndovascular techniques are more appropriate for treatment of arteriovenous fistula instead of open surgery.