مجله علمی دانشگاه علوم پزشکی قزوین
سال:1380 | دوره:5 | شماره:3 (پیاپی 19) |تعداد مقالات:25

Background: New investigations indicate metabolic disruption, such as increased energy expenditure, protein catabolism, negative nitrogen balance, weight loss and muscle atrophy in head-injured patients. Objective: To compare the effects of combined parenteral - enteral nutrition and enteral support alone, on calorie, protein intake and nitrogen metabolism of head-injured patients. Methods: A prospective, quasi-experimental randomized study was performed on 66 purely head-injured patients (55 mares, 11 females, age range of 18 to 72), with 24-hour admission with Glasgow Coma Scare (GCS) score of 4 to 10. They were randomly allocated in 2 groups to receive parenteral-enteral nutrition (group 1) and enteral nutrition alone (group 2). They were followed up for 14 days in hospital. Findings: Group 1 received a statistically significantly higher calorie intake (P<0.00l), had higher cumulative calorie balance (P<0.00l), higher mean nitrogen and protein intake, (P<0.001) and more nitrogen excretion (P<0.001) during 2 weeks. Except nitrogen excretion (P<0.001), these parameters had no statistically significant difference during the second week. Nitrogen balance was statistically significantly more negative in the second group (P<0.001). Conclusion: Parenteral-enteral route can provide more calorie and protein intake for patients in early critical post-traumatic days. This route provides more protein intake and causes more nitrogen preservation; however, it increases nitrogen excretion.  

Background: Immaturity of infants is the most common cause of admissions in intensive care units. These infants need tube feeding due to the incomplete development of alimentary channel. Objective: To determine the physiological effects of intermittent and continuous tube feeding on premature infants. Methods: Through a sequential cross-study, measures of heart and respiratory rate and body temperature of 30 babies who were admitted in the pediatric ward of Emam Hossein hospital of Tehran ; were recorded before, during and after feeding by each method. Findings: Heart beat of the infants decreased during feeding by each method and then increased after feeding. The respiratory rate increased during feeding and continued after feeding. Body temperature dropped in continuous feeding. There was a statistically significant difference in the body temperature 10 minutes after each method of feeding (P<0.001). Conclusion: Both methods of feeding are safe for premature infants. More studies on the related subject on infants also having other complications are recommended.      

Background: Self-concept is the most important characteristic of human beings Changes and decrease in self-concept necessitates a pattern for directing and forming of self-concept in teenage years. Objective: To apply group debate-training to increase the self-concept of teenagers. Methods: Through a two-stage simple clustered method, 34 students for the experimental group and 32 for the control group were selected from 2 high schools in Gonabad. The data was collected by Rogers self-concept test and personal identification questionnaire and training was performed through group discussion on problem-solving upon three identical batches from the experimental group. Immediately and after one month, self-concept scores were computed. Findings: The findings indicated a significant difference between the two groups and also among the experimental group after the intervention (P<0.0001).After first and second evaluations, the self-concept score of experimental group was 5.88 , 5.46 and control group 10.46 , 9.20 respectively indicating the positive effect of group discussion on the self-concept of high school students. Conclusion: The efficiency of group discussion through problem-solving and its constant effect on the increase of teenage self-concept was proven. A practical model for continuous training and follow-up is recommended.      

Background: There are a number of conceptions on the effect of estrogen on skeletal tissues and the most acceptable one is based on the effect of estrogen on cytokines and TNF as well as on the specific estrogen receptors on osteoblasis. Objective: To examine the correlation between the parathormone and osteoporosistype-1 in menopusal women. Methods: The fires of 53 menopusal women, who were on hormone replacement therapy in Dr. Shariati hospital, were studied. The serum calcium and parathormone revels were calculated and with the help of tables and P value the results were studied. Findings: No significant differences were observed neither in calcium nor in parathormone revels, although calcium revel was decreased from 9.42 ± 0.39 Dl to 9.29 ± 0.67 Dl after hormone therapy and parathormone were increased from 52.7±18.1 Dl to 54.9 ±16.3 Dl. Conclusion: According to this study, it seems that the destructive parathormone effect, in menopausal women, is independent on blood hormone concentration. As a matter of fact, the female sex hormone, estrogen, suppresses the destructive effect of parathormone and does not suppress the blood parathormone revel.    

Background: The complications of β thalassemia major can produce growth retardation in children. Objective: To determine growth factors in β thalassemia major patients under 18 years old and compare them with NCHS. Methods: Through a descriptive study, 90 thalassemia cases (46 boys and 44 girls) were studied in Qods thalassemia center of Qazvin hospital in 1997 for six months by interview and observation. The mean weight and height of boys and girls were compared with NCHS. Findings: The findings indicated that the weight curve of the cases was under the NCHS curve. The distance between these curves increased with the increase of age. The maximum distance was observed in 14 year old girls and 16-17 year old boys. The height of the cases was also below the standard revel and the maximum distance was observed in 11 to 14 year old girls and 17 to 18 year old boys. Conclusion: The mean height and weight of thalassemia patients were below NCHS in which the distance increased with the increase of age with a peak in puberty years which is probably due to hormonal disorder      

Background: Local irritations of formaldehyde vapour are one of the major problems of medical students who use dissection laboratory. Objective: To study the local irritations of formaldehyde vapour on medical students. Methods: The study was performed on 51 medical students of Qazvin medical university who had the practical course of anatomy in their third term and each week they spent 2 hours in the dissection laboratory. Findings: The students on the experiment reported symptoms of irritation of the eyes (78.4%), nose (62.7%), throat (35.3%), skin (11.8%) and lacrimation (37.3%) that was caused by exposure to formaldehyde. The average concentration of formaldehyde in dissection laboratory was 1.5 ppm. Conclusion: Smelling and direct exposure to formaldehyde vapour causes the multiple local irritations which in long term causes hazard effects.      

Background: Chronic cholecystitis is one of the most common operations. Several studies have revealed that antibiotics have no effect in prevention of post operative infection while they may cause resistant organisms to emerge and increase hospital cost. Objective: To determine the effect of antibiotic as a prophylaxis for post operative infection in chronic cholecystitis. Methods: Through a controlled clinical trial, 97 patients operated for chronic cholecystitis in 1999 were prospectively divided into trial and control group. The trial group received no antibiotics while the control group received 1 pre op dose and 3 post op dose of cefazoline (1gr Iv. Q 8 h). Both groups were followed for 1 month and incidence of any infective complications (wound infection, intra abdominal abscess and peritonitis) was controlled. The results were analyzed by chi2 and fisher tests. Findings: The rate of post infection in trial group was 3 in 48 patients (6.25%) and in control group was 4 in 49 patients (8.1%) in which the difference was not statistically significant. Conclusion: The results indicated that antibiotics probably have no significant effect on prevention of post operative infection in chronic cholecystitis.      

Background: A new therapeutic modality for treating severe vernal keratoconjunctivitis seems to be necessary. Objective: To determine the effect of supratarsal injection of corticosteroid in the treatment of refractory vernal keratoconjunctivitis. Methods: Through a prospective study, 40 patients with vernal keratoconjunctivitis resistant to all established therapies were randomly assigned to receive supernatural injection of short acting corticosteroid. Relief of symptoms and resolution of clinical signs were also evaluated. Patients were followed up for two years from 1998 to 2000 in Qazvin. Findings: All patients experienced dramatic symptomatic relief within one to five days. Mark decrease on cobblestone papillae was noted in 15 days (mean) after the injection of short acting corticosteroid. Shield ulcers and limbal involvement resolved in one to three weeks. No complications were observed with supratarsal injection of short acting corticosteroid in two years follow up. Conclusion: The dramatic symptomatic and clinical improvements suggest that supratarsal injection of short acting corticosteroidof dexamethazon sodium phosphate may be a valuable thrapeutic approach to treat refractory vernal keratoconjunctivitis.    

Background: Accuracy of preoperative diagnosis should be about 85%. Less than 85% indicates unnecessary operations and more than 90% presents the fact that some patients with acute appendicitis are being observed, while, they should have prompt surgical interventions. Objective: To determine the accuracy of preoperative diagnosis of acute appendicitis. Methods: Surgical and pathological notes of patients (601 cases) who were operated for acute appendicitis in 1995 at Shahid Rajaie hospital were reviewed. Findings: Only 521 patients had acute appendicitis and no pathological findings were found for the rest. The accuracy of preoperative diagnosis of acute appendicitis at Shahid Rajaie hospital center was 86.6%. Conclusion: The accuracy of acute appendicitis diagnosis in patients who undergo appendectomy was acceptable.    

Background: Relatives of the patients should be considered as an important element in programming of nursing care. Objective: To compare the attitudes of nurses and relatives of ICU and CCU patients towards psychosocial needs of the relatives. Methods: Through convence sampling, all employed nurses in critical care units of Kerman university hospitals and 41 relatives of admitted patients in these wards were selected to answer a questionnaire consisting of 25 questions. Re-test and spearman regression coefficient were used for data analysis. Findings: There was a significant difference considering the mean scores of nurses (2.93) and patients' relatives (3.23) , in which patients' relatives gave more important to these needs in comparison to the nurses (P<0.05). Conclusion: The difference between the attitudes of nurses and patients relatives necessities more training programs for nurses in this regard.      

Mycetoma is a chronic subcutaneous infection caused by certain fungi and actinomycetes. The disease has been known for years in Iran and the first case was identified in medical mycology laboratory, School of Public Health, Tehran University of Medical Sciences in 1962. This report is about, the first mycetoma caused by Aspergillus flavus in Iran. The first mycetoma caused by A. flavus has been reported in U.SA in 1996.      

Background: In spite of evidence suggesting that nutrition plays a vital role in the health of every individual as well as the prevention of diseases, nutrition education in the curricula of most medical schools is, in the opinion of the majority of experts in the field, still inadequate. Objective: To assess the nutrition knowledge, attitudes and practices of physicians and medical students in Iran. Methods: Two questionnaires, one for physicians and one for students, were designed to survey the above-mentioned topics. Findings: The findings indicated that while both students and physicians have a moderate knowledge of nutritional principles. Conclusion: To bring this goal to realization, nutrition education needs to be re-evaluated and promoted as an important part of the curriculum in medical of universities in Iran.