JOURNAL OF MAZANDARAN UNIVERSITY OF MEDICAL SCIENCES
Year:2012 | Volume:22 | Issue:89|Papers Count:17

Background and purpose: Surgical site infection (SSI) is the third leading cause of hospital infections which results in increased morbidity, mortality and costs after cardiac surgery. The importance of prophylactic antibiotics in cardiac surgery has been proved. The aim of this randomized clinical trial was to compare two prophylactic antibiotic regimens (cefazolin and cefazolin plus gentamicin) on surgical site infection in CABG patients in Mazandaran Heart Center.Materials and methods: A total of 400 patients, meeting eligibility criteria, were randomly allocated into two groups. In the control group the prophylactic regimen consisted of cefazolin 2 g IV prior to sternal incision followed by 1 g IV every 6 hours for 72 hours. The intervention group received cefazolin 2 g IV plus gentamicin 1.5mg/kg IV before sternal incision followed by cefazolin 1 g IV every 6 hours plus gentamicin 1.5mg/kg IV every 8 hours for 72hrs after the sternal incision. Three, seven, 21 and 30 days after cardiac surgery the patients were observed by a cardiac surgeon for symptoms of surgical wound infection. Moreover, the serum level of creatinine and BUN were measured before the surgery and also in second and forth days after the surgery.Results: From the total of 400 patients 392 were assessed of whom 198 were in control group and 194 were in the intervention group. There was no significant difference between the two groups regarding demographic and clinical variables and also the rate of infection (P>0.05). However, the serum level of creatinine and BUN were significantly higher in intervention group (P<0.05).Conclusion: Since there was no significant difference in infection rates between the two groups and significant increase in serum level of creatinine and BUN in intervention group, using cefazolin as the sole prophylactic antibiotic is suggested to prevent surgical site infection in CABG patients.

Background and purpose: One of the transmission ways of the congenital toxoplasmosis is through the placenta to the fetus, therefore, its diagnosis at early stage is very important. Toxoplasma gondii parasite contains various antigens of which excretory-secretory antigens (E/SA) are used in designing Elisa avidity kit. The aim of this study was to compare the results of commercial kit and designed Elisa avidity kit in mothers with toxoplasmosis. Excretory-secretory antigens of toxoplasma gondii parasite were used in the designed kit.Materials and methods: In this descriptive study aspirated peritoneal fluid of mice which were IP infected by toxoplasma tachyzoite (106 tachyzoites/mL) seven days earlier, were centrifuged at 1000g for 15 minutes. Afterwards, the upper fluid was taken as the main component of E/SA from toxoplasma tachyzoite in order to assess the designed Elisa avidity kit.Results: The results showed that if fresh E/SA are used in designed Elisa avidity kit to detect toxoplasma IgG, better outcomes may found regarding the quantity and titer of antibody.Conclusion: The results drawn from the designed kit using E/SA of toxoplasma gondii were more reliable than that of the commercial kit in detecting congenital toxoplasmosis.

Background and purpose: Cancer is one of the most common growing diseases. According to statistics, its incidence in East Mediterranean region and Iran is increasingly growing. Considering the rise in the number of patients with cancer and threatening nature of this disease as well as problems of the patients and their families, the necessity to know and to understand the patients' needs and problems, especially after revealing cancer diagnosis is imperative. Recognizing patients' needs will help in resolving their problems. The aim of this study was to understand patients' needs when confronted with cancer diagnosis.Materials and methods: Using qualitative approach, the present study was done with content analysis method application. Nineteen participants including patients, physicians, nurses and patients' close relatives were chosen amongst the clients of an oncology unit, a cancer clinic, and a cancer patients support center. Purposeful sampling method was applied at the beginning and continued until data saturation was achieved. Face to face interview and taking field notes were used to collect the data. All the interviews were recorded and transcribed verbatim.Results: Five hundred and sixty five primary codes in four categories were obtained which consisted of 'supports of family and friends', 'effective interaction of medical staffs with patients', 'services offered by supportive organizations' and 'necessity to inform and prepare the patients'. The main common theme of categories was 'support' which was the major need of patients with cancer.Conclusion: The findings of this study showed that when the diagnosis of cancer is made, patients will have a lot of needs. Recognizing these demands by health authorities and clinical staffs could improve their interaction with patients.

Background and purpose: Leishmania is flagellated protozoa and causative agent of leishmaniosis. It is one of the main public health problems in developing countries. Cantharidin is terpenoid component that exists in Meloidae and Oedemeridae beetles. Cantharid in is vesicant and could induce apoptosis in cancerous cells. This study was performed to determine the role of cantharid in in inducing apoptosis in the Leishmania promastigotes and macrophages infected with parasite.Materials and methods: In this experimental study the effect of cantharid in was evaluated at concentration range of 0.5-50 mg/mL on the L. major promastigotes and concentration range of 5, 20 and 50 mg/mL on macrophages infected with L. major after 24, 48 and 72 hrs by flow cytometry assay.Results: Results showed that cantharid in with concentration levels of 50 mg/mL and 0.5 mg/mL has 68.50% cytotoxicity (as 63.23% apoptosis, 5.27% late apoptosis and 0% necrosis) and 14.29% cytotoxicity (as 13.12% apoptosis, 1.12% late apoptosis and 0.05% necrosis) in promastigotes after 72hrs, respectively. Cytotoxicity 0.5 mg/mL and 50 mg/mL cantharid in in infected macrophages after 48hrs was 61.81% (as 43.42% apoptosis, 1.27% late apoptosis and 17.11% necrosis) and 44.44% (as 31.05% apoptosis, 10.08% necrosis and 3.31% late apoptosis), respectively. Cytotoxicity of 50 mg/mL and 5 mg/mL cantharidin in non-infected macrophages after 48hrs was also 49.34% (as 21.35% apoptosis, 4.23% late apoptosis and 23.76% necrosis) and 43.79% (as 34.90% apoptosis, 7.27% necrosis and 1.61% late apoptosis), respectively.Conclusion: This research indicates that cantharid in at different concentration and times could induce apoptosis in L. major promastigotes and macrophages infected with amastigotes.

Background and purpose: Quality of life by definition is "The individual's perception of his/her position in life within the cultural context and value system he/she lives in. This study aimed at assessing the quality of life enjoyment and satisfaction in medical students of Mazandaran University of Medical Sciences in comparison with Natural Resources students of Sari University of Agricultural Sciences and Natural Resources and also identifying the most important factors influencing the quality of life enjoyment and satisfaction.Materials and methods: The research population included 853 students of whom 356 were medical students and 497 were natural resources students. In this descriptive cross-sectional study "Quality of Life Enjoyment & Satisfaction Questionnaire–Short Form" was used. To analyze the data descriptive statistics, t-test and ANOVA were used in SPSS 17.Results: The quality of life enjoyment and satisfaction in medical students was significantly less than that in non-medical students (p=0.002). Students of better economic status (p=0.03), those who lived with their parents (p=0.009), first year medical students (p=0.019) and natural resources (p=0.000) and also younger students (p=0.001) had significantly better scores.Conclusion: Decreasing quality of life enjoyment and satisfaction during acquisition in university could be a warning to those responsible for students' education and welfare. Unsatisfactory life situation may decrease medical students working efficiency and make them poor role models for their patients regarding physical and mental health.

Background and purpose: Recent studies showed that erythropoietin (EPO) despite having role in hematopoiesis, has non-hematopoietic protective effects on ischemia-reperfusion injury. this study evaluates the effects of erythropoietin on reducing ischemia-reperfusion injuries during coronary artery bypass graft surgery (CABG).Materials and methods: in this clinical trial, 60 patients candidate for elective CABG were randomly divided into two groups, EPO and control group. Patients in EPO group received IV infusion of EPO (700 IU/kg), at the start of reperfusion after aorta cross clamp. Cardiac markers including Troponin I and Creatine kinase MB (CKMB) assessed eight hours after CABG surgery. Also echocardiography was performed in all patients six month after surgery. the data was analyzed using t-test chi-square and mann-withney.Results: Troponin I level showed no significant difference in EPO and control group (P=0.30). CKMB level in EPO group was higher than that of the control group (P=0.004). Ejection fraction (EF) was also higher in EPO group after six month but it was not significant (P=0.46). Left ventricle end systolic volume (P=0.017) and also Left ventricle end diastolic volume(P=0.04) in EPO group were significantly less in control group.Conclusion: in this study the administration of erythropoietin caused reduction in ischemia-reperfusion injuries after CABG  by improving ventricular function, and also reduction in myocardial remodeling and Left ventricle end systolic volume and left ventricle end diastolic volume.

Background and purpose: After anemia thrombocytopenia is the most common disorder in pregnancy which is encountered in 10% of pregnancies. Thrombocytopenia in pregnant women may lead to maternal and neonatal morbidity. This condition could involve some complications in pregnancy, so diagnosing its causes is important for treatment. This study was performed to determine the incidence, causes and complications of thrombocytopenia in pregnancy.Materials and methods: In this prospective study, all pregnant women with gestational age of≥24weeks and also those in pregnancy termination stage who referred to two teaching hospitals in Babol, during 2008-2009 were selected. Among this population those with platelet count less than 150,000/ mL were chosen. Causes of thrombocytopenia, method of delivery, maternal and neonatal complications in these patients were recorded. Platelet count less than 100,000/ mL was considered severe thrombocytopenia.Results: During the study period, 4589 pregnant women were examined and thrombocytopenia was reported in 239 cases. The incidence of thrombocytopenia in pregnancy was 5.2%. The causes of thrombocytopenia were gestational thrombocytopenia in 222 patients (92.9%), ITP in 11 patients (4.6%), preeclampsia in five patients (2.1%) and HELLP syndrome in one patient (0.4%). Six pregnancies (2.5%) resulted in IUFD and bleeding occurred only in one patient with ITP during and after delivery. No neonatal complication was seen in newborns of women with thrombocytopenia.Conclusion: The results showed that gestational thrombocytopenia was the most common cause of thrombocytopenia in pregnancy which revealed no complication for patients and their fetuses. However, differential diagnosis should be made to avoid diagnosis of HELLP syndrome or preeclampsia that require urgent termination of pregnancy to prevent further complications.

Background and purpose: This study aimed at determining the relationship between the body mass index and pattern of fat distribution with blood lipid serum among secondary school girls.Materials and methods: A total of 780 students who volunteered to participate in this study signed an informed consent form. Among them 155 were active, 340 were inactive and 285 students were moderately active. The participants in the last group were excluded from the study. Sample size table of Cohen et al (2001) was used and the students were randomly divided into two groups of active (51 students) and inactive (55 students). Height, weight, waist perimeter and pelvic perimeter were measured in order to determine the body mass index and the pattern of fat distribution in the body. Then fasting blood test was done to examine the levels of LDL, HDL, triglycerides, and cholesterol. The Pearson correlation and t-test were applied to analyze the data.Results: The results showed a significant difference between the two groups regarding the body mass index and fat distribution pattern (P<0.05). However, the difference between two groups for LDL and HDL, triglycerides and cholesterol was not significant.Conclusion: This study indicates a significant relationship between body mass index and the pattern of fat distribution and blood fats which are important factors influencing heart disease, but based on the extent of body activity, no difference was seen between the two groups.

Background and purpose: Labor induction is now one of the most common methods in the field of Obstetrics and Gynecology for cervix preparedness and entering the active phase of labor. This study was conducted to compare the effects of misoprostol and oxytocin.Materials and methods: This study was a double-blind clinical trial by recruitments of 60 primiparous women who referred to Boo Ali Hospital in Tehran, 2011. The participants were divided into control and intervention groups by random allocation. Misoprostol and oxytocin by four hour intervals were prescribed for those in pregnancy termination stage in order to induce labor.Results: The mean age and standard deviation in intervention and control group was 24±3.96 and 24.1±3.97, respectively. The main reasons for admission were postdate pregnancy and lack of labor pain.A significant correlation was found between treatment variables, cause of hospitalization, hypertension history and increased or decreased time to achieve regular and suitable contractions for delivery (P<0.05).Results showed no significant difference in two groups until three hours after treatment. However, a better influence of misoprostol was observed among the intervention group (P=0.014).Conclusion: In order to reduce time to reach short and effective contractions using misoprostol in labor induction is more effective than oxytocin. However, the two drugs did not show any significant differences regarding pregnancy outcomes including meconium passage, fetal distress and premature rupture of membrane.

Background and purpose: Utilization of evidence-based research can increase the validity and quality of nursing care and nurses' responsibility. In order to have research based performance by nurses, identifying the barriers to utilization of research findings is essential. This study aimed at recognizing these barriers from clinical nurses' prospective.Materials and methods: A cross-sectional study was carried out on 313 nurses working in three hospitals of Babol University of Medical Sciences in 2011. In this study a questionnaire containing two sections was used in which first part questioned scientific and professional knowledge of subjects, and the other part was extracted from Funk's barriers scale.Results: Four dimensions were identified using factor analysis. These were report, research, nursing and organization. Important barriers were insufficient time to study for implementing new ideas, lack of timely and fast publication of research papers, and lack of physicians' collaborations in implementing the results of nursing researches. These were classified in a different dimension. Some barriers were not included in any dimensions, such as low trust of nurses to research findings, unjustified conclusions drawn from researches, conflicting results, and English publication of most studies.Conclusion: The important finding of this study was that the subjects identified the barriers in nearly all dimensions. According to the first three barriers, authorities should provide nurses with facilities to utilize and implement research findings. Moreover, they should promote educational programs to develop knowledge, skills and positive attitude to research among nurses.

Background and purpose: Despite many improvements in abdominal wall hernia repair different ideas exists regarding the best method for hernia repair. There is high recurrent rate in Mayo repair method, therefore, this study was carried out to investigate the impacts of mesh in patients with small umbilical hernia (<1cm).Materials and methods: A randomized clinical trial was performed on 80 patients aged 20-70 years old who referred to Imam Khomeini Teaching Hospital in Sari. The patients were randomly divided into two groups of mesh repair and Mayo repair. Infection and recurrent of the hernia was assessed in the first week, first month and first year after the surgery.Results: Among 40 patients in Mayo repair group, infection was found in three patients and recurrence was observed in seven patients, however, no infection and recurrence was seen in the mesh repair group. There was significant difference regarding the recurrence between the two groups (P=0.004), while the difference regarding infection was not significant.Conclusion: Since Mayo method resulted in high recurrence of the umbilical hernia, using mesh could be a useful method in repairing even small defects in patients with risk factors such as obesity and multiparity.

Background and purpose: Oral health is one of the most important branches in public health. Great emphasis has been put on this issue by WHO in the department of Chronic Diseases and Health Promotion (CHP). This issue needs more attention regarding the health of pregnant women and their fetus.Materials and methods: A cross-sectional study was carried out on 340 pregnant women who were selected through multistage random sampling method from Arak health centers. DMFT index and HBM (susceptibility, severity, benefits, barriers and self-efficacy) were evaluated.Results: The mean age of women was 28.2±3.7 years old and the mean of DMFT was 5.4±2.83. Self-efficacy and perceived barriers were the main predictors of oral health behavior in pregnant women. The mean of oral health care performance in women was 43.1±9.7. A significant correlation was found between perceived susceptibility and performance (r=0.44, P=0.008), perceived severity and performance (r=0.51, P=0.002), and self-efficacy and performance (r=0.61, P=0.001). In contrast, a significant negative correlation was observed between the perceived barriers to oral health care and pregnant women's performances (r=-0.65, P=0.001).Conclusion: According to this research perceived barriers were associated with oral hygiene behavior (tooth brushing). Therefore, these barriers should receive more attention by oral hygienists to promote educational programs regarding brushing. Moreover, self-efficacy was the most important predictor of oral health behavior in pregnant women. Hence, dental professionals should enhance self confidence in pregnant women so that they could follow oral health care behavior.

Accessory mitral valve tissue is a rare congenital malformation that has been reported in the literature in approximately 130 cases. This condition could be found isolated or in combination with other cardiac anomalies and is usually diagnosed in childhood. It is in differential diagnosis with other cardiac masses as tumors or vegetations.In this article a 27 year old asymptomatic female is presented who referred to hospital for the evaluation of cardiac mass. Transthoracic and then trans esophageal echocardiography revealed a mass in LVOT which was a membranous type of accessory mitral valve tissue without obstruction in LVOT.Echocardiography is highly beneficial in differential diagnosis and planning for surgery or medical follow-up in such rare patients.

Roger's syndrome is a rare form of diabetes in children that is characterized with early onset of diabetes mellitus, megaloblastic anemia, and sensory neural hearing loss. In this report three cases of this syndrome from consanguineous Iranian families are introduced (two siblings and a cousin). They referred to pediatric ward of Imam Reza Hospital with hyperglycemia, anemia and sensory neural hearing loss.Molecular genetics study revealed novel mutation in SLC19A2 gene. Thiamin was used in order to treat the patients. Afterwards, anemia was resolved in all patients and normoglycemia achieved in two of the patients, however, hearing loss remained in all three.

Pseudo aneurysm and cellulitis of femoral artery is so prevalent among intravenous drug abusers. This condition is found more in European countries. However, it was reported in Iran as case reports since the late 2000s. Today more sever cases are seen because of combining pseudo aneurysm and cellulitis with autoimmune disease such as AIDS. In this report 14 cases are presented.