Journal of Mazandaran University of Medical Sciences
Year:2015 | Volume:25 | Issue:130|Papers Count:24

Background and purpose: Strongyloidiasis is prevalent in Northern provinces in Iran.Therefore, this study aimed at investigating the prevalence of Strongyloides stercoralis and other intestinal parasites in rehabilitation centers in Mazandaran Province, north of Iran.Materials and methods: A cross-sectional study was carried out in seven rehabilitation centers in Mazandaran Province, 2013-2014. Fecal samples were collected from 341 participants (239 male, 102 female) aged 11-86 years old. The centers and specimens were randomly selected. All samples were examined by formol-ether concentration and agar plate culture. Diarrheic samples were examined by direct smear and Trichrome staining. Statistical analysis was performed in SPSS V.16.Results: Intestinal parasitic infection was observed in 112 individuals. Protozoa infections were seen in 19.6% and helminth infections were seen in 14.1%. Strongyloides stercoralis was detected in 2.1% of the samples. The infection rate with other helminth parasites included Dicrocoelium dendriticum 7.9%, Trichuris trichiura 3.2%, Echinostoma sp.0.9%, Taenia 0.3%, and Trichostrongylus sp.0.3%.Entamoeba coli was the most common protozoan parasite (19.4%) followed by Iodamoeba butschlii (2.1%) and Chilomastix mesnili (1.2%).Conclusion: This study showed high infection rate with some intestinal parasites. The problems and complications associated with these parasites call for prompt diagnosis and treatment of infected individuals in rehabilitation centers.

Background and purpose: Awareness of people about drinking water impurities and the demand for better water quality have led to widespread application of point-of-use (POU) water treatment devices. The aim of this study was to investigate the bacteriological quality of water produced by household water treatment devices.Materials and methods: This cross-sectional descriptive study was performed on 18 household water treatment devices in 2014. Thirty-six inlet and outlet water samples were collected. Bacterial quality of the samples were determined by total and fecal coliform multiple-tube fermentation techniques, heterotrophic plate count (HPC) was done using membrane filter technique on blood agar medium and gram-negative bacteria analysis was performed via membrane filtration technique on EMB agar medium.Isolated colonies were identified using standard biochemical tests.Results: Total and fecal coliform bacteria were negative at all inlet samples, but were positive at two of the outlet samples. HPC were higher than the maximum limits of 500 cfu/ml at 67% of the outlet samples. Pseudomonas, Alcaligenes, Serratia and Shigella genus were found with higher frequencies at both inlet and outlet samples. However, frequencies of Proteus and gram positive Bacillus have increased in the outlet samples.Conclusion: The removal of residual chlorine by household water treatment devices causes developing biofilm on the filters and storage tank of the devices by the bacteria present in distribution network. Consequently, the number and variety of bacteria are increased in water produced by POU water treatment devices.

Background and purpose: Cardiovascular diseases are the leading cause of death worldwide, accounting for 17 million deaths annually. Poor lifestyle is one of the factors influencing the incidence of some cardiovascular diseases such as coronary artery stenosis. The purpose of this study was to investigate the relationship between health promoting behaviors and severity of coronary artery stenosis among patients in angiography department in Mazandaran Heart Center, Iran.Materials and methods: A descriptive analytical study was performed in 184 patients candidate for angiography. According to angiography, patients were divided into two groups: the arterial stenosis above 50% (n=92) and arterial stenosis less than 50% (n=92). Patients’ lifestyle was investigated using Health-Promoting Lifestyle Profile (HPLP II). Demographic characteristics and risk factors for cardiovascular disease were also extracted from the patients’ medical records. Data was analyzed applying Chi-square test, Mann-Whitney test, and multiple linear regression test in SPSS V.21.Results: According to the results, the mean score for health responsibility, physical activity, stress management and total score for health promoting behaviors were significantly higher in patients with arterial stenosis less than 50% (P<0.05). Also, in this group of patients significant positive relationships were found between age and stress management (P=0.03), and history of hypertension and spiritual growth (P=0.001). In the group of patients with arterial stenosis above 50%, there were significant relationships between history of diabetes and interpersonal relationships (P=0.007) and smoking and spiritual growth (P=0.03).Conclusion: According to this study, educational interventions that promote stress management skills and physical activity among people at risk for cardiovascular diseases may reduce the severity of coronary artery stenosis.

Background and purpose: Sexual dysfunction caused by contraceptive methods threatens sexual health. The aim of this study was to determine the relationship between sexual health and contraceptive methods in women attending health centers in Urmia, Iran.Materials and methods: A descriptive- analytical study was conducted in 2014 in which 198 women were randomly recruited. Data was collected by a standard questionnaire consisting of three parts: socio-demographic characteristics, Female Sexual Function INDEX (FSFI), and Index of Sexual Satisfaction (ISS). Data was then analyzed applying descriptive statistics, t-tests, one-way ANOVA, and Pearson’s correlation coefficient in SPSS V.22. P-values less than 0.05 were considered significant.Results: The mean age of participants was 29.89±7.01 years. The mean scores for sexual function and satisfaction were 20.99±6.73 and 35.93 ± 16.10, respectively. ANOVA analysis showed a significant relationship between sexual function and contraceptive methods. Also, a significant association was found between contraceptive methods and sexual satisfaction (P=0.00). The most common cause of sexual dysfunction and satisfaction was contraceptive injections, while withdrawal method resulted in the lowest incidence of sexual dysfunction and satisfaction.Conclusion: In this study, the most common contraceptive methods in women were withdrawal method and taking oral contraceptive pills (OCPs). The results showed that hormonal methods of contraception particularly contraceptive injections could negatively influence the women's sexual health.Therefore, more training programs should be carried out in family planning counselors, so that appropriate contraceptive methods are implemented while considering women’s sexual satisfaction and function.

Background and purpose: Palliative care is an important concept in nursing practice and in literature several definitions are suggested for this concept. This study aimed at analyzing the concept of palliative care and identifying its features, antecedents and consequences within Iran’s cultural context.Materials and methods: Hybrid model of concept analysis was used to clarify the meaning of palliative care. The three phases of a hybrid concept analysis included theoretical, fieldwork, and final analysis. In theoretical phase different databases including PubMed, CINAHL, Science direct, Google scholar, SID and Magiran were searched for related articles (published in 2003-2013). The search keywords were palliative care and nursing care in the titles and abstracts. In the fieldwork phase semistructured in-depth interviews were conducted through purposive sampling in eight nurses. In next step, by combining the two previous stages the final analysis was performed.Results: In final analytical phase, main themes were extracted including pain management, holistic care, spirituality based care and religious based care.Conclusion: The findings showed that palliative care is an important aspect of clinical practice.It is a holistic, humanistic and corporative care for promoting the quality of life of patients and their families that support them while considering physical, psychological, spiritual, religious, cultural and social aspects. This type of care is beneficial throughout life and also in difficult situations such as famine and it should not be used just for end-stage patients.

Background and purpose: Anxiety and depressive symptoms are common in patients with irritable bowel syndrome. The aim of this study was to determine the efficacy of mindfulness on improving anxiety and depression in patients suffering from irritable bowel syndrome.Materials and methods: In an experimental study (pretest-posttest randomized experiment) we included 30 patients with irritable bowel syndrome attending Hospitals of Tabriz, 2014. Data was collected using the Rome-III diagnostic criteria and the Beck Anxiety Inventory. The participants were randomly selected and divided into control and experimental group (n=15 per group). In experimental group, the mindfulness therapy was performed in 8 sessions, once a week for 90 minutes. Beck Anxiety Inventory was readministered as post-test to both groups. Data was then collected in SPSS V.20 using Multivariate analysis of covariance.Results: In this study mindfulness was found to be significantly effective in reducing anxiety and depression in experimental group.Conclusion: Mindfulness therapy could be used as an effective treatment in improving anxiety and depression in patients suffering from irritable bowel syndrome.

Background and purpose: Development of pulmonary complications after surgery is seen in patients with chronic obstructive pulmonary disease (COPD). Some exercises are used to reduce these effects, but the results of these programs are incomplete. The aim of this study was to perform training programs and evaluation of lung function tests in two weeks before and after coronary artery bypass surgery (CABG).Materials and methods: A clinical trial was performed in which 40 patients with COPD who were candidate for CABG were randomly divided into two groups (n=20 per group). Both groups performed routine exercises. From two weeks earlier, patients in experimental group also performed some other exercises including breathing exercise, hand exercise at width of shoulder, breathing muscle exercise, and walking. Lung function tests were conducted two weeks before and after the exercises in both groups. Paired t-test and ANCOVA were applied for data analysis.Results: According to the study, forced vital capacity values (FVC) in experimental (3.34±1.03) and control group (2.2±0.79), forced expiratory volume in 1 second (FEV1) in experimental (2.98±0.81) and control group (1.67±0.79) (P=0.0001), the Values of FVC / FEV1 in experimental (90.8±10.7) and control group (73.9±19.25), and peak expiratory flow (PEF) values in experimental (5.66±2.17) and control group (3.68±1.62) (P=0.002) were significantly different in experimental group.Conclusion: Four-week exercise therapy in patients with COPD could improve lung function after CABG.

Background and purpose: Adolescents with diabetes are faced with some constraints and may show some negative reactions such as aggressive behavior. These behaviors increase the level of glycosylated hemoglobin in these patients. It is important to assess some interventions that reduce aggression and improve glycosylated hemoglobin level in diabetic adolescents. This study aimed at determining the effect of implementation of the modified aggression replacement training program (ART) on glycosylated hemoglobin levels in adolescents with insulin-dependent diabetes.Materials and methods: A clinical trial was conducted in 70 adolescents suffering insulindependent diabetes attending Parsian Diabetes clinic in Mashhad, 2014. They were divided into two groups: a control (n=35) and intervention (n=35) group. The intervention program comprised five sessions of 1.5-2 hours. The sessions were held at five days intervals and each group consisted of 8-10 individuals. Glycosylated hemoglobin tests were performed before the intervention and two months later.Data was analyzed in SPSS by student t-test and Chi-square test.Results: Before the intervention the glycosylated hemoglobin levels were not significantly different between the two groups (P=0.457). But in post-intervention phase, the glycosylated hemoglobin levels decreased significantly in intervention group (8.7±1.4) compared to the control group (9.6±1.5) (P<0.017).Conclusion: The modified ART could be effective in reducing glycosylated hemoglobin levels in adolescents with insulin-dependent diabetes. Therefore, it is recommended as part of a comprehensive treatment for diabetes.

Background and purpose: Violence against children is one of the most important social and public health problems that affect people in different age, racial, cultural and religious groups. The aim of this study was to determine and compare the prevalence of violence against children in provinces of Iran.Materials and methods: This ecological study used the cluster analysis of data from Demographic and Health Survey (DHS) conducted in 2010 among 31 provinces of Iran.Results: After integration of indicators of violence against children, the highest and lowest mean values of indices in all provinces were verbal punishment (76.99) and corporal punishment (13.12), respectively. In cluster analysis five clusters were formed in which the worst was seen in Golestan province (cluster 2) and the best were observed in Guilan, South Khorasan, Yazd, Ilam, Tehran, Khorasan Razavi, Isfahan, Semnan, Hormozgan, Khoozestan, Alborz, and North Khorasan (cluster 1). According to the results of ANOVA, four indicators of violence against children including inadequate care, exposure to smoking, child labor and believe in disciplinary action against children showed significant differences, but no significant difference was found between corporal punishment and verbal punishment.Conclusion: This study showed that the overall rate of violence against children was high and a wide variety of violence is seen against Iranian children.

Background and purpose: Intelligent methods such as artificial neural networks (ANN) have been recently used as an efficient model for prediction and classification of tumors. Diagnosis of benign and malignant breast tumors based on morphological, clinical and demographic features without using invasive paraclinical methods is very important. The aim of this study was to provide a neural network model to predict the status of breast tumors and compare its efficacy with the common regression model.Materials and methods: In this study, Wisconsin breast cancer database was used. It was obtained from cytology results of the breast tumors of 683 patients. In the proposed model different features such as clump thickness, uniformity of cell size, uniformity of cell shape, etc. were used as input variables. We applied the genetic algorithm (GA) for determination of the best structure and training of multi-layer NN model was implemented in MATLAB. The performance of proposed NN model was compared appling logistic regression (LR) in SPSS.5-fold cross validation was used for accurate calculation of the performance of the models.Results: The results found GA capable of determining the best structure for a multi-layer NN that could also train it properly. In different performances the best NN structure was NN (9-8-6-1) with an average accuracy, sensitivity, specificity, and AUC (area under ROC curve) of 0.971, 0.988, 0.962, and 0.9955, respectively, while the values of the corresponding parameters for LR were 0.968, 0.975, 0.964 and 0.9954, respectively.Conclusion: The achieved ANN model could be used as a method with high sensitivity and specificity alongside common non-invasive diagnostic methods as a diagnosis support system to identify benign and malignant breast tumors.

Background and purpose: Cultural signs may be found among people that speak a local dialect or live in a specific region or historical period. These cultural signs could influence psychopathology. The aim of this study was to design and validate a questionnaire that could evaluate the cultural factors causing concurrent obsessions and major depressive disorders in Iran.Materials and methods: To design the questionnaire, 10 psychologists and psychiatrists who were members of academic boards were questioned by an open questionnaire. Then, the answers to the questions were classified and based on exploratory factor analysis the questionnaire containing 11 factors and 79 questions was confirmed. Internal homogeneity was analyzed by Cronbach’s alpha.Results: The results of Cronbach’s alpha for all factors showed that the highest reliability was 0.90 and the lowest was 0.42. In exploratory factor analysis using Varimax rotation 11 factors were extracted that predict 47.3% of the scale variance.25 factors were extracted of which14 had less than three items, therefore they were omitted because of not being able to acquire reliability as sub factors.Accordingly, a questionnaire containing 11 factors and 79 questions was constructed.Conclusion: The findings showed that the instrument could identify the cultural factors that cause concurrent obsession and major depressive disorders in Iran.

Background and purpose: Cerebral palsy is a common disorder in children leading to their dysfunction in many aspects. Therefore, to provide appropriate treatment plan that could improve the function of these children, a valid assessment tool is needed. Pediatric Evaluation Disability Inventory (PEDI) is designed to evaluate the performance of children with disabilities in three dimensions: self-care, mobility, and social function. The purpose of this study was to evaluate the reliability of the Persian version of PEDI in children with cerebral palsy aged 3 to 9 years old.Materials and methods: In this study, 75 participants were selected by convenience sampling.Information was collected using demographic questionnaire and Gross Motor Function Classification System (GMFCS). The parents were interviewed and PEDI was completed. After two weeks, in order to evaluate the reliability of the test-retest, 22 parents were re-interviewed. Internal consistency was examined by Cronbach's alpha, and the reliability of the test-retest was assessed by intra-class correlation coefficient (ICC).Results: In examining the internal consistency, Cronbach's alpha was found to be high (0.94- 0.98).The results of test-retest reliability of the functional skills and caregiver assistance scale were excellent (0.96-0.97). Also, the results of test-retest reliability in modification scale were excellent in selfcare and social performance (0.99 and 1, respectively) and good in mobility dimension (0.66).Conclusion: This study proved the internal consistency and test-retest reliability of the Persian version of PEDI in evaluating the performance of Persian-speaking children with cerebral palsy.Therefore, PEDI could be applied in research and clinical settings for evaluation of children with cerebral palsy in Iran.

Background and purpose: Locating and measuring the length of the distal femoral canal is a very important stage in reconstructive surgery of anterior and posterior cruciate ligament rupture in knee.Sometimes it is difficult or impossible to measure it in some patients. To resolve this problem, a measuring tool called the Measuring Instrument of the Length of the Femoral Canal (Satkr) was designed and registered in Iranian patent office. The instrument was designed to measure the length of the femoral canal before creating any canal in distal femur (therefore, enabling surgeons to change it if it was not calculated properly).Materials and methods: In this comparative cross sectional study, a part from Satkr, two other instruments which are commonly used in reconstructive surgery of knee ligaments including a 4.5 graded Reamer and a depth gauge that is the final confirming tool for measuring the length of the canal were applied to 50 patients of both sexes. According to the operating techniques, measures of the length of the canal were separately written and statistical differences were recorded in two-sided way.Results: Data indicated significant differences between the scores of Reimer, depth gauge and Satkr (P=0.004).Conclusion: According to this study, Satkr had significantly less errors compared to Reamer.Thus, it can be claimed that the measurements obtained by Satkr are more precise than measurements obtained by other measuring tools.

Background and purpose: The complexity of anatomical variation of Willis circle (CW) has made it susceptible to variation. The goal of this study was to determine the prevalence of the CW variations using magnetic resonance angiography (MRA) without contrast agent in patients attending Sari Imam Khomeini Hospital.Materials and methods: In a cross-sectional study, 200 subjects referring for MRA were analyzed. Variables included hypoplasia, agenesis, stenosis, aneurysm, dolichoectasia, fenestration and duplication. Logistic regression model was applied to estimate the association between variation states in CW and other variables.Results: The most common variation was hypoplasia in left and right posterior communicating arteries (n=118 (59.3%) and n=107 (54%), respectively). Stenosis and dolichoectasia were more prevalent in anterior cerebral artery and basilar artery, respectively. Among the participants 90 (45%) were diagnosed with stenosis and 31 (15.5%) were reported to have dolichoectasia.Conclusion: Typical circles were seen only in 28 (14%) individuals and the rest had other variations. Therefore, MRA could be beneficial for diagnosis, treatment and prognosis.

Background and purpose: The anxiety and birth-related biological stresses lead to delayed onset of lactogenesis stage II and early termination of breastfeeding. This study aimed to determine the effect of continuous support during labor on the onset of lactogenesis stage II in primiparas.Materials and methods This randomized clinical trial study included 80 primigravida women attending Mashahd Omlbanin Hospital who were randomly allocated in to two groups (n=40 per group).The intervention group and the control group received supportive care and routine care, respectively. In both groups the onset of lactogenesis II were measured after delivery. Data was collected through a questionnaire, a checklist and Spielberger State-Trait Anxiety Inventory (STAI). Data was then analyzed using descriptive statistics, student’s t-test, Mann- Whitney U and Chi-Square test.Results: The mean onset of lactogenesis II was 2.6±0.96 days in supportive care group and 3.0±1.1 days in routine care group indicating no significant difference between the two groups (P=0.870). The first duration of breastfeeding postpartum in supportive care group was significantly higher than that in the routine care group. (P=0.007).Conclusion: Supporting the mother during labor dose not effect the onset of lactogenesis stage II, but increases the first duration of breastfeeding postpartum.

Background and purpose: Nitrite and nitrate are considered as pollutant agents of ground water resources that cause several hygienic complications. Agricultural fertilizers that contain nitrate are widely used in north of Iran. This study was carried out to determine the concentrations of nitrite and nitrate in agricultural and drinking water wells in rural areas in Miandoroud, Iran.Materials and methods: In this study, 276 samples were collected from 35 drinking water wells in Miandoroud (Mazandaran province, north of Iran) in March-September 2013. All experiments were performed according to the standard methods examination book. The results were analyzed in SPSS V.16 and Microsoft Excel.Materials and methods: In this study, 276 samples were collected from 36 drinking water and agricultuer wells in Miandoroud (Mazandaran province, north of Iran) in March-September 2013. All experiments were performed according to the standard methods examination book. The results were analyzed in Microsoft Excel.Results: According to the results, the concentration of nitrite was within standard levels established by national guidelines, while in some regions the nitrate concentration was found to be higher than standard levels. In all wells gradual increases were seen in nitrate concentrations. There was a direct relationship between nitrite and nitrate concentrations with depth and temperature.Conclusion: The nitrate concentrations in some wells were higher than standard levels, therefore, more attention should be paid to nitrate pollution in this region.

Background and purpose: Aggressive behavior is one of the most common disorders in children that leads to consultation referral. The aim of this study was to predict aggression in children according to mental health and dimensions of violence against mothers.Materials and methods: The research population included 250 mothers of preschool children who were selected by multistage sampling in Dezful, Iran. Data was collected by General Health Questioner, Violence toward Women Inventory, and Child Behavior Checklist.Results: The results showed a significant negative correlation between mothers’ general health and children aggression (r=-0.517). But significant positive correlation was found between children aggression and mental, physical, sexual, and economic violence (0.647, 0.618, 0.360, and 0.344, respectively) against mothers (P=0.001). Maternal mental health, and sexual and mental violence against mothers could predict aggression in children.Conclusion: To control aggression in children, great attention should be paid to other systems such as family and the relationships within a family.

Background and purpose: Grapes are abundantly found and consumed by people all over the world. Holy Quran has more than a thousand verses about scientific facts and some of them are regarded as the scientific miracles of Quran. Holy Quran has mentioned grape 11 times. The holy book advises human to use both vegetables and animal source foods. This study aimed to review medicinal and nutritional properties of grapes from the Quran’s point of view and Iranian Islamic medicine.Materials and methods In this review study, some scientific databases such as Scopus, Google scholar, PubMed, Science Direct, and Ovid were used. Also, Holy Quran, Islamic narrations and hadith, books about traditional medicine and medicinal plants were studied. The findings were restricted to works published during 1994 to 2014. The keywords included medicinal plant, anticancer effect, Holy Quran, and grape. Finally, the data was categorized.Conclusion: Holy Quran mentioned consuming grapes several times. Also, Imams emphasized using this fruit. Researches have shown high antioxidant activity of grape in treatment of many diseases including alzheimer, parkinson, asthma and different cancers. The current study showed the scientific miracles of Quran about grapes and their known and unknown nutritional values.

Background and purpose: Scoliosis is one of the most common spinal disorders and its delayed diagnosis and treatment may lead to complications in posture, sitting style and respiratory system. The purpose of this study was to systematically review previously published studies concerning the prevalence and associated risk factors of scoliosis among children and adolescents.Materials and methods: A literature search was performed using PubMed, Elsevier, Scopus, Ovid and Science Direct databases for studies published during 2000-2014. The search keywords were scoliosis, prevalence, epidemiology, risk factors, children and adolescents. Iranian indexing databases including SID, Iran medex and Magiran were also searched for studies published in Iran.Results: Fifteen articles were selected according to the inclusion criteria of the study. Of all identified studies, three studies were performed in Iran and 12 studies were conducted in other countries.Eight studies investigated only the prevalence of scoliosis and 7 studies investigated both the risk factors and the prevalence rate. To assess the prevalence of scoliosis one study used clinical examination, three studies performed plain radiography, and in one study clinical examination and plain radiography and bone mineral densitometry were applied. In other studies, clinical examination and plain radiography were applied. Three studies investigated the prevalence among girls and 12 studies investigated the prevalence among both genders. The prevalence of scoliosis among children and adolescents varied from 0.19% to 11.03% and it was higher among girls. Gender, onset age of deviation, weight, body mass index, family history of scoliosis and bone mineral density were reported as associated risk factors.Conclusion: The results indicate a relatively high prevalence of scoliosis among children and adolescents. Prevalence rate is higher among girls and those with family history of scoliosis and decreased bone mineral density.