MEDICAL JOURNAL OF TABRIZ UNIVERSITY OF MEDICAL SCIENCES
Year:2007 | Volume:29 | Issue:2|Papers Count:32

Background and objectives: Ethical decision making is an essential element in nursing practice. There are various contextual factors which can result in ethical conflicts that demand the nurse's abilities to recognize moral dilemmas and make appropriate moral decisions. The aim of this article is description of psychological reactions of nurses to the context in ethical decision making in patients care. Materials and Methods: The present study was conducted by grounded theory method. Participants were 17 Iranian employed nurses. Semi-structured, unstructured and in-depth interview were used for data gathering. All interviews were transcribed verbatim and coded according to Strauss and Corbin method in coding and constant comparative analysis. Results: Job stress and moral distress were identified as a major reaction of nurses to the context in ethical decision making. Satisfaction vs. dissatisfaction, increasing motivation vs. decreasing motivation, happiness vs. fatigue and impatience, hopefully vs. demoralization, worthiness sense vs. unworthiness sense, adaptation and sensitivity vs. be habitual and apathy were other psychological reactions of nurses to the context in ethical decision making. Conclusion: According to the nurses ethical decision making context which include nurse individual and job characteristics, patient and his/her family characteristics, physician characteristics, and structural and nursing management constraints are influence factors in their psychological reactions. Thus, it is necessary that the nurses consider the context in their own psychological reactions. Also, structural involving agents and nursing managers must be attempt to reform and improve the context especially structural conditions.

Background and objectives: Leptin, the product of the ob gene, is a hormone secreted by adipocytes, and results in a decrease in food intake an increase in energy expenditure via hypothalamic interactions. In animal models, obesity can be caused by leptin deficiency or dysfunction of hypothalamic leptin receptor. The aim of this study was to examin the relation between serum leptin levels and body composition. Materials and Methods: In this study, we measured serum concentration of leptin in 51 normal weight subjects (BMI<25 kg/m2) and 50 obese subjects (BMI³25) by ELISA. BMI was defined as the weight in kilogram divided by the square of height in meters and body composition was determined by bioimpedance analyzer. Results: The mean (±SE) serum leptin concentrations were 17.5±0.81 ng per milliliter in obese subjects and 4.9±0.55 ng per milliliter in the normal weight women (p<0.0005). There were a strong positive correlation between serum leptin concentration and body fat mass (r=0.53) and BMI (r=0.41) in obese women and lean body mass was inversely related to leptin concentration in normal weight subjects (r=-0.28). Significant relation between leptin and WHR neither in obese nor in normal weight group was not observed. Conclusion: We conclude that circulating leptin raised continuously with increasing adiposity and body fat mass is the main predictor of serum leptin concentration.

Background and objectives: Spinal muscular atrophy (SMA) is one of the most common autosomal recessive disorders characterized by degeneration of anterior born cells in the spinal cords and leads to progressive muscular weakness and atrophy. The last 10 years have seen major advances in the field of diagnosis of SMA, but no curative treatment is available now. This study aimed to analyze the clinical characteristics of different types of SMA, improve the clinical diagnosis of SMA and prenatal diagnosis of SMA by gene analysis. Methods and patients: Patients with SMA were recruited from neurologic clinic from January 2004 to March 2006.The diagnosis of SMA was made from clinical history and examination, electro physiologic assessment or molecular studies. The clinical characteristics and changes of electrophysiology were assessed in all patients. The deletion of survival motor neuron (SMN) and neuronal apoptosis inhibitory protein (NAIP) genes was studied by PCR. Based on age of onset, age of death, achievement of motor milestones and ambulatory status patients classified into SMA I, SMA II and SMA III. Results: The 42 patients, including 28 (66.7%) males and 14 (33.3%) females were enrolled in this study. The patients were subdivided into clinical groups: 30 (71.7%) of case with SMA I 9 (21.4%) of cases with SMA n, 2 (4.8%) of case with SMA III and 1 (2.4%) of cases with SMA diaphragmatic. They were all characterized by symmetric muscle weakness (more proximal than distal) associated with atrophy, absence or marked decrease of deep tendon reflexes. Fasciculation of tongue was noted in 59.5% of patients. Electroghsiologic studies showed a neurogenic pattern with denervation potentials on 92.8% of cases. The SMN gene was deleted in 78.5% of patients and the NAIP gene was deleted in 54.8% of cases. Deletion of NAIP gene was more common in SMA I, and its deletion correlated with the severity of diseases (P=0.011).Conclusion: The definite diagnosis of SMA will relay on typical clinical characteristics and changes of electrophysiologic study and gene deletion gene. Genetic diagnosis of SMA can provide a basis of prenatal diagnosis of SMA.

Background and objectives: The term of malacia refers to softness and in medical terminolog refers to weakness of bone or cartilage. Laryngomalacia is the most common congenital abnormality of larynx and the patient may suffer from recurrent aspiration. Tracheomalacia refers to tracheal weakness and usually results in airway collapse due to cartilage defect. Bronchomalacia is used to describe the weakness and collapsibility of one or both main bronchus. All of the above mentioned diseases can be diagnosed by bronchoscopy but this method is invasive and may interfere with diagnosis, on the other hand it is intolerable in young individual and severly ill, and patients with coagulopathy. This study was conducted to show the role of virtual bronchoscopy in diagnosis of laryngo-tracheo-bronchomalacia. Method and materials: In a peri- experimental study during 3years (Nov 2003-0ct 2006) 35 patients who had clinical sign and symptom of airway malacia were studied via virtual bronchoscopy. Results: From 35 patients percentage of male and female was 65/7% and 34/3%, Respectively and the mean age was 3/7±1/6 months. The result of virtual bronchoscopy for laryngomalcia, bronchomalacia, tracheomalacia, laryngotracheomalacia and laryngobronchomalacia was 42.8% ,25.7%, 20% , 8.5% and 2.9%, respectively. Conclusion: Virtual bronchoscopy because of non-invasive and speed imaging and excellent ability of assessment of airway stenosis, can be considered as substitution for bronchoscopy.

Background and Objectives: Familial form of polycystic kidney disease which is inherited as an autosomal dominant pattern is one of the most common form of kidney disease. The main manifestation of this disease is the presence of growing cysts in kidney which results in malfunction of kidney. The frequency of disease is one in 1000 living birth. Mutation in one of the three different genes could result in developing polycystic kidney disease. Genetically analysis has been able to identity two of the genes, PKD1 and PKD2, located on chromosome 16 and chromosome 4 respectively. The location of the third gene remains unrevealed and the frequency of families affected due to the mutation on this gene is very low. By applying microsatellites tightly linked to the identified polycystic kidney disease genes, affected families referred from East Azerbaijan were genetically analyzed. Materials and Methods: Families with at least three affected members by polycystic kidney disease were studied. Polymorphic microsatellites from the regions of PKD1 and PKD2 were selected by studying the members of these families. All members of the families were investigated by the polymorphic markers to study linkage analysis. Results: Out of 13 families with 99 members referred by specialists, 7 families with 75 members were selected on the base of availability. Disease in three of these families showed linkage with PKD2 gene and in one family linkage was found between the disease and PKD1 gene. In another family linkage was observed with neither PKDI nor PKD2 genes. None of the markers were informative in two of the families; therefore these families were excluded from the studies.Conclusion: Most of the families with polycystic kidney disease from North West of Iran, showed linkage with PKD2 gene. One of the families did not show linkage with any of the known genes. In this family, disease could be due to mutation in the third gene which remains to be identified.

Background and objectives: In developed countries diagnosis of gastric cancer is performed in early stages through screening and the 5 year survival rate has risen to 86%. Although the patients in developing countries have digestive symptoms for quite a while, they do not undergo early endoscopy. The patients refer to the physicians in developed stages. This research was conducted to determine the median time of delay from the beginning of symptoms to surgery. Materials and Methods: In this research 63 patients suffering from gastric cancer were investigated during 2004-2005. Research questionnaire was completed from patient's admission to endoscopy until surgery through interview with the patients. Mann- Whitney statistical test and SPSS software were used for data analysis. Results: Out of 63 patients 48 (76.2%) were male and 43 (68.3%) rural residents. The most common cancer area was cardia (31 patients) and the most common symptom was abdominal pain (28 patients). The results showed of median total delay from the beginning of symptoms until surgery was 96 days, which the patient delays 8 days, from the first referring to endoscopy (General practitioner delay) 57 days, from endoscopy to pathology affirmation 12 days, and from pathology affirmation to surgery performance 7 days. Factors like place of residence, education, income and gender had no significant effect on the time of delay. Conclusion: Delay from referring to endoscopy performance and from performance of endoscopy to pathologic confirmation was higher than expected. Screening plan for timely referring of patients and performance of endoscopy seems essential.To reduce the time of delay cooperation of different units like medical education, hospital units, pathology and supply of necessary hospital equipment is highly recommended.

Background and Objectives: The modeling of inpatient length of stay (LOS) has important implications in various aspects of health care management, such as hospital management and planning, the management of health care resources and the performance in hospital care. For many health care management systems, it is important to develop a comprehensive analysis of LOS and to identify hospital- and patient-related characteristics influencing LOS variations. By targeting relevant factors, appropriate policies can be developed to manage the hospital care and the health care resources effectively. Except a specific and limited study, a few studies have carried out on LOS modeling in Iran. Materials and Methods: This study has been carried out to compare different models for explaining LOS. A sample of 3546 patients was selected using randomized clustered sampling scheme from different wards of Shiraz educational hospitals in 2005 and their hospitalization (LOS) rate registered as response variable and other demographic variables. Advance statistical models such as Poisson regression, ZTP, ZTNB and percentile regression were applied to analyze and modeling the data. Results: Mean±S.D of LOS were calculated as 8.4±13.7 days. Over-dispersion for LOS was observed. Therefore, negative binomial, gamma, zero truncated Poisson (ZTP), zero truncated negative binomial (ZTNB) and percentile regression were applied. The results showed that ZTNB is an efficient model for explaining LOS in Shiraz's hospitals.Conclusion: Given heterogeneity in LOS in different wards in Shiraz hospitals, negative binomial model explains adequately the LOS values. Also, percentile regression model seems appropriate for LOS which was applied to our data. Application of the cited models here to other hospitals scattered around the country is suggested.

Background and objectives: The clinical differentiation between lumbosacral radiculopathy and generalized peripheral neuropathies of the distal-axonal type is often difficult. In such cases, the electromyographer relies on the presence of paraspinal or proximal muscle denervation and normal sensory conduction studies to indicate radicular disease. These criteria are often is inadequate, such as in elderly patients, when amplitudes of sensory nerve action potentials may be reduced as an age-related phenomenon. So if motor conduction changes in lumbosacral radiculopathy and generalized peripheral neuropathies are adequately described, a useful electrodiagnostic criterion for differentiation of radiculopathy and neuropathy will be available. Materials and methods: Patients were entered in this study that met strict clinical and electrophysiological criteria for L5/S1 lumbosacral radiculopathy or generalized peripheral neuropathies of the distal-axonal type. The distal axonopathy group consisted of 19 men and 17 women, and lumbosacral radiculopathy group consisted of 28 men and 22 women. To minimize classification errors resulting from age-related changes, we excluded patients older than 60 years. Lower limbs of all patients were examined, recorded parameters included compound muscle action potential (CMAP) amplitude, distal latencies and conduction velocities; minimal, mean and maximal latencies of F-waves, and maximum-minimum latency ranges, and persistence of F-waves of tibial and deep peroneal nerves. Results: The mean values of minimal, mean & maximallatencies of F-waves of tibial and deep peroneal nerves in neuropathy group were significantly more prolonged than lumbosacral radiculopathy group (p<0.001).The mean CMAPs amplitudes and persistence of tibial and deep peroneal nerves F-waves in neuropathy group were lower than lumbosacral radiculopathy group (p<0.001), but mean latency range of F-waves for both nerves in lumbosacral radiculopathy group were significantly more prolonged, (p<0.001), that this prolongation is more significant in deep peroneal nerves (p=0.004).Conclusion: In young persons that significant decrease of SNAPs amplitude can reliably help to decision, mere dependence to motor conduction studies is not necessary. Also when there is denervation in proximal muscles that innervated by L5-S1 roots, the radiculopathy is more probable than neuropathy. When a patient is presented with numbness and paresthesia in lower limbs, and sensory nerve conduction or electromyographic studies can not help to decision, in these cases motor nerve conduction studies especially various parameters of F-wave such as; minimal latency, latency range and persistence could be useful.

Background and Objectives: Although anyone working in hospital may become victim of physical and verbal violence, nurses who have direct contact with patients and their relatives are at high risk. The aim of this study was determination' of nature and extent of violence toward nurses in hospitals. Materials and Methods: This descreptive study was carried out on 468 nurses working in hospitals in East Aazarbaijan. The data were collected through modified "workplace violence in health sector Questionnaire" after obtaining validity and reliability through test-re-test. Results: Most violences toward nurses were verbal, physical, racial and sexual violence, respectively. Most perpetrators were relatives of patients. Reaction of most nurses was "told the person to stop". Report of incidence and organization reaction against violence was low. Conclusion: Findings from this study are consistent with previous researches. We suggest, preventive affairs and development new protocols for reporting of violence incidence, so that can improve workplace safety and quality of care.

Background and Objectives: Tools and instrument were developed with progress and development of societies. Whereas inattention to acquire of correct principles of job with these new tools may increased injuries in agriculturists and workers. Occupational hand injuries are one of the most common causes of time lost from work in agriculture and industry. The goal of this study was to investigate the prevalent causes bringing about acute hand injuries in accidents resulting from work in the above mentioned professions and also types and intensity of the injuries caused in the suffering workers and farmers and the time of absence from work. Method and Methods: This is a descriptive prospective study. The population that was selected for this included 1130 case. Patients managed for acute occupational hand injuries during summer 1999- 2003 in Shohada hospital and patients assayed in view of kinds and factors of injuries.Results: From 1130 patients, who admitted in Shohada hospital, 405 cases (35.8%) were related to agriculture injuries and 725 (64.2%) cases industrial injuries. The most common causes of agriculture injuries was lawn mower (38.3%) and the second cause was fall of heavy material (29.6%). In industrial injuries the most common cause was fall of heavy material (38.3%), the second was press or turnery machines (31.7%). The most victims were in the first or second decade of life. Average time of hospitalization was 5 days (1-24 days), and average of follow-up time was 2 months (1 weak- 5 month).Conclusion: We concluded that inadequate experience, training and protective devices incraese the possibility of occupational injuries.

Background and Objectives: Rhinoplasty is performed to improve the appearance of the nose. Rhinoplasty surgery becomes increasingly popular across all sections of the population. Because, it is initiated by patient, surgeons are required to recognize psychological condition of patient and select appropriate candidas for plastic surgery. Materials and Methods: One hundred fifty one patients requesting a rhinoplasty in the E.N.T Department of emam khomeini Hospital in Tabriz from 1382 to 1384 completed SCL-90-TR (symptom cheklist-90-revised) questionnaire and generally questions. Three to nine months (average 6 months) after surgery, patients were called on telephone and asked to rate satisfaction. Results: Prevalence of psychological signs in the patients requesting a rhinoplasty result in: 27/8% somatization, 13/9% paranoid, 9/9% aggression, 7/3% phobia, 6% schycotizm, 2/6% obsessive, 1/3% anxiety, 1/3% interpersonal deficiency and 0% depression.Overall 56/2% (85 cases) patients underwent rhinoplasty, had abnormal signs of psychology. Patients described as paranoid had low satisfaction. There was no significant correlation between the other psychological signs and satisfaction. Satisfaction rate (over 50%) was reported 86/8%.Conclusion: The most of patients appeared generally satisfied with outcome of their procedures, although individuals with paranoid signs (13.9%) did not. Plastic surgery for individual don't appear psychologically healthy may have a negative outcome, creating problems for both patient and surgeon. So, the surgeon required to recognize patient’s psychological condition before proceeding.

Background and Objectives: The stimulating effects of medicinal plants on immune system were taken into consideration. IN this relation, saponins and flavonoids are well known compounds. The presence of these compounds in Citrullus colocynthis (CC), also a report based on leucocytosis activity of C.C, it caused that we were going to investigate the effect of this plant on immune system. Materials and Methods: In the present paper, the histologic effects of pulps and seeds extracts of CC on gastrointestinal mucosal from the point of view of immunity were investigated. Aerial parts of CC were extracted with MeOH 70% and the presence of different groups of natural compounds was assessed by phytochemical methods. Then 30 male rabbits are used, they divided into 5 groups. One group is kept as diabetic control and from the other 4 groups, 2 groups were received 100 and 200 mg/kg/day of pulp extract and two groups were received 100 and 200 mg/kg/day of seed extract of C.C by gavage. After 1 month of experimental period, rabbits were sacrificed by chloroform and specimens from intestine were fixed in 10% formalin and studied with light microscopy. The number of penetrating lymphocytes to intestinal epithelium observed in morphometery was criteria of immune system functional marker. Results: All of animals that received 200 mg/kg/day pulp extract of C.C, and 46% of animals that received 100 mg/kg /day of pulp extract died. The number of intestinal mucosal lymphocytes enhanced in group of received 100 mg/kg/day pulp extract. Mean of penetrating lymphocytes was significant in 100 mg/kg/day pulp extract group in comparison to control group (p<0.05). Increasing of lymphocytes was significant in 100 mg/kg/day and 200 mg/kg/day of seed extract and mean of penetrating lymphocytes was significant in comparison to control group (p<0.005). Conclusion: Immunostimulant effect of the extract of CC seed is higher than the extract of CC pulp but the toxicity of the pulp extract is more than the toxicity of the seed extract.

Background and objectives: Application of transcranial magnetic stimulation as a prognostic tool in stroke patients is a new method. in the present study, we used transcranial magnetic stimulation of the motor cortex to evaluate the functional state of corticospinal pathway innervated the first dorsal interosseous muscle and we have assessed the prognostic value of this study on prediction of motor function recovery. Materials and Methods: We have assessed 34 patients that experience first ever acuteischemic stroke in the middle cerebral artery territory and had complete hand palsy. All patients were clinically evaluated and tested with transcranial magnetic stimulation within the first 24 hours after onset of stroke. Patients were divided into three group, according to the amplitude of the motor evoked potential (MEP) at day!. These testes were repeated at day 14. Then, Correlation between clinical evaluation at day 14 and eleotrophysiologic results at day1 was investigated. Results: After 2 weeks, all patients that their MEP were at the normal range, showed some hand muscle motor function recovery, whereas 25 of 27 patients with initially absent or small MEP were left with complete hand palsy. There was strong positive correlation between MEP amplitude at day 1 and improvement of muscle strength at day 14 (P<0.001).Also, measurement of central motor conduction time showed the same results (P=0.0001).Conclusion: This study showed that transcranial magnetic stimulation of the motor cortex is a useful device for prediction of motor function recovery in patients with ischemic stroke.

Background and objectives: Epilepsy is one of the most common neuronal disorders in man. The amygdala is one of the important locations for seizures originated from piriform cortex. Neverthless, its role in development of such seizures has not been reported so far. Therefore in this study, the effects of amygdala inhibition on kindling rate of piriform cortex were investigated. Materials and Methods: Under two study protocols, thirty male Wistar rats (300-350 g) in 5 groups (n=6) were studied. In the first protocol animals were divided into three groups; first group only were canulated without any treatment, second group received artificial CSF and third group received 0.5 ml of 2% lidocaine intra amygdaloid. The second protocol, included two groups; in the first group the amygdala was lesioned by electrical DC current and animals were stimulated 24 h later and in the second group animals canulated but amygdala was not lesioned Results: In this study, intra amygdala injection of 2% lidocaine and electrical lesion of it increased number of stimulation to receive S4 and S5 stages of seizure, but had no effects on number of stimulations to receive S1, S2, S3 stages cumulative after discharge duration (ADD), after discharge threshold and ADD after the first duration.Conclusion: We concluded that the amygdala has a critical role in the development of epileptic seizures from piriform cortex to other regions and this role is significantly affected by transient and permanent inhibition of neuronal activity of amygdala.

Background and Objectives: Cancers of head and neck can cause functional, cosmetic, social and economic problems. Neck metastasis From upper aerodigestive tract cancers is a concern in management. The aim of this study is to determine the occult neck metastasis from squamouse cell carcinoma (SCC) of upper aerodigestive tract and its proper management. Materials and Methods: This is a cross - sectional study on patients with squamouse cell carcinoma of upper aerodigestive tract that hospitalized in departments of Otolaryngology Head and Neck Surgery and general surgery in Amir-alam referral hospital of Tehran University of Medical Scienses. Results: 33% of patients were involved in occult metastasis in cervical lymph nodes. In 60% of patient’s more than one lymph node were involved. In the majority of patients tumor was in T2 stage. The occult neck metastasis was 24.6% in SCC of oral cavity, 44.7% in SCC of larynx and 42% in SCC of hypopharynx. There was significant relation between occult neck metastasis and T stage of tumor.Conclusion: when the risk of occult neck metastasis is higher than 20% and the primary site treatment modality is surgery elective neck dissection is indicated. In extracapsular spread or involvment of multiple lymph nodes with microscopic metastsis the postoperative radiation to neck is necessary.

Background and objectives: Breast cancer is the most common disease in women. In the expansion and progression of breast tumors combination of tumor markers including prostate specific antigen and telomerase are engaged. The aim of this study was to evaluate relationship between telomerase activity and prostate specific antigen gene expression in breast cancer patients and controls. Material and methods: This study was a case-control and consisted of 25 women diagnosed with breast benign tumors as control and 35 malignant tumors as cases. Telomerase activity was measured in tumor cytosol of samples by TRAP assay. PSA protein was measured using ultra sensitive immunoflourometric assay and PSA mRNA expression was making cleared using RT-PCR techniques in all tumor tissues.Results: Using TRAP assay, presence of the telomerase activity was positive in all of the breast cancer patients. The difference of relative telomerase activity (RTA) values between stages and also all grades were more statistically significant (p<0.05). The PSA mRNA were detected only in benign tumors and stage I and grade I malignant tumor cytosols. Difference of tumor cytosol PSA levels between the cases and control groups and also between all grades and stages of diseases were significant (p<0.05). In all, there was an inverse significant correlation between the RTA and PSA protein levels in the case groups (r=-0.42, p<0.05).Conclusion: Our results showed a reverse relationship between PSA mRNA expression and increasing telomerase gene expression during breast cancer progression and development. In all, measurement of telomerase activity could be favorable biomarker along with PSA in breast cancer diagnosis.

Backgrounds and Objections: Human parechovirus is a genus of picornaviridae. All of picornaviruses have a 3C protease which has a key role in virus protein processing and replication. The aim of this study was to analyse polyprotein processing in human Parechovirus typel by cloning and expression of 3C gene. Materials and Methods: After preparation of cDNA from human parechovirus type 1 (HPEV-l) RNA genome the region of cDNA that was encoded for 3C protein was inserted into plasmid pUBS by Ligase enzyme and recombinant plasmid was prepared. After transformation and replication of this plasmid in E.coli MC 10.22, DNA was isolated by phenol extraction and then expressed in prokaryotic (E.coli BL-21) and In vitro systems under T7 promoter. The results were detected by SDS-PAGE and analyzed. Results: The products of expression of recombinant plasmids (with out 3C gene) in both prokaryotic and in vitro systems were analyzed. Just one large band same size as primary translation product was observed, but with plasmid including 3C gene, several small bands were detected. These results indicate that human Parechovirus typel polyprotein processing occurs by 3C protease. 3C protease was checked by anti protease.Conclusion: Our results showed that HPEV-1has a processing strategy different from other members of Picornaviruses, and 3C protein seems to be the only virus encoded protease that can catalyze cleavages of all sites in the Parechovirus type] primary polyprotein.

Background and Objective: Toxoplasmosis is one of the widely distributed common disease among human and livestock. In humans utilization of contaminated meat is the main source of the infection. In sheep and goat, the abortion and morbidity by toxoplasmosis had lots of economical lost. Animal husbandry Meshkin shahr is an animal husbandry area in west Azerbyjan and supply most of the meat in north- west of Iran. This study designed to evaluate frequency of toxoplasma infection in ruminant of that city. Materials and Methods: In this descriptive cross sectional study during one year (2004), 320 blood samples were collected by a simple random method from the bovine, sheep and goat. The samples examined for the specific antibody against toxoplasma by immuno fluorescent antibody (IFA) method. Results: In 120 sheep's serum samples prevalence of T. gondii was 59%. To titers ranged from 1:2 to 1:32. Likewise out of 100 studied bovine samples only 5% were infected and comparing with sheep's had low frequency of infection. In goats the rate of frequency of infection was 36%. The results of our study showed highest frequency of the infection among sheep and goat.Conclusion: It was concluded that to prevent spread of human infection, the common shepherding area of the region must be managed by hygienic management and public educations and necessary.

Background and Objective: There are currently no reliable estimates of the prevalence of self-injury among adolescent population. The aim of this study is to estimate the prevalence of self-injury among a sample of 10 grade male students in Tabriz city and to evaluate the associated factors such as demographic and risk taking behaviors. Material and Methods: Of all grade-10 male students in Tabriz, 1772 were randomly sampled. A self- administered questionnaire was used to collect demographic data, self-injury, substance abuse and general risk taking behavior and friends smoking. The influence of different factors on self-injury was evaluated with a logistic regression model. Results: Among 1772 students 76 (4.3 %, CI 95%: 3.4-5.3) had self- injury. Eight (10.5%) of them were carving, 4 (5.3%) burning, 9 (11.8%) hitting, 27 (35.5%) cutting, 7 (9.2%) tattooing, 5(6.6%) skin picking and 17(22.4%) bruising. The results indicate that, ever alcohol use (OR=1.52), having smoker friend (OR=2.54) and higher smoking stage (OR=1.85) were factors associated with student's self-injury.Conclusion: This study has shown low prevalence of self-injury and determined some of its risk factors among students. More studies about adolescent population are necessary to approve the observed results of this study and thus allow for a certain generalization of the observations.

Background and Objective: Investigators believed that there is an interaction between personality and high risk behaviors. The aim of this research was investigation of personality variables in HIV positive individuals and the comparison of this people with addict and healthy normal controls.Materials and Methods: For this purpose three groups of subjects (HIV positive, addict and healthy normal) were selected. The control groups (addict and healthy normal) were matched in the demographic characteristics with HIV positive group. The HIV positive subjects were selected from Tabriz, Ardebil and Orumieh Red Crescents. Then the demographic questionnaire and Eysenck personality questionnaire were given to participants.Results: No The socio economic status of HIV positive subjects were low in general. They had not significant differences with other two groups in extroversion dimension, However, in respect of two other dimensions of Eysenck's, questionnaire (neuroticism and psychoticism) they had significant differences with both addicts and normal controls.Conclusion: There is a personality pathways to HIV infection and addiction, and the severe pattern of this trait are seen in HIV positives.

Background and Objective: Staphylococcus aureus is known as an important pathogen causing a variety of bacterial infections. Treatment of this bacterium with antibiotics has led to antibiotic-resistance, especially against methicillin (MRSA) and more recently rare resistance against vancomycin (VISA&VRSA). MRSA strains compared to MSSA strains are resistant to most of the antibiotics in routine use. Aims of this study were to determine nasal carriage rate of S. aureus in hospital personnel and inpatients and to determine antibiotic-resistance patterns in the above mentioned isolates in the same hospitals.Materials and Methods: Staphylococcus aureus isolates collected from nose of 460 hospital personnel and inpatients (160 strains) and from clinical specimens (46 strains) in Imam Khomeini and Children medical centers in a 6 month period were studied in 2005. Antibiotic sensitivity of the collected strains was tested against 13 antibiotics used in routine treatment of S. aureus infections. Oxacillin agar was also used to screen for MRSA. Results: Our results showed 34.7% nasal carrier rate for S. aureus in hospital personnel and patients studied. Seventy seven isolates were able to grow on oxacillin agar, indicating 37.4% MRSA strains. MRSA strains were also resistant to 4-11 antibiotics tested in this study, but MSSA strains, which were resistant to penicillin G (100%), mainly showed sensitivity to other test antibiotics. All of the MRSA and MSSA strains were sensitive to vancomycin. Generally, the resistance to methicillin was higher in clinical isolates compared to isolates recovered from nose (p<0.001).Conclusion: In this study, all of the test isolates were sensitive to vancomycin, which necessitates more caution in using this valuable antibiotic. Screening of hospital personnel and in-patients will better control the incidence of this important bacterium and use of molecular methods in detection of them, especially screening for mecA gene will provide some measures in control of hospital acquired infections.

Background and Objectives: Taking advantage of private sector capabilities in providing health services was considered as a priority through Iran's latest health reform programs. Establishing health cooperatives and transferring health service provision to them through a public-private partnership method was the main strategy chosen in eastern Azerbaijan province of Iran. This study was aimed at comparing management status and staff satisfaction between health cooperatives and public health centers.Materials and Methods: In this analytical study 9 health centers transferred to cooperatives and 18 current public health centers were compared considering staff satisfaction and management status. Study population was health service providing staff from these health centers in a time period from February to April 2002. Data were analyzed by SPSS 10 statistical package. Chi-Square and t tests were used to analyze data.Results: Staff attitude towards management status of health center was found to be statistically higher in health cooperatives than public health centers in areas like: planning for staff welfare, existence of an annual plan, existence of a process improvement plan, good relationship with clients, team work on time supply of consumer goods and required equipments. It was also shown that staff satisfaction in fields of sense of respect and sense of ownership and satisfaction with job environment relations was higher in health cooperatives compared to public health centers.Conclusion: Findings of this study indicate that although health cooperatives are structurally similar to or better to say are copied from public health centers, but their managing style is quite different similar to other private managements. It seems that managing system in cooperatives acts more effectively in staff motivation and considering structural and payment limitations in public sector, health cooperatives can be a good alternative.

Background and objectives: With promising results from several institutions, many centers began to treat patients with esophageal squamous cell carcinoma (SCC) with neoadjuvant chemoradiotherapy followed by esophagectomy. The aim of this research is to determine the feasibility of this method in our selected patients. Materials and Methods: In this prospective phase I clinical trial, 10 patients (7 male, 3 female; 58.4±2.5 Y/O) with stage III and VIA lower thoracic esophageal SCC, were treated with intravenous infusion of 1000 mg/m2/day 5-flourouracil during day 1 to 4, 75 mg/m2 cisplatin in day 1, and a total dose of 18 Gray external beam radiation during day 1 to 6 and underwent transhiatal esophagectomy during day 7 till 10. This group was compared with a retrospective group of 61 patients which treated with surgery alone. Age, sex, duration and grading of the dysphagea, differentiation and staging of the tumor were not different in these two groups. Results: There is no complete pathologic response in the study group. One patient died because of severe leukopenia and sepsis and other because of azygos vein rupture. Other complications were: chylothorax which required later thoracotomy (10%), recurrent nerve paresis (10%), superficial wound infection of the neck incision (10%). All patients had mild to moderate leukopenia (2600±400 /mm3) during days 11 to 16. Total postoperative intensive care unit stay was 2.2±0.5 days and postoperative hospitalization was 15.7±1.8 days and in-hospital operative mortality was 20% and total morbidity was 50% which were not significantly different from control group (p<0.05).Postoperative blood transfusion was 5.3±0.8 unit per patient which was significantly greater than control group (P<0.05). Conclusion: The perioperative mortality and morbidity of this neoadjuvant protocol is acceptable comparing with our control group and we can propose phase II and III studies for determining the long-term effect of these protocol.

Background and Objectives: Since anticoagulant therapy during pregnancy has high fetal and maternal risks, using bioprostheses valve is recommended for young women with cardiac valve disease who hope to have Children. Evaluation of the effect of pregnancy on the rate of deterioration of bioprosthetic valve is the aim of this study.Materials and Methods: This case - control study was done on 53 women in the reproductive age who underwent cardiac valve replacement using bioprostheses during 1977- 2001. Twenty seven patients (mean age 22 ±7.73 yr) at the time of valve replacement had pregnancy (Group A), and 26 patients (mean age 26.8HO.9) had no pregnancy after valve replacement (group B). Mean time of structural valve deterioration, and need for redo valve surgery compared between the two groups.Results: In group A 81.48% of patients underwent mitral valve replacement (MVR), 14.81 aortic valve replacement (AVR), and 3.71% tricuspid valve replacement (TVR). In group B 84.6% underwent MVR, 11.6% AV R, and 3.81% both MVR and AVR. Fifty six pregnancy occurred in group A which 19.6% of them ended with abortion, 76.8% had normal infant birth 94.64% of pregnancies had no complications and 5.3% had valve degeneration during or 2-4 months after delivery. Average time of freedom from structural valve deterioration in the patients who had pregnancy was 16.60 years and it was 16.74 years in patients who had no pregnancy (P=0.91). 55.5% of patients in group A underwent redo valve replacement (14.46±5.4yr) after first operation and 50% in group B after (10.61±5.63 yr) underwent redo valve replacement.Conclusion: Our finding didn't show any differences in structural valve deterioration time or need for redo valve operation between pregnant and non pregnant patients.

Squamous cell carcinoma of scrotum is a rare disease. Risk factors are occupational contacts, low health conditions, psoriasis, treatment with PUAV, and HPV (human papilloma viruses). In this paper a non occupational case is presented witch is not associated with other known risk factors. The patient is a 50 years man which was referred from dermatology clinic with a exophytic cutaneous lesion without any lymphatic or other organ involvement. The lesion was exissed completely. The pathologic report was well differentiated squamous cell arcinoma. In two years follow-up the patient has no complication and is disease free.