JOURNAL OF GUILAN UNIVERSITY OF MEDICAL SCIENCES
Year:2020 | Volume:29 | Issue:113|Papers Count:9

Introduction: The close interaction between vestibular, psychological and neurological disorders causes inefficient treatment of the patients, so it seems necessary for the physicians to consider psychiatric disorders and get to know their different presentations so that they can offer the best treatment. Objective: This study aimed to evaluate the frequency of psychological symptoms in patients with vertigo. Materials and Methods: In this descriptive, cross-sectional study, 104 patients with vertigo referred to neurologic and otolaryngologic clinics of the Poursina and the Amiralmomenin hospitals in Rasht in 2014-2017, were selected by the simple sampling method. After a complete neurologic and otolaryngologic examination, the organic cause of the patient's vertigo (if any) was determined through history taking, clinical examination and necessary paraclinical measures. Then, the patients were asked to complete the SCL-90R questionnaire. Data were analyzed using t test, χ 2 and logistic regression statistical tests with SPSS 22. 0 software. Results: The mean age of participants was 50. 4± 18. 1 years, of the 46 patients (44. 2%) were male and 58 (55. 8%) were female (P=0. 05). Thirty nine patients were with history of dizziness (37. 5%). According to the SCL-90R questionnaire, 28 (27. 0%) had pathologic psychological symptoms, of which about one fifth was severe. The most common psychiatric symptoms were anxiety, paranoid, interpersonal sensitivity, somatization and obsessive-compulsive disorder. There was a significant association between the mean of the general symptom index and age of participants (correlation coefficient:-0. 36, P <0. 001). Logistic regression analysis showed that only age and previous history of vertigo could predict significantly psychological symptoms in our patients (P values 0. 004 and 0. 05, respectively). Conclusion: In patients with vertigo complaints, psychiatric disorders are common. Therefore, it is better to treat multiple aspects of the patients and pay attention to the treatment of psychiatric disorders at the onset of the disease.

Introduction: Hospitals are among the service centers that cause the greatest environmental pollution. Green Hospital refers to a hospital that views the environment as part of its service quality processes and seeks to avoid harming itself and others by employing effective approaches in each of its dimensions including management, water, energy, buildings, waste, medicine, and shopping. Objective: This study aims to determine the extent of medical services centers readiness for the establishment and implementation of Green Hospital standards in Rasht. Materials and Methods: This is an applied research, and a descriptive cross-sectional method is used. Also, survey method is implemented. The statistical population of this study included all public and private hospitals in Rasht. Among them, 8 hospitals were selected as the sample using convenient sampling method. The data collection tool was the hospital checklists, obtained through observation and interviews. The checklist information consists of two parts, demographic information and information about seven variables in the green hospital, in which respondents should state their hospital readiness in each part of the green hospital checklist. SPSS statistical software was used to analyze the data. Also, descriptive statistics (Frequency distribution and percentage and mean) and analytical statistics (t-test, Kolmogorov-Smirnov, etc. ) were used. Results: The results indicated that the 8 under studied hospitals were not in good condition regarding the relevant standards of the green hospital (the rate of meeting standards was 36. 8%). Also, these hospitals are not prepared to implement green hospital standards. Only given the drug use (score 65. 6), they meet green hospital standards; however, they are not in the right position for the establishment of a green hospital in terms of energy management; waste management; water conservation (score 34); use of chemicals (score 43); green architecture (score 35)and purchasing Hospital Requirements (23. 2 points). Conclusion: Green hospital standards are of critical importance in sustainable management and cost saving for hospitals. Apart from the general discussion of green buildings, meeting these principles in hospitals, in addition to its sustainability aspects, has a significant role in improving the patient's therapeutic quality. Implementation ofsuchstandards in the province requires a comprehensive planning of the 7 under-studied variables and clarification of relevant guidelines and rules, training and documentation of actions.

Introduction: Antibiotics are one of the most important drugs used in treatment. Because of the cost and association of their use with resistance to them, their consumption pattern is important and the first step is to optimize the use of such drugs. Objective: Since the use of prophylactic antibiotics was also unreasonable and occasionally continued while the patient was hospitalized, the use of such prophylaxies was also considered. We decided to determine the pattern of antibiotic use in the different wards of three educational hospitals of Ahvaz (Golestan, Imam Khomeini and Razi). Materials and Methods: This study was a descriptive cross-sectional study that evaluated the pattern of antibiotic use in three hospitals of Golestan, Razi and Imam Khomeini (RA) in Ahvaz. 1554 patients were enrolled in three hospitals and items such as age, sex, ward, start and end dates, administration intervals, dosage, and the type of antibiotic used were evaluated. 759 received systemic antibiotics. Antibiotics administration was analyzed separately and completely in hospitals and departments based on DDD / 100 Bed days (consumed per 100 bed occupied days) and the results were evaluated. Results: 48. 8% of the patients received antibiotics, equivalent to 93. 9 DDD / 100 Bed days. 90% of the antibiotics were injected and 10% oral. The highest use of antibiotics was in the Golestan Hospital and the lowest in the Razi Hospital. Among the wards, the highest rate was in the infectious ward of the Razi Hospital (226) and the lowest in Neonatal Department of Imam Khomeini Hospital (5. 7). The most used antibiotics were first-generation cephalosporins (20%) or 21% of total consumption, and the highest belonged to cefazolin (18). Conclusion: Antibiotic use in these hospitals was very high, as evaluated, which needs to be reviewed inthe light of the association between incorrect use of antibiotics, emerging resistance and increased cost of treatment.

Introduction: When the patient discharges from the hospital against medical advice because of dissatisfaction, the treatment will not be complete and can lead to serious complications for the patient. Objective: This research is done, with the aim of reviewing the reasons of discharging against medical advice of hospitalized patients in emergency department in Razi hospital, Rasht, 2016-2017. Materials and Methods: The type of research is descriptive and retrospective. Sampling of this study was done by census method so that all patients discharged against medical advice from emergency department of Rasht, Razi hospital in 2016-2017, were evaluated. To collect the data, we used the information in discharging forms against medical advice, available in the discharged patient’ s files. Results: In this research, most of the discharged persons against medical advice were males (60/9%), and married (81/3%) with 49/7% of them were admitted at night shift. A number of important reasons for discharging against medical advice were unwillingness to continue treatment (39/4%), general improvement (19/3%) and continued treatment in the private center (11/7%). Conclusion: Based on the results, it seems better to review and rewrite the form of discharge from the hospital against medical advice. The option of unwillingness to continue treatment that is ambiguous should be replaced with more detailed questions and further details. Also, giving the necessary information to the treatment staff about discharging against medical advice and its outcomes, how to properly write the forms of discharging against medical advice and legal issues related to this matter, are all highly recommended.

Introduction: Low back pain is a very common disorder that affects a significant percentage of people in the community (1). As a non-mechanical cause, myofascial pain is a primary disorder which may produce lumbar and lower limb pain and is not necessarily secondary to other diagnosis (2-5). Trigger points are the main symptoms of myofascial pain which may mimic the radicular pain in spinal disorders (6, 7). Objective: To evaluate the prevalence of lumbar myofascial pain syndrome in patients with non-specific chronic low back pain and a normal MRI study. Materials and Methods: This cross-sectional study was conducted on 171 patients with chronic low back pain and normal MRI report (age: 43. 96 ± 13. 6years), (weight: 76. 7± 71. 74 kg), ( height: 166. 44 ± 7. 15 cm). Incidence of this syndrome was evaluated in 16 lumbar and lower extremity muscles (8). The trigger points finding was performed by tissue palpation (9). Results: Females constituted 71. 7 % and males 28. 3 % of the participants. The patients maximum incidence percentages were in quadratus lumborum (47. 7℅ )‚ multifidus(43℅ )‚ gluteus medius (36℅ )‚ gluteus maximus (34. 9℅ )‚ piriformis (32. 4℅ ) and other muscles involvement was below 30℅ . In 27. 7% of the patients only two muscles were involved. A significant correlation was shown between the number of involved muscles and age(r=0. 21, p=0. 005) and pain and disability(r=0. 46, p=0. 03). Conclusion: Myofascial pain syndrome should be considered as a hallmark in differentiating chronic low back pain regardless of MRI finding.

Introduction: Anabolic-androgenic steroids are one of the powerful drugs that cause long-term hormonal and psychological changes that can have a wide range of side effects for the athletes. Objective: The purpose of this study was to compare the Behavioral Activation-Inhibition Systems and Sense of Coherence in Bodybuilders with and without Use Anabolic-Androgenic Steroids. Materials and Methods: The method of this research is descriptive-comparative. The statistical population consisted of all bodybuilders with and without taking anabolic-androgenic steroids in Rasht in 2019, of which 140 individuals (70 natural bodybuilders and 70 steroids bodybuilders) were selected purposefully and included questionnaires of Carver & White (1994) behavioral activation-inhibition systems and sense of coherence Antonovsky (1993) responded by the participants. Data were analyzed using multivariate analysis of variance by SPSS 24. Results: The findings of the present study showed that there was a significant difference between the two groups in the activation/inhibition system and the sense of coherence (P<0. 01). Compared with natural bodybuilders, steroid bodybuilders had less behavioral inhibition (15. 95) and sense of coherence (18. 87) and more behavioral activation systems (37. 77). Conclusion: According to the results, we suggest that bodybuilders who have used steroids derivatives have many irreversible problems in their cognitive and physical functions. Therefore, coaches need to pay more attention to the psychological problems of the athletes and examine them before competitions.

Introduction: Dapsone gel (5%) is found to be effective in treating acne. The study was to develop a topical formulation of dapsone in Iran. Objective: Determination of appropriate formulation for generic form of this drug in the treatment of acne. Materials and Methods: Samples of the base of gel were made in the range of 0. 3%-5% by dissolving Carbomer 934P in distilled water, and their physical properties and pH were evaluated. Then, Dapsone was dissolved in its appropriate solvent, diethylene glycol monoethyl ether (DEG) and were introduced into gel base. Afterwards, using Design Expert software 13 samples and in the next step 17 samples were designed, made and their rheological properties and pH were evaluated. Then, two formulations were selected and were characterized by drug content, physicochemical properties, rheology and stability and found to be in accordance with the US Pharmacopeia. Results: The gel bases containing carbomer in the range of 1-3% were appropriate. The pH value of gel bases in first 13 samples were between 5-7 and the viscosity range between 16530-2980000(cp). The viscosity of range of 17 designed samples was between 1100-760000(cp). The final sample with 1% carbomer content had the viscosity range of 14075-268000(cp) and drug release of 78/1% after 3 hours. The sample with 2% carbomer content had the viscosity range of 92660-557000(cp) and drug release of 76% after 3 hours. Conclusion: Viscosity and drug release of both samples were in accordance with pharmacopeia. However, the sample containing 1% carbomer is more commercially suitable and more appropriate lowering pH of the skin.

Introduction: Spinal anesthesia is a commonly used anesthetic technique for cesarean section. The hypotension is the serious and common complication for it. Prevention of this complication is an important challenge for anesthesiologists. Objective: The aim of this study is to compare the effect of prophylactic bolus injection of Phenylephrine and Ephedrine in the prevention of hypotension during spinal anesthesia in elective cesarean section. Materials and Methods: In this double-blind randomized clinical trial, in order to prevent hypotension in cesarean section, 80 pregnant women who were candidates for elective cesarean section were randomly assigned to two groups (Phenylephrine or Ephedrine). Immediately after spinal anesthesia, the first group received 10 mg ephedrine and in the second group, 100 micrograms of phenylephrine was injected bolus intravenously. Both groups were evaluated for nausea and vomiting, systolic, diastolic, mean arterial pressure, heart rate and SPO2 at specific intervals. The neonatal Apgar score was evaluated at first and fifth minutes after birth. The collected data were analyzed by SPSS software version 16 at 95% confidence interval. Results: Although nausea and vomiting, systolic, diastolic and mean arterial pressure were higher in the Ephedrine group than the Phenylephrine group, there were no significant differences between the two groups. There was also no significant difference between two groups in incidence of mean heart rate and SPO2 during surgery. There was no significant difference in neonatal Apgar score at first and fifth minutes between them. Conclusion: In cesarean section, intravenous bolus injection of Phenylephrine without affecting the incidence of maternal nausea and vomiting and neonatal Apgar score, such as Ephedrine is effective in the prevention of hypotension following spinal anesthesia.

Introduction: Various studies have shown that stress is one of the environmental factors affecting the symptoms of patients with inflammatory bowel disease. Objective: The purpose of this study was to determine the effectiveness of mindfulness-based cognitive therapy on perceived stress in patients with ulcerative colitis. Materials and Methods: This study was a quasi-experimental study with pretest and posttest design and control group. 32 patients with ulcerative colitis were selected by voluntary sampling and randomly divided into two groups. Data from 17 patients (9 experimental and 8 controls) were analyzed finally. Data were collected using the perceived stress scale 10-item (Cohen, 1983) in two stages of pretest and posttest. The experimental group underwent a mindfulnessbased cognitive therapy program in 10 sessions of 2-hours per week. For data analysis, Mann-Whitney U analysis was used. Results: The findings showed that the effect of mindfulness-based cognitive therapy on positive dimension of stress was significant (P<0. 05, Z=-1. 976), but not significant on the negative dimension (P>0. 05, Z=-1. 976). Conclusion: Mindfulness based therapy can help UC patients reduce cognitive distortions involved in the perception of stress by changing their assessment of events, so that they can manage stressful events better by increasing their effective coping abilities with disease.