Hormozgan Medical Journal
Year:2006 | Volume:10 | Issue:3|Papers Count:18

Introduction: Hospital mortality makes the highest proportion of all mortalities in the general population. According to the results of a national survey in Iran in 2000, over 50%, 30%, 35% and 40% of mortalities occurred respectively due to infectious diseases, cancers, cardiovascular diseases and accidents in hospital. The present study was conducted to determine the different causes of death in Shahid Mohammadi hospital of Bandar Abbas.Methods: This cross-sectional study was conducted as a six month survey in 2004. Medical records of all cases of death were studied within the first 48 hours of death. As some medical records were not available, we obtained the information from the attending physician via interview. Statistical analysis was performed by Epi info and SPSS software, and results are presented by frequency tables.Results: 10435 cases referred to emergency department and 15317 cases were admitted to the hospital wards. Totally 400 cases died during the study period. Most of them were residents of Bandar Abbas or nearby villages (56.3%). The mean age at the time of death for all cases was 51.4±22.8, and those of traumatic patients, cardiovascular diseases patients and cerebrovascular accident (CVA) patients were 33.2±19.8, 64.6±3.8, and 64.6±14 respectively. Five percent of patients had no attending or resident reports. The mean time between admissions until death in this group was 1.6±1 hours. Ninety four percent of the expired cases were admitted to emergency department on arrival. Thirty eight percent of all deaths occurred in emergency department. The most common causes of death in this hospital were CVA (15%), head trauma (10.59%), myocardial infaction (9.75%) and septicemia (4.25%). Cancers caused 6.8% of all deaths. There was no final diagnosis in 4.3% of the expired patients.Conclusion: According to the results of this study, the mortality rate of this hospital is in acceptable range. CVA, head trauma, MI and septicemia were the main causes of mortality. Given the fact that hypertension is considered the principal risk factors in CVA and since the study indicated that CVA accounts for the highest mortality rate in this hospital, proper evaluation and management of hypertensive patients is vitally important.

Introduction: Jaundice is one of the most common clinical sign in the neonatal period which in severe form leads to neurotoxicity (kernicterus). This study was carried out to determine the effect of clofibrate on serum bilirubin concentration in icteric otherwise healthy term newborns.Methods: The study was a double blinded, clinical trial in neonatal ward of Shafizadeh pediatric hospital in Babol, Iran. We selected healthy full terms breastfed infants with a birth weight of ≥2500gr and total bilirubin of ≥15mg/dl from second day of life. Infants with hemolytic disease, need for exchange transfusion and those treated with Phenobarbital were excluded. Newborn babies were divided to two groups (30 cases, 30 controls). All of them received phototherapy and case group was treated with a single oral dose of clofibrate (100mg/kg). The bilirubin concentration was checked at 16 and 24 hours after treatment and every 24 hours apart. Data (collected by a questionnaire including sex, age and bilirubin concentration) were analyzed by SPSS software, statistical t-test and fisher’s exact test.Results: The mean plasma total bilirubin concentration at 48 hours and 72 hours after treatment was more lower in the case group than the control group (P=0.047 and P=0.024 respectively). At the end of 72 hours, the number of discharged neonates were higher in the case group as compared with the control group (83.3% and 53.3% respectively with P=0.025). No side effect was observed.Conclusion: Clofibrate leads to faster decline in indirect bilirubin concentration and sooner discharge.

Introduction: General anesthesia is the most common technique for performance of various surgical procedures. Thiopental is the most common anesthetic agent for intravenous induction. Since the introduction of propofol as an anesthetic agent, its use has increased progressively and has become the drug of choice for induction of anesthesia in several conditions.The aims of this study were comparison of hemodynamic changes of propofol and thiopental during induction of anesthesia and tracheal intubation and using propofol instead of thiopental for induction of anesthesia.Methods: In this double-blinded, randomized clinical trial study, 60 adult patients in ASA class I and II (candidates for elective operation under general anesthesia) were randomly divided in two equal groups (1. propofol, 2. thiopental). After baseline measurment of systolic and diastolic blood pressures and heart rate and giving similar premedication with morphine and midazolam, 1st group received propofol (2mg/kg) and 2nd group received thiopental (5mg/kg) for induction of anesthesia. Then systolic and diastolic blood pressures and heart rate of patients were measured in 4 different periods: after induction of anesthesia and before laryngoscopy and tracheal intubation, immediately after tracheal intubation, 3 and 5 minutes after tracheal intubation. Duration of laryngoscopy and tracheal intubation were also recorded in all patients. Data were collected and t-test statistical analysis was done.Results: The two groups were similar regarding age, sex, duration of laryngoscopy and baseline hemodynamic parameters. Baseline mean systolic and diastolic blood pressures and heart rate were also similar in both groups, but systolic and diastolic blood pressures and heart rate measured at times after induction of anesthesia and before laryngoscopy, immediately and 3 minutes after tracheal intubation were significantly lower in propofol than thiopental group (P<0.05). There were no significant differences between 2 groups at time 5 minutes after tracheal intubation.Conclusion: According to these findings, propofol can be an ideal substitution for thiopental as an induction agent due to stronger suppression of hemodynamic responses to larynfoscopy and intubation.

Introduction: Immunization and growth monitoring (GM) are the most important primary health cares (PHC) during infancy. Based on the results of national health survey in Iran, Hormozgan province has one of the poorest indices in immunization and GM in comparison with other provinces. The present study aimed at determining the status of these two important indices in infants and mothers’ awareness and cooperation of Bandar Abbas population laboratory (BPL).Methods: According to a large population – based survey (population=36830), the immunization and GM status of all 714 infants were studied. The data were gathered by interviewing them at their homes. Data were analyzed by Minitab software and presented by descriptive indices.Results: 94.9% of all infants had received PHC cares and 98.5% of them had health records in the PHC centers. 68.9% of mothers had some awareness of the necessity of monthly monitoring of their infants. 77.7% of the cases had complete GM charts but 12% had no GM charts at all. More than 45% of mothers had enough awareness to the concept and importance of the above mentioned charts.Over 94% of infants were immunized according to the national immunization protocol. Unavailability of PHC centers was the chief cause incomplete vaccination in the others.Conclusion: More than half of mothers did not have proper awareness to the concept and importance of GM charts, thus education in this regard is essential. More facilities are needed to achieve 100% immunization coverage. As most of infants receive their PHC from public PHC centers, therefore effective training of the health care providers in such centers is immensely important.

Introduction: Systemic lupus erythematosus (SLE) is an inflammatory systemic disease that involves different organs such as heart, lungs, hematologic and musculoskletal systems, gastrointestinal tract and kidneys. Renal involvement has specific importance in disease prognosis. The present study was conducted to identify epidemiologic status, short term effects of treatment on renal involvement, levels of complement and Anti-ds DNA in patients with lupus nephritis admitted to Imam Khomein hospital, Tehran. Methods: This descriptive study was conducted on 40 patients with lupus nephritis in internal and nephrology wards of hospital. Of these patients, 37 had documented disease. All patients had renal biopsy and had received treatment according to their pathology reports. Data including age, gender, clinical manifestation and pathologic findings were recorded. Results were reported in descriptive statistics and frequency distribution tables. Results: The patients had an average age of 12-45 years with mean age of 21.5. The most frequency was in second decade of life (48.6%). 87.5 percent of patients were female and 13.5 percent were male. Malar rash (62.5%) and fever (57.7%) were the most prevalent clinical manifestations. The most frequent pathology and sign were type IV lupus nephritis (37.8%) and hematuria (88.9%). Based on pathology, 97 percent of patients had renal involvement. Pulse therapy with corticosteroids and cyclophosphamide wase effective against preventing chronic renal failure in 50% of type IV cases. 100 percent of patients with lupus nephritis type III had bad prognosis.Conclusion: In patients with lupus nephritis, the most prevalent clinical findings were fever and malar rash of face, the most common renal involvement was hematuria and the most frequent pathology was type IV lupus nephritis. Renal involvement and prognosis is correlated with anti ds DNA titer. Types III and IV of lupus nephritis have indication for glucocorticoids and cyclophosphamide pulse therapy which can be preventive for chronic renal failure in 50% of cases.

Introduction: Brain stroke is the most common neurologic disorder and also the most common cause of mortality and morbidity in neurtologic patients. Thanks to new methods of radiography such as MRI, brain vascular lesions including silent stroke are demonstrated more carefully. This study considers the frequency of silent stroke in patients with acute thrombotic stroke in Rafsanjan by using MRI.Methods: This was a descriptive cross-sectional study with convenience sampling on 106 patients with acute thrombotic stroke. For all patients (without history of stroke) MRI was done and suspicious cases of hemorrhage were eliminated. For the remainder EKG, echocardiography, EKG-Monitoring and cardiovascular consultation was performed and cases with emboli and previous stroke were eliminated too. Then a questionnaire consisting of demographic data and risk factors was accomplished and statistically analysed with SPSS 11.5 software. Results: 65.1% of patients with acute thrombotic stroke were female and 34.9% of them were male. The following data were obtained: 31 patients (29.2%) with silent stroke, 55.7% with history of hypertension, 35.8% with diabetes, 17% with history of hyperlipidemia, 12.3% with history of cigarette smoking, 4.7% with history of using OCP, 19.8% with history of addiction and 31.1% with history of heart disease. The most common area of acute thrombotic stroke was parietal lobe with the frequency of 27.4%. The most common area of silent stroke were parietal lobe and cerebellum, both of them with the frequency of 22.6%.Conclusion: High frequency of acute thrombotic stroke and silent stroke shows that silent stroke can be a risk factor for acute thrombotic stroke.

Introduction: Yoga means unity of body and mind which has been as traditional medicine in the East for 3-5 thousands years and recently it is utilized as a complementary/alternative medicine in the West. Many surveys have been undertaken to evaluate the physiologic function and positive effects of yoga in physical, mental and social health.Methods: This semi-experimental study was conducted on 107 volunteers attending yoga classes (44 male, 63 female) in yoga society center (Fars province) with mean age of 34±7. The participants filled SF-36 questionnaire before yoga exercise and then attended classes 2 days a week for 6 months. After final session, they again answered the questionnaire. Data was analyzed by paired t-test, one way ANOVA and SPSS software (ver.11) regarding P<0.05 as significant.Results: According to statistics, significant improvement was observed in all 8 items related to physical, mental and social health and also general physical and mental health indices in SF-36 questionnaire (in which validity and reliability was defined previously). This improvement was in all age, gender and educational groups. There was no statistically significant difference between various age, gender and educational groups.Conclusion: As reported in other studies, Yoga as a subjective, mental and physical practice can improve well-being sensation. For more definite results, controlled trials should be undertaken.

Introduction: The postpartum period is a time of risk for affective disorders in women. 50 to 80 percent of mothers experience postpartum blues in first week after delivery. The aim of this study was to compare marital satisfaction between cesareaned women with and without postpartum blues.Methods: This was a descriptive, cross sectional study. We selected 150 cases who underwent cesarean section in Dr. Ali Shariati and Ome-Leila hospital of Bandar Abbas. Data collection included demographic questionnaire, information about pregnancy and delivery, visual pain scale, Aizeng self esteem scale, Beck depression scale and Azrin Natan H marital satisfaction scale.Demographic questionnaire and information about pregnancy and delivery were completed after cesarean section. We divided the cases to two groups (with and without postpartum blues) according to Beck depression scale on 3rd or 7th day after cesarean section. Finally Azrin Natan H marital satisfaction scale was assessed on the 7th day and compared in the two groups. Data were analyzed by SPSS software, t-tests, chi square, Fisher and Pearson correlation tests.Results: Marital satisfaction mean score was higher in women without postpartum blues (71±6.3v.s 68.5±8.2) which is statistically important difference (P<0.05). Cases’ agreement with their husbands about sexuality wife’s satisfaction from visiting husband’s family, husband’s satisfaction from visiting wife’s family, and effect of newborn birth on the mother’s occupational situation were all significantly associated with postpartum blues (P<0.05).Conclusion: It is suggested that all professionals involved in maternal postpartum care (especially midwives) be trained about the time of incidence, symptoms and possible methods for reducing postpartum blues.

Introduction: The first step for promoting the health status of low-dose OCP users about pregnancy prevention and related subjects, is determining their educational needs. Unfortunately, figures dedicated that the rate of unwanted pregnancy is high in Bandar Abbas. For the illiterate participants, we used oral questions. Because most of these women use low-dose OCP for family planning, we have surveyed their educational needs.Methods: In this descriptive cross-sectional study we have surveyed the educational needs of 1000 women who used low-dose OCP, by means of a questionnaire. Then all data were analysed by SPSS software and variance analysis. Results: 89% of objects and 92% of their husbands were literate. Statistical test have proven a significant correlation between objects’ literacy level and decreased educational needs, but some educational needs in different domains of knowledge, attitude and application were observed.Conclusion: High level of literacy is a powerful factor in health promotion. In this study, in spite of high literacy in the population, there were some educational needs, which is probably related to the cultural believes or lack of suitable health issues education to this population.

Introduction: Thalasemia such as many chronic illnesses, leads adolescent to suffer psychosocial problems. In order to cope with illness, participation of patient in self care and coping strategies training could be very beneficial. The aim of this study is to evaluate the effect of training on applying coping strategies among thalassemic adolescents.Methods: This research is a quasi-experimental study, made by using personal information questionnaire and standard form of Jalowiec coping scale. Eighty adolescents afflicted with thalassemia referring to clinic of thalassemia in Amirkola pediatric hospital were selected according to research criteria on random sampling and divided into two groups of case and control (each group 4 people). Intervention in this research is self-care training in the form of sessions of practical and theoretical training for 45 minutes in 5 sessions during three weeks. Part of the education was conducted individually (desferal injection) and the rest in 5-member groups for the case group. Information pertaining to problem-focused coping and affective-focused coping for both case and control groups were gathered before and after intervention.Results: There was no significant difference between mean of problem-focused coping (P=0.386) and affective-focused coping (P=0.275) before and after self-care training (P>0.05), but case group used more problem-focused coping strategies and also problem-focused coping had significant correlation with regular desferal injection (P=0.001).Conclusion: This study shows that changing coping strategies after teaching needs time to become a habit. So it is recommended to leave three months interval to assess the effect of teaching on coping strategies.

Introduction: Communication disorders have been acknowledged as a major public health issue because they compromise early childhood development, restrict vocational attainment and undermine the socioeconomic state of people. Problem in reading, which is a concept of human language abilities, can be efficacious in all educational and social aspects of human life. The objective of this study was investigation of different speech disorders among referrers to speech therapy clinic of educational office of Bandar Abbas.Methods: The study was descriptive cross-sectional and all patients were referred from the screening of health assessment program or kindergartens, or introduced by physicians during 2004-5. The data was reported as frequency and partial frequency.Results: From 172 patients with 3-15 years old, 30.2% were girls and 69.8% were boys. The most common disorder was articulation disorder with a rate of 79.1%. Delayed speech and language was the second common disorder in 17.4% of referrers. Stutter was observed in 2.3% of visited children. The last disorder was dysartheria in two children (1.2%). Voice and resonance disorder as well as aphasia were not observed in the studied cases. Conclusion: In this investigation majority of children were 4-6 years old, including the kindergartens children with due attention to other studies that reported speech disorders of this age group 8-12%, the cause of high rate of referred children in this age group showed the good quality of health assessment program and close collaboration of kindergartens educators for identification and introducing these children to speech therapy centers. The articulation disorder (79.1%) had the highest rate of disorders. With due attention to relation between phonological disorders, dyslexia and learning disorders, treatment of this disorder has a special importance, particularly before introducing to the primary school. Speech disorders were limited because of families don’t know about speech therapy and which cases should be referred to speech therapy clinics. They also don’t know the problems that originates from relationship disabilities. Finally another important reason may be the weak relationship between speech therapists and physicians, especially E.N.T specialists and neurologists.

Introduction: The preservation of medical files is the responsibility of hospital manager. Environmental conditions such as chemical, biological, and physical factors can cause the destruction of medical files. The importance of the maintenance of medical records made the researchers to conduct a study on the files kept in Hormozgan province hospitals regarding climate conditions, shelf places, file folders, etc.Methods: This descriptive study was conducted on the filing rooms of hospitals affiliated to Hormozgan university of Medical Sciences. Data was collected using a check list. Data were analyzed manually and presented as frequency and partial frequency.Results: According to the findings in 26.7% of records there has been color alteration, and 5.6% of them have been brittle due to temperature. The humidity of the filing rooms has affected only 7.8% of records and the remaining 92.2% were intact. Neither air conditioner nor filter has been observed in filing rooms. Since most medical records were written with ballpoint pens 83.8% of them were legible. Regarding biological factors (insects and rodents) only 7.8% of records are damaged by insects. Black, red, violet, and yellow stains have been observed on forms and folders in 8.9% of records.Conclusion: Considering the climate condition of the region and lack of proper filing places, i.e. rooms with levels of humidity and temperature, and presence of dust can cause deterioration of files and create a suitable condition for the growth of bacteria and fungi. In order to control the above mentioned destructive agents, proper filing places equipped with thermometers, hygrometers, and air conditioners the recommended.

Introduction: The prevalence of the AIDS in the world is brutally increasing and becoming a global emergency problem. Increasing knowledge can cause disease prevention. This study was conducted for comparing the effects of two educational methods: face to face education and, distribution of pamphlets among to female high school seniors in Sirjan.Methods: This research is based on a semi-experimental study on 300 female high school seniors in Sirjan conducted in 2004, using a multiple stage cluster sampling method. The sample was randomly divided into three groups. Their knowledge and attitude towards the AIDS disease were evaluated before and after intervention. In the control group there was no intervention. In the second group we distributed pamphlets and in the third group we educated the students face to face. We then evaluated their knowledge and attitudes after the intervention by SPSS software, fisher and t-tests.Results: The results indicated that comparing the control group’s knowledge and attitudes before and after intervention, there was no significant change, but increased knowledge in the educated groups (face to face and pamphlet distribution) was noticed, but the attitude in the face to face group was more positive after intervention and the difference is meaningful (P<0.05).Conclusion: These results indicated that pamphlet and face to face methods for increasing knowledge and face to face method for excelling attitude towards AIDS is suggested.

Introduction: Urine drug testing continues to be an important screening tool in our country. This study was conducted to assess the cost-effectiveness of opioids use screening programmes: premarital, preemployment, police detainees, “Harasat” referrals and private sector employees.Methods: Consumable costs data were obtained by examining records. Personnel costs were obtained through interviews with service providers and supervisors. Overhead costs were allocated based on the portion of space used by opioid testing services. For calculation of cost-effectiveness ratio of the screening programs, the total direct cost of each program was divided by the total number of positive TLCs.Results: In total, 64698 individuals were screened by means of the above five programs. 3460 (5.3%) subjects were confirmed by Rapid Screening Assay (RSA) and Thin Layer Chromatography (TLC). Excluding capital costs, police detainees screening program was the most cost-effective. Excluding capital costs the break even point was at 2 percent.Conclusion: Altogether individualized screening programs for opioid use would be cost-effective even at a lower prevalence, and should be continued.