Internal Medicine Today
Year:2006 | Volume:12 | Issue:2|Papers Count:10

Background and Aim: Breast cancer is a prevalent disease in the world, region and Birjand and there are racial and regional differences in the epidemiology and variations in the pattern of P53 gene mutations. We studied the prevalence ofP53 gene mutations, estrogen and progesterone in breast caner patients. Materials and Methods: In this descriptive analytical study, all consecutive pathological specimens of breast cancer patients in Birjand during 2 years were examined. First the neoplasm was determined and specimen from fixed parafinated blocks was obtained. After depparaftnation, immunohistochemistry staining with P53, estrogen and progesterone kit (DAKO Company, Denmark) was done. Data was analyzed by chisquare test. And P≤0.05 was regard as significant.Results: 51 specimens examined. Most of them were olden than 48 years (54.9%), residing in urban area (62.2%) and housewife (82.4%). The specimen were positive for estrogen, progesterone and P53 receptors in 12 (23.5%), (21.6%) and 14 (27.5%) respectively. There was no significant relation between the prevalence receptor positive and age, place of residence. Housewives had less estrogen receptor compared to employed patient (14.3% vs. .66.7% P<0.001). Progesterone and P53 receptor positivists were more common in employed patient comport to housewives but it was not significant.Conclusion: According to the result of this study and high prevalence of breast cancer, more studies with more sample size should be done to help patients for better treatment and survival.

Background and Aim: Type 2 diabetes is a rapidly growing chronic health problem, the complications of which cause significant morbidity and mortality. Advancing age, obesity, upper body fat distribution, and a family history of diabetes are among the well established risk factors for this condition. This study was carried out in order to determine the effects of applying continuous care model on diabetic patients' body mass index and weight.Materials and Methods: This is a Quasi-experimenta1 study which was done in Orumia' s Imam Reza hospital. 74 DM type II patients were selected with random allocation technique and assigned to case & control groups for the purpose of this research. Data collection tools include: demographic information's questionnaire and measuring of weight, height, and calculating of body mass index. Researcher after doing first step of Continuous Care Model (orientation) in both of groups (case and control), did the second step of model (sensitization) only in case group with conducting 20 educative sessions of group discussion about self care in DM type II. Then control was done on case group monthly. In this stage researcher visited patients at their homes and completed check lists then evaluation was done.Results: The mean of BMI and weight amounts in the control group at the beginning of study and at the first, second and third months after were respectively: Repeated measurement test showed that: There is significant relation (P=0.014) between applying continuous care model and reducing BMI and weight amounts in diabetic patients. The mean of weight and BMI measured by pair t test showed that: There is significant relation amounts before and after of study in two groups (reduce route in case group and slightly increase in control group).Conclusion: Considering this findings, research hypothesis that applying continuous care model can reduce weight and BMI amounts in DM patients was approved. Therefore we propose to apply continuous care model on diabetic patients in order to reducing their weight and BMI amounts.

Background and Aim: The optimal maternal position for the most comfortable, efficient delivery has long been a source of contention. The purpose of this study was comparison labor pain in first stage of labor.Materials and Methods: In this study 56 primigravida women that had 2-5 cm cervical dilation and 5-10 minute frequency of contraction randomly assigned in two groups. Group A began with 30 min in the sitting position and group B began with 30 min supine position, followed by 30 min supine sitting position. Therefore maternal position in group A was sitting- supine- sitting- supine, and in group B was supine- sitting-supine sitting.Each 30 min period the woman asked to rate the labor pain using visual Analugu scale (VAS)Results: There were no statistically significant differences between mean pain in upright and supine position in all women.Conclusion: We conclude that a certain position can not provide less pain through the first Stage of labor. Therefore is no reason to discourage patients from adopting the position of their choice in labor.

Background and Aim: Emergency Laparatomy is a therapeutic and surgical method which is applied for many kinds of diseases especially abdominal trauma. Abdominal trauma (penetrating and blunt trauma) is one of the most common causes of emergency laparatomy. Some years ago all the patients with abdominal penetrating trauma underwent laparatomy but since the results were incredible and negative laparatomy had increased, some new criteria were determined for surgery and as a result the elective laparatomy replaced the obligatory laparatomy.Materials and Methods: This is a descriptive prospective study on the patients who had undergone emergency laparatomy following the abdominal trauma. The data were based on the available dossiers in Hospital.Result: out of 138 trauma patients who had undergone laparatomy, 96 of them contacted blunt trauma and 42 penetrating trauma. The largest number of laparatomy patients was in the third decade of their life. The most common reasons for trauma were stab and car accident. CT scan and abdominal lavage were not used for any of the patients. In blunt trauma, clinical symptoms and examinations were used but in penetrating trauma just because it is penetrating, laparatomy was used. In penetrating and blunt trauma there were respectively 20 and 8 cases of negative laparatomy. The rate of mortality in traumatic patients was reported just 5 cases.Conclusion: 52.2% of laparatomy in blunt trauma was the result of car accident and 26.1% of laparatomies in penetrating trauma was the result of stab. This statistics show that social-cultural problems should be taken more seriously. The prevalence of negative laparatomy in penetrating trauma is the best reason for changing the obligatory laparatomy to the elective laparatomy, so being penetrative isn't sufficient for laparatomy .

Background and Aim: Increasing of caesarean delivery beyond of acceptable rate, can have negative effects on the health of the mother and baby and economy of the society. Because of one-third of total caesarean deliveries are due to repeated caesarean, promotion of vaginal birth after caesarean can be a valuable way for decreasing of caesarean rate. The purpose of this study was to determine the attitude of gynecologists and midwives about vaginal birth after caesarean and barriers about it.Materials and Methods: This descriptive study was done on 124 gynecologists, residents and midwives. Gynecologists, residents and midwives of maternity units were selected by random sampling method from teaching hospitals and midwives of health centers were selected by cluster sampling. Research instrument was two sections questionnaire consist of: demographic characteristic and attitude assessment form include 21 phrases with minimum score of 0 and maximum 42. According acquired score attitude was classified to three levels: agree, neutral and disagree. Data were analyzed by using chi- square test, t test, and analysis of variance and Pearson correlation.Results: Data analysis indicated that most of gynecologists (80%), residents (61.1%), midwives in maternity units (81.4%) and midwives in health centers (60.5%) had positive attitude about vaginal birth after caesarean. There was a significant difference between attitude of subjects base on job (P=0.027) and time of graduation (P=0.049). According the views of gynecologists, no legal supports were the most barriers about VBAC.Conclusion: By attention to positive attitude of the gynecologists and midwives, for promotion of vaginal birth after caesarean, searching of barriers and solving them is suggested.

Background and Aim: This study has been achieved to establish the indications of surgical intervention at the appropriate gestational duration for brain and medullary tumors in pregnant women and to evaluate any correlation between gestational hormones and the rate of occurring or rate of growth of brain or medullary tumors.Materials and Methods: In our retrospective study since 1999 to 2005, 1027 patients who had been admitted and operated in neurosurgical centers were determined. The female patients who were in fertility age were selected and statistical analysis with descriptive methods and Chi-Square test was done in patients who had intracranial or intraspinal tumors or their neurological findings were accelerated. Then we compared our results with other studies.Results: From 1027 patients in our study with brain or medullary tumors, 23 patients were pregnant. 17 cases had intracranial and 6 cases had intraspinal tumors. 52.9% of brain tumors and 50% of intraspinal tumors in our study were meningioma. Most of patients in our study were operated after delivery and results were good in almost all of patients.Conclusion: A decision for best management and treatment is different in pregnant patients with intracranial or intraspinal tumors. This study indicated that the rate of intracranial and intraspinal tumors, specially meningioma, or accelerated rate of neurological findings is probably because of hormonal receptors specially progesterone receptors. If the patient’s condition worsens, the tumor should be excised as soon as possible but if the neurological condition of patients is stable, it would be rather the operation is achieved after delivery.

Background and Aim: Hypertension is one of the most important risk factors in incidence heart and vessel diseases, heart and kidney disorders also Cerebral Vascular Accidence (CVA). According to the importance of this plan which is national and is being carried out nationwide, therefore, its stages are one of the most important parts of the plan.Consequently, this research has been done in order to analyze the caring quality and evaluation of the plan among health centers in Birjand.Materials and Methods: The recent study is an analytical cross-sectional of the caring quality assessment.  The society being studied is consisted of all the urban and rural health centers of Birjand having patients of high blood pressure. By utilizing cluster sampling method, four health centers from four different rural districts of Birjand were chosen and then all the relating patients of high blood pressure were analyzed. The means of gathering data in this research was three structured questionnaires; which were collected and completed by the health experts using observation- examination methods. These information and figures were analyzed using SPSS software, descriptive statistics, chi-square test, t- test and Pearson correlation coefficient.Results: The result of the research for assessing the quality of the plan showed that 35% of the high blood pressure patients were under complete control and 45% were introduced to a doctor. Also 40% were of the patients had not been looked after on time instead were being cared by a health worker and only 30% of those who were introduced to a doctor were looked after by the doctor of the health centre. Mean score of health workers knowledge was 13.1±2.86 out of 24 which reveals a moderate level of knowledge of the workers. Between the mean score and the sex of the worker was a significant difference (P<0.05). Also, the average age of the patients was 65.69±10.93 and their awareness mean score was 4.29±1.9 out of 15. We also observed a significant difference between the awareness score, level of literacy and the job of the patients (P<0.05).Conclusion: On the basis of the research results we can conclude that, at first the percentage of patients being cared has been low and in the second, sending patients to doctors and their care by the doctors has also been low. According to the awareness of the health workers and the patients from the plan; having tutorial sessions for the health worker and necessary trainings for the patients via face to face; group discussions or using educational pamphlets can be effective for enhancing the awareness level of them.

Background and Aim: Marriage is the most important decision in life and 95% of the people marry during their life. Common life was influenced by different variables. These variables cause wife and her husband to be satisfied or unsatisfied from their life. The purpose of this study was the comparison of marriage satisfaction in housewives and employed women and their husbands in Gonabad.Materials and Methods: This is a cross-sectional and analytic study. Data collection was performed in two stages. At first stage cluster sampling and at second stage simple random sampling was done and 25 housewives couples and 25 employed women couples were studied. The data was collected by demographic information and Enrich questionnaire and were evaluated by using of t test and ANOVA and linear regression.Results: The mean of satisfaction score in employed women and their husbands was 3.6 and in housewives and their husbands were 3.7 with no significant difference between them. There was no significant difference between satisfaction and education levels in the two groups but it was significant between satisfaction and income in men, and between satisfaction and age of marriage in women. There was a significant difference in marriage satisfaction between employed women and housewives after a time of marriage (P=0.02).Conclusion: There are variables which influence on married life satisfaction on men and women that these variables must be recognized.

Background and Aim: Epidemiological studies have been revealed that there is a relationship between hardness of water and prevalence of CVD. Therefore this study has been planned to determine the influence of local mineral water on blood pressure in hypertensive men.Materials and Methods: In this cross sectional study, 41 middle age men with hypertension (48±8) were matched based on age, BMI, WHR, drug, smoking, and duration of the disease and randomly selected in a First and second groups. Respectively, mineral and usual tap waters were given to first and second groups 2 liters per day for 8 weeks. Blood pressures of subjects were calculated by barometer at the 1st, 4th and 8th weeks of experiment. Wilcoxon, Mann-Whiney and t-test were used for statistical analysis of the results. Dietary intakes of subjects were determined by using 24 hours recall questionnaire at the 1st, 4th and 8th weeks of the experiment and were analyzed by Nutritionist III program, which is modified with Iranian Food Data Bank.Results: The mean SBP in first and second groups were after 4 weeks 131.0±9.98 and 136.1±8.65 mmHg, respectively. The experiment has showed a significant reduction in 4th week 13.53% in first and 5.64% in second groups (P=0.001). The difference between the groups were statistical significant (P<0.05). SBP reduction in both groups did not show statistical significant after 8th weeks between the groups. The mean DBP in first and second  groups were 85.75±6.34 and 92.62±4.07 mmHg, respectively after 4th week of experiment with a significant reduction of 11.3% in case and 3% in control groups (P=0.001). Also significant difference in DBP was seen at 4th week of the study between the groups (P<0.05). DBP reduction in both groups did not show statistical significant difference after 8th weeks between the groups.Conclusion: According to the result, mineral spring water has a significant influence on reducing blood pressure after 4 weeks in comparison with tap water, which it could be leading to lower risk of CVD.

Intussusceptions in adults are rare. We report a 39-year-old woman who had a gastero-deudonojejunal intussusception due to an inflammatory fibroid polyp manifesting. Resection-anastomosis of the intussuscepted segment was done. She is well one year later.