Yafteh
Year:2005 | Volume:7 | Issue:25|Papers Count:10

Background: The incidence of suicide attempts has been increasing in recent years. Presenting a group of patients who attempted suicide, underwent ventilatory support and got postintubation airway stenosis, may help us to better understand and prevent this complication. Materials and methods: Among patients who referred to us for treatment of PIAS, those who were intubated for suicide attempts were investigated in a prospective study. Information were entered in a questionnaire and regular follow- ups were done in a 15 months period (Apr 2003 to Jul 2004). Findings: Among 100 patients with PIAS, 19 enrolled in the study. Mean age was 25.3+9.96 years (17-56 y), there were 10 females and 9 males. The type of disease and reason for suicide was categorized by a psychologist as psychosocial stress with an immature personality background in 11, psychological disorder in 7 and unknown cause in one. Direct causes for suicide were: family problems in 10, lovesick in 2, opium addiction in 3, depression in 6, social problems in 2 (in some patients, there was more than one cause). Mean time of intubation was 14.78 days (3-30 days), mean length of stenosis was 35.12 mm (20-50). Eight patients underwent a tracheostomy procedure. Three patients were treated with bronchoscopic dilation and 16 underwent laryngotracheal resection and reconstruction. There were 8 recurrences in the resected group of patients, of them, 4 were successfully re-resected, 2 recovered by bronchoscopic dilations and 2 managed by stents. This group of patients (study group) was compared with a similar group of patients in whom the causes of intubations were different (control group). The incidence of post-surgical recurrence (P=0.011) and the length of stenosis (P=0.01) were higher in the study group.Conclusions: In our patients, social problems like unemployment, illiteracy and singleness were more frequent cause of suicide than psychological disorders. Patients who underwent mechanical ventilation due to suicide and suffered PIAS could be treated by tracheal resection and reconstruction, although the incidence of post-surgical stenosis recurrence among them is more frequent than the other groups of patients.

ackground: Since recogntion of probable reservoirs of nosocomial infections is important for determining the kinds and antibiogram pattern of hospital pathogens in Shohadaye- Ashayer hospital environment, this descriptive cross- sectional study was done. Materials and methods: Totally, 1020 gowns were sampled in an interval of one month and three times of sampling. Samples were carried to laboratory in thioglycolate broth medium, and incubated for 24- 48 hours at 37ºC in BHI agar or tripticase soy agar, Macconky agar and Sabrod Dexterose agar. Colonies were identified and antibiogramed by kerby- Buear method and results analyzed by SPSS version 7.5 software. Findings: Results showed that 100% of gowns were positive at least in one or three times of sampling. Acinetobacter species were the most common type of isolated bacteria (27.47% of the cases) and the most contaminated wards were emergency and outpatient operation room.Conclusions: In general, among isolated bacteria, the following five groups were the most prevalent bacteria respectively: Acinetobaccter species, Corynebacterium species, Enterobacteriaceae, Bacillus species, and Psuedomonaseae species. All of the isolated bacteria were susceptible to aminoglycosids and relatively resistant to beta- lactams.  

Background: Hyperbilirubinemia is a common problem in neonates that affects approximately 60% of term neonates and 80% of pre-term neonates in the first week of life. Newborns, due to prematurity of the liver and digestive tract, could not eliminate bilirubin quickly. This phenomenon leads to hyperbilirubinemia and jaundice during the first days of the birth. Because indirect bilirubin is toxic for central nervous system and is not soluble in water, elimination of it is difficult. Severe hyperbilirubinemia causes kernicterus, mental retardation, hearing loss, cerebral palsy, behavioral disorders and death. The most common method of treatment is phototherapy and in severe cases, is exchange transfusion. In Lorestan province, it is believed that putting barely flour on skin of icteric neonates decreases and sometimes treats icterus state. The observed effect is due to cold nature of barely. The aim of this study is to introduce barely flour therapy to medical society, as one of the traditional methods if it is effective, and to inform Lorestan people and warn them about complications of severe jaundice if it is not effective. Materials and methods: A controlled clinical trial in neonatal ward of Madani pediatric hospital of Korramabad affiliated to Lorestan University of medical sciences was done during a period of one year. During this period, all full-term neonates with indirect bilirubin > 16mg/dl were studied. Neonates divided into two groups of cases and controls. In the study group, in addition to phototherapy, filtered and fine barely flour was put on whole skin of neonates, except their face and umbilical area. Control group, only treated with phototherapy. Data were collected by questionnaire and laboratory tests. Findings: Ninety neonates including 45 neonates in case and 45 neonates in control groups were studied. Of these, 62 (68.9%) were boys and 28 (31.1%) were girls. The duration of hospitalization in 44.4% of study group was 48 hrs and in 33.3% of control group was 96 hrs (4 days). The average of hospitalization period in study group was 2.7 days. (Minimum 1 day and maximum 4 days with SD=1.09) and in control group was 3.7 days (minimum 2 days and maximum 7 days with SD=1.2). Duration of hospitalization of two groups was statistically significant (P=0.001).Conclusions: Our study indicated that phototherapy in conjunction with barely flour therapy is more effective than phototherapy alone. But, people must be informed that affected neonates have to be underwent medical therapy, and barely flour therapy alone is not a reliable treatment.

Background: Free radicals and reactive oxygen species (ROS) are the most important factors in formation of oxidative stress reaction. Now, radical damage has been suggested to contribute to a wide variety of diseases such as Alzheimer, atherosclerosis and cancer. Transition metal ions in the presence of the various biomolecules produce these active compounds. The aim of this study is introducing a new and rapid method for measuring of ROS. Materials and methods: In this cross-sectional study, the amount of free radical production by transition metal ions such as iron, copper and vanadium in the presence of the thiol group- containing glutathione and cysteine (as reducing agents) and molecular oxygen was measured in vitro by thiobarbitturic acid (TBA) test. For measuring free radicals levels, the suger deoxyribose was used as a detector molecule. Attack of free radicals on deoxyribose produces a number of aldehyde compounds such as malondialdehyde (MDA). Then, MDA was combined with TBA as a detector, which makes a chromogen with maximum absorption at wavelength 532nm. Also, the effects of vitamin C and E on the radical production by these metal ions were studied. Findings: Vanadium was considerably more effective than iron and copper (Pvalue<0.05) to generate free radicals. The generation of free radicals by iron and copper was depended on the presence of glutathione or cysteine in medium (for Fe-glutathione system was 0.611±0.039 and for Cu- cysteine system was 0.592±0.033). Vitamins C and E had an inhibitory effect on the radical production by three metal ions that were used (Pvalue < 0.05). Specially, vitamin C in 100 micromolar concentration had the greatest effect on free radical formation (83% Inhibition with P value < 0.05).Conclusions: These results suggest that reaction of transition metals with thiols in the presence of oxygen, generate ROS, and vitamin C and E inhibit free radical production.

Background: Induction of anesthesia in patients that undergo cardiac surgery has more risk than others, because of specific cardiovascular effects of the anesthetic drugs and the preoperative state of these patients, so the hemodynamic stability is very important in these patients. It seems that midazolam have less cardiovascular side effects than thiopentone. In this study, the effects of midazolam and thiopentone on cardiovascular system were compared. Materials and methods: Sixty patients in ASA class 2,3 that underwent coronary artery bypass grafting were randomly divided into two groups, all patients were pretreated similarly. Anesthesia induction was performed by a bolus injection of midazolam (0.25 mg/kg) in first group and thiopentone (5 mg/kg) in second group, and succinylcholine (1.5 mg/kg) in both groups. Their trachea was intubated. Heart beat rate and arterial blood pressure were measured in following times: before (base) and after anesthesia induction, during intubation and 3, 5 and 8 minutes after intubation. Findings: The data showed that administration of both drugs decreased blood pressure during induction of anesthesia and changed heart beat rate minimally. However after intubation, blood pressure and heart beat rate increased in both groups. But, midazolam had less effect than thiopentone. Conclusions: Hemodynamic effects of midazolam are similar to thiopentone. Midazolam is a water-soluble, safe and effective inductive anesthetic with short- term effects, much lesser venous irritation, and it can be used instead of thiopentone in patients with cardiac diseases or those patients which thiopentone is contraindicated for whom.   

Background: Because of the scarcity of antifungal drugs, their undesired side effects and emergence of drug resistant strains; research for finding novel antifungal drugs with less side effects is necessary. In this research, the antifungal effects of satureja khuzistanica essence, which is a native plant in our province, on ten kinds of fungi were evaluated. Materials and methods: To extract the essence, we exploited water extraction by Clonger apparatus for dermatophytes and saprophytes. SDA media with different concentration of the essence were prepared and mean growth diameter of colonies was measured after 7 and 14 days. Disks with different concentrations were prepared for Cryptococcus neoformans and mean diameter of inhibition zones were measured after 7 and 14 days. The collected data were analyzed by SPSS software. Findings: The results indicated that at concentrations equal to or more than 0.02 mg/ml, the essence inhibits the growth of Microsporum gypseum, Trichophyton mentagrophytes, Epidermophyton floccosum and at concentrations ≥ 0.06 mg/ml, it will inhibit the growth of Aspergillus fumigatus, Aspergillus flavus, Fusarium, Trichophyton rubrum, Trichophyton verrucosum, Microsporum canis (100% inhibition with two concentrations). For Cryptococcus neoformans, maximum concentration of 1000 mg/ml (pure essence) caused 62% inhibition. Conclusions: The essence of S. Khuzistanica could be used for treating many fungal diseases and also as a disinfectant.

Background: Preeclampsia is one of the most common complications of pregnancy. It is the cause of high morbidity and mortality for mothers and fetuses, especially in developing countries. The etiology of preeclampsia is unknown. One of the hypothesis on pathophysiology of preeclampsia is dyslipidemia. The aim of this study was to determine maternal plasma levels of lipoproteins in patients with preeclampsia and normotensive pregnants women who referred to Asali hospital. Materials and methods Plasma levels of total cholesterol, total triglyceride, low density lipoprotein (LDL) and high density lipoprotein (HDL) were measured in 20 preeclamptic women and 20 normal pregnant women with gestational age between 37- 40 years. Findings: The plasma levels of total cholesterol and total triglyceride and low density lipoprotein (LDL) were significantly higher in preeclamptic women than in controls p<0.001). Levels of high density lipoprotein (HDL) did not differ significantly between two groups. Conclusion: The results indicate that dislipidemia is a risk factor for pathophysiology of preeclamsia.

Background: Hospital as the gravitational center of the health and treatment system and an open system involving complex processes and various (qualitative and quantitative) resources, needs an effective leadership style and an appropriate strategy to solve the organizational disagreements and conflicts in order to achieve its basic objectives. The object of this research is to study the relationship between leadership style and conflict management among the managers of the hospitals, which sponsored by Lorestan university of Medical sciences during the year 2004. Materials and Methods: This research is a descriptive– analytical study. The necessary information was gathered by three different questionnaires (personal information, leadership style using Fiedler’s LPC method and conflict management), and also by interviewing the subjects. The collected data were analyzed using statistical software. The research sample consisted of 177 managers from 13 hospitals, which were sponsored by Lorestan University of medical sciences. Results: The findings demonstrated that 54.2 percent of the subjects had a duty- oriented leadership style, 35.6 percent had a relationship– oriented leadership style, and 10.2 percent of the subjects had an independent – social leadership style. Considering conflict management strategies, 49.7 percent showed a non– confrontational strategy, 44.6 percent demonstrated a control- oriented strategy and 5.7 percent had a problem- solving strategy. The subject’s leadership style had a significant statistical relationship with their job experience (p=0.043). Also, there was a significant statistical relationship between conflict management strategies and the sex of the subjects (p= 0.036). Age of the subjects and their control- oriented strategy also demonstrated a significant statistical relationship (p=0.01). Conclusion: Determining the leadership and management styles and identifying the methods of dealing with disagreements and conflicts in hospitals is crucial. Since some of the factors involved in leadership style and conflict management have been studied in this research, it is suggested that the effect of other factors such as organizational culture, social culture, race, personality, etc. on the leadership style of people be studied more comprehensively.  

Background: World wide, cervical cancer comprises 12% of all cancers in women. In developed countries, routine cervical cytology tests resulted in a large decline in cervical cancer incidence. This study is a descriptive- analytical research to evaluate the order of cell sampling from exocervix and endocervix and compare final cytological diagnosis. Materials and methods: Totally, 1129 smears were obtained by an Ayre spatula and an endocervical brush from patients who referred to Tehran health and birth control clinic. patients were divided into two groups. In 563 cases, the endocervical brush was used first, but in 565 cases the spatula was used first for sampling. Results: Statistical testing showed that there is not any difference between groups regarding their age, age of marriage, partity, and type of contraception. More smears were obscured by blood when brush was used first (78 or 13/8% compared with 48 or 8.5%, P= 0.004) but we observed an insignificant difference between two groups and cytologic diagnosis. We observed higher proportion of atypical squamous cells of undetermined significance (ASCUS) detection in the spatula- first group (33 cases, 59%) compared with brush- first group (20 cases, 3.6%) which is insignificant (P=0.09). This study showed that the ability of squamous intraepithelial lesion (SIL) detection in spatula- first group (27 cases, 4.8%), was comparable to brush-first group (23 cases, 4.1%).Conclusions: Because reported SIL cases are higher when samples are first taken from exocervix and rate of blood contamination increases when samples are taken from endocervix (p=0.004), it is better to take samples first from exocervix for Pap Smear. This strategy increases the chance of diagnosis of cellular lesions of cervix.