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Breast cancer is the most common cancer in women. Histologic grading is one of the prognostic factors in breast cancer. The present study performed in analytic descriptive method and based on the slide review of beast biopsies received in the pathology department of 5th Azar Hospital from 1976 to 1978, and on the basis of Bloom-Richardson criteria (Mitoses, tubule formation and nuclear pleomorphism). The results are consist of: 1) Infiltrating duct carcinoma is the most common histopathologic form, and tubular carcinoma is the least common 2) The most common age is 36-45 years 3) There is meaningful relationship between mitoses and tubule formation and between pleomorphism and tubule formation. But there is no relation between nuclear pleomorphism and tubule formation in the tumor. Histologic grading of breast carcinoma should be reported by pathologist for clear determination of prognosis and also the best choice for management of the tumors.

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Meningitis is one of the urgent medical ceases, and in spit of tramendous efforts. There is a high prevalency in various part of the world, still has got a high mortality. Rapid diagnosis is one of the best way to control the disease, and the basis for the present study is to find out the rate of occurrence of meningitis in suspicious cases. During nine-month study (Sep 1999-June 2000), 100 children with suspicious sings of meningitis referring to Taleghani children hospital were taken under medical surveillance, and LP has been carried out by the pediatrician. The samples were transferred to the laboratory and various tests has been done on the samples. On the ground of clinical and paraclinical findings 15 meningitis patients (7 bacterial, and 8 viral were diagnosed). The most abundant isolated bacteria from the CSF was Pneumococci (42.8%) and the most significant clinical finding was fever, vomiting, stiffness of neck. In all bacterial meningitis the CSF’s appearance was deeply turbid, and the average WBC in CSF was about 3200, the rate of PMN was 92%, these results had significant meaning with comparison to the viral and non-meningitis sample (P<0.001). CFS’s protein level was much more higher in bacterial meningitis, than other cases (P<0.001), and this can be used as diagnostic tool, but in spit of reduction in CSF glucose concentration, and CSF/blood glucose ratio (48% in bacterial, 70% viral, and 74% in non-meningitis), these ratios didn’t have significant meaning (P<0.4). The results of this research indicate the clinical manifestation such as fever, convulsion, vomiting turbidity of CSF, WBC count more than 500, and positive CRP, could help effectively in the diagnosis of bacterial meningitis.

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Golden Staphylococci is one of the most common factors in skin and systemic infection. About 30% of people are carrying this bacterium in their skin and nose. Increased drug resistance in this microorganism and consequent infection, has gained the attention of scientific organization. Therefore we decided to determine the prevalence of nose carrier of this bacterium in healthy children in Gorgan schools. During the winter 1998 to March 1999 the sample has been taken from 1193 student’s nose with sterile cotton swab. These results showed that in 194 samples (16.3%) Staphylococci Aureus has been isolated, from these samples 114 cases belong to girls (16.1%) and 80 cases were boys (16.4%) that there is not a meaningful variation between them. The number of bacteria isolated from the villages children was 109 cases (17.6%) and in town’s children were 85 cases (14.8%), also this difference didn’t show significant difference. The prevalence of carrier among the 6-12 years old was 12-25.3%, which has got a significant meaning (P<0.001). Antibiotic resistance in the isolated S.aureus were tested and result showed that 34.8% of samples are resistant to Methicilin and 1.7% were resistant to Vancomycin, only 4% were sensitive to Penicillin. Therefore with regard to the results of this investigation, further researches are recommended in relation between strain’s of S.aureus that isolated from carrier’s and strain’s that isolated from patients and to determine their drug resistance in this region.

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Depression is a common disorder in the world. Depression may due to general medical condition disorder such as diabetes mellitus. This study explains the relationship between diabetes M and depression (Prevalence, age, duration, sex, type, control of disease) among diabetic patients. This is a analytical and cross-sectional study. Sampling has been done by random among out-patients diabetics in Gorgan 5th Azar Hospital, diabet clinic, during year 2000. About 100 NIDDM diabetic patients type and 50 IDDM type selected by randomization. They were assessed according to age, sex, FBS, HbA1c, duration, type and beck inventory standard test. The findings showed: 40.6% have moderate and sever depression with beck test over 21 points. There are a significant relationship between age of diabetic patients and depression (P<0.14). There are a significant relationship between duration and depression. There aren’t any relationship between sex and depression (P>0.81). There aren’t any relationship between type of diabet and depression (P<0.236). There aren’t any relationship between HbA1c and depression (P>0.85). Depression is more common among diabetic patients than general population and incidence have a direct relation with age and duration of disease.

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Toxoplasmosis is a disease caused by a ubiquitous, obligate intra cellular protozoan Toxoplasma Gondii. Based on serological evidences, Toxoplasmosis infection is a widespread disease with regard to this fact and because to the occurrence of congenital Toxoplasmosis infections due to asymptomatic infections in pregnant women, determination of the rate of Toxoplasma antibodies (IgG, IgM) before pregnancy and finding the involved factors in increasing Toxoplasmosis prevalence seems to be necessary. This study was a cross-sectional and descriptive study and sample population was the women referred to marriage consultation the prevalence of Toxoplasma antibodies (IgG, IgM) was determined by ELISA method. Blood sample were collected randomly from 300 women referred to the center for consultation in 2001 and they was transferred to the laboratory for antibodies determination. The results showed that the general prevalence to the positive cases based on high titer of IgG was 48.3% and of IgM was 11.7%. There was not any relation between positive cases and age, education, place for residence, job, keeping domestic animals (Except cat) vegetable consumption and wash-up, but there was a relation between positive cases of IgM and keeping cat at home (P?0.025). More over 51.7% of pregnant women in Gorgan were seronegative and the were prone to acute Toxoplasmosis during their pregnancy. The results of this study confirm that the determination of the diagnostic Toxoplasmosis is an necessary test during pregnancy.

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All the different kind of Mycobacterium species except Tuberculosis Leprae and Bovis are considered as environmental Mycobacterium, which usually can be isolated from sand, water and dusts. In addition to the role of their pathogenesis, they can stimulate the immune systems. The immune mechanisms following Mycobacterium environmental contamination can be either protect or destroy the immune system when facing the disease related to the Mycobacterium. The Golestan province has got 2 regions from the point of view of TB epidemy, it is higher in the east. The aim of this project is determine the prevalency of various types and strains of environmental Mycobacterium in the east and west of the region. The samples were collected from both regions from the wet sand, and muddes covered with grass and following their preparation they were cultured on the Lowen Stein Jenson. The total of samples were 220 from these 120 samples were from the region with epidemy of TB out of these we had 25 samples with positive culture (20.8%) and 47 type of mycobacterium were isolated, the most common forms of them were Mycobacterium Fortuitum (34%), Mycobacterium Flavesens (21.2%), Mycobacterium Chelonae (12.8%). From 100 samples taken from the region with low epidemy of TB 66 samples were with positive culture (66%) which 114 strains of Mycobacterium were diagnosed. The most common forms of these microorganisms were Mycobacterium Flavesens (20.1%), Mycobacterium Chelonae (18.4%) and Mycobacterium (16.6%). In conclusion in all the Golestan province without taking notice the TB epidemy form 220 samples 91% were positive culture (41.2%) which 161 different strains were diagnosed out of these the most common were Mycobacterium Fortuitum (21.8%), Mycobacterium Flavesens (20.5%) and Mycobacterium Chelonae (16.8%). The epidemy and variousity of environmental Mycobacterium in the region with low epidemy were much higher than the region with high epidemy and in regard to that these differences are due to the bioenvironmental factors. So therefore this can indicate that the possibility of higher contact between the immune systems and the environmental Mycobacterium. These Mycobacteriums can act as Booster of BCG vaccine which can continuously stimulate the immune systems and this can help the body’s proper responses when facing with the TB Mycobacterium.

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Stress is applied to the collection of somatic, emotional and mental reaction, which can disturbed the equilibrium in human beings. One type of stress is work in dependent stress environment, which can affects on personnel due to its internal stressful factor. The object of this research is to investigate the rate of stress in operating room personnel and its relationship with some relevant factors. The present study has been done on 104 personnel of operating room in hospitals belong to the Gorgan Medical Sciences University. The tools for collection data were questionnaire, which contained demographical variables, physical and mental environment stress factors in operating room life stress scale. The results from this investigation indicated that 54.4% of all personals had a mild stress. The stress factors present in the operation room were inconvenient smells the highest with 76% uncooperated team work was the other factor with 29.7% and personnel equipment was (42.6%) it become clear from this investigation that there is a reverse between stress and demographical variables, of stress has a meaningful relationship with age (P=0.01) and years of service in the operation room which means as the age and working in the operation room increased the level of stress decreased. According to the results from this investigation it is suggested therefore to use the old and well-experienced staff to work in the operation room to avoid such problems.

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Background and objective: Nosocomial infections are the important problems in health care centers in the world. Incidence rate in different countries is very variable and has been reported about 5% to 15%. This research was done for ascertainment of level of knowledge, attitude and practice of employed nurses to nosocomial infection in teaching hospitals of Golestan University of Medical Sciences. Materials and methods: This is a descriptive and analytical study, total number of employed nurses (518), 189 male and 328 female. The research carried out using a questionnaire. The data was used to analyze the data SPSS software. Results: Results of research showed that 26.5% of nurses had very low knowledge, 63.9% medium knowledge and 9.6% good knowledge. About attitude 52.4% had negative attitude, 36.4% medium and 11.2% positive attitude. About practice 37.1% had poor practice, 49% medium and 15.9% good practice. In this research between attitude and knowledge, knowledge and practice there was not any meaningful correlation but difference between attitude and practice was statistically significant. Conclusions: The nurses are playing important role in prevention and control of nosocomial infection. So, it is necessary for nurses to have enough knowledge about how to control the infection and to have positive attitude, if they want to do their job property.

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Background & Objective: Hemodialysis patients quality of life is a significant subject. Style of coping or adjustment among hemodialysis patients is a complicated problem that affects the quality of life status. Responses domain to these problems are different from readjustment to suicide. The object of this study was to determine the relationship between quality of life and copings the problem, which were applied by hemodialysis patients. Materials & Methods: This is a descriptive analytical and correlational study. The study has been done in hospitals of Gorgan, Gonabad and Bandar Torkaman cities. The data were collected using a questionnaire with likert scale (From 1 to 5). Sample population was 167 patients. Results: The results showed that 89 patients were male, 78 patients female, 25.74% between 35-44 years old and hemodialysis of duration of 114 patients was more than 4 years. The quality of life mean score and standard deviatior were respectively 89.58, 8.13. About 75.42% of patient’s quality of life were moderate. The emotional and problem focused strategies were used in moderate way by the hemodialysis patients. Statistic tests between quality of life and emotional focused coping was significant (P<0.05). In general there are relationship between quality of life and total coping (P<0.05). Conclusion: According to study, we conclude that emotional focused coping and total coping influence the quality of life of hemodialysis patients. Therefore hemodialysis patients must be educated and supported, to cope with the problems.

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Background & Objective: Major ?-Thalassemia is the most common form of anemia, which has a relatively high prevalency especially in the northern part of the country one of this disease side effect the hearing abnormality. This study has been carried out in Gorgan for the determination of the hearing level of ?-Thalassemic patients, and its relation with the level of serum Ferritin, the rate and the duration of blood transussion and dyspheral. Materials & Methods: In this study 95 patients with major ?-Thalassemia have been studied for the rate of hearing level. The variation parameter include age, gender, Ferritin level, the rate and duration of disferal consumption. Audiometry, tempanometry and physical examination carried out on all the patients. The findings from this research gathered and were analyzed using the SPSS statistical software. Results: 95 patients (190 ears) with age 3-29 year of old were gone under this study and only 72 ears had the threshold over 15 decibel, from this 43.9% were from sensorineural type of hearing. The 80% of ears’s thempograms were type A. The results from this study showed that there is a meaningful statistical correlation between the hearing loss and serum Ferritin level. The rate of dyspheral consumption, in each time and its duration (P<0.05). Conclusion: This study showed that high serum Ferritin level and the increased length of dyspheral consumption lead to the hearing loss in major ?-Thalassemia, therefore clinical examination of hearing interrally has to be carried out.

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Background & Objective: Peritonsillar space infection can be occurred either as cellulitis or abscess formation. Antibiotic therapy, needle aspiration insicion, drainage and finally tonsillectomy are among the types of treatment, which may be carried out in this disease. When tonsillectomy was not done, the recurrence of peritonsillar abscess may be observed. The present study was set up to find out the recurrence rate of peritonsillar abscess with the type of treatment the patient is received. Materials & Methods: This study was done on 52 patients with peritonsillar space infection, 45 cases of these patients were presented with peritonsillar space abscess. The primary procedure such as recording personal demographic and previous medical treatment on this patient was done. These patients were home visited by doing that, the rate of recurrence, re-hospitalization, the possible duration of recurrence and elective tonsillectomy were evaluated, these patients were also clinically examined. The gathered informations were analyzed by statistical software (SPSS). Results: From 45 peritonsillar space abscess, 8 cases (17.7%) were recognized as recurrence, from these numbers of patients 6 cases (13.3%) and 2 cases (4.4%) had once and twice recurrence respectively. The highest recurrence was seen among the patients with drug treatment. There was a meaningful correlation between the method of treatment and the rate of recurrence incidence (P<0.05). The highest rate of recurrence was among 20-29 years of age. The prevalence of peritonsillar space abscess in women and men were 28.9% and 71.1% respectively. Winter and spring were the seasons with highest incidence. The rate recurrence of this abnormality among men and women were 15.6% and 23% respectively. Conclusion: It is recommended the patient with peritonsillar space abscess to have tonsillectomy especially later in adulthood, because of high incidence of recurrence. In cases where that abnormality is controlled by drug treatment alone, the tonsillectomy should be taken into consideration.

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Background & Objective: The most common disorders in psychiatry are anxiety disorder. The onset is from adolescence through early adulthood. Some people due to various reasons are susceptible to these disorders, such as airport tower’s controller. This study was done in order to determine anxiety level and its relationship with some variables such as age, length of employment, gender, education, marital status, cigarette consumption, physical training and employment satisfaction. Materials & Methods: This was a cross-sectional descriptive analytical study, which was performed on all of the controller personals (101 samples) during spring 2003, at Tehran Mehrabad Airport, control towers controllers. They were studied by using an anxiety questionnaire. The relationship between anxiety level was determined by 8 independent variables. Results: The findings from this study indicated the following results: Undetectable minor anxiety (22.8%), mild intermediate anxiety (52.5%) and high-very high anxiety (24.8%). Conclusion: According to the results from this study. The employment satisfaction could play an important role, in preventing the anxiety. In this sensitive job, the personal attention and concentration is of upmost importance, any factor that disrupts, this concentration should be prevented, otherwise unwanted accidents may happen. Therefore it is suggested that the responsible authorities select, the appropriate persons and provide them with a good and satisfactory job conditions to pave the way for the up grading the level of immunity in air flight.

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Background&Objective: The scale of depression and the cost of prevention in some disease such as chronic renal failure is high. The present study was set up to determine the scale of depression among the haemodialysis patients. Materials&Methods: The present study a cross-sectional research. The sample population was all of the haemodialysis patients in the Golestan province (129 patients with the age group 11-77 years). The infromation gathered using, two questionairs included demographic characteristic and Beck depression inventory (BDI). Results: It showed that 37.2% of patients suffered from low to modrate depression and 31% from severe depression. Among different variable there was only significant correlation between depression and etiology of chronic renal failure (P<0.05). Conclusion: This study showed that depression is a serious problem in haemodialysis patients and a threat for their health. It is suggested that periodic psychiatric clinical examination should be carried out to have early diagnosis and subsequent treatment of haemodialysis patients.

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Background&Objective: Celiac is a digestive disease. In this disease, small bowel is damaged and the absorption of nutrients are adversely affected. These patients do not absorb gluten. There is probably a correlation between esophagus cancer and celiac. The aim of this research was to study the seroepidemiology celiac disease in this area with high prevalency of esophagus cancer. Materials&Methods: This research was a descriptive study, which was performed on blood donors in Golestan province during the year 2005-06. blood samples were taken from 2547 subjects. tTG-IgA determination were carried out using ElISA technique, the titre<4U/ml, 4-10U/ml and >10Um/l were considered to be as negative, weakly positive and positive respectively. EMA antibody assessment were carried out on all sample population with more than 4U/ml, using IFA method. Results: 28 subjects (1.1%) had tTG-Ab positive test, out of this number 18 subjects (0.7%) were weakly positive and 10 persons (0.4%) were considered to be positive. EMA test were positive in 70% of subjects with tTG positive results. There was not any significant meaning between positive tTG test and ethnicity from weakly positive tTG, 15 subjects (83.3%) and 3 subjects (16.7%) were male and female respectively. The entire tTG positive were male subjects. Conclusion: In regard to high prevalency of esophagus cancer in the region and the relation of celiac disease with above cancer, it seems necessary to look more seriously at the celiac disease.

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Background&Objective: Two enzymes have the ability to hydrolyze acetylcholine. One is acetylcholinesterase, which is called true cholinesterase, it is found in erythrocytes. The other cholinesterase is pseudocholinesterase, it is found in serum. Some chemical components of organophosphates group and carbamates affected cholinesterase activity. Determination of cholinesterase has application in diagnosis of liver disease, liver damage by insecticide and assessment of fatty liver. Pesticide factory workers are one group of peoples which are exposed of poisoning by pesticide. Materials&Methods: This research in 2005 performed in pesticide producers. In two stages (3 month interval) from 58 of personal blood was drown. Results: Mean of erythrocyte cholinesterase in first stage was 48.5±11.2 IU/gHb and second stage was 37.9±17.3 IU/gHb. Decrease of erythrocyte cholinesterase was significant differences (paired t test, P<0.05). Increase of serum AST was not statistically significant. Increase of serum ALT and Albumin was significant differences (paired t test, p<0.05). In 15 individual (25.9 %) cholinesterase decrease more than 35% and in 16 workers (27.6 %) erythrocyte cholinesterase decrease between 26-35%. Conclusion: Since in more than 26% of personnel cholinesterase decreased over than 35%, routine assessment of cholinesterase in similar factory, is recommended.

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Background&Objective: High blood pressure (BP) is one of the most important health problem world-wide (2005), and risk factor of cardiovascular diseases. This study was determine the prevalence of high blood pressure (BP) among urban subjects in Golestan of province, during 2005. Materials&Methods: This cross sectional study was done on 5000 subjects of 17-70 years old in different towns of Golestan province during 2005. Two equal ratios of both sexes were selected on random clustering sampling in the morning and afternoon. A questionnaire consisting of demographic data and clinical information such as electronic presser gauge filled by trained persons. All of the data analyzed using spss-11.5 and descriptive statistics. Results: The result showed that 2500 male (50%) and 2500 (50%) female, ethenicity were (4.6%) Torkaman, (18.9%), and Sistani (76.4%) Fars group from age of 17 to 70 years old. This study on this basis criterion JNC-5 (46.4%) all of studied subjects had blood pressure normal, (22.6%) blood pressure high normal (21.4%), blood pressure light (7.4%), blood pressure medium and (2.2%) blood pressure severe. Conclusion: The prevalence high blood pressure among the urban population in this province in this province was 31%. Which is slightly higher than other regions in Iran and other part of the world. This issue can be considered in the health planing and theraputic programs in the region.

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Background&Objective: Cardio pulmonary resuscitation (CPR) is referred to some activites performed by individuals to resuscitation heart and ventilation. Knowledge, skill, experience and positive attitude by resuscitating personals have an effective role on CPR. This study aimed to explore the effect of CPR training on knowledge of nurses working in the hospitals affiliated to Golestan University of Medical Sciences. Materials&Methods: In this quasi-experimental study, 26 nurses from the hospitals affiliated to Golestan University were selected randomly. Data collected using a questionnaire including 43 questions which completed by participants before and after training session. The teaching method was lecturing and practicing on the manikin during two eight hours session in two days. The content of training included both basic and advanced CPR. The data was analyzed using Wilcoxon test with significant level at α =0.01. Results: 57.7% of nurses were male and 42.3%were female with the average age of 35.54±5.99 years and the average age of work experience of 10.35 years. The data showed the knowledge of nurses staff regarding arrhythmias, therapeutic algorithms, and also drug therapy was low before training, however it improved significantly after training according Wilcoxon test. It was not found any significant improvement in amount of knowledge of our participants regarding cardiac arrest symptoms, airway management, cardiac massage, after training. Conclusion: The results indicated personals low knowledge about arrhythmias and related issues. Also the results showed the effect of training program on improvement on knowledge of nurses about CPR.

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Background & Objective: Pityriasis rosea is an acute inflammatory dermatosis with an unknown cause. Although it is a self limitted disorder and has no chronic side effects (nevertheless it will take between 3-6 weeks) but it may continue for two months. In order to shorten pityriasis rosea course and remove itching and skin lesions, it is advisable to cure the disease with an appropriate drug. Based on the above, the present study was performed to investigate efficacy of Erythromycin in comparison with placebo and improve this disease period. Materials & Methods: A randomized double blind clinical trail was carried out on typical pityriasis rosea patients who had referred to 5th Azar clinic Gorgan-Iran during December 2004-May 2005. 46 patients were selected and randomly divided into two groups (23 patients in each one). Since it was a double blind study, treatment for two weeks was prescribed then the cure rate was measured during second, fourth and sixth week. In case group, Erythromycin 1gr/day was prescribed and continued for two weeks. In the other group only placebo was prescribed. Statistical analysis: Pearson chi-square analysis with 2- sided p value was applied to compare the distribution of pityriasis rosea between patients by using Sspss-11.5 software Regard to the kind of study and qualitative attribute, we used comparison between ratios in order to analyze them. Meaningful level for these tests was α=0.05. Results: Even though we gained good results in case group during second, fourth and sixth week after treatment, but there was no significant difference between these two groups at α=0.05. Conclusion: This investigation shows that Erythromycin has little effect on pityriasis rosea period. Therefore we suggest complementary study with larger samples in future.

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Background & Objective: More than 50% of patients with hypertension will have end organ damage (such as: CHF, retinopathy ,CVA or renal failure).Left ventricular hypertrophy (LVH) is an independent risk factor for death and cardiovascular disease .Both renal dysfunction and LVH are signs of end organ damage so we carried out this study to evaluate the correlation between LVH in echocardiography and kidney function in patients with essential hypertension. Materials & Methods: This descriptive analytic study was carried out on 102 patients whome reffered to 5 Azar hospital in Gorgan- Iran, suffering from essential hypertension and had proved LVH in echocardiography with no other disease during 2005-6. Kidney and urinary tract assessment such as serum BUN, Creatinine level and kidney sonography was done on subjects. Left ventricular hypertrophy was defined as a left ventricular mass index (LVMI)>=135g/m2 in men and>=110g/m2 in women. Renal function was estimated by means of the serum Creatinine level and proteinuria and sonographic findings of kidney and urinary tract. Data was analysed by Spss-11.5 and Chi-Squre test. Results: The average age of patients were 60±8.8. 58%, 36% and 7% of patients had mild, moderate and sever LVH respectivly. The means of Creatinine and BUN level were 1.09±1.12 mg/dl and 20.6±10.76 mg/dl had direct correlation with kidney dysfunction (P<0.05). There was a significant relationship between LVH severity and presentse of Kidney scar in sonography (P<0.05). Conclusion: This study showed that a very large fraction of the subjects with essential hypertension have kidney problems. Therefore, serum BUN and Creatinine level and sonographic scar of kidney can be reliable markers for assessing and controlling target organ damages that are induced by Essential hypertension.

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Background and Objective: To evaluate the effectiveness of Neonatal Intensive Cares Many different data banks have been developed. Furthermore, various scoring systems such as SNAP and CRIB have been validated to designate and compared differences among hospitalized patients in NICU. This study was done to determine mortality rate and prevalence of complications in neonates admitted to Taleghani and Dezyani NICU centers in Gorgan - Iran. Materials and Methods: In this discriptive study a questioniare including sex, birthweight, gestational age, duration of hospitalization, age at the time of discharge or death, complications and other information needed for CRIB scoring system, was completed for 46 neonates with gestational age of less than 37-week old and birth weight of less than 1500 grams. Results: Mortality rate was 37% (17 neonates) with the most common cause being respiratory failure. RDS was associated with a 101-fold increase for the chance of death (OR=1.1, CI=12.9-793.6). This probability was 4.7 fold for delivery-time asphyxia. The mean of birthweight, gestational age and CRIB in living and dead infants were 1201 and 934 grams, 30 and 28 weeks and 3.76 and 11.7, respectivly. Using a ROC curve, a cut off point of 7 was reached to predict neonatal outcome for CRIB scoring. Conclusion: This study showed that the mortality rate was higher than the rate in most centers of the world. The mortality rate was directly related with the increase of CRIB score,especially for scores more than 11.