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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.

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Background & Objective: Trauma is the second most common cause of death regardless of age in Iran and the health system annually defrays a vast cost for trauma patients. The majority of cases comprise abdominal trauma. This study was performed to determine individual and pathologic characteristics of patients with blunt abdominal trauma in Gorgan – Iran. Materials & Methods: This descriptive and retrospective study was done on 239 patients with blunt abdominal trauma in 5 Azar hospital, Gorgan - Iran from March 2001 to March 2005. Results: 197 (82.4%) of cases were male and 42 (17.6%) were female. The mean age of patients was 23.4 years. The mean of hospital stay was 8.8 days. The most common cause of blunt abdominal trauma was traffic injury. The most common damaged organs were spleen (49.4%) and liver (21.3%) respectivly. Mortality rate was 16.3%. The hypovolumic shock was the major cause of mortality. Conclusion: This study showed that epidemiology of trauma is similar to those in other regions of our country. Therefore, programming and attempts of governmental organizations are needed to prevent and decrease traffic accidents.

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Background and Objective: Esophageal and gastric cancers are among the most prevalent cancers in the world which cause a high mortality rate annually. Several risk factors are supposed for them. Water hardness is considered as a protective factor against above cancers. This ecologic study was designed to determine the correlation between water hardness and upper gastrointestinal cancers. Materials and Methods: In this ecological study data on water components in Golestan's urban areas were obtained during 2004-05 and the averages were reported. All cases of esophageal and gastric cancers resided in urban areas which were diagnosed during this period were recruited to estimate the incidence and age standardized rates (ASR). The province was divided into low, intermediate and high incidence, based on 33% and 66% quartiles of both cancers. Pearson correlation coefficient test and regression model were used to analyze the data. Results: The water hardness was in the normal standard range permitted for the drinking water, and did not have any relation with the risk of esophageal and gastric cancers. Conclusion: This study showed that water hardness has no effect on the incidence of esophageal and gastric cancer in this area.

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Background and Objective: Acute appendicitis is one of the most common surgical emergencies. Preoperative diagnosis of acute appendicitis remains challenging, despite improvements in history taking and clinical examination. Methods advocated to assist in the diagnosis of appendicitis include laparoscopy, ultrasonography, computed tomography and magnetic resonance imaging. The purpose of this study was to assess the accuracy of ultrasonography in the diagnosis of acute appendicitis. Materials and Methods: This prospective descriptive study was done to evaluate 265 patients suspected to have acute appendicitis and admitted to the emergency department of 5 Azar hospital of Gorgan from Aug 2005 to Aug 2006. Suspected patients visited by the general surgeon and ultrasonography of the appendix was performed subsequently. The ultrasonography examination was done using high graded-compression ultrasongraphy with 5 MHz variable focus linear array transducer. The sonographic data were compared with clinical, operative and pathological findings. Results: The sensivity and specifity of ultrasonography was 66% and 4%, respectively. Also positive and negative predictive value of ultrasonography was 98% and 40%, respectively. Conclusion: This study showed that ultrasonography is a useful method in the diagnosis of acute appendicitis. It also increase diagnostic accuracy of acute appendicitis and minimize negative laparotomy and prevent unnecessary appendectomy.

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Background and Objective: Ageing is a bio-cognitive which can be described as a progressive and degenerating process in human. One of the major changes in the elderly is loss of teeth, which can affect on dietary intake and nutritional status. This study was designed to assess the dental health in elderly people in Gorgan, North of Iran. Materials and Methods: This descriptive and cross-sectional study was conducted on 400 subjects (211 female and 189 male) aged 60 years and above in two selected health centers in Gorgan-Iran. Data were collected by questionnaire and oral and dental examination. Data was analyzed by using SPSS-13 software and chi-square test. Results: The mean age of the subjects were 66.7+-6.7 Sixty percent of the participants were without natural teeth and forty percent had natural teeth. only 10.5 percent of subjects had complete natural teeth. 19.7 participants had decayed teeth. The mean of decayed teeth was 9.2 (rang 1-28) and filled teeth was 4.8 (rang 1-16) in 12.5 percent of participants. Age, level of education and level of income were significantly associated with the number of existed teeth (P<0.05). Conclusion: In regard to high prevalence of without natural and decay teeth in the elderly population, this study, it is recommended the serial assessment of dental health to be screened on routine bases.

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Background and Objective: Helicobacter pylori (H.pylori) with positive Cytotoxin associated Gene A (CagA) have higher potential for pathogenesis. Cytotoxin associated Gene A (CagA) accelerate the pathogenecity of bacteria due to cytotoxin production stimulation. The aim of this study was to determine the prevalence of the anti-CagA antibody among H. pylori infected persons in Golestan province-North of Iran. Materials and Methods: This descriptive study was carried out on 676 H. pylori positive subjects in Golestan province, northern Iran during 2008. Anti CagA antibody were determined in H.pylori positive subjects. Data analyzed by SPSS-16 software and chi-square test. Results: Prevalence of anti CagA in Helicobacter pylori infected cases was 57.7% (390 cases: 179 males and 211 females) (95% CI: 53.9-61.4). According to age the highest and lowest cases of anti CagA antibody were seen in, 15-24 (63.4%) and under 5 years old (26.3%). The level of anti CagA antibody in Sistanian ethnicity group (67.2%) was more than other ethnic group. Anti CagA antibody in Rural area was more than urban regions. Sero prevalence of anti CagA antibody was highest in Minudasht twon (78%), located in East of province in comparison with Bandar Gaz (44%) in west of province. Conclusion: This study showed the prevalence of CagA positive Helicobacter pylori strains in this region is similar to other regions of Iran, Asia and Europe and higher than African population.

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Background and Objective: Cardiovascular diseases is the first cause of mortality in developed and developing countries. This study was done to determine findings of coronary arteries angiography of subjects referring to Kosar angiography center in Golestan province, Iran.

Materials and Methods: In this descriptive study 5444 patients whome referred to the Kosar angiography center in Golestan province, Northern Iran undervent in this study during 2008-09. Gender, age, ethnicity, body mass index (BMI), cigarette smoking, opium, hypertension and coronary arteries angiography findings were completed for each subjects. Coronary arteries angiography was performed on 5400 of subjects. Data was analyzed by using SPSS-13, ANOVA, Chi-Square and Kruskal-Wallis tests.

Results: In this study 52% of subjects were men. 72% of patients were Native Fars. 49.5% of subjects were found to be illiterate. While 92.6% of clients did not reported any history of smoking, 22.5% of subjects were addicted to different opium. The mean BMI was 27.48 and 38.2% of clients reported a history of hypertension. Coronary arteries angiography was performed on 5400 of subjects. Coronary arteries disorders were determined in 3142 of subjects (58.8% males, 41.2% females). Left anterior descending, right coronary artery, circumflex and obtuse marginal were the most involved coronary arterial branches in positive angiograms, respectively.The most severe failure (47.7%) has been found in left anterior descending artery.

Conclusion: Due to high incidence of coronary arteries disease in this region of Iran, it is suggested to design a project to investigate the preventive mearsures of cardiovascular disorders.

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Background and Objective: Suicide is one of the important causes of death worldwide particularly among 44-15 years. The aim of this study was to survey the prevalency of attempted suicide in Golestan province, North of Iran during 2003-07.

Materials and Methods: This descriptive study conducted on 4977 suicide attempted subjects in Golestan province, North of Iran during 2003-07. Data were gathered through a filed questioners. Data was analyzed by SPSS-18 and Chi-Square test.

Results: Mean±SD of the subjects was 22.91±7.59 years. The female to male ratio was 1.62. 55.6% of subjects were single. The subjects resided in urban and rural area were 62% and 37.8%, respectively. 61.4% and 27.1% of subjects have finished and un-finished high-school studies. 2% and 0.9% from those attempted sucide were died and referred to specific centers, respectively for further medical follow-up. There was a positive correlation between suicide single status and low educated subjects with P=0.036 and P=0.001 respectively.

Conclusion: The findings indicated that the prevalancy of suicide were higher among single, female and those with lower education.

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Background and Objective: The prevalence of hepatitis B infection is increasing worldwide. The main way to prevent hepatitis B transmission to newborns can be through accurate detection of HBsAg positive pregnant women and implementation of standard protocol for their infants. Therefore, this study carried out to determine the frequency of HBsAg in pregnant women in Gorgan, Iran. Materials and Methods: This cross sectional study was done on 1553 pregnant women whom attended to Dezyani hospital in Gorgan, North of Iran during 2008-09. Blood samples were taken and tested for HBsAg and HBeAg using ELISA method. Results: HBsAg was found positive in 15 (1%) pregnant women. However, HBeAg were negative in all cases. Seven of these cases (46.7%) were not diagnosed before admission to the hospital for delivery and therefore had not received any immunoprophylaxis or HBIG treatment for their newborns. In contrary, six mothers and their newborns received immunoprophylaxis due to falsely diagnosed HBsAg seropositive. Conclusion: This study showed that the current protocols for dealing with HBsAg seropositivity and case finding among pregnant women in this region should be thoroughly revised. Furthermore, it is suggested that pregnant women during third trimester should be screened for HBsAg.

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Background and Objective: Headache is one the most common compliant of patients and has different causes and the migraine and tension headaches are common. Personality is characteristics forming an individual distinctive manner. This study aimed to determine the frequency and association of different types of personality characteristics in patients with migraine and tension headaches. Materials and Methods: This descriptive-analytic study was done on 160 (12 male and 148 female) subjects with chief complaint of headache whome referred to 5th Azar clinics of Gorgan, Iran during 2007-08. Subjects were selected by simple random sampling and were examined by either a neurologist or psychiatrist patient with diagnosis migraine either of or tension headache were included. Selected patients evaluated by short form of Minnesota Multiphasic Personality Inventory (MMPI). Data were analyzed using SPSS-13 and Chi-Square test. Results: The mean age was 11.18±33.29 in women and 34.33±13.7 in men. 96 patients (60%) had tension headache and 64 (41.2%) had migraine. In tension headache, depressed personality (43.8%) and hysterical personality (16.4%) were more common but in migraine headache, depressed personality (48.9%) and paranoid personality (20%) were common but this difference was not significant. Conclusion: This study showed that there is no relation between personality characteristics with tension headach and migraine.

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Background and Objective: Since accurate and quick clinical and paraclinical diagnostic methods are not available, in some cases diagnosis of active pulmonary tuberculosis occurs after considerable time from the onset of disease. This study was designed to determine the diagnostic value of High Resolution Computed Tomographic (HRCT) scan in active pulmonary tuberculosis, in Gorgan, Golestan province, North of Iran. Materials and Methods: This diagnostic screening study was carried out on 135 (79 male and 56 female) hospitalized patients suspected with active pulmonary tuberculosis, and HRCT was used in their course of treatment as recommendation of their clinician. The patients were chosen from 5th Azar hosptial during 2009-10. Also it should be mentioned that patients were selected on avaliabity bases, and they were examined by smear, and sputum culture. The patients with negative smear and culture were set up as true healthy group (64 subjects). The lung or small nuddles in HRCT was considered as proper position of lung involvument in active lung pulmonary. The HRCT findings between the case group (71 subjects) and healthy group were compared. According to HRCT findings, the sensitivity and specifity were determined for each patient. Data were analyzed using SPSS-16 and Chi-Square test. Results: In this study, sensitivity, specificity, positive predictive value and negative predictive value of HRCT in active pulmonary tuberculosis were equal to 97.2%, 71.9%, 79.3% and 95.8% respectively. Involvement of upper and middle lobe of the right lung and upper lobe of the left lung were significantly higher than the control group (P<0.05). Conclusion: This study showed that HRCT has high sensitivity and specificity in diagnosis of active pulmonary tuberculosis and can be used as a quick diagnostic way in active pulmonary tuberculosis, especially in patients with strong clinical suspicion and negative smear.

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Background and Objective: Coronary angiography is a routine and gold standard cardiac diagnostic procedure. Patients are restricted to bed rest after the procedure due to potential vascular complications using a femoral approach. Many patients are required to remain on bed rest for up to 24 hours after the procedure. The aim of this study was to assess the effect of changing position and early ambulation on the amount of bleeding, hematoma and urinary retention in patients with coronary angiography. Materials and Methods: In this clinical trial study 140 patients, which referred to coronary angiography center in Dezfoul-Iran, were randomly divided into four 35-individual groups. The patients in the control group were in supine position for 6 hours without movement. Position change was applied to the first interventional group based on a specific protocol, early discharge was applied to the second interventional group and both early discharge and position changes were applied to the third interventional group. The level of bleeding, hematoma and urinary retention were measured at zero, 1, 2, 4, 6 and 24 hours after angiography. The findings were collected using the individual data questionnaire and Kristin Swain’s checklist in order to evaluate the level of bleeding and hematoma. Results: There were no significant differences between the four groups in terms of occurrence of vascular hematoma and bleeding. The incidence of urinary retention was non significantly higher in the control group in compare to others. Conclusion: Changing position following angiography speed up patient discharge from hospital.

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Background and Objective: Otalgia is a complaint triggered from either ear disorders or adjacent structures due to common innervations between ear and adjust organs. This study was done to explore the causes of primary otalgia. Materials and Methods: This descriptive study was done on 770 patients with otalgia in Gorgan, Iran during 2009-10. After clinical examination age, gender, patient complaint and signs were recorded for each patient. Results: 668 patients (86.8%) had primary otalgia including 39.9% left, 41.3% right and 18.8% bilaterally. 63.9% were female and 36.1% were males. External otitis was the most common causes of primary otalgia with 64.8%. Other causes consist of acute otitis media (14.5%), serumen (14.1%), chronic otitis media (5.8%), foreign body (4%) and trauma (3%), respectively. Conclusion: The most common cause of primary otalgia was external otitis.

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There is not comprehensive information available about the control, complications and treatment methods of factor VII deficiency. Online registry system called seven treatment evaluation registries (STER) has been created which investigated the disease as an international multi-center prospective observational project in order to provide information about the effect and immunity of available therapies. In this report, five patients with factor VII deficiency were diagnosed and registered in Golestan Province, Northern Iran, during 2010-11. All treatment protocol, demographic charectristic of patients were collected and registered in www.targetseven.org on the basis of STER´s protocol.

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Background and Objective: Deferoxamin is the current “gold standard” chelator in comparison with new chelators. Combined therapy of Deferiprone and deferoxamin reduces the cardiac iron overload in patients with major talassemia. This study was done to evaluate the effect of defriprone-deferoxamine on heart function in patients with major thalassemia. Methods: In this historical cohort study, 8 patients with major beta thalassemia treated by subcutaneous deferoxamine were randomly selected and LVEF (the rate of blood that exited from heart in each beat) and serum ferritin were measeared. The patients were treated by deferiprone (50-100 mg/kg/day) compained with dferoxamine (30-50 mg/kg as 3 times in a week). In the end of each year, LVEF and serum ferritin of patients were measured. Results: The ferritin level changed from 3243.12 in the first year to 2672.75 mg/kg at the end of third year. The mean of LVEF changed from 71.12% to 64.62 %. The correlation of serum ferritin and LVEF only at the end of third year was significant (P<0.05). Conclusion: Combined therapy of deferiprone-deferoxamine during 3 years reduces ferritin and LVEF in patients with major thalassemia.

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Background and Objective: Venous thromboembolism (VTE) is a common clinical condition with a mortality rate of 15-20%. Neutrophil to lymphocyte ratio (NLR) is known as an indicator in predicting clinical outcomes in patients with various diseases and malignancies. This study was conducted to determine the value of neutrophil to lymphocyte ratio in the prognosis of death in patients with venous thromboembolism during the short term.
Methods: This retrospective cohort study was performed on 93 hospitalized patients with spontaneous venous thromboembolism in Gorgan, northern Iran during 2012-15. Demographic, blood and biochemical parameters of the patients were evaluated in the prediction of fatal outcome in a follow-up of 30 days after thrombose diagnosis.
Results: Sixteen patients (17.2%) died within 30 days. The variables of age, white blood cells, neutrophils, NLR, creatine kinase MB and lactate dehydrogenase significantly increased (P<0.05), and lymphocyte also platelet significantly reduced within the occurrence of death in a short period of 30 days follow up (P<0.05). A cut-off point of 7.21≤NLR had sensitivity, specificity, positive and negative predictive value of 56.3%, 87%, 47.3% and 90.5%, respectively.
Conclusion: Neutrophil to lymphocyte ratio can be used as a useful biomarker in the prediction of mortality during short periods of time in VTE patients.

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Background and Objective: Cancer can cause many problems in all aspects of the physical, mental, social, economic and family life of the elderly patients. This study was done to determine the supportive care needs of the elderly people with cancer in north of Iran.
Methods: This descriptive- analytical study was carried out on 248 elderly patients with cancer whom referred to governmental and private medical centers in Gorgan, Northern Iran during 2018. Data were collected by a valid and reliable questionnaire "Supportive Care Needs Survey-SCNS" consisted of five domains of physical needs and daily functioning, health system and information, supportive and care, mental, and sexual chracteristics.
Results: There was a significant relationship between physical activity and daily functioning, sexual domain, support and care, health and information system with gender (P<0.05). Female seniors were more in need of assistance in the areas of physical and daily functioning, and male seniors in the areas of sex, support and care, health systems, and information.
Conclusion: This study showed that unmet needs in the elderly with cancer are particularly high in physical and functional areas.

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Background and Objective: Due to high incidence and mortality of gasteric cancer and important of clinical symptoms to early diagnosis and tertment; this stady was done to determine the survival rate of gasteric cancer in Golestan provience (north of Iran).
Methods: This retrospective cohort stady was done on 131 patients (77.9% males and 22.1% females) with adeno carcinoma gasteric cancer wich diagosed during 2007-09 in northern Iran. Age, sex, job, nationality and tribe clincal presentation kind of treatment food regiemns, survival collected from archive. In cases whom nesacery data completed with telophone calling or face to face interview. Survival rate of patients for 1, 3 and 5 years were determined using caplan Mayer method.
Results: First symptom in 31.3% of patients was abdominl pain and distance between the first symptom and diagnosis was 1-14 months. 34.4% of patient did not receive any treatment. Survivial rate for 1, 3 and 5 years was 37.4%, 13% and 6.1%, respectively. Age, gender and ethnicity did not not altere survival rate but type of treatment had significant relation to survival rate (P<0.05).
Conclusion: The diagnosis of gasteric cancer in early stage and surgical treatment can help a better survival rate in patients with adeno carcinoma gasteric cancer in northern Iran.

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Background and Objective: Unhealthy lifestyle is the main cause of morbidity, mortality and preventable complications in the elderly. Performing health promotion behaviors are one of the most effective factors in maintaining and improving health. This study was done to determine the health promotion lifestyles in the elderly people.
Methods: This descriptive-analytical study was performed on 110 elderly people aged 60-88 years referred to teaching and medical centers in Gorgan, north of Iran during 2019. Data was collected using Health Promotion Lifestyle Profile 2 (HPLP-II) questionnaire. This questionnaire includes six dimensions of spiritual growth, responsibility for health, interpersonal relationships, stress management, physical activity and nutrition for evaluation health promotion behaviors status. The total score range of the instrument ranges from 52 to 208. A score of 52-103 was considered low level of compliance with health promotion behaviors and a score of 104-155 and scores above 156 was considered intermediate and high level, respectively.
Results: The mean±SD of health promotion lifestyle was 143.52±17.36. There was a significant relationship between lifestyle and demographic characteristics (P<0.05). Spiritual growth and interpersonal relationships had the highest score among the six dimensions of health promotion behaviors.
Conclusion: Health promotion lifestyle in the elderly was low in terms of physical activity and stress management.

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Background and Objective: Coronary disease is the most common life-threatening among chronic diseases. Coronary angiography is one of the most important diagnostic procedures that have complications similar to other invasive procedures. This study was performed to determine the effect of changing sandbag weight on complications of femoral artery catheterization and patient comfort.
Methods: This single-blind clinical trial was performed on 140 patients who were referred to Amir Al-Mo'menin Kordkoy hospital in northern Iran. Patients were randomly assigned into four groups consisting 35 patients. After angiography, sandbags with different weights (control group, first intervention, and second intervention, third intervention with weights of 4, 3.5, 3 and 2.3 kg) were placed on the angiography site for 6 hours. Bleeding, hematoma, pain and comfort of patients were recorded and compared immediately, 2, 4, 6, 8 and 24 hours after angiography.
Results: Bleeding and hematoma were not observed in any of the patients. There was a significant difference in pain and patients comfort between groups (P<0.05). The third intervention group had the lowest pain and highest comfort at 6 and 8 hours after angiography. Also, the control group had the highest pain and the lowest comfort.
Conclusion: Reducing sandbag weight leads to decrease back pain and improves patient comfort without increasing vascular complications.