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This case report is about a 25-year-old patient with microangiopathic in toxemic pregnancy. Clinical manifestations are such as hemorrhage in digestive system and urinary tract accompanied with anemia thrombocytopenia, liver, and kidney, disorder. The clinical diagnosis for this patient was HELLP syndrome, with all of the clinical manifestations of this syndrome the patient was admitted to the 5th Azar Hospital in Gorgan. All of the clinical manifestations and paraclinical observation returned to normal during one and three weeks respectively. The prevalency of this syndrome among the total pregnancies is about 0.2%-0.8% and the risk of recurrence of this disorder is about 3-25%.

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Low birth weight (LBW) is the main known determinant mortality in under 1 year old children particularly in neonates. The aim of this research is to study the rate of LBW and evaluation of some effective factors in LBW, such as: Difference races, residential conditions, maternal age, parity. This research is analytic-descriptive and cross-sectional study. The study population consists of 2183 newborns that are given birth in Dezyani Hospital during 1996. These samples were chosen by systemic randomized technic (3:1). Information was gathered by a questionnaire. The findings show that LBW rate was 6.3% in population under study, which in male and female newborns were 5.7% and 6.9% respectively. The LBW rates in newborns with mothers age?18 years old and those with ?35 years were 1.8% and 1.4% folds higher than LBW rates for newborns with mothers age 19-35 years. The LBW percentage for primiparous women were 1.9 folds to multiparous who had 2-4 deliveries. LBW rates for newborns with Systanie race were approximately 1.8 folds higher than newborns with Torkman ethnic. The results of this study indicate factors such as: Maternal age, race, parity, affect on LBW rates.

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Enuresis is one of the most common and complex problems of childhood and it affects the relationships between children, parents and coevals. It negatively affects these relationships. Studies have shown that in comparison with normal children, Enuresis children have behavioral problems and suffer them. This survey was done with this aim to determined and compare enuresis and non-enuresis children’s behavioral adjustment in Hamadan primary schools. This study was conducted by case-control method and a total of 320 pupils were studied. These subjects were selected randomly by multi-phase sampling. The interview forms were the data collecting means. It was based on children’s behavioral checklist for the school-aged children which had been reported by Russel and Cassel. The survey results showed that there was a difference in scores obtained by enuresis and non-enuresis children from the view point of self, social, physical, home and school and general personality adjustment and high percentage enuresis children had behavioral problems and there was statistical meaningful difference between the scores obtained by two groups.

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Recent publications have questioned the efficacy of massage. It is acknowledged that critical care environment are stressful for patients in term of invasive medical, and nursing procedures. Continuous brighting and excessive noise prohibits the potential relaxation and sleep. In this article, which is a research study, the physiologic response during and following a five minutes administration of back massage are described. This study is a semi-experimental research in which a 5 minutes back massage was offered to 25 patients as stress reduction intervention. Physiological data (Heart rate, mean arterial blood pressure, respiration and peripheral oxygen saturation) were obtained from the patient bedside monitoring system. Results indicated there was significant effect from the intervention on peripheral oxygen saturation (P<0.002). However, a significant decrease in heart rate (P<0.001), blood pressure (P<0.001) and respiration rate (P<0.001) was observed during the back massage intervention. Results indicated back massage had the potential effect of increasing relaxation as evidenced by physiological change during the intervention administration to critically ill patient in intensive care unit massage was found to be a useful therapy to enhance relaxation and sleep in critically ill patient.

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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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Background and Objective: Home surplus drugs are an important problem in the developing countries especially in Iran. Iran is one of the most important consumers of drugs in the world. Materials and Methods: The study was descriptive and limited one and included 257 families of Yasuj (25 clusters) that are selected by random sampling. The method of survey is done by questionnaires and intends to evaluate home surplus drugs on basis of value, dosage forms, which is wasted from the therapeutic categorie and expiry date of drugs. Results: The findings that 83% of families had home surplus drugs on basis of dosage forms tablets, capsules, syrup and ampoules (Vials) are ranked. On basis of the therapeutic categories, gastrointestinals, analgesics, antibiotics, CNS and antihistamines are ranked. 80.50% of families are covered by one of the current insurance organizations and 19.5% are not. Conclusion: The average value of drugs for every one family was 8869 girls and from macroeconomic point of view, it will be a huge amount of money budget of country.

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Background and Objective: Cryptosporidium is a parasite with worldwide distribution, a significant cause of diarrhea in children and immunodeficient patients. In some country this parasite is either or fourth factor of diarrhea in children. In developing country the prevalence rate of disease is increased but because of specific method recognition in special survey, information about prevalence in our country isn’t completely available. Materials and Methods: From December to March in Zahedan, capital of Sistan and Baluchestan province, 528 patient referred to Ali-Asghar Hospital, parasitology center, in 25 cases of whom Cryptosporidium Parvium was detected (4.7%). Results: The prevalence rate of disease was more in the 1-2 age group. The infants who didn’t use mother milk were significantly more commonly infected and children in nursery school similarly more infected. The majority of cases were detected in summer and spring, although there was no significant relationship between season’s prevalence. Conclusion: Although some C.parvum cases harbored Giardia Lamblia, there was no relation between the two infections.

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Background and objective: To determine the effects of duration of second stage of labor on the newborn’s Apgar score in primigravida women admitted in Fatemeh Zahra Hospital. Materials and methods: Case control study on the 120 primigravide women (40 women with a duration second stage more than 2 hours and 80 women with a duration second stage less than 2 hours). The criteria such as pregnancy history, quality of prenatal care and socioeconomical status were the same for the both groups. Patients with preterm labor, cesarean section, multiple pregnancy, malpresentation, malformation and receipt sedation of narcotic less than one hours to baby’s birth were excluded. From this study statistically analysis had done by Chi-square and Z-test and person’s coefficient correlation. Results: Statistically significant relationship was observed between the age of the mothers and the duration second stage of labor, so that, the mothers with more than 30 years of age had prolonged duration in second stage of labor (P<0.05). More than half of the sample population had used oxytocin for augmentation of labor, which this difference was significant (P<0.05). Conclusion: The different studies showed that the duration of second stage of labor was significantly associated with fetal lactate and low Apgar score less than 7 at birth, but didn’t have any role in five-minute low Apgar scores and neonate morbidity.

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Background and objective: The south of littoral of Caspian sea is located on the Asian belt of oesophageal carcinoma, where has the highest incidence in the world. The objective of this study was to determine the epidemiologic aspects of patients with oesophageal carcinoma in the north of Iran. Materials and methods: Based on the existing data of medical charts, we conducted a descriptive study of 668 patients with oesophageal carcinoma who referred to Shahid Rajaei Radiotherapy Center in Babolsar during 1993 to 1999. The data was included age, sex, occupation, residence area, and history of alcohol, smoking, drug consumption, anatomic location and histologic type of tumor. We used T-test and Chi-square test in statistical analysis. Results: The mean (±SD) age of 668 patients was 62.8 (±11) years and the modal age group 60-69 years. The mean age of males was significantly greater than females (63.8 vs. 61.2 years, P<0.05) 54.5% of patients were male and 62.1% of males were farmers, 14.5% clerk, and 7% workers whereas 92.4% of females were housewives. Roughly, 0.7% of patients had a history of alcohol consumption, 19.3% smoker and 7.9% drug users and 50.3% of patients were residence of urban area. The most common histologic type of tumor was squamous cell carcinoma (91.3%) and 7% of tumors were adenocarcinoma. The ratio of men to women of adenocarcinoma was 3 to 1 Also squamous cell carcinoma was more common among men than women The relation between the histologic type of tumor and gender was significant (P<0.05). The most common location of squamous cell carcinoma was the upper third of oesophageal (47.1%) and for adenocarcinoma the lower third (86.4%). Also, we observed a significant relation between occupation and the histologic type of tumor. Conclusion: The results indicated that the frequency of oesophageal carcinoma is increased over the age 50 years. The relation of histologic type of tumor with location and gender are consistent with those reported in the other studies in the western countries, which shows the same pattern of epidemiologic aspects of this neoplasm in the world.

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Ehler-Danlos syndrome is rare disorder of collagen metabolism, characterized by skin fragility and hyperlaxity, hypermobility of joint. Type I collagen or III collagen is metabolically disordered. Our case report is 27 years old Turkaman male referred top dermatology clinic 5th Azar Hospital for disability, echymose and papyraceus scar. After clinicopathologic evaluation, the diagnosed case proved to be Ehler-Danlos.

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Background & Objective: One of the most current aggressive methods to access to blood vessels intravenous peripheral catheters that contains excess complications and prevention of it is one of important medical goals. Therefore, this study was done to determining influence dressing with gauze sterile using in complication appearance rate of side effects patients in CCU and having venous catheter. Materials & Methods: This clinical trial accomplished on 64 patient’s hospitalization in CCU and post CCU of Malayer Hospital. 32 of patients in the experimental group (Use of dressing with gaze sterile) and 32 of patients shelled in the control group (Routine) randomly. For data collecting was used checklist and laboratory reports, the method was according to following. Form: In beginning, questionnaire which contained demographic information completed and then venous catheter was enclosed sterility in patient’s hand by one person, after the catheter was replaced, placed the gauze sterile on catheter site for the experimental group (Routine) then every 12 hours considered the place in aspect of phlebitis and infection to 72 hours duration, since phlebitis appearing and or finished 72 hours, the angiocat plastical tip detached from trunck by sterile bisturi and transferred to laboratory tube containing nutritive materials and sent the laboratory during minumm time possible time it was cultured in a culture environment growing 15 colony number on every platelet was considered as positive. Results: 65% of 2 groups are among 61-70 years old 53.1% of both group are illiterate. The majority of both groups (59.4%) had myocardial ischemic heart disease. Catheter situation in the experimental group 53.7% was in the left hand and the control group 63.1% was in the right hand in aspect of type of used drug 44.1% individuals of the 2 groups used 2 drugs heparin and vasodilators. Study’s result about phlebitis with (P<0.05) showed that the gauze sterile dressing has effected in preventing of it’s appearance, therefore statistical fisher test showed that gauze sterile dressing is not effected in preventing of venous catheter’s local infection. Conclusion: The use of the sterile gauze dressing can effect in preventing of phlebitis and colonization.

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Background & Objective: Neural tube defect is one of the most important malformations of the newborns. The aim of this study was to investigate the rates of NTD, anencephaly, spina-bifida cystica, encephalocele and the relation of these abnormalities with sex, ethnicity, mother’s age and consanguineous marriage in north of Iran (Gorgan). Materials & Methods: A cross-sectional study was done on 26280 birth in Dezyani Hospital in Gorgan during 1998-2001. Results: This study has showed that, the NTD rate was 3.08, 2.78 and 3.38 per 1000 in total, males and females, respectively, female to male ratio was 1.31. The rate of spina-bifida, anecephaly and encephalocele were 1.48, 1.48, 0.11 per 1000, respectively. In regard to different races, the rate was 6.78/1000, 4.76/1000 and 2.41/1000 among Turkmans, Systani and native Fars, respectively (P<0.05). The rate of NTD in the mothers under 20 years was 2.29/1000, in 20-34 years was 3.37/1000 and over 35 years was 2.54/1000. Interstingly, 29.6% of parents with affected newborns had consanguineous marriage. Conclusion: We concluded that there is a higher rate of NTD in this, area, that it might be due to race-ethnicity variations.

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Background & Objective: Neural tube defects (NTDs) are a heterogenous group of malformation which is resulting from failure of normal neural tube closure between the 3rd and 4th week of embryonic development. The most common form of this malformation is anencephaly, spinabifida and ancephalocele. Prevalence of this malformation differs from geographic situation and race distribution. Materials & Methods: The aim of this study was to determine the prevalence and risk factors of NTDs in Birjand Hospital between 1996 to 2000. After diagnose of malformation among the 16785 infants born in the 2 hospitals in Birjand, reliable questionnaire was completed for the mothers who had malformed infants. The data was analyzed by SPSS software. Results: Prevalence of NTDs was 2.97 per 1000 birth, more higher than other countries anencephaly and spina bifida is common form of NTDs in this area. Consanguinity, previous abortion, malformed childbirth, malformed child in the family, diseases during pregnancy and winter delivery were some of the risk factors. Most of the mother (96%) didn’t take the Folic Acid during their pregnancy. Conclusion: The findings from this study indicate that the rate of NTD in Birjand is relatively higher comparing to other studies in different countries. Further investigations are recommended to find out the etiology of NTD in this area.

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A 70- years old female referred with left upper quadrant pain since about 72 hours prior to hospital admission. In physical examination the patient was pale, hypotensive, tachycardiac and a vague left upper quadrant (LUQ) mass palpated. LUQ mass and free intraperitoneal fluid declared by ultrasound investigation there was no history of abdominal trauma and with impression of intraabdominal bleeding of unknown origin the patient underwent laparotomy. A huge fundal gastric mass identified with surrounding rupturea retroperitoneal hematoma and intraperitoneal hemorrhage. No intragatric penetration or hemorrhage was seen, so complete excision of the mass with safe margin was done with subsequent splenectomy. She had an uneventful post operative course and was discharged at the 7th post- op day. A microscopic analysis of the excised tumor demonstrated gastric leiomyoma.

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Background&Objective: Decrease in production of erythropoietin has been noted as one of the main factors causing anemia in ESRD patients, and administration of recombinant human erythropoietin (rhEPO) has been used to correct the anemia. Iron deficiency, including functional iron deficiency, limits the efficacy of rhEPO therapy in ESRD patients. This study examined the effects of maintenance intravenous iron sucrose (Venofer) on haemoglobin level and, optimization of erythropoietin therapy. Materials&Methods: Forty eight haemodialysis patients with haemoglobin level<9 gr/dl who were dialyzed three times weekly went under the study. Two thousands units of rhEPO were given subcutaneously at the end of each dialysis for seven weeks. At the end of the seventh week, those with haemoglobin level<9 gr/dl and with ferritin level <200 ng/dl (29 patients) were chosen for intravenous administration of 100 mg Venfor during the next five consecutive haemodialysis while maintaining the rhEPO dose at 2000 units with each dialysis. A week after the last dose of Venofer, haemoglobin and serum ferritin were determined. Results: Average haemoglobin level among the patients before administration of rhEPO was 7.5 gr/dl. After seven weeks of subcutaneous rhEPO at 2000 units with each haemodialysis, the average haemoglobin level raised to 8.5 gr/dl. The effect of maintenance IV Venofer was an increase in average haemoglobin level to 10.4 gr/dl. The same effect was seen on the ferritin level. The ferritin level of 131 ng/dl increased to 237 ng/dl a week after last dose of IV venofer. Conclusion: Intravenous (IV) iron improves haemoglobin response and, thus, optimizes rhEPO therapy.

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Background&Objective: Stress in managers will effect and destroy the immune system on mental health. Clinical studies have revealed that, social support is one of the moderating factors of negative effect of stress on immune system. The aim of this research was study the correlation between social support and immune system of high school managers in khozestan province. Materials&Methods: An experimental study was conducted on 360 male and femal managers who were participated. Then randomly two groups (n=80 in each group) of low and high social support were selected. Subjects who suffered from disorders that affected the immune system were excluded. Number of T-helper cells (CD4), T-suppressor cytotoxic cell (CD8), Natural killer cells (CD56+CD16), Complement system (C3,C4,CH50), Immunoglobulin M and G (IgM&IgG), cortisol hormone, Eosinophils, Neutrophils and Lymphocytes were measured. Results: There was a significant positive correlation between social support and CD4, CD4/CD8, NK cell (CD56+CD16), CH50, IgM and Neutrophils. Also there was a significant negative correlation between social support and CD8, cortisol and Eosinophils. There was a significant difference between high and low social support managers in CD4, CD4/CD8, CD8, cortisol, CH50, C4, C3 and Lymphocytes. Conclusion: The results indicated that social support has a positive significant correlation with those immune cells that improve the immune system and has a negative correlation with those immune cells that decerase the immune system. In fact the social support is a moderating factor angainst stress and its negative effects on immune system.

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Background&Objective: In recent century, progress of technology and hygiene has caused improvement of human life. But factors such as car accidents and braws cause body damages. Due to absence of about the prevalence of jaw and face fractures proper pattern and related damages in Golestan province, this study was done to determine the pattern of jaw and face fracturs in 5th Azar hospital in Gorgan – Iran (2003-04). Materials&Methods: In a 3-years prospective study (2003-04), 221 patients in referral hospital in Golestan province were evaluated and data about demography, etiology, related damages and therapeutic procedures inserted in informational forms and extracted data was analysed by SPSS 11.5 software. Results: In this study 84.1% and 15.9% of patients were male and frmale, respectively and most of them were 21 to 30 years old. The most common causes of fractures of jaw and face in these patients consist of driving accident (72.8%), falling down (15.4%) and major trauma (11.8%). In accidents, motor accidents were the commonest cause (60.9%). Mandible bone was the commonest site of fracture (77.8%) and trauma to the skull and nervous tissues was the most common accompaniment damage. Open reduction was the main therapy in these patients. Death was not seen in this study at all. Conclusion: This study showed that driving accidents, specially motor accidents are the most common causes of fractures of jaw and face. Therefore , emphasis on observation of driving regulations and use of life belt and helmet is very important.

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Background&Objective: Thalassemia is the most common genetic disorder, 2-3 million carriers and 20 thousands with major thalassemia exist in our country. National prevention program of thalassemia started in 1998 and to encourage carriers to dispense marriage with increasing their knowledge was its main strategy. This study was designed to determine the effectiveness of thalassemia prevention program on couples knowledge and carriers and marriage avoidance in Gorgan province- Iran Materials&Methods: In this cross-sectional study, the data were collected by the questionairs which their validity and reliability were already confirmed. The sample population consist of 282 couples which were going to get married 107 couple with minor thalassemia which cancelled their marriage during 1998-2003 were also included in the sample poulation in this research. The detailed study were carried out on whole subjects. Data were entered into the SPSS and analyzed by chi-square, t-test and ANOVA. Results: In 282 couples, mean age was 20.5 on women and 24.86 in men, 57.8% were urban residents, 39.4% were relatives. Most of men had self-employed job and women were house keeper and half were under high school diploma. Distribution of knowledge level: 2.5% weak, 9.2% moderate, 53.2% good and 29.1% excellent. Relationship between knowledge and educational state, residency and job was meaningful (P<0.05), and there was not any relationship with age, gender and familial relativity. Ten couples were carrier that two of them were avoided from marriage. Also 43% of 107 carrier's couple whome were diagnosed in 1998-2003 avoided to get marriaged, meaningful relationships between subjects residency, education status and relativity (P<0.05). Conclusion: In spite of having a good knowledge, but some of the samples population in this study, did not show a suitable practice and most of high risk couples enter into marriage.

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Background & Objective: Surgery and /or radiotherapy are major local treatments for esophageal carcinoma. The results of radiotherapy alone have been unsatisfactory. The purpose of this study was to evaluate the treatment outcome of definitive chemoradiotherapy for patients with esophageal SCC.

 

Materials & Methods: This prospective histological descriptive study was done on 190 nonmetastatic esophageal SCC patients which received definitive chemoradiotherapy (55-64 Gy, Cisplatin 80-100 mg/m2 day 1-5FU 750-1000 mg/m2, 24h infusion days 1-4) with curative intent in cancer research center, Mashhad University of Medical Sciences between Jan 2000-Jan 2004. At least one course of chemotherapy was prescribed concurrently with radiotherapy.

 

Results: There were 99 male and 91female patients with the median age of 65 (range, 25-87). The median radiation dose prescribed was 60 Gy (range, 55-64) and median chemotherapy courses was 4 (range, 1-8). With a median follow-up time of 12 months (range, 3-60), one, two and three-year survival rates were 67.8%, 48.7% and 36.3% respectively and median survival was 22 months. Reduction of symptoms was shown in 84% of patients with dysphagia. 109 patients remained disease free with a median follow-up of 14 months (range, 3-60), among which 34 were followed more than 24 months. We found 81 cases (42.6%) with treatment failure during the follow-up (34 locoregional failure, 14 distant metastases, 33 distant metastases accompanied with locoreginal failure).

 

Conclusion: Although definitive chemoradiotherapy can result in long term disease free survival and even cure in a subset of patients with SCC of esophagus, locoregional failure and distant metastasis has remained the main causes of treatment failure.

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Background & Objective: Job satisfaction is the one of factors that affected by leadership style of managers and can effect on health organization practice. The aim of this study was to determine relation between leadership styles of nursing managers and rate of nursing employees' job satisfaction.

 

Materials & Methods: This cross-sectional study was done on 720 nursing employees of Gorgan Medical teaching centers during 2006. Leadership style and job satisfaction were main variables of study. Data gathering tools were questionnaire of demographic characters, job satisfaction and standardized Bark's leadership style. Gathered data were analyzed by c², Mann-Whitney and ANOVA statistical tests.

 

Results: The most of participants (74.3%) were women, nurses (86.6%) with the mean age of 32.7±7.32 years. The rate of satisfaction in the most of nursing employees (79.8%) was low and moderate. 63.2% of participates believed that their nursing managers had transactional leadership style and 34.9% of them said nursing managers apply transformational leadership method. Data analysis showed that nursing managers have transactional leadership, had higher job satisfaction rate (88.01 V.S 86.36). This difference was not significant.

 

Conclusion: This study showed that, there is not statistical relation between leadership styles of nursing managers and rate of nursing employees' job satisfaction.