Yafteh

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Introduction: Chemical weapons , which their history dates back to the first world war , refer to any factor that has direct toxic effects on human being , animals and plants. Iraqi regime used chemical weapons and various poisons during the imposed war against Iran of which mustard and nervous gases are examples that their effects are seen in victims even after passing many years. Materials and Methods: This descriptive cross – sectional study was carried out in2001-2002 to evaluate skin manifestations in 95 chemically wounded combatants of Lorestan province whom were exposed to the chemical weapons during the war .Data was collected by clinical examination and information recorded in a questionnaire. Findings: All of the studied cases with mean age of 39.26 years old had skin manifestations among which the most common symptoms were itching , burning ,dry skin , scaling. From view point of lesions, the most common signs were erythema (81%) , excoriation (87.9%) and pruritic papules (49.5%). Final diagnosis in 78% of the patients was chronic dermatitis and in 7.7% of them was seborrhoeic dermatitis and in 8.8% both chronic and seborrhoeic dermatitis were observed .During exposure to chemical gases only 37.9% of these combatants had used special masks and 40% had properly worn special clothes to protect themselves which covered their body completely , but rest of them had either used protection instruments improperly or had not used them at all. Most of the lesions were in trunk , lower extremities , abdomen , head and neck .78% of the cases had multiple lesions Conclusion: Regarding the results of this study all of the chemical wounded combatants of Lorestan province suffer from different degrees of skin lesions , although more than half of them were not aware of kind and nature of the chemical gases , but it is suggested to do further studies on long-term effects of these chemical gases.

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Background : Blood is a resusciate source of life which there is no replacement for it. Limited time of preserving, screening tests of blood health, group determining, and cross-matching, that necessitate personal and laboratory costs, increase the importance of correct request and suitable consumption. This study was conducted to determine the frequency of blood transfusion and its components and calculate the ratio of C/T. Materials and Methods: This descriptive-analytic study included 648 patients for whom blood and blood components were requested during the study. The data regarding the variables were recorded in a checklist and then were analyzed using the SPSS software. Results: The results showed that during the study 7746 patients were hospitalized and blood or blood components were requested for 648 (8%) of them. Out of these patients, 265 (40.9%) received transfusions of blood or its components. Packed cell was the most frequently transfused component (71.3%). The mean HB (hemoglobin) in the patients before transfusion was 9.49 gr/dl. Chronic anemia was the most prevalent indication of transfusion, and femoral fracture surgery was the most frequent operation needing blood transfusion. The C/T ratio was found to be 1.1. Conclusion: In this study, 59.1 % of the requested units were not used. Realizing requests based on scientific needs, and costs of production, preserving, separating components, transporting them to hospitals, and cross-matching including laboratory needs and manpower are recommended.

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Background : Anemia is one of the most common health problems in Iran and the world. Moreover, iron deficiency anemia is the most prevalent nutritional anemia in the world. Considering the high prevalence of iron deficiency anemia and the relationship between their severity and cultural-economic condition in an area, this study was conducted to obtain the prevalence and plan the treatment of diseases. Materials and Methods: This cross-sectional study was conducted using a census method. All the adult patients with anemia signs and symptoms referred to the internal clinic of Shohada Ashayer were examined for CBC and RBC indices. The patients whose hemoglobin amounts fell in the anemia definition range were included. Iron level, serum ferritin, and TIBC assessments were performed and a questionnaire was completed for each patient. Then data were analyzed statistically. Results: Out of all the anemic patients, 44.4% suffered from iron deficiency anemia. The prevalence of iron deficiency anemia was 52.3% in women and 22.6% of the men. 60.9% of the patients in 15-49 age group and 24.5% of those aged over 49 had iron deficiency anemia. A significant relationship was found between age, sex, and iron deficiency anemia. No significant relationship was found between history of NSAIDs consumption and the incidence of iron deficiency anemia. Conclusion: Since the prevalence of iron deficiency anemia in the studied population is high, considering improving and preventive interventions and comprehensive training programs in this regard seem to be necessary.

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Background : Self-care is considered as an important process in to control diabetes. The aim of this study was to investigate the self care and its influencing factors in diabetic patients in Khorramabad city. Materials and Methods: In this cross-sectional study 80 patients with type 2 diabetes, a‌dmitted to hospitals diabetes clinic and urban health care centers and an endocrinologist's office in Khorramabad, were selected using convenience sampling method. Data ghathering tool in this study was self-care scale Tubert – Glasgow which assessed the self care of their patients in different domains during the past seven days. Data were analysed by independent t- tests and one way ANOVA. Results: Self-care average scores in patients were (32.7±12.76) and the utility level was moderate. Low self-care behaviors were seen in daily check of blood glucose (3.4±3.8), physical activity(4.7±4.2) and general care of the feet(4.9±4.9). The self care average scores based on litrecy, resident place , type of treatment and the patients' life net was significantly different . Conclusion: : In order for health promotion and optimal control of disease in diabetic patients, training programs to empower patients in their self care should be considered.

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Background : Health care workers, as their profession require, are constantly exposed to patients, infected blood and body fluids. The main objective of this study was to determine the epidemiologic and clinical aspects of occupational exposure to patients, blood and body fluids and related factors in health care workers of Shohada Ashayer hospital. Materials and Methods: In this cross sectional study, during 2010-2011, all Shohada Ashayer hospital personnel, who had been exposed to blood and other body secretions of patients were studied. The data collection tool was a questionnaire containing demographic information of the exposed persons, the exposure way, source of contamination, cause of exposure and hepatitis B vaccination status. The data were analyzed using descriptive statistics and Fisher's exact test. Results: In the mentioned interval of time, 80 health care workers had been exposed to blood and body fluids. The highest rate of occupational exposure was found among nurses (32.5%), medical students (20%) and interns(11.3%). These exposures had occurred most commonly in the emergency ward (41.3%). Percutaneous injury was reported in 96.3% of the cases. Most cases (52.5%) were reported in the morning shift.The most causes of body secretions expoture in‌‌ our subjects were IV catheters(26.3%) and sheaths the needle(22.5%). Sources‌ of infection was unknown in 56.3% of the exposed personnel. No significant statistical difference was observed between cause of exposure to patients, body secreations, and personnels profession and sex. Conclusion: Training in prevention methods of exposure to patients, discharge by use of protective barriers, and enhance the clinical competency of health care workers can play an important role in the prevention of occupational exposures.

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Background: Identification of food patterns is of crucial important. As far as we know, no study has been yet carried out in the west of Iran. The aim of this study was to determine staple food patterns among adult persons in Khorramabad city. Materials and Methods: In this cross-sectional study food intake of 973 people (736 women) were gathered by Food Frequency Questionnaire (FFQ 208 food items). These food items were stratified to 40 food groups and using factor analysis were analyzed by SPSS software. Res‌ults: Factor analysis determined 3 major food patterns: healthy dietary pattern (HDP) (high in poultry, low fat dairy products, high fat dairy products, cruciferous vegetables, yellow vegetables, green leafy vegetables, other vegetables, whole grains, fish, olives, and fruits) western dietary patterns (WDP) ( high in meat, processed meat, organ meats, margarine, condiments, sweets and desserts, soft drinks, dried fruits, snacks) traditional dietary patterns (TDP) ( high in eggs, tea, fruit juices, refined grains, nuts, pickles, hydrogenated fats, sugars, salt, spices). In general, these food patterns justified 29.88% of variances. There was no significant difference between men and women from the view point of dietary pattern. Conclusion: Three food patterns were identified among adults (18-70 y) in Khorramabad. Association between these food patterns and health problems will be discussed in another study.

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Background : Complaint against physicians is one of the problems that every physician may be subjected to it during practice. According to the existing statistics, the number of complaints is increasing in Iran. Identification of these causes may be effective in preventing such complaints. This research was conducted to identify the causes of complaints made to the Medical Council Organization of Khorramabad from 2006 to 2011. Materials and Methods: This study is descriptive cross-sectional and retrospective. To carry out the research, all of the complaints to the Medical Council Organization of Khorramabad from early 2006 to 2011, were studied. The required data were transferred from the files to the questionnaires. Finally, the collected data were entered into statistical software and analyzed with statistical tests. Results: In this research, 260 complaints made to the Medical Council Organization of Khorramabad were studied. A major part of the complaints was made against public hospitals(68.8%). The highest cause of complaints was recklessness(55.4%), while the lowest state was neglecting public regulations(21%). Of the 260 cases of complaints investigated by the preliminary committee, 80 cases (30.8%) were recognized as negligence and 180 cases (69.2%) were considered as non-negligence. According to the disciplinary committee, of the 260 cases, 61 cases (23.5%) were recognized as negligence and 199 cases (76.5%) were considered as non-negligence. Conclusion: Observing medical ethics and career commitment, establishing proper communication by physicians and treatment staff with patients and their companions, lack of exaggerating the treatment results, continuous study and updating medical knowledge, physician’s adequate skill and experience, lack of applying the methods which he has never passed their training courses, proper selection of patients, and obtaining the informed consent of patients and aquittance may lead to reduce the number of complaints against physicians.

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Background : Diabetes is a chronic and worldwide common disease. This disease has many physical chronic complications. The aim of this study was to evaluate chronic complications of type 2 diabetes in the patients hospitalized in Shohada Ashayer hospital because of lack of control of plasma glucose with oral drugs. Materials and Methods: This retrospective cross sectional study was carried out on the patients hospitalized because of lack of control of plasma glucose by oral drugs in 2009-2010. The required data were gathered using a questionnaire. The collected data were analyzed by SPSS software and chi-square and Fisher's exact test. P value <0.05 was statistically regarded significant. Results: Studied subjects were 299 patients, of them 177 were female. The mean age of the patients was 58.6±14.7 years. Cardiovascular diseases (41.5%) and retinopathy (37.4%) were the most frequent complications. There was a significant relation between retinopathy and nephropathy, and the duration of the disease. Conclusion: Considering the high prevalence of cardiovascular complications in the patients and the lack of a routine method for evaluation of these complications in the diabetic patients, designing a plan for periodic evaluation of these patients is suggested.

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Background: The aim of this study was to investigate the relationship of familial history of gastrointestinal cancers and personal history of colon polyps with colorectal cancer incidence in khorramabad in 2012. Materials and Methods: This cross-sectional study included 50 patients with definite diagnosis of colon cancer based on colonoscopy and pathology in 2012. The control group included 56 persons from outpatients without a history of gastrointestinal diseases admitted to the skin and eye clinics of shohada ashayer hospital, who were matched with the patients for age and gender. The two groups were studied in terms of familial history of gastrointestinal diseases in immediate relatives and personal history of colorectal polyps using a self-constructed questionnaire. Fisher exact test and odds ratio estimate was used for data analysis. Results: The mean age of the patients was 52.8±15.5 years old, and 56% were male. A significant relationship was found between familial history of gastric and colon cancers in immediate relatives and colorectal cancer incidence in the patients (p<0.05). The odds ratio estimate of colorectal cancer incidence in the individuals with a positive history of gastric cancer and colon cancers in immediate relatives were respectively 3.96(CI=1.44-6.61) and 6.75 (CI=2.4-11.1) times of the estimate in the control individuals. No significant relationship was found between a history of esophageal cancers in immediate relatives with colon cancer incidence in the patients (p=0.61). Moreover, a significant relationship was found between a history of colon polyps and colorectal cancer incidence (p=0.004). Conclusion: The results of the present study should be confirmed in the further studies with larger sample sizes, so that serious measures to control the cancer can be taken through developing comprehensive prevention programs based on screening.

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  Background : The quality of mother-child relationship play an important role in personality shaping, social functioning and mental health of children in the future . This study was designed to evaluate the prognostic factors of mother - child relationship patterns.

  Materials and Methods: In this cross sectional study 110 mothers admitted to children's hospital of Khorramabad selected by consecutive sampling method. Data gathering tool was Mother - Child Relationship Evaluation (MCRE) questionnaire. At first the view points of the mothers about four communication patterns including: over protection, child rejection, overneglignce and child acceptance were examined, then according to each pattern cut off, the type of communication pattern was determined. Fisher's exact test and linear regression were used for data analysis.

  Results: The mean age of participants was 28.6±6.46. Communication pattern in 66.4% of the mothers was over protection and 19.1% of them had overneglence pattern. Also communication pattern in 12.8% of the participants was child acceptance and 1.8% followed from child rejectoin communication pattern. A significant statistical relation was seen between age, education level, marital status, mothers residence and pregnancy status with the pattern of their relationship (P <0.05). In linear regression analysis, most important factors in predicting the communication pattern were single parent and unplanned pregnancy.

  Conclusion: Raising awareness of mothers through workshops can increase proper child skills and led to the development of social skills and reducing child behavior problems in the future.

 

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Background : In many patients with chest pain, the correct diagnosis of acute myocardial infarction(AMI) is dependent mainly on the measurement of cardiac markers such as cardiac creatin kinase isoenzyme (CK-MB) and cardiac troponin I (cTnI) ,because the electrocardiogram is often non-diagnostic. The measurement of cardiac markers are superior for the detection of minor myocardial injury and more-accurative diagnosis. The purpose of this study was to evaluate the assay of routin method of CK-MB and cTnI in comparison with rapid test method in suspected patients to AMI. Materials and Methods: The study population comprised 142 patients admitted to the emergency ward with acute chest pain for less than 12 hours before admission. Venous blood specimen were obtained to measure CK-MB and cTnI rapid assay tests with Acon and Golden kits, and Elisa cTnI and photometry CK-MB assays. Results: The results of Elisa cTnI assay had 52 positive and 90 negative patients compared to Golden cTnI rapid test, 27 positive and 110 negative patients, while in comparison with Acon cTnI rapid test there were 30 positive and 112 negative patients ( p≤ 0.001). The results of photometry CK-MB assay had 39 positive and 103 negative patients compared to Golden CK-MB rapid test which had 60 positive and 77 negative patients( p ≤ 0.001), while in comparison with Acon CK-MB rapid test in had 78 positive and 64 negative patients ( p ≤ 0.035). Relative sensitivity and relative specificity were compared to routne metohs: for the Golden rapid cTnI test were 50% and 98.8% respectively for Acon rapid cTnI test 51.9% and 96.6%, for Golden rapid CK-MB test 69.2%/ and 63.1°/o, and for Acon rapid CK-MB test 69.2% and 50.4% . Conclusion: The present results showed that the rapid cTnI test is very specific but not sensitive for AMI diagnosis while rapid CK-MB test is neither sensitive nor specific for AMI dignosis in patients with acute chest pain.

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Background : Helicobacter pylori is a microorganism which results in gastritis, peptic ulcer and is associated with GI malignancies. This bacteria has an important role in GI disease .There is not enough data about prevalence of H.P infection among children (1-14 years old) in Lorestan province, so this study performed to determine the sero-prevalence of H.P among children referred to Shahid Madani children's hospital of Khorramabad and risk factors related to it were studied too. Materials and Methods: This analytical epidemiologic study was carried out during 2011-2012. At first children’s parents were interviewed and after filling a questionnaire and an informed consent. Blood samples were obtained from the children in order to determine serum level of H.P IgG using ELIZA method. Demographic data such as age, gender, mother’s education, father’s job, were recorded in the questionnaire .Then statistical analysis was performed using SPSS software. Results: In this research 200 children (1-14 years old) were studied to determine H.Pylori antibody prevalence. The average age of the children was 5.1 ± 2.9. 61% of them were male and 39% were female. Based on age, H.Pylori was most common among children aged 10-14 years old (57.9%) and the least prevalence among children under 1 year old was (16.7%), and according to Fisher exact test this difference was significant (p=0.032). Statistical analysis indicated that H.pylori infection prevalence was significantly higher (54.2%) among low income families (income <2500000 Rials) and this was important (p=0.006). The prevalence was not significant among children living in cities with those living in villages (p=0.83). Conclusion: Based on serum levels of antibody of H pilory antibody there is a linear relationship between the prevalence of this infection and age ،height and the present weight of the child (p<0.05).It means that with age, height and weight, the amount of serum antibody of H.pylori increases significantly. H.pylori infection prevalence was significantly higher among low income families (income <2500000 Rials).

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Background: Prevalence of End Stage Renal Disease (ESRD) is increasing in the world. Because of clinical importance of ESRD and absence of significant data, we studied the epidemiology of end stage renal failure in patients under hemodialysis in Lorestan province. Material and methods: This descriptive cross sectional study was carried out between January 2012 and January 2013 in dialysis centers of Lorestan university of medical sciences .Subject were selected by census method and data galhered using a questionnaire. At the end, collected data were analyzed by SPSS software, descriptive statistics and Chi-square test. Results: All the patients under hemodialysis were 318 cases, 182 out of them (57.2%) and 136(42.8%) were male and female respectively. The mean age of the subjects was 53.2± 16.4 years. The cause of renal failure in 38.1% of the patients were hypertension, diabetes (19.2%) and unknown factors (27.4%). As well as 5.97% of the patients infected by HCV, HBV or HIV . A significant statistical difference was observed between causes of chronic renal failure and different ages of the subjects (p=0.002). Conclusion: Augmentation of screening programs and especially, early referral of high risk subjects to nephrologists is recommended for prevention of end stage renal disease.

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Background: Medical interventions in labor have been common in recent years. Oxytocin is amongst them which is used to speed delivery. Unfortunately the indiscriminate administration of it could lead to maternal and infant complications. The aim of this study was to compare labor outcome with oxytocin and spontaneous delivery in low risk pregnant women. Materials and Methods: In this descriptive – comparative study, 395 women with single fetus, cephalic presentation, normal delivery, in the active phase of labor were selected. 197 of the cases, as Oxytocin group, received oxytocin by physician,s order during their labor and 198 of the samples, as the second group, had spontaneous vaginal delivery. In both groups, some of the maternal and neonatal outcomes including: maternal morbidity , Apgar score at minutes one and five, admitted in neonatal intensive care unit and were studied.Data were analyzed using SPSS 16, t-test, Chi-square and Mann Whitney tests. Results: The findings showed that oxytocin significantly increased rates of episiotomy, laceration, post partum hemorrhage, hospitalization of neonate in intensive care unit and reduction of Apgar score at minutes one and five that were statistically significant (p <0.05). Conclusion: The results showed that the acceleration of delivery is not a safe method and increases the rate of maternal and infant complications. Therefore, it should be used in the case of medical necessities.

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Background: Studying the situation of observance of patients' rights and interaction of those individuals who provide and receive health services are regarded as the most significant and salient parameters of qualitative evaluation of health services. This study was performed to determine respecting patients' bill of rights from the viewpoint of patients admitted to Shohada Ashayer hospital in 2013-2014. Materials and Methods: This cross-sectional study included 286 patients admitted to Shohada Ashayer hospital in 2013 and 2014. Respecting patients' bill of rights from their viewpoint was determined by a questionnaire. Results: The results demonstrated that respecting patients' bill of rights from the viewpoint of the patients was good in 11.2%, average in 86.7%, and poor in 2.1%. Older age, lower educational status, urban residence, shorter hospital admission, and admission to internal and infectious wards were related to better attitude (P<0.05). No significant relationships were found between gender and history of previous hospitalization, and respecting patients' bill of rights (P >0.05). Conclusions: In total, based on the obtained results ,it may be concluded that respecting patients' bill of rights from the viewpoint of patients is not considered as optimal. Therefore, it is necessary to identify the effective factors in this area to promote respecting patients' bill of rights.

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Background: Diabetic ketoacidosis is an acute complication of diabetes, and a medical emergency that is usually seen in type I diabetic patients. No manifestation of type I diabetes is sometimes diagnosed, particularly in children, and the disorder is accompanied by insulin deficiency, reduced size, and altered mental status. Materials and Methods: This descriptive epidemiological study included all the diabetic patients with diabetic ketoacidosis who had been hospitalized in Shohada hospital from June 2009 to June 2013. The records of the patients were studied and the necessary data were extracted considering the specified criteria. The data were then recorded in a questionnaire. Results: Thirty-eight cases with diabetic ketoacidosis were found in the hospital records. Most of the infected cases were female, and the complications was more prevalent in the age groups of 9-10 and 20-29 years. Discontinuation of insulin was the single most frequent predisposing factor. Most of the cases were severe, mostly in the females. Conclusion: The patients and their families' unawareness of the acute symptoms of the disease, and refusal of treatment, which led to the discontinuation of insulin use, were the probable causes of the severity of the disease in our study population.

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Background: Authorizing abortion in some cases of fetal and maternal diseases which was implemented by passing its law in 2005, a major change in therapeutic abortion was performed in Iran,s health system. Although there may be cases of illegal abortion, but our study examined legal abortion of Lorestan province in 2013, which led to increase in awareness of health professionals about indications of therapeutic abortion, the time to do it and answer to related questions. Materials and Methods: In this epidemiological and cross-sectional study, all applications for abortion permission, received by Lorestan legal organization in 2013, were studied. The data were recorded in a questionnaire and analyzed using SPSS software. Results: From 205 cases during a year, 144 of them obtained permission for abortion of which 88% issued for fetal abnormalities and 12% due to illness of the mother. The most common diseases in the fetus were, the brain and skull abnormalities, and in the mothers, cardiovascular diseases and hematologic abnormalities were the highest. In these cases, the most frequency belonged to the age group of 25-34 years. For 61 requests, permission for abortion had not been issued. High gestational age (26 cases) and diseases of the brain and skull, were the most common reasons of request for abortion. Conclusion: Abortion means therapeutic abortion and with the increase in the authorized therapeutic abortion, the illegal abortion will be reduced and leads to increase in the health of pregnant women. By increasing awareness of the medical staff about permitted therapeutic abortion and related laws, a correct and better guidance of pregnant women, we can help them to have a healthy community. As well as the problems of obstetricians and gynecologists, in this field, will be decreased.

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Background : Since only the correct and effective Cardiopulmonary Resuscitation (CPR) can increase the survival of patients with cardiopulmonary arrest, the aim of this study is to determine the effects of CPR training in the anesthetioligy ward to improve CPR knowledge and clinical skills of interns of Lorestan university of medical sciences. Materials and Methods : A 10-month Educational experimental study was done on 31 undergraduate medical students at Lorestan university of medical sciences in 2013. During a period of 15 days of anesthesiology internship course, all these students underwent CPR training including Basic Life Support ( BLS ), Advanced Cardiac Life Support ( ACLS ) and practical skills. Data were collected via a questionnaire with 4 parts including demographic, pre and post knowledge and skills as standpoint of interns and ward,s professor. Results: After training the mean of score about knowledge of CPR and its practical skills significantly increased from 5.68 to 7.94 and 10.65 to 23.45 respectivly (PV=0.0001) . A significant relationship between preinternship exam score and knowledge of CPR before anesthesiology internship course was shown (PV=0.001), but there was no significant relationship with practical skills score pre and post CPR training in anesthesilogy ward.(PV=0.38) Conclusion: The CPR training course in anesthetiology ward leads to significant increase in CPR skills and Knowledge of medical interns. Adding this course to undergraduated medical students is essential

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Background: With regard to the importance of attachment in developing separation anxiety, the purpose of this study was to investigate the effectiveness of attachment based intervention via video feedback on decreasing negative representations and separation anxiety problems in preschool children. Materials and Method: The research method was semi experimental with pretest-posttest and follow up. For this, 21 mother-child dyads (11 dyads in experimental and 10 dyads in control group) were selected from 2 child counseling centers based on including criteria. The experimental group received 8 to 10 individual attachment based intervention sessions and the control group received the other relation based intervention for comparison of their effectiveness. The participants were assessed using maternal behavior Q-SORT, MacArthur story stems and child psychopathological symptoms inventory in pretest, post-test and 3 months interval follow up. Results: The findings revealed the effectiveness of attachment-based intervention on increasing maternal sensitivity, decreasing negative representations of child and also separation anxiety symptoms in children of experimental group. The mean scores of experimental group in comparison to witness group have significantly decreased in all variables. Conclusion: Considering this results, it seems attachment-based intervention could increas maternal sensitivity and this change with decreasing negative representation of child via recovering interactions have a positive effect on decreasing separation anxiety problems of children.

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