[Effective risk factors for foot skin in diabetic patients]

Introduction: foot ulceration is one of the most serious and disabling complications of Diabetes Mellitus and identification of risk factors affecting foot ulcer can prevent it from causing irreparable consequences

Objective: therefore the aim of this study was to comparing the situation of the foot skin in diabetic patients with and without foot ulcers

Methods: in this cross - sectional study of 355 diabetic patients referred to Razi Hospital in 2013 were randomly selected based on a questionnaire consisted of four parts: demographic profiles, clinical characteristics, skin situations and diabetic foot, by a trained nurse were studied. History of the disease based on Charlson Co morbidity Index and foot ulcers by Wagner ulcer classification system were evaluated. Patients were divided into two groups of foot ulcer and non-ulcer and each of the variables were compared between these two groups. We used Chi square test and logistic regression analysis to compare some variables. P-value less than 0.05 was considered significant

Results: based on these findings, 16.1% had foot ulcers. Dry skin with no sweating, pallor, fisher, edema, impaired growing toe nails in the group with ulcer was [89.47%, 42.1%, 26.31%, 21.05%, and 64.91%] and in the group without ulcer was [73.48%, 35.9%, 11.74%, 12.08%, and 48.65%]. There is significant correlation between foot ulcers and dry skin [p=0.01], fissure [p=0.004] and impaired growth toenail [p=0.02].Risk of foot ulcers in people with dry skin 3.07 times, the people of Fisher 2.68 times in people with impaired growth and toenails 1.95 times higher

Conclusion: since skin problems affecting the foot ulcer, nurses by identifying risk factors played a role in the prevention and treatment of foot ulcers

Distribution of hepatitis C virus genotypes in haemodialysis patients of Guilan, northern Islamic Republic of Iran

The incidence of hepatitis C virus [HCV] infection among patients undergoing haemodialysis is high. The aim of this study was to identify the HCV genotypes among chronic haemodialysis patients who were HCV positive in Guilan province, northern Islamic Republic of Iran. All patients on haemodialysis at Guilan haemodialysis centres were enrolled. Enzyme-linked immunosorbent assay and polymerase chain reaction testing were performed. Out of 514 enrolled patients, 11.9% were serologically HCV positive and 6.2% had positive HCV-RNA. HCV genotypes were determined with HCV genotype-specific primers. The most frequent genotypes were la [59.4%] and 3a [40.6%]. There was no significant relationship between virus genotypes and sex or age. The HCV genotype pattern among haemodialysis patients in Guilan province was different from other countries of the Middle East and was more similar to North American and European countries where genotype 1 is predominant

[ survey of the male and female students1 attitude toward the gender role in the schools of IIam]

The training and inoculation of stereotypic roles by family, school and mass media may affect the attitude of both sexes toward their roles. The basic principle which is raised today is not the sex difference between girls and boys, but their attitude toward their sex role in a way the girls are satisfied of being female and the boys are satisfied of being male which will lead to their mental health. The aim of this study was indicating the male and female student's attitude toward their sex role and the opposite sex. In a descriptive - analytic survey - 402 highest grade students [206 boys and 196 girls] of elementary, guidance, high school and collage institute of Ham were selected through cluster and simple random sampling. Sample size in mind than a good attitude and accuracy rate of 50% was estimated five hundredth. The data were gathered through answering a questionnaire. The gathered data were analyzed via SPSS computer software by descriptive method. Overall, 74% of students have positive attitude toward their Gender

Ilizarov versus AO external fixator for the treatment of tibia open fractures

In developing countries, Ilizarov or AO external fixator is usually used for treatment of tibial open fractures. The purpose of this study was to compare the efficacy of these two methods for treatment of tibial open fractures. From April 2002 to April 2010, 120 patients with open tibial fractures admitted to the Department of Orthopedics of Babol University of Medical Sciences entered this study. In each arm, 60 subjects randomly received Ilizarov or AO external fixator. All patients were followed at least for one year. These two groups were compared regarding non-union, malunion and cure rates. The mean age of the patients in Ilizarov group was 32.35 +/- 11.28 and for AO were 31.3 +/- 10.99 years. Mean time for union in Ilizarov group was 5.25 +/- 1.85 and for AO external fixator was 5.85 +/- 2.13 months. Non-union rate in Ilizarov group was 10% and for AO external fixator was 11.7%. Malunion rate in Ilizarov group was 10% and for AO external fixator was 18.3%. Totally, efficacy of treatment in the Ilizarov group was 81.7% and in AO external fixator was 65%.The efficacy of treatment in Ilizarov was higher than that AO external fixator in treatment of open tibial fractures

Assessment of propofol usefulness as an anesthetic agent during colonoscopy

Propofol is used as a sedative drug during colonoscopy. In this study we analyzed the adverse effects of propofol [i.e., hemodynamic and respiratory] on patients who underwent colonoscopies. This study was performed in Qom Province, Iran. In this study, 125 patients [63 females, 62 males] were enrolled. Study patients were administered [0.5-1.5 mg/kg] intravenous propofol by and anesthesiologist. Oxygen saturation and blood pressure were recorded at three minute intervals. We used the American Society of Anesthesiology [ASA] classification to stratify patients by risk prior to the procedure. For statistical analysis, the chi-square and paired t-tests were used. A p-value less than 0.05 was considered significant. Patients' mean age was 45.36 +/- 16.19 years. ASA-I comprised 25.6% of study patients and 74.4% were categorized as ASA-II. Hypopnea occurred in 56.8% of patients and was prolonged in 32.4%. Of the study patients, 5.6% developed hypoxemia which was successfully controlled by the administration of nasal oxygen and no need for mechanical ventilation. The mean arterial blood pressure [p< 0.0001], oxygen saturation [p< 0.0001] and heart rate [p<0.0001] significantly decreased during colonoscopy. The occurrence of hypopnea significantly increased in patients with pre-procedure oxygen saturation levels /= 50 years [p< 0.0001] and ASA class II [p<0.0001] Agitation, hypotension and cough were seen in 1.6%, 1.6% and 0.8% of patients, respectively. Propofol has a short half life that enables faster recovery of normal neurologic and social functions we recommend the use of propofol under supervision of anesthesiologist or a trained gastroenterologist

Clinical manifestations of Hirschsprung's disease: a six year course review of admitted patients in Gilan, northern Iran

Hirschsprung's disease [HD] is a congenital disease in which intestinal ganglionic cells are absent, leading to intestinal obstruction. The disease has various clinical manifestations and different lengths of bowel may be involved. Our aim was to study Hirschsprung's clinical presentations and its rate of intestinal involvement in hospitalized patients in a six year course study in Gilan, a northern province of Iran. We studied patients diagnosed with HD who were referred to the Gilan Surgery Referral Center in Poursina Hospital from 1995 until 2001. In this cross sectional descriptive-analytical study, all data were collected from patients' files and questionnaires. Data included demographics, clinical presentations, diagnostic methods, involved intestinal segments, type of surgical procedure, and surgical complications. There were 58 cases of HD during this six year period that underwent surgery. Of these, 19 patients were female and 39 were male whose ages ranged from one day to 18 years old. A variety of clinical findings such as: constipation, abdominal distension, failure to pass meconium, diarrhea, and other less common manifestations were present. We found three different pathological types: rectosigmoid, ultra short segment and total colonic involved segment. No differences between disease presentations were discovered among these three types. The following surgical procedures were performed: Swenson, Soave-Boley, and Lynn. Early complications, which occurred during the first month following surgery, were anastomotic leakage, wound infection, hemorrhage and anastomosis stenosis. Late complications, occurring at least one month after surgery, comprised the following: long-term con-stipation, enterocolitis, incontinence, and obstruction due to adhesion. No significant difference between the complications of these surgical procedures and any accompanying anomalies were found. Most patients had chronic constipation and abdominal distension regardless of the types of involvement, age or clinical presentations. There were few associated anomalies amongst the patients. In some cases, surgical complications were less than those seen in other studies; therefore, it seemed that the performed procedures had fewer complications or may have been performed at the appropriate time

Prevalence of Helicobacter pylori infection among children in Rasht, northern Iran

Helicobacter pylori [H. pylori] infection usually occurs during childhood, especially in developing countries. The aim of this study was to evaluate the prevalence of H. pylori infection among children in primary schools of Rasht, a northern Iranian city. This cross-sectional study was conducted among 961 primary school students in Rasht. Samples were randomly selected and stored at -20°C until analysis. The stool assay was performed using the HP AgT kit. Overall 475 boys and 486 girls, aged 7 to 11 years were evaluated. A total of 384 [40%] children were diagnosed as H. pylori positive by the stool test. A higher prevalence of H. pylori was found in the stools of individuals who consumed well water and municipal tap water when compared to boiled water [p<0.05]. There was no significant difference between the rate of H. pylori infection and individuals' ages, gender or socioeconomic levels. The results of this study suggest that the source of drinking water may play a role in transmission of H. pylori. Transmission can be minimized with the use of boiled or mineral water

Prevalence and characteristics of irritable bowel syndrome [IBS] amongst medical students of Gilan northern province of Iran

Irritable bowel syndrome [IBS] is one of the most prevalent gastrointestinal disorders characterized by non-specific symptoms such as abdominal pain and altered bowel habits with no known organic pathology. Its prevalence varies in different communities. We performed this study to determine the prevalence of IBS in medical students who attended Gilan University of Medical Sciences [GUMS]. Medical students of GUMS were studying during 2002 academic year were enrolled in this cross-sectional study. Within a specifically designed schedule, trained general practitioners performed student interviews. The interviewers used a structured questionnaire based on the Rome II criteria. Data were analyzed using SPSS-10 software. Results were presented as percentages and the mean +/- SD and level of significance was denoted as a p-value <0.05. This study included 422 students, 148 [35.1%] males and 274 [64.9%] females, trained in various educational levels at GUMS whose mean age was 23.7 +/- 2.9 years. The prevalence of IBS was 12.6% [53 of 422]. IBS was more prevalent in females than males [15% [41 of 274] vs. 8.1% [12 of 148]; p<0.05]. Reported a Physician 37.7% of cases visit in comparsion to 17.6% of non IBS case [p<0.05]. This study shows a higher prevalence of IBS in medical students than in other sections of the Iranian population. A prevalence of 12.6% in medical students, who are in an active phase of life, requires careful planning to provide alleviation

Fascioliasis

Fascioliasis is a parasitic Hepatobilliary disease caused by most prevalent Fasciola Hepatica Trematoda. This illness occurs worldwide in all age group and race. Incidence of infection has increased over the past 20 years. An estimated 180 million cases have been at risk of infection and 2.4 million cases have infected, worldwide. Northern of Guilan has been in the high prevalent region of this infection. In Guilan province, 10000-15000 cases in 1368 and, 30000 cases in 1387; the second peak of infection prevalence, affected. In chronic Fascioliasis infection that doesn't treat in human, complication of disease manifests with iron deficiency anemia, billiary obstruction and collangitis or portal fibrosis. Extra Hepatic manifestation among them, pleura Pericarditis, meningitis, Lymphadenopathy

Pulmonary function test results in patients with ulcerative colitis

Pulmonary complication of IBD includes airway inflammation involving small and large airways, pulmonary paranchymal disease and serositis. The aim of this study was to determine the prevalence of Pulmonary Function Test [PFT] abnormality in ulcerative colitis [UC] patients. During spring and summer of 2006, PFT [spirometry and body box plethysmography] of 50 UC patients were compared with 50 healthy persons matched for age and sex [control]. Data collection form including demographic specification and UC condition were filled. Mean age of patients was 37.2 years [SD=14.5]. Active UC was seen in 24% of patients while 18% of patients suffered from severe UC. PFT results included 42% air trapping [only increase in residual volume/total lung capacity], 20% small airway obstructive pattern [only decrease in maximal expiratory flow at 25-75% of vital capacity], 12% restrictive ventilation defect, 2% obstructive airway, 2% hyperinflation and 6% upper airway obstructive pattern. There was a significant relationship between small airway obstructive pattern and duration of UC and no relationship was noticed between other pulmonary disorders and severity, activity, duration of UC. According to high prevalence of air trapping, small airway disease may be the prominent feature of lung involvement in UC patients. Therefore a meticulous work up for respiratory diseases is necessary in UC patients

[Situation of supplementary feeding in 6-12 month old children in ilam]

Exclusive breast feeding is highly recommended for children under six months and the best time for starting supplementary food is the end of sixth months. Inadequate feeding can lead to malnutrition. Since infants' supplementary feeding pattern is influenced highly by the socio-cultural status; it is necessary to study the subject in diverse conditions. This study aimed to investigate supplementary feeding pattern in 6-12 months children referred to Ilam clinics in 2002. In this study, 364 mothers with 6-12 months children were selected using convenient sampling method from 10 health care centers. Data were collected using a four-sectioned questionnaire including mothers and their babies demographic characteristics, feeding pattern [frequency, the type of milk], supplementary food [the age of onset and the type of the first supplementary food, the time of starting mixed foods, and the source of information about supplementary food] and mothers' performance about feeding with supplementary food. The questionnaire was filled via interview. Findings showed that the growth curve in 84.8% of babies was in the health road. About 38% of babies were the first child. In 50.9% of samples, supplementary food was started before 6 months of age and in 49.9% of the cases, it was started after 6 month old. Supplementary feeding accompanied with breast feeding in 83.5% of the infants. The most used supplementary food was rice mucilage [40.8% of the babies]. The interval between starting one supplementary food and the other one was 3-4 days in 50.2% of the cases. Also 80.8% of samples started feeding in the amount of one spoon and increased it gradually. The majority of mothers [64%] did not add sugar, salt and spices in order to attract their babies. As well, 75.6% of samples used spoon and cup for feeding and 92.9% knew the safe time for keeping cooked food in the refrigerator. The source of information about supplementary feeding in 65.4% of mothers was health care providers and in 5% were books and booklets. Findings indicated that more than half of mothers began supplementary feeding for their children before 6 months old without pursuing any accepted pattern. It seems that usual educational programs in Ilam were unable to answer all the problems aroused in this issue. Hence, educating mothers using other methods such as visual teaching material is recommended

immunologic response to anti-hepatitis B vaccination among medical students of Guilan university of medical sciences, Guilan, Iran

An important way to prevent hepatitis B infection is vaccination especially among high-risk populations including healthcare workers. Unfortunately, immunologic response to the vaccine is not perfect. Multiple different factors such as gender, age, body mass index [BMI], smoking and underlying diseases can influence the immunologic response. So, this study was conducted to evaluate the post-vaccination immunologic response of medical students of Guilan University of Medical Sciences [GUMS]. In this cross-sectional study, GUMS medical students who had received complete vaccine series at zero, one, and six months were enrolled. Their demographic data and the factors which could probably alternate the immunologic response were collected by interview. The anti-HBs Ab titer was evaluated by Enzyme-Linked-Immunoassay [ELISA]. Appropriate immunologic response was supposed to be HBsAb >=10 mIU/ml. The collected data were analyzed using SPSS 10.00.P value <0.05 was considered significant. We evaluated 233 students with mean age of 24.9 +/- 4.5 years. 74.7% were female. 4.9% did not respond properly to vaccination. Females' immunologic responses were significantly higher than males' [P=0.001]. Responsiveness was significantly lower in smokers than non-smokers [P=0.02]. Mean age in inappropriate and appropriate responder groups were 28.67 +/- 5.4 and 24.77 +/- 4.4 years, respectively [P=0.004]. 95.1% of students had a protective level of anti-HBsAb [>10 mIU/ml]. Since health-care staffs including medical students are a high risk group to be contaminated with HBV, it is preferable to be evaluated for anti-HBs titer 1-3 months after full three-dose vaccination especially when these factors are present; in this way the false sense of being immunized among them may be decreased

Irritable bowel syndrome [IBS] prevalence in medical students of Gilan university of medical sciences

Irritable bowel syndrome [IBS] is one of the most prevalent gastrointestinal disorders, characterized by non-specific symptoms such as abdominal pain and altered bowel habit without any organic pathology. Its prevalence varies in human communities. We performed this study to determine the prevalence of IBS in medical students of Gilan University of Medical Sciences [GUMS]. Medical students of GUMS in 2002 enrolled in this cross-sectional study. Under a schedule they were interviewed by trained general practitioners with structured questionnaire, which based on Rome II criteria. Data was analyzed by SPSS-10 software. Results were presented into percentage and mean +/- SD. Level of significance was denoted as p value less than 0.05. This study included 422 students training in various educational levels of GUMS, 148 [35.1%] males and 274 [64.9%] females whose mean age was 23.7 +/- 2.9 years. Prevalence of IBS was 12.6% [53 of 422 with 95%, CI 9.5%-16.1%]. IBS was more prevalent in females than males [15% [41 of 274] vs. 8.1% [12 of 148]] [p<0.05]. This study shows higher IBS prevalence in medical students than other published Iranian reports. Prevalence of 12.6% in students, who are in active phase of life, necessitates planning to help this population