Psychological, social and structural determinants of diabetes self-management

Self-management of diabetes, an important aspect of diabetes treatment, is strongly affected by psychological and sociostructural factors. The aim of this research was to investigate the psychological, social and structural determinants of diabetes self-management in patients with type 2 diabetes. In cross-sectional design study, 500 out patients [245 men and 255 women] with type II diabetes were selected by convenience sampling. Data collected by demographic questionnaires on the Scales of diabetes self-management, diabetes self- efficacy, belief to treatment effectiveness, belief to illness certainty, treatment motivation, patient- provider therapeutic communication, diabetic knowledge, satisfaction for therapeutic services, access to therapeutic services, familial social support, and on collaborative decision-making, were analyzed by correlation and stepwise multiple regressions. Diabetes self-management mean [standard deviation] was 45.77 [21.81]. Self-efficacy, belief of treatment effectiveness, social support, >HbA1c%7 and Insulin therapy significantly predicted diabetes self-management variance [P<0.001]. The variables explained 91% of diabetes self-management [R2 = 0.91]. Self-efficacy has highest weight in prediction of diabetes self-management [beta = 0.338, P<0.001]. Self-efficacy, belief of treatment effectiveness, social support, mild HbA1c and treatment type are important factors for diabetes self-management and these variables explained the high rate of the diabetes self-management variance, emphasizing the importance of improvement of self-management behaviors in these patients

Prevalence of depression in personnel of Zanjan University of Medical Sciences

Depression has been assumed as a prevalent disorder of the era. Depression cannot be attributed to a particular social class. Factors such as incompatible situations may lead to mental disorders and affect physical immunity. This study was carried out to investigate the prevalence of depression among the staff of Zanjan University of Medical Sciences. This study was of cross-sectional type study whereby 693 subjects were selected through classified randomized sampling. The rate of depression incidence was obtained using Standard Beck Questionnaires. The data was analyzed by Chi-2 tests and cohesion indexes of Kramer and Gama were also used. According to the results of this study 40% of the personnel were suffering from depression. They were identified as 23% with low depression, 13% with moderate depression, and 4% with severe depression. A significant correlation was found between depression and education level, type of settlement, and city where they worked. Regarding the widespread prevalence of depression among the staff, planning and organization of consultation sessions by the authorities is suggested

[Prevalence of depression in personnel of Zanjan university of medical sciences]

Depression has been assumed as a prevalent disorder of the era. Depression cannot be attributed to a particular social class. Factors such as incompatible situations may lead to mental disorders and affect physical immunity. This study was carried out to investigate the prevalence of depression among the staff of Zanjan University of Medical Sciences. This study was of cross-sectional type study whereby 693 subjects were selected through classified randomized sampling. The rate of depression incidence was obtained using Standard Beck Questionnaires. The data was analyzed by Chi-2 tests and cohesion indexes of Kramer and Gama were also used. According to the results of this study 40% of the personnel were suffering from depression. They were identified as 23% with low depression, 13% with moderate depression, and 4% with severe depression. A significant correlation was found between depression and education level, type of settlement, and city where they worked. Regarding the widespread prevalence of depression among the staff, planning and organization of consultation sessions by the authorities is suggested

[Seroepidemjological survey of visceral leishmaniasis by direct agglutination test in bojnoord district, north Khorasan province in 2007]

This study aimed to determine of the seroprevalence of visceral leishmaniasis to design a prevention and control program in Bojnoord district. This was a descriptive and cross sectional study with multistage random sampling method. The study was carried out on children up to 12 years old and 10% of adult's population in 8 rural areas of Bojnoord district in 2007. In total, 1608 blood samples were collected to detect anti-Leishmania antibodies. All the samples were tested by direct agglutination test [DAT]. In order to determine Leishmania species, necropsy was performed on four suspected dogs in the studied areas. The species of Leishmania was determined by RAPD-PCR and PCR-RFLP methods using to amplify the ribosomal internal transcribed spacer 1 [ITS1]. Thirty and eight [2.36%] out of 1 608 collected blood samples had anti- Leishmania antibodies at titer 1:800 and nine [0.56%] were just positive at 1:3200 by DAT. There was no statistically significant difference between female and male seroprevalence [p>0/05]. The seoprevalence in children <=12 years old compared to individuals greater than 12 years old did not show any statistically significant [p>0/05]. Amastigotes were observed in all 4 necropsied dogs. The species of Leishmania isolated from 2 dogs, was determined as L.Infantum. Their ITS1 sequences were registered with Accession numbers EU810776 and EU810777 in NCBI. These findings showed that visceral leishmaniasis has been circulated with low endemicity in Bojnoord district. Therefore an appropriate monitoring system is needed for health services in this area

[ comparative study on spinal fentanyl and sufentanil plus 5% lidocaine at the onset of pain and analgesia after caesarean sections]

The administration of either intrathecal or epidural opioid can provide deep neuroaxial anesthesia without significant changes in sensory or motor functions. This technique may reduce both mortality and morbidity, in comparison with systemic opioids. It seems, then, that using opioids [e.g. Fentanyl or Sufentanil] along with anesthetics [Lidocaine] in spinal anesthesia may also provide better pain control both during and after caesarean sections. This study was a prospective, randomized, double-blind and controlled trial on 86 pregnant women, ASA I-II, who were scheduled for elective caesarean section under the subarachnoid block in the year of 2008. The patients were divided into two groups [1 and 2] on the basis of a randomized digital table according to their taking sufentanil or fentanyl. In both groups, the local anesthetic used was hyperbaric lidocaine 5% [80 mg] with a total volume of 2.2 ml. of the solution. Then, the onset of pain and the need for analgesia after the caesarean section were evaluated. Both groups received drugs intrathecally as follows: Group 1: 20micro g Fentanyl, 80 mg lidocaine%5, 0.2 mg Epinephrine. Group 2:2 micro g Sufentanil, 80 mg lidocaine%5, 0.2 mg Epinephrine. In addition, Visual Analogous Scale [VAS: 0-10] was used to assess the intensity of pain and the patient's sedation both in the recovery room and in the ward every one hour for 6 hours. The side effects and the need for drugs were recorded. As the findings of the study suggest, the onset of pain after cesarean section was more significant in the Sufentanil group than the Fentanyl group [P=0.046]. In this study, the Sufentanil group's pain began about twenty minutes later than that of the Fentanyl group. Although the patients in the Sufentanil group appeared to need analgesic about twenty-six minutes later than those in the Fentanyl group, there was not any significant difference between these two groups of the study [P=0.003]. As for Neonate's APGAR and the other side effects, there weren't any significant differences between the two groups, either. Fentanyl and Sufentanil plus intrathecal Lidocaine provided a good pain control for elective caesarean section; however, no significant difference was noted in terms of side effects. As a whole, Fentanyl and Sufentanil plus 5% Lidocaine can intrathecally induce sufficient analgesia after cesarean sections. More specifically, spinal anesthesia with lidocaine 5% and 2 micro g of Sufentanil may bring about sufficient analgesia after the operation and is recommended for induced anesthesia in operations

[Evaluation of chromogenic media compared to traditional culture methods for presumptive identification of entrococci from urine specimen]

Entrococci is a clinically important pathogenic bacterium in UTIs. CHROMagar orientation is a recently method for rapid, easy and economic isolation and identification of entrococci. This study compares the chromogenic media with traditional methods for presumptive identification of entrococci from urine specimen. We evaluated 240 gram positive cocci from urine specimens. These isolated microorganisms were inoculated on CHROMagar orientation and were presumptively identified according to manufacturer instruction. The identity of all isolated microorganisms was then confirmed by conventional identification tests and compared with the results obtained from CHROMagar orientation. In this study, the sensitivity and specificity of CHROMagar orientation to identify entrococci, solely, were 100% and 40.8%, respectively. Although CHROMagar orientation was rapid and sensitive method for identification of entrococci in urine culture, CHROMagar orientation alone appeared not to be very specific for entrococci and needed to be combined with other tests for greater exclusivity. So, CHROMagar orientation media is not recommended for routine usages in medical laboratories in Iran

Role of TCD4 + cells and cytokines in response to treatment in cutaneous leishmaniasis

Cutaneous leishmaniasis is one of the protozoal diseases in which%90 of cases occurs in Iran, Afghanistan, Syria, Saudi-Arabia, Brazil and Peru.Mashhad is one the most important foci of infection in our country. Various responses and prognosis to specific treatment in different patients from one side, and importance of IFN gamma and IL-4 producer cells on the other side impressed us to study the profile of lymphocytes and their subtypes by flow cytometry in patients with cutaneous leishmaniasis. The study was conducted in Ghaem Hospital and Bu - Ali Research Institute, Mashhad University of Medical Sciences, on 36 patients with cutaneous leishmaniasis from August 2001 until October 2002. Lymphocytes were counted and cultured to determine the cytokines. While cells were stimulated by phorpol 12-myistate 13-acetate [PMA], Inomycin and Monensin, cytokines were measured and analyzed, using different conjugate monoclonal antibodies [e.g. anti-IFN gamma - PE etc,], obtained from IQ Products Co., The Netherlands. In this project, the percentage of different responsible immunity cells in 29 subjects were [who carried out the survey] determined by F.C.S before and after medication. In our study, Thl in the whole population of the patients as well as 22 patients of group 1 who gave a positive response to the treatment showed a significant increase as [P=0.016] and [N 0.069], comparing with the control group. The present results show resemblance with the results obtained in most of the previous studies. Mean while, the Thl of the whole patients as well as the patients in group 1 involved in this study, shows a significant decrease, that is [N 0.063] for the whole patients and [P= 0.0039] for group 1, after the treatment in comparison with the status before the treatment. Perhaps, the toxic influence of medicine and stimulation of lymphocytes by PM.A. [none-specific stimulator] are the reasons for the reduction of Th1 in this group of patients

[Evaluation of cells with CD 14 marker monocytes in patients with cutaneous leishmaniasis before and after medical treatment]

Leishmaniasis is one of the human diseases severity of wich varies from a self limiting cutaneous lesion to a severe visceral form. It is endemic in several parts of the world including our country Iran and especially in the province of Khorasan and the city of Mashhad. The study was intended to evaluate the percentage of monocellular macrophages in 36 patients and to investigate their role in prevention of the disease and its response to the treatment. The study was a case-control study conducted from August 2001 until October 2002 in Ghaem Hospital and Bu-Ali Research Ins. of Mashhad University of Medical Sciences and finally 29 patients were carried out the survey as the study group and 23 people of their families as control group. A blood sample of 10 cc was obtained from both groups before and after treatment. Compelet Blood Counting and CD14 marker studies by flow cytometry for evaluating monocyte percentage were used. Personal, laboratory and treatment data were recorded in a questionare. Qualitive and descriptive statistics were used for analysis. The percentage of monocytes in the whole population of patients was significantly more than control group [p=0.006].The percentage of monocytes in patients who gave a positive response to the treatment [group I] and those who did not recovered after the treatment [group 2] was significantly higher, with a p value of 0.0 13 and 0.015 respectively, comparing with the control group. In order to get a more delicate evaluation, the study was repeated again by flow cytomctry method considering the CD14 marker. The result was similar; percentage of CD14 was increased significantly in whole patients, first group and second group [p<0.001, p= 0.003 and p=0.015 respectively], comparing with the control group. Meanwhile, comparing the three studied groups before and after medical treatment, the percentage of monocytes slightly decreased; the study had a similar result conducted for evaluating CD14 marker. This study suggests the major role of monocytes in revealing the disease and perhaps decreased percentage of monocytes caused by the influence of medical treatment

Clinical appearance, leishmanin test and elisa using monoclonal antibody in diagnosis of different forms of cutaneous leishmaniasis

Introduction: Cutaneous Leishmaniasis [CL] has 2 principal clinical forms in Iran: Anthroponotic and Zoonotic. These forms, previously called Dry and wet forms, are caused by Leishmania tropica and L. major respectively. Formerly, diagnosis of different forms was based on epidemiological status and clinical signs; but at present, definite diagnosis by advanced laboratory tests such as ELISA and Isoenzyme methods is possible. In order to investigate correlation between ELISA test, clinical appearance, and skin test, a study was undertaken in Emam Reza Hospital, Mashhad

Material and Methods: The study population was selected among the volunteers who had suspected skin lesions for C.L. Direct smear, culture and Leishmanin skin test was performed for 153 patients. ELISA using specific monoclonal antibodies [SMA] performed species determination

Results: The minimum and maximum ages of the patients were 19 months and 97 years old respectively. Most of the patients were Females [63.9%]. Among 72 patients whose cutaneous lesions were approved for Leishmaniasis, 91.6% had ulcers with dry appearance and 8.4% had appearance of wet form C.L. The etiologic agents isolated from the skin lesions of the latter patients were L.tropica [66.6%], L.major [28.8%] and unknown form [4.2%]. Among the patients who had skin lesions with wet appearance, the isolated agents were L.tropica [5.6%], L.major [1.4%] and unknown form [1.4%]. The sensitivity of Leishmanin Skin Test was higher in-patients infected by L. major

Conclusion: ELISA method using SMA is a sensitive and reliable test for differential diagnosis of Anthroponotic Cutaneous Leishmaniasis [ACL] and Zoonotic Cutaneous Leishmaniasis [ZCL]. Both ACL and ZCL are present in Mashhad. ACL is three times more prevalent than ZCL. Clinical appearance is not a valid factor for determination of species of Leishmania. The sensitivity of Leishmanin Skin Test is higher in wet form in relation to dry form. There may be other species of Leishmania causing cutaneous lesions in Mashhad

Association between reproductive factors with breast Cancer risk

Introduction: Breast cancer is a worldwide burden in both developed and develop: countries and unless some action is taken, it will continue to grow for the foreseeable futi Hence, diagnosing its risk factors is of great importance

The aim of this study was to investigate the association between menstrual and reproductive fact with breast cancer

Material and Methods: In a case-control study in Mashad loss patients with confirmed bre; cancer were compared with loss healthy women who were patient s neighborhood and matched cases by age and interview. A questionnaire including demographic information as well questions regarding reproductive factors emphasizing abortion were used. Data collect we analyzed using SPSS ver 12

Results: The findings indicated Early age at menarche, age at menopause, late age at first f term pregnancy and fewer number of full term pregnancy significantly associated with breast cam risk

The risk of breast cancer showed an increase in women who had a history of aborti [OR=2.09%95 C1M.2-3.7]. Also women experiencing abortion before their first full te pregnancy showed a higher risk of breast cancer [OR= 5.9 95% CI= 1.8-19.6]

Conclusion: Our findings suggest that decreased parity, early Age at menarche, late age menopause and first birth and abortion were the most important determinants of breast cancer thus authors purpose health interventions about these mothers

[Study the effect of valeriana officinalis and echium amoenum on the liver and renal function tests in rats]

Nowadays herbal medicine is marketing without standard toxicological study. Although people believe that herbal medicine do have any toxic effects, there are some reports indicating the toxicity of the herbal medicine. The aim of this investigation is to study the renal and hepatic effects of Echium Amoenum [EA] and Valeriana Officinalis [VO]. Percolated extract of these plants with doses of 100 and 200 mg/kg was administered to 5 groups of rats via orogastric tube for 7 days. At the 8th days, the blood samples were taken for biochemical studies. The results showed significant variation of the levels of AST. ALT and AlkP in comparisons with control groups. AlkP was increased significantly after oral administration of two extracts with dose of 100 mg/kg and 200 mg/kg. ALT was decreased with dose of 100 and 200 mg/kg of VO significantly but AST increased significantly only with dose of 100 mg/kg. ALT was decreased with dose of 100 mg/kg of EA but increased only with dose of 200 mg/kg. [p<0.01]. AST did not change with dose of 100 mg/kg, but decreased significantly with dose of 200 mg/kg [p<0.01].Renal function tests including BYN [Blood Urea Nitrogen] and Creatinine did not change significant after oral administration of two extracts. The data of this investigation indicate that hepatotoxic effect of extract of EA was greater than VO especially at high dosage

Artillery shell fragments in the heart: diagnosis and management

Delayed evaluation and management of penetrating cardiac injuries especially mortar fragments were performed in 30 war victims in the Shahid Rajai Heart Hospital, Tehran. All were men with a mean age of 20.7 years. Pleuritic chest pain was the most common symptom [53.3%], while physical examination was negative in the majority of cases [66.8%]. 50 percent of the cases had pericardial effusion on the echocardiogram. The right ventricle was the most frequent site of involvement [26.6%] followed by the left ventricle [16.6%], right atrium, left atrium, aorta [each 13.3%], pulmonary trunk [10%], and inferior surface of the heart [6.6%]. More than half of the cases had associated hemothorax. Shell fragments were removed in all cases but two. Fragments larger than one centimeter in the vicinity of the heart structures in the pericardium are recommended to be removed