Journal of Mazandaran University of Medical Sciences
Year:2013 | Volume:22 | Issue:97|Papers Count:29

Background and purpose: Despite the availability of typical and atypical antipsychotic drugs, a large number of patients with schizophrenia do not show a good response to monotherapy with these drugs. This study was done to evaluate the effect of purslane on psychological symptoms of schizophrenic patients.Materials and methods: This randomized clinical trial was carried out in 60 chronic schizophrenic patients treated with risperidone in Sina hospital Joneghan, Iran during 2011-2012. The patients were randomly divided into intervention and control groups. The control group received risperidone 6mg/day and Biperiden 4mg/day for eight weeks. The Patients in the interventional group received 1gr extract of purslane daily with the same regimen for eight weeks. The scales for assessment of positive symptoms (SAPS), assessment of negative symptoms (SANS) and CRP level were recorded prior to and 8th week after the study. The data was then analyzed using SPSS V.16.Results: At the end of study, the mean score of positive symptoms were 47.93±18.56 and 57.1±14.83 in intervention and control groups, respectively (P<0.05), and the mean score of negative symptoms were 40.83±11.03 and 46.13±9.34, respectively (P<0.05). The CRP levels of patients in intervention and control groups were 0.53±0.55 and 1.72±0.73, respectively (P<0.05).Conclusion: According to findings using purslane as an adjunct to respridone can improve psychological condition of chronic schizophrenic patients and decrease their CRP levels.

Background and purpose: Hyponatremia is the most common electrolyte disorder in hospitalized patients and different report exists about its prevalence. This study aimed at determining the frequency of hyponatremia and its associated factors in hospitalized tuberculosis (TB) patients in Razi hospital, Iran.Materials and methods: This cross-sectional study was done using the existing data and the study population included all TB patients admitted in Razi Hospital during 2006 to 2011. TB was diagnosed based on clinical symptoms, positive sputum culture, positive radiographic finding and anti TB treatment. Variables included level of Na, age, sex, and drug regimen (standard/second line).Hyponatremia were sodium levels less than 135 in two consecutive tests. The data was analyzed by SPSS and Chi-square test.Results: The cases were 200 TB patients including 115 (57.5%) male. The mean age of patients was 51.2±20.8 years. Hyponatremia was seen in 36 (18%) patients (CI 95%: 12.6% -23.4%). Distribution of mortality was not significantly different in patients with and without hyponatremia (P>0.05). No significant difference was seen in frequency of hyponatremia according to the type of tuberculosis.Conclusion: Hyponatremia was considerably higher in patients with TB which should receive more attention for proper management and follow up.

Background and purpose: Cognitive models refer to the effect of early maladaptive schemas in formation of psychology pathologies in establishing psychological problems. This study aimed at determining the relation between early maladaptive schemas with procrastination and mental health of medical and non-medical students of Shahid Beheshti University of medical sciences.Materials and methods: This correlational descriptive study was done using procrastination questionnaire (GP), early maladaptive schema of Yang (YSQ-SF) and General Health Questionnaire (GHQ-28) were applied to collect the data. The data was analyzed using SPSS.Results: The subjects included 462 students including 232 medical students and 230 non-medical students who were recruited according to accessibility features. There results showed a significant correlation between early maladaptive schema and procrastination and mental health in medical and nonmedical students.Conclusion: This study verified the role of early maladaptive schema in psychological pathology and procrastination. However, further studies should be carried out to define and clarify the cognitive content of any psychological malfunction.

Background and purpose: Nanotechnology researchers have identified a wide range of nanoparticle uses that may have an important role in medicine, prevention and treatment of diseases. Paucity of information on toxicity of silver nanoparticles made the authors to evaluate the effect of silver nanoparticles on the enzyme creatine phosphate kinase.Materials and methods: In this study, 40 adult male Wistar rats with average weight of 220 ± 20 gr were injected with 50, 100, 200, and 400 PPm of nanosilver particle in five consecutive days.Then three, eight and twelve days after the last injection, blood sampling was performed and skeletal tissue samples from the muscle were stained using hematoxylin- eosin. To investigate the effect of nanosilver on Phospho creatin kinase ANOVA was used in different days.Results: Different concentrations of silver nanoparticles has no significant effect on the phospho creatin kinase activity (P=0.841), but the effect of time was apparent on this activity (P=0.005). In fact the mean of the phospho creatin kinase activity increased in all concentrations of nanosilver after eight days.Histological changes were also occurred in 400 PPm doses of silver nanoparticles.Conclusion: Development of nanotechnology has increased its use in cosmetic and medical supplies. So precautions are needed when using appliances containing silvre nanoparticle.

Background and purpose: Breastfeeding is the best method of nutrition for infants and would lead to better somatic growth and neurologic development. It is an effective factor in decreasing infant morbidity and mortality. Inadequate breastfeeding results in complications such as failure to thrive, dehydration, uremia, azotemia and hypernatremia. The aim of this study was to assess the incidence of failure to thrive due to inadequate breast milk intake.Materials and methods: This descriptive study was performed in 300 neonates born in Imam Khomeini Hospital in Sari, 2010. We compared the weight of the neonates at birth and by 7-10 days of age. Weight loss more than 10% was considered as failure to thrive. In this research SPSS V.13 was used to analyze the data.Results: From the total of 300 participants 20 (6.6%) neonates showed more than 10% weight loss in the first two weeks of life. The mean percentage of weight loss was 15.42±6.24. Failure to thrive was statistically correlated with less than 34 weeks gestational age. The majority of mothers were not aware of their babies' weight loss. In the course of the study two patients (0.7%) were severely dehydrated and admitted to the neonatal intensive care unit.Conclusion: In spite of instructions for breastfeeding shortly after delivery, failure to thrive occurs due to inadequate feeding in breastfed newborns. Therefore, early follow up of the breastfed mothers and neonates should be done to assess the weight gain in neonates.

Background and purpose: Road accidents are a major cause of mortality throughout the world especially in undeveloped and developing countries. Mazandaran Province in Iran has one of the busiest roads with a high rate of accidents and fatalities. Environmental and social conditions influence this problem. This study aimed at exploring the social and geographical pattern of mortality due to road accidents and hazardous regions of Mazandaran province were also determined.Materials and methods: This ecological study used the data from 2007-2010 recorded in Mazandaran province. The Information regarding the age, sex and place of accidents were collected. To analyze the data descriptive and inferential statistics were done using SAS (version 9.2).Results: A total of 2828 fatalities were found during the study period from which 78.7% were men and 21.3% were women. The mean age of men and women were 39.06 and 39.1 years, respectively.Mortality rate was higher in urban roads and among men (P<0.001). A significant correlation was seen between population density and mortality rates (P<0.032). Geographical pattern showed a higher risk of accidental mortalities in central to western regions of the province.Conclusion: The correlation between mortality rate and population density indicates lack of access to emergency services, delays in treatment of the injured person, and long distances to reach the nearest hospital. Therefore, more preventative programs should be carried out in hazardous areas to reduce the fatality rate.

Background and purpose: The newly updated American Diabetes Association guidelines based on evidence-based medical practice have proposed screening of the patients for neuropathy at the time of diagnosis with type II diabetes mellitus. However, the complex and extensive clinical manifestation of diabetic peripheral neuropathy and lack of objective evaluation indexes makes this screening rather troublesome. The goal of this study was screening of sensory peripheral neuropathy in type II diabetic patients in Ahvaz, Iran.Materials and methods: Our study population consisted of 150 patients treated for diabetes mellitus in the Clinic of Diabetes at the Ahvaz Jundishapur University of Medical Sciences. Nonrandomized sampling method was used to select the participants. All patients were tested for sensory neuropathy using two different modalities of testing: 8 and 10 gram Semmes-Weinstein Monofilaments Examinations. In next phase nerve conduction velocity was examined. Then, sensitivity and specificity of 8 and 10 gram Semmes-Weinstein Monofilaments were analyzed.Results: Gram Semmes-Weinstein Monofilament had a sensitivity ranging from 30.8% to 64.1% at sites 1-10 while its specificity ranged from 64% to 89.2%. The sensitivity and specificity of 8 gram Semmes-Weinstein Monofilament were 28.2 to 64.1% and 62.2% to 88.3%, respectively.Conclusion: Semmes-Weinstein Monofilament is believed to be the best choice for clinical screening that has a good predictive ability for the risk of ulceration and amputation among people with diabetes.

Background and purpose: Practical use of cytology in diagnosis of skin cancers is limited due to lack of information regarding its reliability and accuracy. This study assessed the diagnostic value of scraping cytology in superficial skin cancers.Materials and methods: We compared papanicolaou stained glass slides of scraped samples of 60 suspicious skin lesions to H and E stained histologic sections for the diagnosis and typing of malignancy. The performance of cytodiagnosis was assessed by determining its specificity, sensitivity and accuracy.Results: Histological examination showed 50% malignancy among the patients. Cytology agreed with the diagnosis of the nature of lesions (93.3%) and in 56.60% of the histology of skin lesions.Misdiagnosis occurred in 6.7% of the cases. Sensitivity and specificity of scraping cytodiagnosis in malignant cases were 90% and 96.6%, respectively. The false negative rate was 10% (3.30) and the false positive rate was 3.4% (1.30).Conclusion: According to this study scraping cytology could be a reliable and simple method for diagnosis and typing of superficial skin cancers, but further pooled studies should be done to verify its true accuracy.

Background and purpose: Acetaminophen is one of the most popular analgesic and antipyretic drugs and its overdose can cause severe damage to liver and kidneys in human and animals. Renal dysfunction and acute renal injury can occur without damage in the liver. Unlike kidney damage, mechanisms of liver damage are poorly understood. The aim of present study was to investigate the protective effect of curcumin, derived from Curcuma longa, on acetaminophen-induced kidney damage.Materials and methods: This study was performed in rats that were divided into five groups.Group I as control, group II was i.p. injected with curcumin (200 mg/kg b.w). Group III received DMSO as vehicle control. Group IV was treated with a single dose of acetaminophen (1000 mg/kg b.w, i.p.), and group V that received acetaminophen+Curcumin. After 24 hours, all rats were sacrificed with mild anesthesia. Urea and creatinine levels were measured in the plasma, and the levels of lipid peroxidation (TBARS) and superoxide dismutase (SOD) and catalase (CAT) activity in the kidney and total antioxidant capacity of plasma (TAC) were determined. Data analysis was done using SPSS and the differences between the groups were analyzed applying t-test and Mann Whitney tests at the significance level of 0.05.Results: Administration of acetaminophen caused elevated level of urea and creatinine in plasma and TBARS in kidney. While the activities of SOD and CAT decreased in kidney tissue. Curcumin with acetaminophen decreased the urea, creatinine and TBARS levels significantly but it significantly increased the activity of SOD, CAT, TAC.Conclusion: Our results showed curcumin as the potent protective agent against acetaminophen induced biochemical alterations and oxidative damage in rats. However, further studies are necessary to identify the curcumin's mechanism of biochemical reaction before clinical application.

Background and purpose: Only correct and effective Cardiopulmonary resuscitation (CPR) can increase the survival probability of patients with cardiopulmonary arrest. Therefore, assessing and controlling the CPR performance is of great importance. The aim of this study was to determine the CPR skills and knowledge of medical students in Mazandaran University of Medical Sciences.Materials and methods: Eighty students of medicine in their internship participated in the study. Theoretical knowledge of students on CRP was assessed through a questionnaire. Then all the subjects performed CPR on a resuscitation manikin. To analyze the data t-test and ANOVA were done in SPSS ver.16 Results: None of the participants was completely competent in performing CPR. Among the students 32 (40%) believed emergency medicine courses as the best resource for proper learning of CPR.Thirty eight (47%) participants stated their level of proficiency in CRP as preliminary while the study showed poor theoretical knowledge among 50% of the subjects.Conclusion: This study underscores the necessity of compulsory CPR trainings for all medical students and re-assessment of their CPR skills. Moreover, establishing new strategies for CPR education should be taken into account.

Background and purpose: Systemic mycoses can cause a tremendous variety of health problems. In this study, the prevalence of systemic mycoses infections was determined in patients admitted to Kerman teaching hospitals for six months.Materials and methods: This descriptive study was conducted in 104 suspected samples of systemic fungal infections collected from hospitalized patients. Direct smear and culture was done for fungal observation. The results of endoscopy and radiology were used in the diagnosis of systemic mycoses infections.Results: In this study we found 74 (71.1%) patients with systemic mycoses infections, 3cases (2.9%) of Dermatophytes and 27 cases (26%) were negative since no fungal elements was seen among them. Blood samples were found as the most infected samples which involved 49 samples with systemic fungal infection. The main causes of fungal infection were Candida, Saprophytic and Zygomycetes.Conclusion: The statistical results of this study suggest systemic fungal infections as the most important problems in the course of treatment among patients admitted and those who are more likely to be infected.

Background and purpose: Nowadays delivery of unnecessary medical interventions has led to adverse outcomes in mother and infant. This study compared maternal outcomes in nulliparous women in labor, in two methods of physiological and traditional delivery.Materials and methods: This single blind clinical trial was performed in 370 nulliparous mothers in Talesh Shahid Nooraani Hospital. The subjects were randomly assigned into physiological and conventional delivery (group A and B) through Rand List. The intervention for both group included aromatherapy, pelvic exercises with ball, back and stomach massage during contractions using Lavandula oil, and an accompanying person in active phase of labor. The data was collected through observation and interviewing the mothers using a checklist of five parts including: profile of subjects and assessment of first, second, third, and fourth stages of delivery and also ten days after delivery. T-test and chi-square were used in SPSS (ver13) to analyze the data.Results: The rates of cesarean section in groups A and B were 11.4% and 35.1%, respectively (P<0.05). The incidence rate of infection was significantly lower in group A (5.9%) compared with that of the group B (14.1%) (P<0.05).Conclusion: Attention to the physiological process of labor and avoiding unsuitable medical interventions could reduce maternal outcomes. Therefore, prenatal care educations could inform the mothers about normal delivery process.

Background and purpose: Happiness is comprised of at least three components: emotional, social and cognitive. The emotional aspect results in positive expressions, the social aspect leads to expanded positive relationships with others and cognitive component creates a thinking which optimistically interprets daily events. This study evaluated the level of happiness and some influencing factors in medical students of Mazandaran University of Medical Sciences.Materials and methods: This descriptive cross-sectional study was done in all medical students (n=356) who were consent to fill the questionnaire. The "Oxford Happiness Questionnaire" with a demographic questionnaire were completed by the students. The scores were analyzed by calculating mean scores of different groups and t-test and ANOVA using SPSS ver.17.Results: From the total of 356 medical students 208 handed the questionnaires. The mean score of happiness of medical students was 41.23. The mean score of happiness was significantly high (42.87) among students of medicine aged 18-22 years while it was lower (38.79) among those aged 22-31 years (P=0.027). The mean score of happiness for medical students with physical disease was (35.06) which was lower than that of the healthy students (41.9) (P=0.039). Findings from the study of five inventory factors showed different levels of self-esteem among male and female students of medicine (P=0.005).Conclusion: The findings showed no relationship between sex, marital status, residential status and happiness among medical students but age and physical health influenced their level of happiness.

Background and purpose: Friendly behavior (as a one of the main characteristics of positive affect), and positive and negative feelings about body image can influence life satisfaction among women. This research aimed at determining the relationship between friendly behavior and body image with life satisfaction in women.Materials and methods: The research sample consisted of 200 women, aged between 20 to 25 years who were selected through random cluster sampling method in Shahrood, Iran. Friendly behavior scale, body image questionnaire and satisfaction with life scale were used. The data was analyzed using Pearson correlation coefficient and multiple regression analyses.Results: Results showed positive correlation between friendly behavior (r=0.30) and body image (r=0.66) with life satisfaction in women (P<0.001).Conclusion: This study showed that friendly behavior and body image highly influence (62%) life satisfaction among women.

Background and purpose: Clostridium botulinum bacteria produces seven types of botulinum neurotoxins among which types A, B, E and F are responsible for human botulism. One of the treatments for botulism is the inhibition of botulinum neurotoxins catalytic domain activity by inhibitors. In this study, botulinum neurotoxin type E catalytic domain has been cloned in pET28a vector and expressed in E. coliBL21 (DE3).Materials and methods: In order to cloning of the catalytic domain, the genomic DNA was extracted. The sequence was amplified by Polymerase chain reaction (PCR) and was inserted into pGEMT Easy vector. Then, the recombinant vector was transferred toE. coli DH5α cells. Afterwards, the cloning product was removed from pGEM-T Easy vector and inserted into pET28a vector using ligation reaction. Finally, the recombinant pET28a was transferred intoE. coli BL21 (DE3) cells. Expression of catalytic domain was studied in standard conditions.Results: The results of enzymatic digestion and PCR reaction confirmed that cloning and subcloning occurred in pGEM-T Easy and pET28a vectors, respectively. The process was verified by sequencing. Finally, expression of this sequence was confirmed by the sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE) and Western blot analysis.Conclusion: The cloning of the sequence was accurately conducted in pGEM-T Easy and pET28a vectors. Also, the results showed that the expression of this sequence has been performed properly.

Background and purpose: Prostate cancer is one of the most prevalent diseases among men. The role of heredity in prostate cancer has been proved by epidemiologic studies. By utilization of prostate specific antigen (PSA) and digital rectal exam (DRE) we could diagnose the disease before the clinical manifestation and implement screening programs. The purpose of this study was to screen the prostate cancer in individuals over 40 years of age who were first degree relatives of prostate cancer patients.Materials and methods: This cross-sectional study was conducted in relatives of confirmed prostate cancer patients during 2010-2011 in Babol. After giving verbal informed consent, 103 individuals (brothers and sons) were recruited. We examined PSA and DRE during the screening program. Quadrant biopsies were performed if the PSA level was greater than 4 ng/ml or DRE was suspicious.Results: The participants aged between 40-60 years old and the mean age was 51±8.88. The screening tests results showed that 15 cases were abnormal in which six cases (5.8%) had a PSA level of greater than 4 ng/ml, six (5.8%) had a suspicious DRE and 2.9% were found with suspicious findings on both tests. At the second stage of the study, biopsy was done for those who had abnormal screening results. However, eight people refused to continue the study and the biopsy was taken from others.According to pathology results, malignancy was confirmed in three cases and the detection rate of prostate cancer was 2.9% (95% CI: 0-6.1).Conclusion: Our results emphasize the usefulness of PSA and DRE to detect early prostate cancer in high risk families.

Background and purpose: Health organizations consider behavior as one of the main causes of today's common diseases and health problems. In order to modify behavior and also to reduce occupational risks, it is always recommended to combine ergonomics interventions with health promotion activities. This study assessed the impact of educational interventions based on theory of planned behavior on safety behavior of workers in Qazvin industrial Town, 2009.Materials and methods: This quasi-experimental randomized controlled trial was done in 150 workers who were assigned into intervention (n=75) and control (n=75) groups. Demographic information and data regarding theory of planned behavior (TPB) constructs, and knowledge and safety performance were recorded two weeks before the intervention, and three months and six months after the intervention using a questionnaire and safe operation checklist. Panel of Experts, Cronbach's coefficient alpha, test-retest reliability coefficients, and Kappa coefficients were used to confirm the psychometric properties of measurement tools. Educational intervention was carried out through group discussion according to TPB constructs in four training sessions of 45-60 mins attended by 8-15 people in each class. The data was analyzed using SPSS ver.16, Chi-square, Mann-Whitney, ANOVA, Repeated measure ANOVA.Results: The mean age of participants was 31±7.4 and 65% were male. There was no significant difference between the two groups regarding demographic features and the study variables. But the results after the training sessions showed significant increases in the mean scores of attitude (from 17.2±5.3 to 25.6±4.5, P<0.001), subjective norms (from 4.7±2.1 to 7.0±1.5, P<0.05), perceived behavior control (from 2.7±1.1 to 6.8±1.6, P<0.001), intention (from 8.0±3.6±10.9±2.8, P<0.05), self-report behavior (from 2.2±1.0 to 3.6±1.2), knowledge (from 7.0±1.8 to 9.8±1.5), and safety behavior (from 6.3±1.5 to 8.5±2.1, P<0.05) in experimental group. But no significant changes were found for these variables in the control group.Conclusion: The results showed that educational intervention is able to change the consciousness, attitude, perceived behavior control, subjective norms, intention and safety behavior of workers and improve their safety performance. Therefore, applying this model of change in behavior is recommended in other settings.

Background and purpose: The need to find new antiviral compounds is increasing due to the emergence of resistant strains and toxicity of currently available HIV drugs. In this research the inhibitory activity of a number of novel iron chelating compounds derived from 3-Hydroxy-4-pyridinosnes was studied.Materials and methods: Single cycle replicable (SCR) virion was produced by transfection of HEK293T cells with pmz NL4-3, pSPAX2 and pMD2G plasmids. HEK cells were infected with SCR virus and the production of new virions was evaluated by p24 ELISA. Also, cytotoxicity of these compounds was investigated by XTT method and then the effect of compounds on viral infection was examined by GFP-expressing virions.Results: PhH, PhHB, DNB, TsB, AbphE and Adlb compounds had the ability of inhibition of virus production insofar as PhH, PhHB, DNB, TsB, AbphE and Adlb inhibited the viral production with IC50 of 63, 43, 10, 73, 12 and 78mM, respectively. DNB and AbphE showed high toxicity for target cells (CC50 of 113 and 112mM). Similar activity was found in single round infection assay compared to the results of replication study.Conclusion: This study found derivatives of 3-Hydroxy-4-pyridinosnes effective in preventing the HIV virus. Compounds with high anti-viral potential and low cytotoxicity are promising candidate for more anti-viral studies.

Background and purpose: Bacteremia is one of the most common infective diseases. Rapid diagnosis of bacteremia could be of great benefit in treatment of the disease and could result in a successful treatment by prescribing effective antibiotics. Bacteremia due to Enterococcus faecalis is more common in hospitals and resistant strains are the usual causes. Routine method for diagnosis of bacteremia is time consuming and more rapid assays are preferred. The aim of this study was evaluating a PCR assay for rapid diagnosis of bacteremia in rat model similar to human bacteremia.Materials and methods: To establish experimental bacteremia we used a standard strain to prepare suspensions with 108 cfu/ml bacteria for inoculate into 10 rats. Blood samples were taken from all rats after 24, 48, and 72 hours. PCR and routine assay was performed for all rats' specimens. Ten blood samples of healthy rats were used as control cases.Results: Culture was positive for all specimens. Two specimens were found positive in PCR in the first day, seven samples in second day, and eight specimens in third day after inoculation. Routine and PCR assays were negative for all control samples. Sensitivity and specificity of PCR were 69.8% and 100%, respectively.Conclusion: PCR is a more rapid assay than routine method for diagnosis of bacteremia and could be very effective on successful treatment. Therefore, it could be considered as an alternative method for culture but for increasing sensitivity of the test, we recommend using a more efficient DNA extraction method.

Background and purpose: Diazinon is an organophosphate insecticide used mainly in agriculture, horticulture, and animal husbandry. Exposure to diazinon affects the redox process, the activity of antioxidant enzymes and could increase the lipid peroxidation in many organs. This study aimed at examining the chronic effect of diazinone on cell membrane lipid peroxidation and the protective effect of l-carnitin on this process.Materials and methods: In this study, male Wistar rats were divided into 8 groups. The groups were administrated normal saline (control group), diazinon (20 mg/kg), l-carnitine (50, 100, 150 mg/kg), and a combination of diazinon with the mentioned doses of l-carnitine, intraperitonealy (IP) for 4 weeks.The rats were anesthetized with ketamine 24 hours after the last injection and 2 ml blood was taken from their heart. Then, Lappena method was used to measure the serum concentrations of malodialdehiyde (MDA). The data was analyzed using SPSS and the differences between the groups were analyzed applying cruskal-wallis and Mann-Whitney test at the significance level of 0.05.Results: The serum concentration of MDA was significantly higher in rats exposed to diazinon compared with the control group (P=0.009). A significant decrease was seen in the serum concentration of MDA in the groups exposed to diazinone/l-carnitine (P=0.014).Conclusion: Diazinon induce the production of free radicals and oxidative stress. Probably, lcarnitine can reduce diazinon-induced lipid peroxidation in cell membrane by scavenging free radicals.

Background and purpose: Coma results from brain damage and patients in intensive care units (ICU) are often more at risk for sensory deprivation. This study compares the effects of familiar and unfamiliar voices on recovering the consciousness level in comatose patients.Materials and methods: This double blind clinical trial (patient and assessor) was performed in 45 traumatic comatose patients with Glasgow Coma Scale (GCS)≤8 within the age range of 15-75 years, admitted to ICU training centers affiliated to Mazandaran University of Medical Sciences. The subjects were randomly allocated into three groups. Group A was stimulated with a familiar voice, group B’s auditory stimulation was done by the researcher introduced as a nurse) and no intervention was done for group C (control group). The interventions were conducted twice a day for 1-5 minutes. The level of consciousness was measured using the GCS scale. To analyze the data descriptive and inferential statistics (Logrank Test) were used.Results: In the day before the intervention the mean levels of GCS in groups A, B, and C were 6.40, 5.66, and 5.53, respectively. Logrank test revealed significant differences between the groups in the time to reach CGS=15 which happened sooner in group A (P<0.0001).Conclusion: Familiar voice could highly influence the auditory level of patients in ICU. Therefore, auditory stimulation programs are recommended for comatose patients.

Background and purpose: Implementing medical ethics rules and patients' bills of right are necessary in achieving high quality health care services. The present study was performed to assess the implementation of patients' bills of right from the physicians and nurses' viewpoints, working in Mazandaran University of Medical Sciences Educational Hospitals.Materials and methods: This descriptive-cross sectional study was done using stratified random sampling in 487 physicians and nurses working in four educational hospitals in Sari, 2012. The data was collected using a two-section questionnaire including demographic characteristics and likert type scale regarding implementation of patients' bills of right. Analytical tests including Mann–Whitney U and Kruskal-Wallis were performed to analyze the data.Results: The mean score for patients' bills of right was 2.65±0.83 from their own points of view. The least score was for respecting the patients, their privacy and indiscrimination (2.09±1.03) and the highest score was seen in the right to choose and making decision freely (2.82±0.94).There was a significant difference between the physicians and nurses' mean scores for implementation of patients' bills of right in which physicians believed in poor implementation (P=0.006). The implementation of patients' bills of right was followed the least in internal ward (2.30±0.72) and the most in psychiatry ward (2.85 ± 0.99) (P=0.003).Conclusion: The patients' bills of right is not fully implemented by physicians and nurses working in educational hospitals. Therefore, necessary actions are needed to remove barriers against patients’ bills of right and to facilitate its implementation in hospitals.

Background and purpose: In most cases, drugs used for chemotherapy are ineffective and have unpleasant side-effects. This has made scientists to find more effective drugs with less toxicity. Lagenaria siceraria is an important medicinal plant in the world and anti-tumoral activity of Lagenaria species has been reported in some studies. This study was designed to evaluate the anti-tumoral effect of methanolic extract isolated from Lagenaria siceraria on lung cancer cell line.Materials and methods: Hydroalcoholic extract of Lagenaria siceraria was prepared by percolation method. Cultivated cancer cell line of lung (A549) was incubated with different concentrations (0.1, 1, 10, 100, 250, 1000, 500, and 5000 mg/ml) of the extract for 72 hours and cell growth inhibition was determined using MTT assay. Cisplatin was considered as positive control. The resulting data was analyzed using ANOVA and t-test.Results: Results of MTT assay showed strong and dose-dependent inhibition of cancer cell growth by the extract of Lagenaria siceraria. This extract caused a significant decrease in proliferation of lung cancer cell line (IC50=93.094±6.5 mg/ml).Conclusion: The results of this study suggest anti-tumoral activity of Lagenaria siceraria, however, isolation of efficient compounds of this extract and evaluation of their effects on tumor-bearing animal models are suggested.

Background and purpose: Vitiligo is a common acquired pigmentation disorder. There are various therapeutic options for the treatment of vitiligo which bare some limitations due to their side effects.Recently topical immunomodulators (TIMS) such as topical Pimecrolimus have been used for the treatment of vitiligo in children as safe and efficient therapeutic options. This study compared the efficacy of the combination therapy of Pimecrolimus 1% cream and Mometasone cream with either agent alone in the treatment of childhood vitiligo.Materials and methods: In a nonrandomized double blind interventional study, 50 patients were enrolled. In each patient three lesions was selected. Topical Pimecrolimus cream 1% was applied to the first lesion twice daily, topical Mometasone furoat 0.1% ointment was applied for the second lesion every night, and Pimecrolimus cream 1% and topical Mometasone ointment 0.1% were applied to the third lesion twice/daily for the first five days. Topical Mometasone furoat 0.1% ointment was used at nights for the rest of the days of the week. All three treatments were administered simultaneously over three months. The data was analyzed using SPSS V.20.Results: Forty patients completed the study period whose mean age was 10.6 years and 46% were male. Significant decreasing trend was seen in the lesions size over time (P<0.0001). However, this decreasing trend was not statistically significant among the three treatment groups at the end of the study (P=0.5).Conclusion: In this study combination therapy had no any advantage to either Pimecrolimus or Mometasone. However, due to the limited number of patients in this study, further studies with large sample sizes are needed to evaluate the efficacy of this type of combination therapy and other combination therapies.

Background and purpose: Ammonia in form of ammonium ions pollutes the acceptor water through industrial, domestic and agricultural wastewater. Ammonium ions are toxic and could decrease the dissolved oxygen in water and endanger the aquatic life. One of the conventional methods for removing ammonia from water and wastewater is exchanging the ions using zeolites. The aim of this study was to assess the efficacy of zeolite Clinoptilolite in removing ammonia from water, in both batch and continuous systems.Materials and methods: In this study batch experiments were exposed to different concentrations of natural Clinoptilolite (5, 10, and 50 g/l) with aqueous solution containing ammonium ions (1, 5and, 10 mg/l) in different exposure times (10 to 240 minutes). The continuous experiments were also conducted at ammonium concentrations of 5 and10 mg/l.Results: The maximum ammonium absorption occurred at pH=7 and in 60 minutes exposure time. Increase in initial concentration of ammonium increased the sorption capacity. Also, sorption capacity decreased when the absorbent material increased. Considering higher correlation coefficient (R2) the isotherm obtained in this study matches the Freundlich isotherm model. The results of column tests showed longer time to reach the breakpoint when initial concentration of ammonium decreased.Breakpoints for ammonium concentrations of 5 and 10 mg/l were 6.45 and 6.32 mg/g, respectively.Conclusion: This study proved that ion exchange using zeolite Clinoptilolite is a low cost method that could result in complete removal of ammonium from water.

Background and purpose: High concentrations of heavy metals in industrial and domestic wastewater cause adverse effects on the environment and human health. Therefore, removing heavy metals from water resources is considered as a positive step towards sustainable development. Today, application of artificial wetlands to remove pollutants such as heavy metals is increasing due to high costs of construction sites, low operation, maintenance, and energy needs.Materials and methods: This research was carried out in a pilot scale in adjacent of wastewater treatment plant in the campus of Mazandaran University of Medical Sciences. The pilot was composed of four rectangular concrete reactors with 6´1.5´0.8 m length, width and affective depth. One reactor was used as control. The research was performed in five phases. Different hybrid systems of the reactors (combination of vertical and horizontal with parallel and series flow) were evaluated. The samples were digested using an acid digester and concentrations of plumb and cadmium were analyzed using atomic absorption spectrophotometer. The data was analyzed using SPSS.Results: By increasing the hydraulic retention time (HRT) from 2 to 6 days, the mean percentage for removal of studied metals increased to 58 (which was 42 at the beginning). Among the different phases, phase four was more efficient which removed 54% of the heavy metals while the lowest removal percentage was detected in phase one. The average percentage removal of cell output for reed planting and the controls were 65% and 35%, respectively. These differences were statistically significant (P≤ 0.05).Conclusion: The findings of this research showed that combination of DF-UF (down flow-Up flow) reactors was the best condition for the removal of plumb and cadmium from subsurface wetlands. The optimal hydraulic retention time was 4 to 6 days and 10 to 20 mm gravel could be more appropriate for the size of gravel in wetland.

Background and purpose: Suicide is a complex mental phenomenon which is influenced by personal and environmental factors. Increase in number of suicides made the authors to define and explain its etiologies.Materials and methods: In this cross-sectional study, 934 cases from a five year period were studied. The subjects were those who were referred to forensic dissection hall of Fars legal medicine center among whom suicide was the main reason for death. Related questionnaires were completed and the data was analyzed using SPSS V.19.Results: The results showed that the most common etiology for suicide according to the victims' relatives was mental disorder (31.3%).Conclusion: To reduce social pathologies like committing suicides institutions such as families and elementary schools should identify and treat children with early signs of mental disorders.

Hereditary angioedema is a rare disorder of complement system which is often seen with autosomal dominant hereditary. Clinical characteristics include non- pruritic and non-pitting mucocutaneous edema that could involve all parts of the body. This study reports seven cases of hereditary angioedema with classical manifestations accompanied by low function of C1INH (type 2). One death occurred due to laryngeal edema. This case study aimed at increasing the knowledge regarding hereditary angioedema, its early diagnosis and correct managements.

A rare complication of AMI is papillary muscle rupture (PMR), occurring in 1% of patients with acute myocardial infarction (AMI). Mitral regurgitation related to PMR occurs at a median of 1 day (ranging from 1-14 days) after onset of myocardial infarction. PMR tends to occur in those having a first time AMI and those without extensive collateral circulation. PMR involves posteromedial papillary muscle and anterolateral papillary muscle in 75% and 25% of the cases, respectively.We report a 79-year-old man who referred to our hospital with acute severe pulmonary edema. Transthoracic echocardiography showed ruptured anterolateral head of papillary muscle resulting in flail anterior mitral valve leaflet and acute severe MR. Patient undergone emergent coronary angiography and we found normal epicardial coronary anteries. The patient was emergently transferred to operating room and MV was replaced with a bioprosthetic valve. He was discharged after one week, feeling well.This study proves the significant role of accurate transthoracic echocardiography in determining the mechanism of acute MR and planning for prompt treatment.