Journal of Mazandaran University of Medical Sciences
Year:2013 | Volume:22 | Issue:98|Papers Count:47

Background and purpose: Nursing is a stressful job and nurses are always susceptible to health threats in various aspects due to long shifts. Zinc is a trace element that is essential for human health. This study was performed to assess the effect of zinc supplement on general health of nurses working in intensive care units (ICU).Materials and methods: This double blind randomized clinical trial was performed in 46 ICU accessible nurses from Imam Khomeini and Fatima Zahra hospitals (Sari-2011) with general health disorder (n=23 intervention and 23 control). In intervention group zinc sulfate 220 mg capsules were administered twice daily every 78 hours for a month while for the control group placebo were administered in the same way. General health and serum zinc level were measured pre and postintervention.Data was obtained using demographic and standard general health questionnaires. For data analysis we applied SPSS ver.18, chi square, t-independent, paired t-test and kolmogorov-smirnov tests.Results: In the intervention group the mean of general health score was 23.04±9.54 after a month and in the control group it was 27.96±13.82, (P=0.298). Among the four aspects of public health, significant improvement was observed only in physical symptoms in the intervention group (P=0.044).After a month the mean levels of zinc were 73.57±13.4 and 59.67±14.3 in the intervention group and in control group, respectively. The study showed significant increase in level of zinc in the intervention group (P=0.034).Conclusion: This study indicated a low level of zinc serum in nurses working in ICU. The zinc supplements showed positive effects on some aspects of general health, hence, administrating zinc supplements could be of great benefit in enhancing the general health among nurses.

Background and purpose: Coronary artery disease (CAD) is the first cause of death in modern societies. It is also the first cause for individual health care cost. Multiple risk factors are mentioned for its development among which elevated uric acid is recently introduced as an inflammatory factor. This study was performed for evaluating the serum uric acid level and severity of CAD determined by coronary angiography in patients with chronic stable angina after considering and adjusting other risk factors such as age, smoking (C.S), hypertension (HTN), hyperlipidemia (HLP) and diabetes mellitus (DM).Materials and methods: This cross-sectional analytic study was performed in 200 patients with chronic stable angina to determine the relationship between the level of serum uric acid and severity of coronary atherosclerosis in angiography. Other common cardiovascular risk factors including age, DM, HTN, HLP and C.S were also considered.Results: A total of 78 women (39%) and 123 men (61%) were included in the study. There were no significant differences between sex and risk factors including DM, HTN, HLP, C.S, age and serum uric acid level. In the studied population, the mean severity of coronary atherosclerosis score measured by Gensini score was 15.8±10.7 and the mean level of uric acid was 10.5±6mg/dl. Significant correlation was seen in severity of coronary atherosclerosis and level of serum uric acid in the study population (r=0.51, 0.537, respectively P<0.0001). Also, there was significant correlation between coronary atherosclerosis severity and HTN, age, DM and HLP. Multivariate analysis showed 15% contribution of serum uric acid level in developing coronary atherosclerosis.Conclusion: This study showed an independent relationship between serum uric acid level and severity of coronary atherosclerosis.

Background and purpose: Giardia lamblia (G.lamblia) is one of flagellated protozoan pathogens. Giardiasis is the most common human parasite infection in the world, causing a lengthy course of diarrhea. The aim of the present study was to compare five different methods of DNA extraction from G.Lamblia cyst and determining the most efficient DNA extraction method.Materials and methods: This study was carried out in 30 human fecal samples with Giardia infection. To diagnose giardiasis wet mount from feces and staining with Lougol’s stain were performed.The cysts were purified and concentrated in a sucrose gradient. The isolated DNA from cysts was performed using different methods including freeze-thaw cycles, glass beads, and stool DNA extraction Kit (Accu prep); freeze-thaw cycles and Pheol-Cholorform-Isoamil alcohol (PCI); boiling and PCI; sonication and PCI; freeze-thaw and high salt. Then the gdh gene was amplified through single round PCR method.Results: The highest and lowest mean of OD were found in FGK and High salts, respectively.The highest and lowest means of concentration were seen in the freeze-thaw cycles and PCI and the FGK methods, respectively. Moreover, after using the FGK bands of PCR no smears were observed. Also, the lowest time of extraction was detected in FGK method.Conclusion: To remove problems of DNA extraction and decreasing the time of extraction, glass beads along with Accu prep stool DNA extraction Kit (Bioneer) could be suitable and the most efficient method.

Background and purpose: Gallstone is one of the most common problems of hepatobiliary system. Laparoscopic cholecystectomy is a gold standard treatment for this problem. Carbon dioxide (CO2) insufflated in the abdomen for better exposure in laparoscopic cholecystectomy could increase the liver enzyme levels. The goal of this study was to assess the effect of different CO2 pressure (12-16 mm Hg) on liver enzymes in laparoscopic cholecystectomy compared with open cholecystectomy.Materials and methods: In this clinical trial 60 patients were randomly assigned into three groups. The first group had low pressure (12mm Hg) laparoscopic cholecystectomy. The second group had laparoscopic cholecystectomy with high pressure (16mm Hg) and the third group had an open cholecystectomy. To assess the liver enzyme levels we checked the AST, ALT, ALP, LDH, and Bil, before, 24h, and 72h after surgery. Data analysis was done in SPSS ver.15 using repeated measures ANOVA.Results: The changes in liver function tests were significantly different before and 24h after the surgery in first and second group, however, these changes reduced to primary level after 72h. In the group with open cholecystectomy significant changes were seen in AST and ALT levels before and 24h after the surgery which decreased to primary level after 72h. The level of LDH was significantly different before and 24h after the surgery in group one and two.Conclusion: Gas insufflation in to abdomen transiently changed the liver enzyme levels that reduced to primary level after 72h.

Background and purpose: Individual characteristic helps people in better understanding of themselves and others. The purpose of this study was to investigate the gender differences in personality factors in students of Mazandaran University of Medical Sciences.Materials and methods: This cross-sectional study included 394 students (174 male, 220 female) who were randomly selected from Mazandaran University of Medical Sciences. NEO Personality Inventory (NEO-PI-R) scale was used for data collection.Results: The results of this study showed no significant differences in four factors of personality (neuroticism, extraversion, agreeableness and conscientiousness) among both sexes. However, significant differences were found in openness to experience between males and females (P=0.016).Conclusion: According to this study there is no difference between the sexes in personality factors of neuroticism, extraversion, agreeableness and conscientiousness. Therefore, any planning associated with different personality types should be done regardless of gender differences.

Background and purpose: Childhood obesity is an important health issue in Iran, however, there is not enough information about the effects of entertainment media on this issue. The aim of this study was to evaluate the association between the times spent watching TV and playing games with body composition in children aged 6-9 years old in Tehran.Materials and methods: A cross sectional study was conducted among111children selected through multistage sampling from primary schools in Tehran. Information about the time children spent watching TV and playing games was collected using a questionnaire completed by the children’s parents. Moreover, body composition of the children was measured by the Bioelectrical impedance analysis (BIA), and the Actigraph was used to determine the children’s sleep patterns and physical activities. Finally, energy and macronutrient intake data was obtained using 3-day food records.Results: There was no significant gender difference for the time spent watching TV or videos and playing games. Furthermore, we found a significant positive association (P<0.05) between the hours spent watching TV and the fat mass index (FMI). The results revealed no significant relationship between the total fat free mass index (FFMI) and the time spent watching TV or videos and playing games (P>0.05).Conclusion: The findings of the present study show that FMI as a measure of body fat is associated with watching TV. However, further studies are needed to identify the true association between using entertainment media and the alarming rise in childhood obesity and body fat.

Aneurysms of sinus of Valsalva are rare cardiac abnormalities. They are dilatations of the aortic sinuses and are classified as congenital or acquired. If located in the right coronary sinus they are usually ruptured into right heart chambers and frequently a ventricular septal defect coexists with this condition.This paper reports a 30-year-old woman with ruptured aneurysm of the right sinus of Valsalva into the right ventricle. Transesophageal echocardiography examination and transthoracic echocardiography provides precise information about the aneurysms and coexisting cardiac malformations. Aneurysms of sinus of Valsalva even if asymptomatic, has potential risks of expansion, rupture, cardiac failure, endocarditis, embolism and sudden death. This justifies surgical correction, with a low mortality rate in both the short- and long-term. Careful physical examination and echocardiography in our patient led to early diagnosis before appearance of serious complications.

Background and purpose: Gastric cancer is one of the most prevalent cancers with a low-five year survival rate. Some factors such as molecular pathway are associated with the development of disease and metastasis is the most important factor for death. Caspase 9 is initiator CASP of internal apoptosis pathway and have important role in cancer development. Polymorphism of CASP 9 gene promoter could influence the gene activity and cause sensitivity to cancer.Materials and methods: In this case-control study, 100 patients with gastric cancer and 100 normal subjects were considered for caspase 9 promoter gene polymorphism. DNA extraction was performed from white blood cells according to manufacturer protocol. PCR-RFLP was carried out to detect -712 C>T gene polymorphism. Data was analyzed using SPSS V.18 and P<0.05 was considered significant.Results: In the present study 200 subjects including 143 men and 57 women were studied. All subjects were well matched for geographic area and race. The results showed a relationship between increase in allele T and gastric cancer (P=0.095 r=0.0224).Conclusion: Screening of -712C>T caspase 9 polymorphism could be a marker in personal sensitivity to gastric cancer and useful in cancer treatment and prevention process.

Background and purpose: After marked reduction of pertussis during recent two decades the incidence of disease is increasing, particularly in early infancy. The main sources of infection in this age group are mother and other household close contacts. Our purpose was to examine whether administrating prepregnancy pertussis booster dose can induce long-term protection enough to provide higher maternal antibodies levels to their off springs compared with prebooster titers.Materials and methods: Totally 114 healthy 18-35 year-old childbearing age women planning to become pregnant were boosted with one dose of adult type pertussis vaccine. Blood samples were obtained before, four weeks, and one year after boosting. Sera were tested for IgG antipertussis-antibodies using ELISA method. Descriptive statistical method and paired t-test were used to compare the data before and after vaccination.Results: Seroprevalence rate and mean concentration of antibodies at before vaccination were 69.3% and 68.19 (SD 38.46) Eu/mL, respectively which significantly increased to 93.8% and 152.82 (SD 70.31) EU/mL, respectively. One year after vaccination these rates were significantly higher than before vaccination (82.4%, and 107.0 (SD44.75) EU/mL, respectively). Serologically recent pertussis infection was detected in 3.5% of the women.Conclusion: Pertussis booster immunization was safe, well tolerated and highly immunogenic and resulted in immunity which was preserved for more than one year. Further investigations with larger sample size and longer duration are recommended. According to these findings and review of literature, targeted prepregnancy pertussis vaccine boosting may be an alternative strategy to protect young infants.

Background and purpose: Growth disorders in children are important amongst health issues resulting in serious complications. The aim of this case-control study was to determine factors related to growth disorders in 6 month to 2-year old children using multiple regression analysis.Materials and methods: In this study 150 children with growth problems as cases, and 200 children with desirable growth as controls were randomly selected from ten primary health care centers. A questionnaire regarding demographic characteristics, fertility history and nutritional status was completed through face-to-face interview with selected children’s mother. The influence of different factors on undesirable growth was evaluated using multiple logistic regression in SPSS and Stata.Results: The results indicated a significant correlation in type of pregnancy (wanted or unwanted) (OR=2.58), mother’s age (<20) (OR=1.52), number of pregnancies (OR=2.7), gestational age (preterm) (OR=3.8), breast feeding (OR=3.3), type of labor (OR=2.4), multiple pregnancies (OR=2.02), low socioeconomic status (SES) (OR=1.68), and conflicts in the family as a proxy of stress (OR=1.66) with growth problems (P<0.05). Also, some variables such as conflicts in the family, type of pregnancy, birth weight and breast feeding, number of pregnancies and type of labor showed interactional influences.Conclusion: This study showed that some factors are highly associated with growth disorders among which some could predict the growth problems. Parental training on nutritional requirements of children, suitable time of pregnancy, supporting poor people and decreasing stress are recommended to enhance the health of children.

Background and purpose: Non-alcoholic fatty liver disease (NAFLD) is one of the most common causes of increased liver enzymes. The world population are suffering from NAFLD (30% in IRAN, 20% - 40% in western countries, and 5%-30% in Asia-Pacific). The prevalence of NAFLD is higher in hyperlipidemic, diabetic and obese people. This study assessed the preventive effect of sylmarin on the progression of NAFLD/NASH.Materials and methods: This clinical trial was performed in 41 patients with NAFLD referring to gastrointestinal clinics in Sari. The patients were randomly divided into case and control groups. The case group was treated with a tablet containing 140 mg silymarin twice a day for six months and the control group was given placebo for the same period. The data was analyzed using independent t-test, paired t-test and Chi-Square in SPSS.Results: At the end of the treatment period the improvement of steatosis in sonography was more significant in case group (P=0.03). Liver enzymes reduced significantly in silymarin group compared to other group (P=0.002 for ALT and P=0.01 for AST).Conclusion: In this study sylmarin reduced the liver enzymes in the intervention group. Therefore, it could be of great benefit in the treatment of NAFLD.

Background and purpose: Cerebral venous thrombosis (CVT) is the thrombosis affecting cerebral veins and sinus and is a rare condition. The diagnosis may be late or neglected due to the great clinical spectrum of symptoms, various forms of initial presentation and unspecific signs of neuroimaging.Materials and methods: In this descriptive study, the included patients were followed up according to clinical manifestations, diagnostic efforts and clinical suspicions. The information regarding the subjects’ age, gender, clinical presentation, diagnostic efforts and classified treatment results were recorded. The data was obtained during a 21 months period and analyzed in SPSS.Results: The most prevalent symptoms among the study population were headache, papillary edema, blurred vision, sensory-motor disorder, disorders of consciousness, double vision, behavioral disorder, speech impairment, focal seizure, and generalized seizure. The most common reasons were taking oral contraceptive pill (OCP), pregnancy, infection, idiopathic, drug abuse, hematologic diseases, trauma, previous cerebrovascular accident, CVT, diabetes, and hypertension.Conclusion: The most prevalent complaint was headache and the most founded neurological sign was papillary edema. In our study, OCP and pregnancy were the greatest etiologies, while infection was the next common etiology.

Background and purpose: Proteinurea is the commonest symptom of chronic kidney disease. The most risk factors for proteinurea are diabetes and hypertension. Other researchers showed that serum level of some metals might change in proteinurea. In this study we checked the changes of zinc and copper serum concentration in non-diabetic proteinuric patients.Materials and methods: This case-control study was performed during 2010-2011 to compare the zinc, copper, iron and selenium serum level in two groups, including 46 cases of healthy control group and 46 cases of non-diabetic patients with proteinurea which were matched for age and sex. The levels of metals (Zn-Cu) were analyzed by atomic absorption spectrophotometer. The data was analyzed with SPSS software using independent-sample t-test and Pearson correlation coefficient.Results: The number of female cases was 26 and male cases were 20 in each group. The mean serum level of Cu in healthy women was 1.167±0.46 and in patient women was 1.232±0.58. These mean numbers were 1.142±0.43 and 0.962±0.46 for healthy and patient men, respectively. The mean serum levels of Zn in healthy and patient women were 1.201±0.38 and 0.918±0.43, respectively. These mean numbers were 1.163±0.35 for healthy men and 0.828±0.503 for patient men. Significant decrease was observed in serum Zn and Cu level in patient group compared with healthy group (p0.05).Conclusion: This study revealed that the cause of reduction in zinc and copper plasma concentration in proteinurea could be the excretion of protein and albumin from urine. Therefore, edema, disturbance in oxidative process, and renal disorders might occur.

Background and purpose: Hyperglycemia leads to some complications in traumatic patients and its control could improve the patient's prognosis. In this study the prevalence of hyperglycemia and its effects were investigated in patients with multiple traumas.Materials and methods: In this cross-sectional study the blood glucose levels of 472 multiple trauma patients attending emergency department at Imam Hossein Hospital were measured in June-Oct 2010. Diabetic patients were excluded. SPSS ver.16 was applied to analyze the data.Results: The incidence of posttraumatic hyperglycemia in multiple trauma victims was 20%. There was a significant relationship between posttraumatic hyperglycemia and presence of fracture (FX). However, no significant correlation was observed between hyperglycemia and age, sex, mechanism of trauma, and site of trauma. Moreover, this study found a significant correlation between hyperglycemia and intracranial bleeding.Conclusion: Considering high rate of posttraumatic hyperglycemia and previous findings on controlling and improving the patient’s prognosis, we recommend checking the blood glucose level of trauma patients` on arrival, particularly among those suspected of having FX. However, further studies are needed to investigate this issue in other traumas.

Background and purpose: Development of the male phenotype and the initiation of spermatogenesis are intricately dependent on the cellular events that respond to androgens. The actions of androgens are mediated by the androgen receptor (AR). The aim of this study was to investigate the association of AR 5' UTR and codon 211 genetic variation with the risk of idiopathic male infertility.Materials and methods: Genomic DNA was extracted from 60 men with idiopathic infertility and 70 healthy men. The genetic variation of 5' UTR and codon 211 was determined by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) - and PCR-single strand conformation polymorphism (SSCP), respectively.Results: No mobility shift was seen in the PCR products of 5' UTR in patient and control groups.We did not identify a single mutation at 5' UTR of AR gene in patients and controls. Genotype frequencies of codon 211 in patient group were GG (67%), GA (23%), AA (10%) and in control group there were GG (77%), GA (21%) and AA (1%). No significant differences were found between the two groups in allelic frequencies (χ2=2.40; P=0.3).Conclusion: Our findings suggest no correlation between these polymorphisms and male infertility in the studied patients. However, further studies of AR polymorphisms with their biological functions are needed to understand the role of these polymorphisms in the development of male infertility.

Background and purpose: Low birth weight (LBW) is a key determinant of infant morbidity and mortality. Zinc deficiency during pregnancy may have unfavorable effect on pregnancy outcome, particularly low birth weight. The aim of this study was to determine the association between infant anthropometric characteristic and cord blood plasma zinc level.Materials and methods: This study included 268 pairs of mothers and infants (at time of delivery) from whom 134 healthy mothers and their infants<2500g were recruited as case group and 134 healthy mothers and their infants weighing 2500-4000g were participated in control group. The subjects were selected from Fatemieh Hospital Hamadan, Iran. The infants’ birth weight, length, head circumference, chest and mid arm circumference were measured. Cord blood plasma zinc level was determined by Atomic Absorption Spectrophotometry (AAS). The concentration of plasma zinc less than 60 mg/dl was considered as sever zinc deficiency, between 60 to 70 mg/dl mild to moderate deficiency and more than 70 to 150 mg/dl were considered normal. Twin infants, abnormal infants and mothers who smoked, consumed alcohol, used illicit drugs, and those with severe stress were excluded from the study.Results: Sever zinc deficiency was significantly related to infant low birth weight [OR=12.382, CI; 1.210, 126.710, P=0.040]. No significant relationships were found between infant length, mid arm, chest and head circumference with plasma zinc level.Conclusion: Present study indicated a relationship between infant weights and severe zinc deficiency in plasma cord blood. Severe zinc deficiency could be considered as a major predictor of infant birth weight.

Background and purpose: Assessment of tooth length has an important role in success and failure of dental treatments. As yet periapical radiography has been used for the assessment of tooth length causing high x-ray exposure, long time and patient discomfort. Using panoramic radiography can resolve these problems. The major disadvantage of panoramic radiography is monotonous magnification. The aim of this study was to assess the relationship between real and panoramic tooth lengths.Materials and methods: In an analytical study, 89 teeth consisting 59 maxillary first premolars and 30 maxillary second premolars from patients referring to orthodontic clinics of babol were selected. According to universal numbering system the teeth were divided into four groups: T14, T24, T15, T25. Measurements of real and panoramic tooth length were accomplished by a digital caliper. Length linear regression model analysis was used for the prediction of tooth.Results: Real and panoramic tooth lengths and their magnification showed significant differences between two sexes (P<0.05). For each gender regression models were produced: (male first premolar tooth length=0.818X+3.017) (female first premolar tooth length=0.852X+1.875) (male second premolar tooth length=1.030X-2.028) (female second premolar tooth length=1.020X-2.246).Conclusion: Using panoramic radiography for estimation of maxillary premolar real tooth length in studied machine is practical and reliable.

Background and purpose: Asthma is the most common chronic disease of childhood and adolescence resulting in variable restrictions in most aspects of patients’ life and decreases their quality of life (QOL). Control of the triggers could be of great benefit in the management of asthma. This study was conducted to assess the effect of education on asthma triggers and controlling them on QOL among adolescents suffering from asthma.Materials and methods: This randomized clinical trial was performed in 60 adolescents aged between 12-18 years. They were randomly assigned into intervention and control groups. Mini Pediatric Asthma Quality of Life Questionnaire (Juniper 1997) was used prior to intervention and five weeks post intervention in both groups. The intervention group was educated regarding asthma triggers, then they were followed up through telephone calls. The data was analyzed using SPSS V.13, Chi square and t-tests.Results: Significant differences were found in the scores of QOL among both groups. Therefore, education on triggers of asthma and controlling them was effective in enhancing QOL (P≤0.001).Conclusion: This intervention was found potent in improving the QOL of adolescents with asthma. Hence, educational programs should be carried out in outpatient clinics on triggers of asthma with the participation of adolescents instead of their parents.

Background and purpose: Water and soil pollution with heavy metals are among serious evergrowing environmental problems. Human activity accounts for much of the poisonous metals and results in increases soil pollution. There are many factors related to soil and plants properties and environmental issues. Release of heavy metal into food chain in critical densities has harmful metabolic and physiologic effects on living creatures.Materials and methods: Three regions including Movaram Kola, Seyyed Mahalleh, Jouybar Mahalleh Kola located in Sari, Jouybar and Qaemshahr (central regions of Mazandaran province) were investigated to determine the concentrations of heavy metals in paddy fields irrigation and Tarom rice within 2010-2011 agricultural year. Sampling included samples of irrigation with water and rice, and field study for qualitative and quantitative properties of rice. Sampling and test method of heavy metals was in accordance with suggestive method of standard book of method. Finally density of heavy metals of samples was measured using atomic absorption machine. For statistical calculation and quantitative study of data Prism, Stata 11 and t-test were applied.Results: In the studied water samples, level of cadmium in Seyyed Mahalleh was higher than standard level which is worrying due to accumulative effect of cadmium. In addition, level of cadmium in rice samples of Jouybar (Mahalleh Kola) and Seyyed Mahalleh was higher than standard level. Levels of chrome in all studied areas were lower than standard levels.Conclusion: Accumulative effects of heavy metals and their harmful effects on human societies could endanger food safety, therefore, more precautions are needed to reduce such effects.

Background and purpose: Early maladaptive schemas develop in childhood and result in high vulnerability to mental disorder. The aim of this study was investigating the relationship between early maladaptive schemas and depression in guidance school students in Falavarjan.Materials and methods: In a relational design study, 250 male students from guidance school in Falavarjan were selected using cluster sampling. To collect the data Schema Inventory for Children (2010) and Depression Self-Rating Scale (DSRS_R, Birleson, 1981) were used.Results: The results of Pearson correlation showed significant correlations between some maladaptive schemas such as loneliness, vulnerability, mistrust, defectiveness, failure, unrelated standards, entitlement and depression among 11-13 year-old boys. Furthermore, stepwise regression showed five schemas including loneliness, defectiveness, mistrust/abuse, vulnerability and unrelated standards could predict 38.4% depression on the studied population (p<0.05).Conclusion: This study found that early maladaptive schemas can predict significant rate of depression among adolescents. These findings confirmed cognitive theories of depression. Thus, it is necessary to consider maladaptive schemas in treatment plans for adolescent’s depression.

Background and purpose: The incidence of injuries and accidents, their types and leading causes and the victims' features are variable in different areas and times. Different aspects of injuries and accidents should be considered in researches thereby. This survey aimed at investigating the epidemiological features of accident and injuries victims attending Mazandaran hospitals, during 2010.Materials and methods: In a cross sectional research, all referred victims of accidents and injuries (n=58750) to hospitals of Mazandaran province were studied. Required data was collected from existing injuries registration system of hospitals emergency departments. Data analysis was performed in SPSS using descriptive statistics, chi-square and independent t-test.Results: The incidence rate of all injuries was 2306.7 in 100, 000 population. Among the victims 71.7% were male. The mean age of cases was 29.9±17.01 and injuries (34.6%) occurred more in the group aged 20-29 years old. Incidence of injuries were higher in June (10.6%) and July (10.2%). Most injuries (70.6%) occurred in urban areas. Road traffic accidents (39.8%) and trauma and falling accidents (31.8%) were the most common injuries.Conclusion: According to the findings, the main cause of injuries in Mazandaran was road traffic accidents that have posed high burden to the province. The aforementioned rate of injuries shows that many people experience some kind of injuries throughout their life. Therefore, practical implementation of the Safe Community Program is an urgent need that should be considered in all national and regional initiatives. The success of such programs largely depends on participation of all agencies, organizations and individuals.

Nowadays solid lipid nanoparticles (SLN) and nanostructured lipid carriers (NLC) have been investigated as carrier systems for many applications. SLNs consist of pure solid lipids, while NLCs are made of a solid matrix that entraps liquid lipid nano-compartments. These systems revealed several advantages compared to other colloidal carrier systems. They provide a controlled drug release and an increase in chemical stability of the incorporated drugs. Moreover, they are safe carriers which can be produced easily in a large scale. This paper reviews the commonly used materials, production techniques, characterization, and physical stability of these systems.

Background and purpose: perceived value is defined as customer’s overall assessment of the utility of a product or service based on perceptions of what is received and what is given. The aim of this study was to investigate the relationship between service quality and perceived value by patients in private hospitals of Tehran.Materials and methods: This cross-sectional descriptive and analytic study was conducted in 2010. The study population included 969 patients selected from eight private general hospitals in Tehran.The data was collected through a questionnaire containing 18-items (service quality: 14 items and perceived value: 4 items), which its reliability and validity were confirmed. Data analysis was performed using descriptive statistics and multivariate regression in SPSS.17.Results: The mean score for patients' perception of service quality and perceived value were 4.01, and 3.43 out of 5. Regression analysis showed that about 27% of the variance in perceived value could be explained by the service quality. The interaction quality is the strongest factor influencing patient perceived value and its predictive power is about twice more than two other dimensions of service quality (process quality and environmental quality).Conclusion: Three dimensions of service quality were the key determinants of perceived value in private hospitals of Tehran. To promote the perceived value by patients, the quality improvement activities must focus on reduction and rationalizing monetary costs, accurate service scheduling, and strengthening the interpersonal relationships and communication skills of doctors, nurses and staff.

Background and purpose: Multiple sclerosis (MS) is a chronic and debilitating disease in which the central nervous system (brain and spinal cord) is destroyed. The most common complications of this disease are fatigue, cramps, tremor, diplopia, and unsteadiness of gait. This study investigated the effects of 12-week Pilates and aquatic training on fatigue in women suffering from MS.Materials and methods: This quasi-experimental study included 57 female patients attending Kashani MS clinic. The subjects (with MS 0<EDSS>4/5; 8±2 years disease; 20-40 years old) were randomly assigned into Pilates, aquatic training and control group. Training program for Pilates and aquatic groups was carried out for 12 weeks (three sessions of one hour per week). Patients' level of fatigue was measured using a fatigue questionnaire, before and after the exercise. The data was analyzed using descriptive statistics and analysis of covariance and paired comparisons of adjusted averages in SPSS V.18.Results: The results showed significant differences in the adjusted mean of fatigue scores in the experimental groups (P<0.05). Pilates exercise interventions and aquatic training significantly decreased the level of fatigue in the experimental groups.Conclusion: Pilates and aquatic training reduced fatigue in patients with MS. Therefore, such exercises could be used as a complementary treatment alongside medications for MS patients.

Background and purpose: Diabetes-associated depression may occur due to changes in the quality of life imposed by treatment, or may be a consequence of biochemical changes accompanying the disease. There are some reports indicating that treatment with methanolic extract of dried rhizomes of ginger could lead to a significant reduction in streptozotocin (STZ) -induced elevation of glucose level. The aim of this study was to evaluate the behaviors of diabetic mice through an animal model of depression -the forced swim test (FST) -, and to determine the efficiency of ginger extract as an antidepressant.Materials and methods: Balb/C male mice (25-30 g) were submitted to the forced-swimming test after seven days induction of diabetes with streptozotocin (100 mg/kg, i.p.). The test was analyzed using an ethological approach and we investigated the changes of blood glucose levels of diabetic mice during the test. Methanolic ginger extract (175, 350 and 700 mg/kg) was administered i.p.45 min before the test.Results: Diabetic mice were significantly more immobile during the forced-swimming test. Ginger extract at doses of 175 and 350 mg/kg did not change blood glucose values and decreased immobility of diabetic mice with no change in behavior when compared with nondiabetic mice. Both blood glucose levels and immobility time were significantly lower in the diabetic mice that received the dose of 700 mg/kg ginger extract.Conclusion: These results demonstrate that diabetic mice present more intense depressive-like behavior, when exposed to the forced-swimming test. Ginger extract resulted in antidepressant-like effect in these animals. Increased blood glucose level is involved in depression associated with diabetes, because ginger extract counteracts these changes with modifying blood glucose.

Background and purpose: Migraine affects about 12% of the general population and is one of the causes of cerebral parenchymal. Applying cross sectional imaging of brain particularly MRI opens a new approach in diagnosis of migraine pathogenesis and could highly influence the patients’ follow up program. We investigated anatomical MR imaging abnormality in people with and without migraine in sensitive MRI sequences.Materials and methods: This case-control study included 120 patients between 50-30 years of age referring neurology clinic. Patients with clinical symptoms of migraine were introduced to MRI units.The cases in the control group included those not meeting the diagnostic criteria for migraine. Brains MRI were evaluated for anatomical signal intensity changing. Two radiologists detected and recorded abnormal findings blindly in both groups based on special protocols.Results: Sixty people presented in each group were matched for age and sex. The mean ages of patients in case and control groups were 39.3±6.9 and 38.6±6.2 years, respectively. Changes of white matter hyper intensity foci were significantly higher at subcortical regions of the brain. In 35 patients (58.3%) of case group and 12 patients (20%) of controls there were supratentorial white matter signal changes in the brain MRI (P=0.000). Cerebral cortex was also involved in some individuals among the case group.Conclusion: In migrainous patients hypersignal foci were detected in white matter of the brain, therefore, proving such presence in patients with typical symptoms of migraine can assist in diagnosis and even MRI can be used in follow-up of the disease. Parenchymal abnormalities in migraine could show severity of the disease and brain damage.

Background and purpose: Bioindicators are microorganisms directly associated with environmental changes which their numbers are affected by chemical pollutants.Materials and methods: Sampling was done from four stations in Shirood River in depth of 20 cm of water surface and transferred to laboratory in less than 24 hr. KF medium, SPS, ECC Chrome agar, Plate count agar were used for isolation of fecal streptococci, sulfate-reducing bacteria, E. coli, coliform and heterotrophic bacteria, respectively.Results: The mean count of TVC, fecal streptococci, coliform, E. coli, sulfate-reducing bacteria, in four stations in shirood river were 6.78×105, 9.7×104, 1.07×106, 1.27×106 (cfu/1ml); 6×101, 3.65×102, 5.83×102, 1.6×102 (fecal streptococci); 3.58×103, 3.54×103, 2.11×103, 4.42×103 (coliform); 2.51×102, 6.81×102, 1.95×102, 3.62×102 (E. coli); 3.21×102, 2.62×102, 2.25×102, 2.04×101 (sulfate-reducing bacteria).Conclusion: The results of this study showed that the rate of pollution in the studied stations was higher than the standard limits. Other studies also indicate that distribution of some bacterial bioindicators such as coliform and fecal coli forms is very high in site of effluent of domestic and urban sewage.

Background and purpose: The widespread use of silver nanoparticles in therapeutic and diagnostic methods has created some concerns. Different sizes and shapes of nanoparticles have different effects. In this investigation, toxic effects of spherical nanosilver with average diameter of 4 nm were investigated on MCH and HGB in male Wistar rats.Materials and methods: In this study, concentrations of silver nanoparticles at 50, 100, 200 and 400ppm were applied through skin contact for the treated groups. Then blood sampling of the inner corner of eye was performed in rats using capillary tube. The mean of MCH and HGB in the treatment and control groups were recorded on day 12 after treatment and ANOVA test was used to analyze the data.Results: Blood damage caused by skin contact with silver nanoparticles in rats resulted in stimulated red blood cells in all groups. Significant differences were found for dose concentration in the MCH 200ppm on day 12 after the treatment (P<0.05). However, there were no significant differences in HGB among the studied groups.Conclusion: In 50ppm concentration of nanosilver, possible mechanisms of the change MCH are releasing free radicals, oxidative stress and apoptosis in red blood cells. Further studies are needed with different sizes and shapes of silver nanoparticles.

Background and purpose: One of the methods of preparing controlled-release dosage forms is the incorporation of drug in a matrix containing a hydrophilic rate-controlling polymer. Drug-polymer ratio, drug particle size and HPMC particle size have been identified as modifiers of drug release. This study evaluated the relationship and influence of formulation factors such as drug-HPMC ratio and particle size of drug and HPMC on drug release from matrices containing HPMC K 15 M and thophylline as model drug.Materials and methods: Theopylline tablets were obtained by the direct compression method using different particle sizes and ratio of theophylline and HPMC K15M. The physicochemical properties of prepared tablets were investigated. Drug release rate was also studied using USP I dissolution apparatus at pH 1.2 and 7.2. From different formulations the theopylline release was analyzed and then the data was fitted to Kinetic models.Results: The results of the present study showed that the rates of theophylline release from HPMC K15 M matrices are mainly controlled by the drug-HPMC ratio. The drug and HPMC particle size also influenced the drug release parameters, although to a lesser extent.Conclusion: The main factor influencing the drug release from formulations is the polymer content. There is direct relationship between the polymer particle size and drug release. However, there is an inverse relationship between the drug particle size and release of theophylline.

Background and purpose: Cadmium is a very toxic metal that have adverse effects on human health and aquatic environments even at low concentrations, therefore, efforts should be made to eliminate this metal from aquatic ecosystems. The aim of this study was to investigate the efficiency of Lcysteine functionalized single-walled carbon nanotubes (SWCNs) in cadmium removal from aqueous solutions. This study also assessed the role of some parameters such as pH, adsorbent dose, contact time and cadmium concentration.Materials and methods: Single-walled carbon nanotubes were functionalized with L-cysteine.Then the optimum level of pH, carbon nanotubes dose, contact time, and cadmium concentration were determined during the adsorption process. The experimental data were compared with the Langmuir and Freundlich adsorption isotherm models.Results: qe increased when the pH level increased, while contact time and Cd concentration decreased by increasing of the carbon nanotubes dose. The Langmuir adsorption model agreed well with the experimental data (R2=0.997). Efficiency of removal of Cd by SWCNs was 94.26% in optimal condition.Conclusion: The results showed that L-cysteine functionalized single-walled carbon nanotubes could be effective for the removal of cadmium.

Background and purpose: Acute otitis media (AOM) remains a frequent global infection of childhood, with up to 80% of children having at least one episode by three years of age. Ten to 30% have recurrent episodes, and 2–25% will have persistent middle ear effusion extending beyond three months.This study was conducted to determine the prevalence of Streptococcus pneumoniae in patients with acute middle ear infections and determine the antibiotic susceptibility patterns of this microorganism.Materials and methods: In total 102 middle ear discharge specimens were collected during 6 months period from patients with acute otitis media attending Amir Alam Hospital, affiliated to Tehran University of Medical Sciences. The inclusion criteria included: perforated acute otitis media diagnosed by a physician and not taking any antibiotic in recent two weeks. Specimens were assessed for Streptococcus pneumonia by microscopic examination and culture. The antibiotic susceptibility test was done by disk diffusion method of Kirby-Bauer and sensitivity frequency of tested antibiotics was assessed by appraisal diameter of the growth inhibitory zone.Results: Of 102 tested specimens, 15 (eight males and seven females, 14.7%) were recognized as Streptococcus pneumonia. The sensitivity of isolated Streptococcus pneumoniae to different antibiotics included gentamicin (86%), kanamycin (80%), amikacin (74%), tetracycline (73%), and colistin (73%).The resistance patterns were seen in penicillin (80%), amoxicillin (80%), cephalotin (73%), erythromycin (65%), ampicillin (65%), nalidixic acid (60%), nitrofurantoin (60 %), vancomycin (53%), chloramphenicol (53%), and carbenicillin (53%).Conclusion: According to the emergence of resistant strains of Streptococcus pneumoniae to conventional antibiotic therapy, especially beta-lactam antibiotics and erythromycin, it is recommended to perform further studies to determine full picture of antibiotic susceptibility in circulating Streptococcus pneumoniain patients with AOM to revise existing guidelines of empirical therapy of AOM in Iran.

Background and purpose: Critical thinking has a major role in desirable professional attribute and a highly valued educational outcome. The aim of this paper was to assess the dimensions of critical thinking abilities among medical students in Mazandaran University of Medical Sciences.Materials and methods: Using multistage cluster random sampling, 120 medical students were assessed. Critical thinking skills were measured using the California critical thinking skills test (CCTST).The data was analyzed through descriptive statistics and t-test in SPSS.Results: In this study 118 students completed CCTST questionnaire. The mean of critical thinking score for medical students was 10.91±3.37. Dimensions of critical thinking were not related to gender, marital status, and academic level (P>0.05).Conclusion: This study revealed that critical thinking did not enhance among medical students while studying at university. It is widely believed that critical thinking is essential to clinical decisionmaking, so lecturers in medical universities should focus more on nurturing critical thinking in order to improve the clinical competency of medical students.