JOURNAL OF MAZANDARAN UNIVERSITY OF MEDICAL SCIENCES
Year:2018 | Volume:28 | Issue:166 |Papers Count:26

Background and purpose: Due to the properties of Stevia, it seems that this plant can be effective in reducing oxidative damage consequent to ischemia-reperfusion, and increase the survival of skin flap. This research aimed at investigating the effects of oral extract of stevia on apoptosis and skin flap necrosis in rats. Materials and methods: In this experimental study, Sprague Dawley rats were orally gavaged 25 mg/kg/daily of stevia leaf extract for one week, before or after the removal of flap. One week after surgery, the amount of flap necrosis, the content of malondialdehyde (MDA) in flap tissue, and superoxide dismutase (SOD) activity were measured. Results: Pre-treatment or post-treatment with stevia leaf extract reduced the necrotic area in the flap compared to the control group. It also reduced the MDA content and increased SOD activity. Pre-treatment with stevia leaf extract was found to have a better protective effect than post-treatment in all variables investigated. Conclusion: Current findings confirmed the survival of the flap with oral administration of stevia leaf extract. The beneficial effects of oral extract of stevia leaf can be clinically examined in reducing ischemic flap necrosis before and after surgery.

Background and purpose: Telomerase activity has a major role in acute promyelocytic leukemia (APL). It also has a critical role in disease recurrence. This research aimed at studying the cytotoxic effects of telomerase inhibition using oligonucleotide-based molecule against human telomerase RNA template (hTERC antisense) and non-nucleoside small molecule targeting catalytic subunit (BIBR5132) on APL-derived cell line. Materials and methods: To evaluate whether inhibition of telomerase using either hTERC antisense or BIBR5132 could exert cytotoxic effect in APL, NB4 cells were subjected to different concentrations of the inhibitors and subsequent cell viability, metabolic activity, induction of apoptosis were investigated using Trypan blue assay, MTT, and annexin/PI staining, respectively. Also, Caspase-3 enzymatic activity and transcriptional alteration of apoptosis-related target genes were investigated. Results: We found that targeting telomerase using hTERC antisense (45 pmol/L) and BIBR1532 (75 µ L) for 48 h reduced the survival rate of NB4 cells nearly by 30% and 40%, respectively and induced a caspase-3-dependent apoptosis. Our results also suggest that suppression of c-Myc and subsequent increment of Bax/Bcl-2 ratio coupled with decreased telomerase activity may be rational mechanisms for the cytotoxicity of both telomerase inhibitors against NB4 cells. Conclusion: Current results clearly indicated that both BIBR1532 and hTERC antisense had anti-tumor activity against NB4 cells and anti-telomerase-based therapy may be an efficient treatment for acute promyelocytic leukemia.

Background and purpose: Lentiviral vectors (LVs) are suitable candidates for gene delivery to cells with stable and high-level of transgene expression in target cells. MicroRNAs (miRNAs, miRs) are non-protein coding, short (~22 nucleotides) and single-stranded RNAs that act as post-transcriptional regulators of gene expression, and are involved in various cellular processes, including proliferation, differentiation and apoptosis. Several studies have shown that miR-499a promotes cardiac differentiation in cardiac stem cells. So, the aim of our study was to construct lentiviruses carrying miRNA-499a. Materials and methods: Specific sequences of miRNA-499a (3p and 5p) were designed and constructed. Then, miRNA-499a was cloned into lentiviral vector. Analytical digestion and nucleotide sequence analysis were performed to ensure successful introduction of the miRNA to the vector. Then, the lentiviral particles produced (miRNA-499a-3p and miRNA-499a-5p) were used for transduction of human bone marrow-derived mesenchymal stem cells (hBM-MSCs). Results: Analytical digestion and sequence analysis confirmed the accuracy of the constructs. The high expression of eGFP represented the high efficiency of transfection and transduction. The lentiviral particles carrying miRNA-499a-3p/5p were made and could transduce hBM-MSCs. Conclusion: In this study we made lentiviral particles carrying miR-499a that could be used for differentiation of stem cells to cardiomyocytes.

Background and purpose: Circulating monocytes are divided into different subpopulations according to the expression of CD14 and CD16. In this study, we investigated the correlation between the severity of coronary artery disease (CAD) and the frequency of two monocyte subsets and also expression level of CCR1 receptor on these monocytes. Materials and methods: The study was conducted in 88 patients who underwent diagnostic coronary angiography (CAG) in Tehran Shahid Rajaee Heart Center, 2014-2015. The participants were selected using convenience sampling. They were divided into four groups: 50% stenosis in one vessel (MVD), single vessel stenosis (1VD), 2 or 3 vessels stenosis (2+3 VD), and no CAD as the control group. The severity of CAD was evaluated by Gensini score. Frequency of the two monocyte subsets, including classical (CD14+CD16-) and non-classical (CD14+CD16+) were measured by flow cytometry. Mean fluorescence intensity (MFI) of CCR1 receptor on monocyts was also measured in two subsets and all groups of patients. Results: Circulating non-classical monocytes were observed more frequently in patients with 2+3 VD than in controls, MVD, and 1VD groups, but the differences were not statistically significant (P> 0. 05). Both classical and non-classical monocytes expressed CCR1, but it was expressed on higher number of classical monocytes than in non-classical ones. Also, no significant differences were seen in MFI of CCR1 in different groups. Conclusion: This study showed that higher frequency of non-classical monocytes was correlated with severity of CAD.

Background and purpose: Thyroid nodules are quite common witch are found in clinical or ultrasound examinations. They are detected in 4-8% of clinical examinations and 7-15% are malignant. TSH is one of the growth factors for nodule growth. Controversial reports are published on the effect of TSH on thyroid nodule malignancy. This study aimed at investigating the effect of TSH in predicting malignancy in thyroid nodules. Materials and methods: In this cross sectional research, 500 patients were studied. Serum TSH level was measured prior to fine needle aspiration (FNA). Data analysis was done applying inferential statistics. Results: The patients were 457 (91. 4%) females and 43 (8. 6%) males and the mean age was 43. 43± 13. 9 years. Among the patients 240 had single nodule and 260 had multiple thyroid nodules (P=0. 08). The mean size of nodules in benign and malignant nodules were 26. 1± 12. 2 and 27. 3± 9. 8 mm, respectively (P=0. 6). Malignant and benign nodules were observed in 31 (6. 2%) and 469 (93. 8%) patients. Mean TSH level was 3. 3± 6. 9 and 2. 4± 2 in patients with benign and malignant nodules, respectively (P= 0. 47). To investigate the association between TSH and FNA cytology, TSH levels were divided into <0. 5, 4. 9-0. 5, and ≥ 5 using person correlation. This study showed no significant difference between the three groups (P= 0. 3). Conclusion: TSH alone is not a suitable marker for predicting thyroid malignancy.

Background and purpose: Neglect is amongst the deficits in family functioning in Iranian population which is caused by lack of adequate knowledge on related factors. A major problem on this issue is lack of clear definition of this term. The purpose of this study was to analyze the concept, operational definition, and empirical references of neglect in health care system in Guilan province, Iran, using hybrid approach. Materials and methods: The research was conducted using a three-stage model: the review of studies, working in the field, and final analysis of hybrid. At the theoretical stage, we investigated national and international articles, dissertations, and indexing databases for relevant information published between 2000 and 2017. Working in the field was accomplished by collecting clinical data in which 12 participants (selected via targeted sampling) were interviewed. The information was then analyzed. Results: By reviewing the articles, the operational definition of negligence was expressed as forgetting and ignorance. Negligence was recognized as deprivation of human rights and was associated with the function of elderly people. According to the interviews, three main themes and eight sub themes were identified: interactive separation (inevitable avoidance, bitter oblivion, and forgotten by close relatives), psychological conflicts (traumatic experiences, perceived violence, and emotional failure), psychosis (mental excitement and companion concern). Conclusion: There is always an emphasis on respect for the elderly in Iranian culture, however, this vulnerable population is ometimes subject to negligence. Iran is aging and nurses can play a major role in identifying elderely at risk of negligence. Theefore, effective steps can be taken to improve the health of the community by appropriate planning.

Background and purpose: Microleakage is the most common cause of secondary caries and failure of restorations. The aim of this study was to evaluate the Microleakage between resin modified glass-ionomer (RMGI) and resin composite in sandwich restorations using different bonding agents. Materials and methods: Forty four premolars were used in this experimental study. Class II cavities were prepared and the gingival margin placed 1 mm below cementoenamel junction. RMGI (Fuji II LC) was inserted on the gingival floor in 1 mm thickness and the teeth were divided into two groups. Group I: cavities were etched, rinsed and treated with a total etch adhesive (Adper single bond 2). Group II: An universal adhesive (Single bond universal) was applied in self etch mode. All cavities were then restored incrementally using resin composite (Filtek Z 250). To evaluate the microleakage, the samples were subjected to thermocycling (3000 cycles), immersed in methylene blue for 72 hours, and sectioned mesiodistally. The samples were subsequently observed under stereomicroscope. Mann-Whitney test was used to analyze the data (P<0. 05). Results: The microleakage was significantly higher in Adper single bond 2 group (520. 5± 401. 5µ m) compared with that in single bond universal group (193± 269. 5µ m). Conclusion: This study showed that application of universal adhesive between RMGI and composite in self etch mode leads to lower microleakage compared with total etch adhesive in open sandwich restorations.

Background and purpose: Cardiac failure is a disabling disease affecting all aspects of life and many patients may feel frustrated due to reduced abilities. The aim of this study was to determine the effect of family-centered education on hope in patients with heart failure. Materials and methods: In a randomized controlled trail, 110 patients with heart failure were selected by objective sampling and randomly assigned to either the control or experimental group. The control group received only hospital routine care and the experimental group, including the patient and an active member of his/her family, attended three 60-minute sessions for three days during hospital stay. The experimental group received face to face trainings and an educational booklet. Data was collected using a demographic questionnaire and the Miller Hope Scale before and three months after the intervention. Data analysis was done in SPSS V20. Results: The mean values for hope in experimental and control groups before and after the intervention were 147. 52 ± 33. 15 and 151. 63 ± 23. 5 and 173. 05 ± 37. 45 and 134. 05 ± 33. 15, respectively. There was no significant difference in the mean score for hope between the two groups before the intervention (P= 0. 193). But, after the intervention significant difference was seen in the mean score for hope between the experimental group and controls (P= 0. 0001). Conclusion: Training cardiac patients and their families by nurses significantly increased their levels of hope. This low-cost intervention in family members could be of great benefit in controlling and preventing heart failure.

Background and purpose: Family relationships have a major role on the behavior of children, so, this study aimed at investigating the association between quality of family relationships (parental conflict, sister brotherhood relationships, and parenting styles) and social anxiety while considering the mediating role of family cohesion. Materials and methods: The research population included all high school girls in Karaj, Iran among whom 250 were selected using multi-stage cluster sampling. The participants completed Social Anxiety Scale for Adolescents (SASA), Family Confidence Questionnaire (FCS), Conflict Tactics Scale (CTS), Index Brother or Sister Relationship (IBR or ISR), and Baumrind Parenting Style Index (BPSI). The path analysis was conducted to investigate the mediating role of family. Results: The findings showed a significant positive correlation between social anxiety and parental conflicts and authoritative parenting style (p<0. 05). But, there was a significant negative correlation between social anxiety and the quality of sibling relationships (p<0. 05). The mediating role of family cohesion was confirmed only between the quality of sibling relationships and social anxiety. In this research, 60% of social anxiety variance was explained through the variables in the model proposed. Conclusion: It is believed that the quality of family relationships (parental conflicts, the quality of sibling relationships, and the authoritative parenting style) and family cohesion could be used for theoretical explanations and psychological treatments in people with social anxiety.

Background and purpose: Hearing impaired children with cochlear implant experience many problems as they have developmental language impairments with impaired working memory. The aim of this study was to develop a working memory test and investigating the working memory in children with cochlear implant. Materials and methods: In this cross sectional study, a Persian working memory scale for children was developed. Content validity (n=9), face validity (n=9), and reliability (n=30) of the test were evaluated. Then, the auditory working memory test was performed in 30 Persian speaking children with normal hearing and in five with cochlear implant. Results: The content validity was 100%. The performance of children confirmed face validity of the scale. Test-retest reliability was 0. 938 (P <0. 05). There was a significant difference in the mean scores between the group with normal hearing (78. 06± 27. 017) and those with cochlear implants (28. 2 ± 25. 547) (95% CI, [P <0. 05]). Conclusion: The Persian working memory scale for children was found to have content validity, face validity, and reliability. Children with cochlear implants performed weaker than normal children on working memory tasks.

Background and purpose: The impact of cancer on various aspects of life is definitely proven in many studies. In this research, we aimed to study the psychological, social, and economic status of patients with different types of cancer in Mazandaran province, Iran. Materials and methods: This cross-sectional study was conducted in patients with cancer who were admitted to Sari Imam Khomeini Hospital, 2017. Data was collected using a researcher-made form that was designed to determine the frequency of the most important and the most common psychological, social, and economic components. The form was completed by researchers, at the Cancer Research Center, for 375 patients with cancer who were selected by convenience sampling. Results: Psychologically, most of the patients accepted their disease at the time of diagnosis (46. 9%). Most of the participants mentioned the death of loved ones as the most important bitter incident before the disease (41. 6%). Children status was one of the main concerns among the patients (57. 3%). From the social point of view, the majority of patients reported optimum emotional relationship with their spouse (75. 4%). The results also showed that most of the patients were financially dependent on their spouse (62. 7%). Conclusion: This study suggests that simultaneous attention to psychological, social, and economic aspects of cancer patients can lead to significant outcomes.

Background and purpose: Women who develop preeclampsia are prone to post-traumatic stress disorder (PTSD). The major role of spiritual health is well understood in health contexts. On the other hand, the effects of stress, anxiety, and depression are known to influence the treatment process in women with preeclampsia experiences. So, this study aimed at comparing spiritual health and perceived stress levels in women with preeclampsia, affected and unaffected by PTSD. Materials and methods: This descriptive-analytic study was done in 278 multipara women with preeclampsia at 36-40 weeks gestation admitted to public hospitals in Mashhad, Iran 2017. The Perinatal Posttraumatic Stress Questionnaire (PPQ), the Post Traumatic Disorder Checklist (PCL), Depression Anxiety and Stress Scales (DASS 21), and the Spiritual Well-Being Scale were administered. Data were analyzed using SPSS V16 applying independent T-test, Mann Whitney, and Spearman's rank correlation coefficient. Results: Among the patients 68 (26%) developed postpartum PTSD. Significant relationships were found between the two groups of affected and unaffected by postpartum PTSD in spiritual well-being (P= 0. 030), depression (P= 0. 001), stress (P= 0. 000), and anxiety (P=0. 000). Conclusion: Low levels of spiritual health and high levels of depression, anxiety, and stress in postpartum women are amongst the main causes of developing PTSD in women with history of preeclampsia.

Background and purpose: Vestibular Schwannoma (VS) is a lesion in peripheral vestibular system that leads to reduction of Vestibulo Ocular Reflex (VOR) gain and incidence of corrective saccades. Researches showed that the result of Video Head Impulse Test (VHIT) is positive in peripheral vestibular system disorders and negative in central vestibular system disorders. The aim of this study was to evaluate and compare the results of VHIT in patients with vestibular schwannoma and patients with central vestibular system tumors. Materials and methods: A descriptive-analytic study was conducted in 12 patients with unilateral VS tumor and 15 patients with unilateral central vestibular system tumors in Iran Gamma-Knife Center (December 2014-September 2015). The patients were selected based on diagnosis of neurosurgeon and their complaints from vertigo, imbalance, and dizziness. Assessment of VHIT was performed using horizontal and vertical head impulses. Finally, the amount of VOR gain and the corrective saccade ratio were evaluated in two groups of patients with tumors. The gain of VOR ≤ 0. 80 was considered as abnormal criterion. Results: Mean VOR gain in effective side was 0. 38 in patients with VS tumor, and 0. 96 in patients with central vestibular system tumors (P= 0. 001). Also, corrective saccades ratio was 30. 34 in patients with VS and 3. 44 in patients with central vestibular system tumors (P= 0. 007). Conclusion: The results of VHIT improved differential diagnosis of peripheral vestibular system tumors from central vestibular system tumors.

Background and purpose: Hemodialysis patients experience special conditions of illness and treatment and are exposed to various physical, mental, psychological, and social damage that will reduce their sense of subjective well-being. Perceived social support and spiritual health can enhance subjective well-being by adapting to the severe conditions of the disease. The aim of this study was to examine the relationship between subjective well-being and perceived social support and spiritual health in hemodialysis patients. Materials and methods: This correlational study was performed in 130 hemodialysis patients in east of Mazandaran province, Iran. Data were collected using a demographic questionnaire, Subjective Well-being Scale (Keyes), Spiritual Well-Being Scale (SWB), and Perceived Social Support Scale. Data were then analyzed by descriptive and inferential statistics, including Pearson correlation and Multivariate linear regression analysis. Results: Pearson correlation coefficient indicated significant direct relationships between perceived social support and subjective well-being (r= 0. 507, p<0. 001), and also between spiritual health and subjective well-being (r= 0. 751, p<0. 001) in hemodialysis patients. Subjective well-being was also significantly associated with gender, economic status, job, and physical ability (p<0. 05). Considering the moderating effects of interventional variables, the predictive value of subjective well-being was calculated based on perceived social support and spiritual well-being. Conclusion: Spiritual well-being and perceived social support can predict subjective well-being, therefore, they should be considered in training programs for patients.

Background and purpose: Ovarian cancer, compared to other gynecologic malignancies, has the highest fatality rate among women. Studying the demographic and epidemiologic characteristics can play an important role on planning and implementation of preventive proceedings and early detection according to geographical location. The aim of this study was to determine the epidemiological characteristics of ovarian cancer in women attending Sari Imam Khomeini Hospital. Materials and methods: A descriptive study was done in 130 patients selected by census sampling. Data was obtained from the Comprehensive Cancer Center affiliated with Mazandaran University of Medical Sciences using a checklist. Data analysis was done in SPSS V24 using descriptive statistics (frequency, mean, and standard deviation). Results: Most of the patients aged 41-60 years old. The majority of patients were diagnosed with epithelial ovarian cancer (71%). Also, about 30% were diagnosed at advanced stages (stage IV). Conclusion: High fatality rate of ovarian cancer and late diagnosis could be prevented by providing women with appropriate trainings on the risk factors and protective factors for ovarian cancer and regular screening programs.

Background and purpose: Sonocatalytic process as an advanced oxidation process is considered for degradation of pollutants in aqueous solution. The aim of this study was to increase the removal of dye by doping of TiO2 with non-metal element such as nitrogen. Materials and methods: Un-doped and N-doped TiO2 nano-particles with different nitrogen contents were synthesized by a simple sol– gel method in laboratory. X-ray diffraction (XRD), Field emission scanning electron microscopy (FE-SEM), Energy dispersive X-ray analysis (EDX), and UV– visible diffuse reflectance spectra (UV-vis DRS) were used for characterization of the synthesized nanoparticles. The sonocatalytic activity of synthesized nanoparticles was evaluated by investigating degradation of reactive blue 29 under ultrasonic radiation and the effects of nitrogen doping content, different initial pH of solution, and dye concentration. Results: The study showed that both un-doped and doped nano-particles were in nano-sized that tend to agglomerate. By using different nano-particles, the highest sonocatalytic activity was achieved by 0. 6 N-doped TiO2 with 58 % after 90 min of ultrasonic irradiation. Effect of initial pH of aqueous solution showed that the sonocatalytic activity decreased by increase in initial pH. Conclusion: Sonocatalysis using N-doped TiO2 was found to be an effective method for degradation of textile dyes. The high sonocatalytic activity could be attributed to the band gap narrowing and anatase phase in TiO2 nanoparticles. Sonocatalytic degradation followed the Langmuir– Hinshelwood kinetic model (R2 = 0. 98) with a rate constant of 0. 01 mg L− 1 min− 1.

Background and purpose: In order to design an industrial-scale adsorption process, it is necessary to model exact simulation of the dynamic behavior of fixed bed adsorption system. This study aimed at evaluating the performance of fixed bed column using sucrose-modified pumice in removal of metronidazole from aqueous phase. Materials and methods: In this experimental study, the adsorbent was prepared from pumice stone and sucrose was used to modify the pumice. The laboratory mode reactor was a cylindrical shape in 20 cm length and 2 cm diameter. Different parameters such as initial concentration, pH of the solution, flow and pumice height in bed were investigated to assess the performance of fixed bed column in removal of metronidazole. Thomas and the Adams– Bohart models were used to evaluate the breakthrough curves of metronidazole removal. Results: According to findings, the BET of modified pumice per gram of adsorbent increased from 8. 4 to 35. Decrease in pH and contaminant concentration resulted in increase in bed lifetime. The experimental data were found to fit well with the Thomas model. Conclusion: According to this study, the Thomas model could be used in designing and investigating the amount of adsorbent in real conditions. Also, the fixed bed column can be used as an effective method to remove antibiotics from water.

Background and purpose: Styrene, one of the most important compounds of VOCs, causes some health concern. In current study, the ability of ZSM5, TiO2/ZSM5, UV/ ZSM5, and UV/TiO2/ZSM5 methods was investigated in removing styrene from air synthetic current. Materials and methods: In order to synthesize the zeolite and TiO2-coated zeolite, the sol-gel and saturation methods were employed, respectively. In this study, the effect of the type of removal process, saturation time and initial pollutant concentration were investigated on the removal of styrene in a photoreactor. Phocheck device with direct reading system was applied to determine the output concentration. Also, SEM, XRD, EDX, and BET analyses were used to characterize the chemical and physical properties of ZSM5, and TiO2/ZSM5. Results: SEM analysis showed that zeolite has a crystal form, and TiO2 successfully covered the surface of this compound. In addition, the EDX analysis demonstrated that a great part of zeolite structural includes Al and Si constituents. The XRD pattern showed the presence of attached TiO2 in the zeolite structure. BET analysis revealed that the surface area of zeolite decreased when TiO2 was coated on its surface. The order of increase in removal efficiency was as follows: UV/TiO2/ZSM5 > ZSM5> TiO2/ZSM5. The saturation time of ZSM5 and TiO2/ZSM5 in the 300 ppm concentration was 370 and 280 min, respectively, while the outlet concentration in the UV/TiO2/ZSM5 method was fixed at 74% removal efficiency after elapsing 310 min. The increment of time exposure and initial styrene concentration also led to decrease in removal efficiency. Conclusion: In this study application of UV/TiO2/ZSM5 process provided a higher efficiency of the styrene removal than that of TiO2/ZSM or ZSM5 in the same time.

Background and purpose: Today, health is one of the main priorities of human life. Nowadays, the viewpoints about health are different and more attention is paid to nonmedical expectations. So, this study aimed to analyze the Health Reform Plan in healthcare sector using SWOT approach from the stakeholder perspective. Materials and methods: This qualitative study was conducted in 37 people using semi-structured in-depth interviews in 2017. The participants included individuals who were informed about the Health Reform Plan, executive managers, health administrators, family physicians, and patients in comprehensive healthcare centers. They were selected by purposive sampling. The interviews were transcribed and analyzed by framework method. Results: The main strengths included empowering the managers, developing and facilitating the health network, electronic health records, increasing the accessibility of services, and promoting self care. The weak points were as follows: management of human resources, choosing the managers, financial management, poor infrastructures, treatment-based system, low efficacy of recording system, and payment system. The opportunities included authorities’ supports, legal backing, and public-private sector cooperation. The threats were lack of sustainable financing, aging phenomenon, and non-communicable diseases. Conclusion: This study showed the strengths and weaknesses of Health Reform Plan in healthcare sector, and its opportunities and threats. Therefore, efficient interventions are needed to ensure appropriate and precise planning and implementation of this project.

Background and purpose: Metoclopramide is frequently used in emergency departments to control nausea, vomiting, and headache. This study aimed at comparing the effects of two rates of intravenous infusion of metoclopramide (slow and fast bolus) on the incidence of akathisia in patients with cancer in an emergency department. Materials and methods: In a double blind clinical trial, 112 patients with cancer hospitalized in Sari Imam Khomaini emergency department were included. The participants were randomized to receive either 20 mg metoclopramide as a bolus and normal saline infusion over 20  min (bolus group), or normal saline bolus and 20 mg metoclopramide infused over 20  min (infusion group). Patients were assessed for akathisia using the Prince Henry Akathisia Rating Scale. Nausea, sedation, pulse, and blood pressure were measured in both groups at 0, 30, 60,   and 120 min after drug administration. Results: The mean ages of patients in bolus and infusion group was 59. 4 ± 16. 1 and 60. 3 ± 14. 2, respectively. Frequency of women in bolus and infusion group was 48. 3 and 56. 1%, respectively. Objective akathisia in patients receiving bolus metoclopramide was 4 times more than that in infusion group. (P=0. 000) (RR: 4, CI: 95%: 1. 8-6. 5). Trend of sleepiness was not significantly different between the two groups (P=0. 625). But, the trends of nasaue, pulse, and hypertension showed significant differences between blouse and infusion groups. (P=0. 000 and P=0. 000, respectively). Conclusion: Current findings showed that intravenous infusion of metoclopramide could reduce objective akathisia and nausea.

Background and purpose: Missed detection of some major trauma in the context of multiple trauma remains a persistent problem in both clinical aspects and forensic medicine. This study aimed at investigating the prevalence of missed injuries in patients with major trauma. Materials and methods: This prospective cross-sectional study was done in all multiple trauma patients (7-28 years of age) admitted to emergency, orthopedic, and surgical departments in Sari Imam Khomeini Hospital, 2016. Data was collected using a checklist to study the demographic information (age and gender), mechanism of injury, time of injury, the type of trauma, and treatment interventions. SPSS V19 was used for data analysis. Results: The patients were 82% males. The frequency of missed injury was 5. 8%, including clavicles, metacarpal, scaphoid, acetabulum, femoral neck, intertrochanteric, heels, Lisfranc, and ankle fractures, and hip dislocation. The results indicated a relationship between the frequency of missed injuries and older ages, more trauma, male patients, blunt trauma, and higher level of consciousness (P= 0. 034). Also, in 44. 4% of the cases, identifying the damage led to changing the non-surgical treatment to surgical treatment. Conclusion: Tertiary surveys in multiple trauma patients could be of great benefit in identifying missed injuries and eventually cause better patient management.

Background and purpose: Leaving the hospital against physician advice is associated with negative consequences. The aim of this study was to investigate the prevalence of discharge against medical advice in a psychiatric hospital and factors associated with this decision. Materials and methods: The study was conducted using the records of 1112 patients admitted to Sari Zere Hospital, Iran between April 2014 and March 2015. The cases were selected using census. They were asked about the reasons for discharge against medical advice on telephone calls. Data analysis was done in SPSS V24 applying Chi-square test. Results: Among the patients 150 were discharged against medical advice. Main diagnosis of these patients was bipolar mood disorder (22. 7%) accompanied by psychotic features and borderline personality disorder. The onset of disease was during youth in 57. 3% of the patients. Among the subjects, 60% were admitted for the first time. At the second time of discharge against medical advice, frequency of patients with substance abuse was higher. The most common causes of discharge against medical advice were family pressure (44%), patients will for early discharge (33%), dissatisfaction from medical staff (11%), and costs associated with hospitalization and family problems (11%), respectively. Conclusion: The findings suggest providing patients and their families with appropriate training and information on the consequences of discharge against medical advice.

Background and purpose: Crimean Congo Hemorrhagic Fever (CCHF) is a dangerous viral zoonotic disease. Ticks are the main vector which transmit CCHF virus from livestock to human. The present study was done to provide a comprehensive database on major ticks in the CCHF virus transmission and their geographical dispersal in Iran. This would be of great benefit in planning for intelligent control of the disease based on the budget and personnel in areas where the incidence of the disease is high. Materials and methods: In this study, the articles published (2003-2017) on five important vectors of the CCHF in Iran were reviewed in electronic databases, including PubMed, Google scholar, SID, Iran Medex, Elsevier, and Scopus, using the following keywords: Tick Fauna, Iran, Ixodidae, CCHF, detection of CCHF and Tick distribution. Then, the data in Excel was exported to ArcGIS 9. 3 to provide geographic dispersion and vector infection map. Results: Distribution map of five important tick species in transmission of CCHF virus including Hyalomma marginatum, Hy. anatulicum, Hy. asiaticum، Hy. dromedarii, and Rhipicephalus sanguineus were drawn. The distribution map of these five tick species and molecular methods indicated that in 8 of 31 provinces CCHF virus was identified in two species, including Hy. marginatum and Hy. anatulicum. Conclusion: More extensive studies are needed to detect the fauna and distribution of ticks. Also, isolation of disease agents from samples in areas where the disease was reported should be done. Current findings could be used to update the database for prediction and modeling of CCHF based on the effective factors.