Journal of Mazandaran University of Medical Sciences
Year:2016 | Volume:26 | Issue:136|Papers Count:33

Background and purpose: Tretinoin is the most active metabolite of Retinoic acid (RA) in the body. It has a variety of biological activities, including antioxidant and immunomodulatory effects on a number of inflammatory and autoimmune conditions. The purpose of this study was to investigate the effects of tretinoin on plasma insulin and nitric oxide levels in streptozotocin-induced diabetes in mice.Materials and methods: In this experimental study, 15 male C57BL/6 mice were divided into 3 groups (n=5 per group) including a normal group, diabetic control group (streptozotocin: 40 mg/kg/day for 5 consecutive days) and treatment group (tretinoin: 20 mg/kg/day i.p. for 21 days after induction of diabetes).Then, the levels of nitric oxide in spleen cell culture supernatant and insulin level of plasma were evaluated. Data was analyzed by One-way analysis of variance (ANOVA) and Tukey’s test in Microsoft Excel.Results: Tretinoin prevented the STZ-induced reduction in plasma insulin, indicating a possible protective effect of tretinoin against b-cell damage. Also, nitric oxide production significantly reduced in treatment group (P<0.05).Conclusion: These findings indicate that tretinoin may have a therapeutic effect against the autoimmune destruction of the pancreatic beta-cells during the development of STZ-induced type 1 diabetes in mice.

Background and purpose: Carpal tunnel syndrome is one of the most common causes of orthopedic referrals. Today, many surgeons tend to perform minimally incision surgery (MIS). This study was conducted to compare the results of open surgery and MIS by Smillie knife.Materials and methods: In this prospective study, 72 patients (98 surgeries) with carpal tunnel syndrome were randomly divided into two groups of open surgery (n=46) and MIS by Smillie knife (n=52). Clinical improvements were investigated in both groups according to the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ). Electrodiagnostic improvement, duration of surgery, length of incision, and complications were compared between the two groups using paired-sample t-test, independent t-test, and Chi-square test.Results: Paresthesia resolved immediately after surgery, except in two cases in open surgery group and one case in MIS group. After the surgeries, no difference was seen in electrodiagnostic parameters between the two groups. The number of individuals with pain was significantly lower in MIS group in week two and six after the surgery (P=0.035 and P=0.011 respectively). The Boston score showed no significant difference between the two groups after three months but after six months the score was significantly different in MIS group (P=0.515 and P=0.029 respectively). One patient in open surgery group suffered wound dehiscence after removal of sutures.Conclusion: MIS is associated with quicker clinical improvements and because patients receive no anesthesia, it is superior to classic surgery.

Background and purpose: Constipation is one of the most common digestive problems in hemodialysis patients that has negative effects on quality of life in these patients. Non-medical treatments have more benefits compared to medical treatments. This study aimed to investigate the effect of acupressure on fecal impaction in hemodialysis patients.Materials and methods: A double blind clinical trial was conducted in 60 hemodialysis patients suffering from constipation. They were randomly assigned into either intervention or control group. In intervention group, one minute acupressure was applied three times a week for four weeks during hemodialysis in acupressure points while in control group it was done in false points. Fecal impaction was measured before and after the intervention.Results: There was a significant difference in fecal impaction between the two groups in week four after the intervention (P<0.001) and the stool was more natural in intervention group compared to that of the control group (thicker and more adhesive).Conclusion: Acupressure has a positive effect on fecal impaction in hemodialysis patients with constipation. Therefore, it could be used as a complementary treatment of constipation in hemodialysis patients.

Background and purpose: Preeclampsia is one of the three main causes of death in pregnant women in which multiple causes may be involved including lifestyle, stress, and sleep disorders. The purpose of this study was to determine the relationship between pre-eclampsia and restless legs syndrome.Materials and methods: This case-control study was conducted in 150 pregnant women with pre-eclampsia and 150 pregnant women without pre-eclampsia attending health centers and state hospitals of Mashhad, Iran in 2014. The diagnosis of preeclampsia was made by a systolic blood pressure equal to, or greater than 140 mm Hg or a diastolic blood pressure equal to, or greater than 90 mm Hg, accompanied by urinary protein excretion more than 300 mg per 24 hours. The presence of restless legs syndrome was determined based on the diagnostic criteria updated by the International Restless Legs Syndrome Study Group. Data was analyzed using SPSS V.16 and chi-square test, odds ratio, independent t-test, mann-whitney, chi-square, correlation coefficient and logistic regressions. P value less than 0.05 was considered significant.Results: Restless legs syndrome was observed in 15.3% of the participants with preeclampsia and 7.3% of the control group indicating a significant relationship between pre-eclampsia and restless legs syndrome (P<0.001). In fact, participants with pre-eclamsia were more at risk of restless legs syndrome compared to those without it (OR=2.28, CI95%:1.07-4.88).Conclusion: Due to an increased risk of preeclampsia in women with restless legs syndrome during pregnancy, it can be considered as a risk factor for preeclampsia.

Background and purpose: Diabetes is the most prevalent metabolic disease and a network of environmental and genetic risk factors. Control and prevention of diabetes are based on self-care and patients education. "The Method of Islamic Care" is a common and successful method of behavior modification in Islamic ethics and mysticism. The aim of this study was to evaluate the effect of Islamic Care Method on nutritional self-care, anthropometric indices and blood pressure in diabetic patients.Materials and methods: In a randomized clinical trial, 110 middle-aged patients with type two diabetes were randomly assigned to either the experimental or control group. Nutritional self-care behaviors were determined using a questionnaire. Weight, height and blood pressure were measured. The same education about diabetic diet was presented in both groups. In the intervention group Islamic teachings and Islamic Nutritional Care Method were taught with the intention of satisfying Allah. Two months later, the variables were measured again in 98 patients. Data analysis was performed in SPSS V.22, using Paired and Independent- samples T- Tests, Chi-square, and Analysis of covariance.Results: After adjustment for confounding variables, the intervention group had a significant increase in nutritional self-care (P<0.002) and significant decrease in weight (P<0.05) compared with those in the control group. The results indicated significant improvements in most of the indices in both groups at post-intervention (P<0.001).Conclusion: Islamic Care Method demonstrated its efficacy in promoting nutritional self-care behaviors and reducing weight indicator. This method is recommended for controlling chronic diseases influenced by behavioral factors.

Background and purpose: To prevent Surgical Site Infection (SSI), a short duration of antimicrobial agents is prescribed just before the surgery which is known as preoperative antibiotic prophylaxis (PAP). In spite of evidenced-based guidelines for PAP administration, many studies have shown poor adherence to the guidelines. The aim of this study was to determine an effective intervention in improving surgeons’ adherence to the standard guideline of PAP administration in cardiac surgeries.Materials and methods: An interventional prospective study (before-after design) was performed in 335 patients undergoing cardiac surgery during 2011-2012. Three consecutive interventions were conducted including educational, managerial and regulatory interventions. The outcome measures were the duration and type of the PAP administration which was measured before and after each intervention. The changes were also monitored through a 5 months follow up.Results: No significant changes were detected after the educational intervention. After the managerial intervention significant changes in the type and duration of the PAP were detected in coronary artery bypass grafting (CABG) (P=0.03), but no significant change was observed for PAP administration in valve repair/replacement surgeries (P=0.54). Regulatory intervention caused significant changes in the type and duration of PAP in both CABG and the valve repair/replacement surgeries (P=0.01). The improvements lasted for at least 5 months after the regulatory intervention.Conclusion: Managerial and regulatory interventions in addition to educational intervention could be of benefit in optimizing the PAP administration.

Background and purpose: Hypoglycemia is an important problem in newborns which requires early diagnosis and treatment. Laboratory testing of blood glucose level and glucometer readings are used to detect hypoglycemia but sometimes the results are given late. This study aimed at evaluating the accuracy of glucometer in detection of hypoglycemia in newborns at neonate intensive care unit (NICU), 2014-2015.Materials and methods: A diagnostic study was performed in which 408 blood samples (glucometer capillary and venous derived samples) were obtained from 204 neonates in NICU within two hours after birth. Blood glucose concentrations were measured by glucose oxidase and photometric analysis. The mean values for blood glucose level, correlation coefficient, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were determined. Data analysis was performed in SPSS V.19.Results: The mean neonatal weight was 2915±840 gr. In our study, 92 neonates were females and 112 were males. In laboratory testing the prevalence of hypoglycemia was found to be 21.6% (CI 95% 15.9-27.3%). Mean values of blood glucose level (86.4±60.9 mg/dl) with glucometer was significantly higher than that of laboratory level (77.8±69.1 mg/dl), (P<0.001). At cutoff point of 40 mg/dL blood glucose level the diagnostic indices of glucometer were as follows: sensitivity 95.6%, specificity 45.5%, PPV 86.4%, and NPV 74.1%. According to ROC curve, 49 mg/dl was obtained as the glucometer cutoff point and the prevalence of hypoglycemia was found to be 15.2% (CI 95% 10.2-20.2%).Conclusion: Glucometer was found to have appropriate sensitivity and NPV in detecting neonatal hypoglycemia, therefore, it is recommended in screening of neonatal hypoglycemia without any side effects.

Background and purpose: Substance abuse is one of the main social problems among young adults. This study aimed at evaluating the prevalence of substance abuse and associated factors in hookah users in Zahedan, Iran.Materials and methods: This cross-sectional study was carried out on 600 hookah users in Zahedan, 2015.The city was divided into 5 districts (north, south, east, west and center) according to the maps. Then a start point was randomly selected and all individuals in first hookah place were entered into the study. Other cases were studied by referring to next nearest hookah places. The study questionnaires were completed in each districts. Data analyses were performed in Stata.12 using Chi-square, Independent T test and multiple logistic regression.Results: The subjects’ mean age was 26.1±5.1 years old. About 53% of the participants used hookah in groups. The ages of first hookah experience in males and females were 17.1±6.13 and 21.2±5.6 years old, respectively (P=0.04). Total prevalence of substance abuse was 70.4%. Using hookah in groups (OR=2.03, P=0.05), using hookah every other days (OR=2.2, P=0.042), living alone (OR=2.27, P=0.046), being university student (OR=3.7, P=0.01), and being male (OR=3, P=0.032) significantly increased the chance of substance abuse among hookah users.Conclusion: The prevalence of substance abuse in hookah users was found to be more than that in general population. Use of hookah can play a role in initiation of substance abuse. Also, the situation of hookah use and pattern or levels of consumption are the most important predictors in tendency of hookah users to other tobacco products and addictive industrial materials.

Background and purpose: Attending to maltreatment is very important since it could have strong influence on different dimensions of personal and social life. The aim of this study was to predict major depression disorder based on childhood psychological maltreatment caused by maladaptive schemas and difficulties in emotion regulation.Materials and methods: A cross-sectional descriptive study was performed in 300 patients with major depression disorder attending Sediq Psychiatry Center in Lorestan Province. They were selected by convenience sampling in November 2014 to February 2015. Data Data was collected using a demographic questionnaire, Psychological maltreatment Inventory (AMI-24), Young Schema Questionnaire (YSQ-75), Difficulties in Emotion Regulation Scale (DERS-36), and Hamilton Depression Rating Scale (HAM-D-24).Results: A positive significant relationship was found between psychological maltreatment and maladaptive schemas (a=0.01) (r=0.41, P<0.01) and difficulties in emotion regulation (a=0.05) (r=0.13, P<0.05). But there was no significant relationship between depression and psychological maltreatment (a=0.05) (r=0.11, P>0.05). Path analysis indicated that psychological maltreatment by the mediating role of maladaptive schemas and difficulties in emotion regulation could predict depression (P<0.01). Also, path of the psychological maltreatment to depression was not found to be significant (P>0.05).Conclusion: Considering the significant role of childhood psychological maltreatment by the mediating role of maladaptive schemas and difficulties in emotion regulation on predicting depression, clinical specialists are recommended to design appropriate clinical trials or modify current interventions.

Background and purpose: Presence of heavy metals in water resources is of great concerns due to adverse effects on human health. The aims of this study were to evaluate the efficiency of coagulation process using Polyaluminum Silicate Chloride (PASiC) in removal of hexavalent chromium and Cadmium from aqueous solutions and comparing that to the standards.Materials and methods: Experiments were carried out by Jar test using PASiC coagulant. The applied pH range in this study was 4 to 11, and different PASiC dosage (15 to 187.5 mg/l), heavy metal concentrations (5 to 100 mg/l), and settling times (10 to 90 minutes) were investigated. All experiments were repeated three times for accuracy and precision.Results: The optimum conditions for chromium removal was in PASiC dose of 150 mg/l, pH=5, and settling time=45 minutes, which decreased the chromium concentration (from 10 mg/l initial concentration) to 3.118±0.29 mg/l and this was more than the standard levels of wastewater discharge into receiving water. The PASiC in 75 mg/l could reduce the cadmium level to 0.019±0.01 mg/l (from 5 mg/l) in optimum condition (pH=8 and settling time=30 minutes). This level of cadmium removal was less than the standard levels of wastewater discharge into the receiving water.Conclusion: The PASiC coagulant was found to be more effective in removing cadmium than chromium from aqueous solutions and could be applied for cadmium removal from water and wastewater.

Background and purpose: During trainings for operating room technician a student is familiarized with innovative technologies in different surgical procedures and would learn how to care and manage patients before, during and after a surgery. This study aimed at analyzing the performance of operating room technicians (who earned a bachelor degree) according to their college curriculum.Materials and methods: This qualitative study used a content analysis approach in which semi-structured interviews were conducted among operating room technicians. Participants were purposefully selected and interviews lasted for 6 months until data saturation. Data (from 10 interviews) was analyzed using conventional qualitative content analysis.Results: Qualitative content analysis of data resulted in six themes reflecting the analysis of operating room technicians’ about their performance based on their college curriculum. The themes included ineffective teaching, credentialism, performance-based experience, the crisis of ignoring the staff dignity, learning motivation, and concerns over ignoring main modules.Conclusion: The main concern of the participants was inefficiency of teaching in undergraduate educational programs since the courses in this period are not practical. Also, common training programs in this field do not increase the students’ knowledge and skills to ideal level. Therefore, appropriate planning is recommended to provide more practical trainings.

Background and purpose: The purpose of this study was to evaluate the use of complementary/alternative medicine (CAM) and related factors in diabetic patients attending diabetes clinics in Sari and their attitudes and satisfaction.Materials and methods: In this cross-sectional study, the use of CAM methods, attitude and satisfaction of 270 diabetic patients, were assessed by a questionnaire. The t-test, chi-square test and logistic regression were used to analyze the related factors.Results: Among the participants 99 (36.6%) had used at least one of the CAM methods in the year before the study. The most commonly used CAM were medicinal plants (n=85 patients), cupping (n=14), acupuncture (n=11), bloodletting (n=5), and massage (n=1). The most common herbs were nettle, fenugreek, barberry, cinnamon, and green tea. More than 51% of patients expressed their satisfaction with the effects of these methods and over 67% were willing to use them again. There was a positive attitude towards CAM methods in 47 patients (17.4%). A significant correlation was observed between the use of these methods and marriage (P=0.02), duration of disease (P=0.01) and duration of treatment (P=0.02).Conclusion: In our study, the use of non-conventional methods in diabetic patients was found to be common which was related to duration of diabetes and its therapy. More studies are needed to evaluate the effects, side effects and interactions of these methods with conventional methods in treatment of diabetes.

Background and purpose: Magnetite hydroxyapatite (m-Hap) as a magnetic nano-adsorbent was synthesized for the removal of tetracycline (TC) from aqueous solutions.Materials and methods: The properties of m-Hap were investigated by scanning electron microscope (SEM) and Fourier transform infrared spectroscopy (FTIR). Factors affecting the adsorption of TC including pH (3-10), adsorbent dosage (0.1-5 g/L), contact time (5-120 min) and initial concentration of TC (10-25 mg/L) were investigated. The effect of adsorbent on the removal of tetracycline from real wastewater was also studied.Results: The nanocomposite was almost spherical in shape and about 20-30 nm in diameter. In optimum conditions more than 99% of TC was removed (contact time 60 min, adsorbent dose 1g/L, and pH 7.5). The equilibrium data were well fitted into Langmuir model (R2=0.977) and the maximum adsorption capacity was 64.4 mg g-1 at pH 7.5 and 298 K. Adsorption experiments on hospital wastewater indicated a slight decrease in adsorption removal of TC (85%).Conclusion: This study showed that the magnetic Hydroxyapatite nanoparticles could be used as a highly efficient and promising adsorbent in water and wastewater treatment systems.

Background and purpose: Viable tissue detection after STEMI can lead to successful revascularization for reversing myocardial dysfunction. The purpose of this study was to compare the Thallium-201 SPECT and MRI findings in viability assessment.Materials and methods: A cross-sectional study was performed on 17 patients with STEMI. In addition to Thallium SPECT, contrast enhanced MRI imaging was done. Viability was determined as more than 50 percent thallium uptake after 4 hours in SPECT and lower than 50 percent gadolinium enhancement after 10 minutes in each segments in CMRI.Results: Two hundred eighty nine segments were studied using both methods. TL SPECT showed 15.6% of the segments as non-viable tissue while MRI showed 35% non-viable tissue. There was a substantial agreement between these methods in apical septal and apical segments (k: 0.653, k: 0.757, respectively).Conclusion: The percentage of non-viable myocardium in MRI was found to be higher than that of Thallium SPECT and also considerable agreement was seen between MRI and Thallium SPECT in determination of myocard viability in apical septal and apex segments.

Background and purpose: Following coronary artery bypass grafting (CABG) respiratory failure is inevitable, therefore, invasive ventilation is used in patients. This study was conducted to investigate the effect of airway pressure release ventilation (APRV) on arterial blood gas (ABG) of patients after CABG.Materials and methods: This study was conducted in 32 patients in Mashhad Imam Reza Hospital, 2014. The patients were randomly divided into two groups (n=16 per group). The two groups received synchronized intermittent mandatory ventilation (SIMV). Then the patients in group I were switched to APRV while in group II SIMV continued for another half an hour. Afterwards, group I received SIMV and group II received APRV for half an hour. In all three stages the values for ABG were recorded. Data was then analyzed in SPSS.Results: The mean values of PaCO2 showed no significant changes in three stages between the two groups (P>0.05) but the mean values of PaO2 in APRV stage in first group (P<0.001 and P<0.01) and second group (P<0.003 and P<0.002) showed significant increases compared to that of the first and second SIMV mode.Conclusion: APRV led to improvement of oxygenation.

Background and purpose: Hemodialysis adequacy is one of the key factors in evaluating the health services provided for hemodialysis patients. This study was performed to determine the adequacy of dialysis with low-flux membrane in Hamadan Shahid Beheshti Hospital at 2011.Materials and methods: In a cross sectional descriptive study, 40 patients were put on low-flux membrane (FR6). Blood samples were taken before and at the end of dialysis (30 second after decreasing the blood flow rate to 80ml/min). KT/V and URR were used to determine the hemodialysis adequacy. Data was analyzed in SPSS ver. 19.Results: The patients were 67.5% male and 32.5% female (mean age: 48.37±10.38 years). The mean KT/V and URR were 1.10±0.32 and 0.61±0.14, respectively.Conclusion: Periodic assessment of hemodialysis adequacy is necessary to achieve international standards.

Background and purpose: The main features of non-fluent aphasia are inadequate production, limited vocabulary and agrammatism. Such patients have deficits in sentence comprehension and production and their speech is short and telegraphic. In this study, morphological and syntactic errors in speech of non-fluent aphasia were compared with those in healthy subjects.Materials and methods: A cross-sectional study was performed in 8 patients with non-fluent aphasia and 8 healthy individuals who were matched for age, sex and educational level. The morphological and syntactic structure of speech in healthy subjects and patients were elicited by two tasks (spontaneous speech and pictures description). Data analysis was conducted using the Mann-Whitney test.Results: In spontaneous speech and pictures description significant differences were observed between healthy subjects and patients in average number of names (P=0.004). The average number of verbs showed significant difference between the two groups only in spontaneous speech (P=0.022). Also, other morphologic and syntactic elements such as the number of content and grammatical words, intransitive and transitive verbs, active and passive verbs, and mean length of utterance were significantly different between patients and healthy controls in both tasks.Conclusion: The results showed inappropriate use of syntactic and morphological structures in sentences by patients. Total number of grammatical words and content words were considerably lower in patients.

Background and purpose: New theories about social anxiety focus on the cognitive processes such as metacognition and anxiety sensitivity. The purpose of this study was to determine the effect of metacognitive beliefs and anxiety sensitivity in social anxiety disorder. Materials and methods: In a correlational study, 261 university students (118 males and 143 females) were selected using convenience sampling in 2013-2014. Participants completed the Anxiety Sensitivity Index (ASI; Reiss et al., 1986), Metacognition questionnaire (Wells, 2004) and Social Phobia Inventory (Canoor, 2000).Results: The mean ages of male and female subjects were 23±2.74 and 20±2.60, respectively. The results indicated significant relationship between some components of metacognitive beliefs and social anxiety (t=6.28, P<0.001). Also, social anxiety was predicted by the components of anxiety sensitivity.Conclusion: This study showed the effects of anxiety sensitivity and metacognitive beliefs on social anxiety.

Background and purpose: Thermophilic Campylobacter spp. are among the most frequently causes of human gastrointestinal infections worldwide which is mainly due to poultry meat consumption. This study aimed at investigating the prevalence and antibiotic resistance of Campylobacter isolates collected from gastrointestinal track of broiler chickens.Materials and methods: A total of 150 fecal samples were taken from 30 commercial broiler farms during 6 months in 2014. The samples were cultured and incubated in microaerophilic conditions and stained by Carbolfuchsin. The strains were then identified using biochemical tests (catalase and oxidase test). C. jejuni was detected by hippurate hydrolysis test and C. coli and C. lari were identified using indoxyl acetate hydrolysis. Antibiotic resistance against 12 common anti-microbial agents was tested by Kirby-Bauer method.Results: Thermophilic Campylobacter spp. were isolated in 80% of broiler flocks and 65.3% of the samples. A total of 98 Campylobacter spp. isolates was found in which C. jejuni and C. coli were detected in 79.59% and 20.4%, respectively. The highest levels of resistance were found against nalidixic acid (67%) followed by ciprofloxacin (56%), and tetracycline (56%). The lowest levels of resistance were observed against gentamicin (0%), chloramphenicol (2.5%), and erythromycin (3%).Conclusion: Multiple resistance against anti-microbial agents was seen in several isolates and there was no isolate sensitive to all antibiotics.

Background and purpose: One of the aims of health systems is to promote the health of people which is obtained by providing appropriate healthcare services. This study was conducted to survey the inpatient satisfaction level from Health System Transformation Project (HSTP) in educational hospitals in Mazandaran province, Iran.Materials and methods: A cross-sectional study was done in 2015 on 1200 patients going to be discharged from eight educational hospitals in Mazandaran province. The hospitals were selected using random sampling. Data was collected using a demographic questionnaire and a questionnaire measuring satisfaction levels of HSTP parameters.Results: The patients’ satisfaction level was found to be good in majority of the participants (50.2%). There was a significant difference between the mean score for patients’ satisfaction level and marital status (P=0.002), educational level (P<0.001), and occupation (P<0.001).Conclusion: According to this study the patients were rather satisfied with HSTP. Our results indicated that various factors affect the level of patient’s satisfaction.

Background and purpose: Irrational discharge of toxic waste in environment leads to contamination of water, soil and agricultural fields. The aim of this study was to evaluate the contamination levels of cadmium, zinc, copper, lead, arsenic, and iron in the soil of two landfill area in Ghaemshahr, Mazandaran province.Materials and methods: Soil sampling was carried out in a waste burying area and around Tabarestan steel factory in Ghaemshahr from 0 to 20 cm depth of soil in December 2014. The concentrations of heavy metals in soil samples were assayed after drying and acid digestion according to the No. 8523 method of Iran national standards using the atomic absorption spectrophotometer.Results: Comparison of heavy metals concentration indicated that the arsenic levels in both areas and the copper in waste discharging area were higher than the standard levels. Evaluation of contamination index showed that zinc contamination was high and copper and arsenic contaminations were moderate in landfill area. Also, arsenic and zinc contaminations were moderate in the soil around the Tabarestan steel factory.Conclusion: The concentrations of zinc, copper and arsenic in studied areas were higher than standard levels. Moreover, possible harmful effects of heavy metals accumulation in nature and biological systems calls for appropriate planning for toxic waste discharge in these areas.

Background and purpose: Pressure ulcer is known as the third most costly disorder following cancer and cardiovascular diseases. Until now no exact estimate has been reported on the prevalence of bedsores in Iran. The purpose of this study was to estimate the prevalence of bedsores in Iran using meta-analysis.Materials and methods: An electronic search was conducted in some databases such as Pub med, Scopus, ISI, Google Scholar, Sid, Medlib, Iran medex, and Magiran and articles published/presented in 1998 to 2014 were selected. The search keywords included pressure ulcer, bedsore, and Iran. The data was analyzed using Meta-Analysis (Random Effects Model). The heterogeneity of the studies was investigated using the I2 index. Data was analyzed using STATA Ver.11.Results: According to 14 studies (sample size=5973 people), the prevalence of bedsores in Iran was found to be 19% (Confidence interval 95%: 13 to 25). The prevalence of first, second and third degree bedsores was 38%, 41%, and 9%, respectively. The most common site of bedsore was sacrum (54%) and the prevalence of bedsores among brain disease, motor impairment and coma patients was 25%, 19% and 46%, respectively.Conclusion: High prevalence of grade 1 and 2 bedsores were detected in this review, so special protocols are needed to decrease the prevalence of bedsore.

Background and purpose: Changes in neuromuscular control of the neck muscles, is one of the problems associated with neck pain. The purpose of the present study was to review the previously published studies concerning the effect of chronic neck pain on neuromuscular control of cervical region.Materials and methods: A literature search was performed for the studies published in 1990-2014 in some databases including ProQuest, Google scholar, Medlib, PubMed, Science direct, Scopus, and EMBASE. Neck pain, motor control, electromyography, and cervical muscles were the search keywords. Fifteen articles that reviewed cervical muscles’ activities in patients with chronic mechanical neck pain by surface electromyography were included. All studies had a case-control design. There were some variations among the studies in terms of methodology, location and type of the muscle, sample size, and investigation of muscles during different tasks. The studies were rated as ‘A’ to ‘E’ based on Hailey’s study design and performance.Results: According to some studies the activity of the deep cervical muscles reduced in patients compared to that of the controls. Also, a dramatic increased compensatory activity of the superficial muscles was seen compared to healthy controls.Conclusion: The results showed changes in motor control strategies of the cervical region, electrical activity of the different muscle layers and the structural characteristics of these muscles in presence of neck pain.

Voriconazole is an antifungal triazole, approved for management of invasive fungal diseases in patients. It is absorbed during two hours and its serum levels will be above 90%, based on the underlying factors, when the drug is administered orally. Voriconazole shows a propotional increase in an area under the plasma concentration-time curve (AUC), with increasing dose. Plasma protein binding of voriconazole is approximately 60%. Standard doses of the drug and optimal concentration are not predictable due to voriconazole’s nonlinear pharmacokinetics, drug-drug interactions, age, and genetic polymorphisms of the cytochrome CYP2C19. Therefore, in order to prevent adverse effects and optimize outcomes, therapeutic drug monitoring is highly suggested. The application of linking pharmacokinetic and pharmacodynamics characteristics provides information about the relationships between antimicrobial in vitro susceptibility, dosage, drug concentrations and antimicrobial or toxicological effects. The current review paper presents a comprehensive overview of the relation between pharmacokinetic and pharmacodynamics parameters for voriconazole treatment efficacy.