JOURNAL OF MAZANDARAN UNIVERSITY OF MEDICAL SCIENCES
Year:2016 | Volume:25 | Issue:132|Papers Count:54

Background and purpose: L-asparaginase is a well-known enzyme that is used as one of the most effective anti-leukemic drugs. Considering that the asparaginases used as antitumor are bacterialbased enzymes, the aim of this study was to find indigenous potential bacteria producing asparaginase.Materials and methods: The enzyme producing bacteria was isolated from the agricultural soils around Gharchak, Tehran province, Iran. Screenings were performed on nutrient agar and M9 agar, respectively. The most efficient bacterium having asparaginase activity was selected and identified by biochemical and phylogenetic methods. Asparaginase activity was assayed by Nesslerization method. Optimization of the enzyme production was conducted by assessment of some factors such as the effect of carbon and nitrogen sources, salt concentration, pH, temperature and agitation.Results: The selected bacterium was identified as a strain of staphylococcus that was named MGM1.The optimal conditions for enzyme activity was obtained at following conditions: 1% glucose as carbon source and 0.5 g/l beef extract as nitrogen source, without salt (NaCl) at pH range of 7-8 with shaking 120 rpm at 35oC.Conclusion: The optimal activity for the enzyme produced by MGM1 was similar to physiological conditions of human body, therefore, further studies on this enzyme would be of great value in finding a new efficient asparginase enzyme.

Background and purpose: Multiple sclerosis (MS) is one the most prevalent diseases associated with neurological and non-traumatic disability in adults. This autoimmune disease affects the central nervous system (CNS) and manifests different signs and symptoms. The prevalence of disease and age of onset varies considerably across the world. This study aimed at investigating demographic, clinical characteristics, and different risk factors in patients with MS.Materials and methods: The study was performed on 152 MS patients from May 2013-July 2014. McDonald diagnostic criteria were used for disease diagnosis. Data was recorded and analyzed in SPSS V.17.Results: The mean age of patients was 31.6±7.3 and females were three times more likely to be afflicted with MS. Most of the female patients were married. The majority of patients had benign disease (86.4%), and positive family history of MS was found in 21.2%. Plaque lesions in MRI were seen in 94% of the patients. Sensory loss, visual impairment and depression were observed in 45.7%, 43.8%, and 9.2%, respectively. Visual impairment was the first sign of the disease that was observed in most of the patients (41.3%). Fatigue and sexual dysfunction were significantly different between relapse-remitting, primary progressive, and secondary progressive form of MS (P=0.05 and P=0.02, respectively). Fatigue was associated with disease progression but other symptoms were not significantly different between three forms of the disease.Conclusion: Demographic and clinical characteristics of MS in Mazandaran province were similar to those reported from other countries. MS registry is recommended to record all MS cases in order to increase knowledge on demographic and clinical characteristics, treatment options, and patient’s response to medications. Furthermore, high familial prevalence of multiple sclerosis in Mazandaran province compared with other regions in Iran calls for further genetic analyses.

Background and purpose: The family physician is the first point of contact between people and health system (after the health workers) that should be capable of providing first-class services. The aim of this study was to investigate the performance of family physicians.Materials and methods: A cross-sectional study was conducted in 1956 patients, 110 family physicians, and 70 health managers. Check lists and questionnaires were used to collect the data. The check list included different dimensions such as education, service delivery, performance management and community participation. Also, a questionnaire was used to study about the relationship with patients and health management of the region. Data was analyzed in SPSS V.18 applying ANOVA, T-Test and Pearson Correlation.Results: According to the family physicians and health managers, the strongest and weakest dimensions were performance management and health management of the region. Among the patients 48.9% reported a good physician-patient relationship. There were significant relationships between age of the family physicians and community participation (P=0.044), their sexuality and education (P=0.019) and community participation (P=0.02), the town where family physicians work and service delivery (P=0.029), and their employment statuses and the health management of the region (P=0.001). We found significant relationships between the sexuality of managers and community participation (P=0.001), services delivery (P=0.008), performance management (P=0.006) and health management of the region (P=0.004). Also, significant relationships were found between the physician-patient relationship and patient’s age (P=0.003) number of referrals (P=0.001), city (P=0.001) and level of education (P=0.009).Conclusion: Despite the fact that dimensions of training, service delivery, performance management, and physician-patient relationship were in appropriate levels but dimensions of community participation and health management of the region need to improve their performance.

Background and purpose: Mothers are highly vulnerable during pregnancy and after childbirth. Some problems could even lead to mortality and morbidity after childbirth. Therefore, this study was carried out to evaluate the effect of lifestyle educational package on prevention of postpartum’s health problems in nulliparous mothers.Materials and methods: This randomized clinical trial was conducted on 220 nulliparous women in postpartum ward. The subjects were allocated into two groups using block randomization method. Intervention group received face to face training, telephone counseling, booklets and informative text messages (both fathers and mothers), while the control group had no education or training. Any health problem on the day of discharge and two and six weeks after delivery were compared between the two groups using logistic regression test.Results: By lowering the frequency of health problems during pregnancy, the chances of developing some complications including constipation, hemorrhoids, anal fissure, abdominal pain, headache, painful or infected suture, sleep problems during the second and sixth weeks postpartum as well as the chances of having cold and fever, backache, leg cramp, breast pain, nipple fissure, fatigue or weakness, sadness and discomfort and vaginal infection during the sixth weeks of postpartum decreased by more than 50% in educational group compared with the control group.Conclusion: In this study, postpartum lifestyle intervention reduced the chance of developing many health problems. Therefore, more comprehensive interventions should be carried out by healthcare providers during pureperium period in postpartum ward and the health centers for mothers and fathers.

Background and purpose: Crimean-Congo Hemorrhagic Fever (CCHF) is a tick-borne viral disease. In Iran human cases of the disease were reported in some regions including Nur County (Mazandaran Province, northern Iran). Therefore, this study investigated high risk behavior of people involved in meat industry and animal husbandry in different districts of Nur County.Materials and methods: A cross-sectional questionnaire-based study was conducted in 314 livestock and meat industry workers including shepherds and animal keepers, butchers, slaughters, chefs, veterinary physicians and veterinary staff to monitor their high risk behaviors regarding CCHF from July to December 2012 in Nur County. Statistical analyses were performed using Chi-square and binary regression test at 0.05 significance level.Results: Two hundred eighty nine individuals were interviewed and filled out the questionnaire with an average age of 43.7±14.4 of whom 84.4% were male. Odds ratio (OR) of high risk practices including slaughtering and contact with fresh flesh and blood of livestock of males compared with females was 3.35 (OR = 3.35, CI 95%: 1.73-6.47). High risk individuals living in rural and mountainous areas of Baladeh had significantly longer history of contact with livestock and had more high risk behaviors including slaughtering and contact with fresh flesh and blood of livestock, eating raw liver, and removing ticks from animals' body or squashing them with unprotected hand (P < 0.001). Lack of protective clothing in high risk individuals in highland areas (OR = 9.24, CI 95%: 2.66-32.13) and Baladeh district (OR = 9.80, CI 95%: 2.78-34.53) was significantly higher than the rest of the studied areas.Conclusion: The results clearly showed extensive high risk practice in individuals involved in livestock in Nur County. Such behaviors and lack of management programs may increase the occurrence and epidemics of CCHF in the re gion especially in West of Mazandaran Province where current CCHF cases are reported.

Background and purpose: Sea anemones of the genus Actinia are commonly found in the intertidal zone of the northern rocky coast of Spain. Actinia fragacea is one of the most important species that secretes a toxic protein, fragaceatoxin C (FraC), for defense and hunting purposes. The aim of this study was transformation of plasmid containing the gene encoding the FraC to Escherichia coli bacterial strain BL21, and identifying optimum expression condition.Materials and methods: In this experimental study, chemical transformation was conducted by washing the bacteria with cold calcium chloride to take up the plasmid containing the FraC gene. To ensure the transformation of plasmids, bacteria were grown on a medium containing an appropriate antibiotic (ampicilin). For greater certainty, the minipreparation of transformed plasmids was done using GF-1 plasmid extraction Kit. The plasmids were then went under digestion check using NcoІ and Hind ІІІ enzymes and PCR check. After confirming the presence of a plasmid containing FraC in the host bacteria, the bacteria were induced by 1mM IPTG in different times at 20 ºC to find the optimum expression conditions. After collecting bacteria expressing FraC at different times, its expression was visualized on Sodium dodecyl sulfate-polyacrylamide gel (SDS-PAGE).Results: Our results showed that the plasmid containing the FraC was successfully transformed.Also SDS-PAGE results indicated that the FraC was successfully expressed at times of 6 and 8 h using 1mM IPTG at 20oC.Conclusion: According to the results, both steps of chemical transformation had significantly influenced the transformation efficiency. Following the principles and selecting optimum temperature could help us in finding the optimum conditions for expression of each specific protein in bacteria.

Background and purpose: Obstructed Defecation Syndrome (ODS) is a common clinical problem. Stapled transanal rectal resection (STARR) is a relatively new technique in treating this disorder. The aim of this study was to evaluate the efficacy and complications of this technique in treating Iranian patients with ODS due to intussusception and/or rectocele Materials and methods: A cross-sectional study was conducted in patients with ODS caused by intussusception and/or rectocele attending Colorectal Clinic in Tehran Rasool Akram Hospital, 2008- 2010. Hundred and fifty patients with ODS were treated by medical treatment and biofeedback. In case of treatment failure, the patient was considered as candidate for surgery. Finally STARR procedure was performed in 61 patients with ODS. Clinical evaluation was done by ODS and incontinence scoring system.Results: The mean age of the patients was 46.4±3.4 (range: 22-74 years) and the mean operation time was 38±9 minutes. Mean follow up time was 11.5±2.4 months. Mean ODS score improved from 14.7±0.9 preoperatively to 4.3±0.7 postoperatively (P=0.00). Mean pre and posoperative incontinence scores were 0.6±0.2 and 1.2±0.3, respectively (P=0.1). Among the subjects 84% were satisfied with operation and recommend the surgery to other patients.Conclusion: STARR is a safe and effective method in treating ODS due to intussusception or rectocele.

Background and purpose: People are exposed to various chemicals during life especially in their working environment. Some of these chemicals have potential health risks. In risk assessment of chemicals, necessary actions are recommended to protect the involved people against hazardous chemicals. This study was designed to assess the semi quantities risk of TDI and MDI in car paint shops in Alborz province, Iran.Materials and methods: A cross-sectional study was performed in 2013. Singapore’s Workplace Safety and Health framework was used for risk assessment of TDI and MDI in car paint shops. The samples were collected from car paint shops using NIOSH 5522 method and analyzed by HPLC.Results: Hazardous rate of TDI and MDI were 2 and 3 and the exposure rate of materials was 5.Risk factor of TDI and MDI were 3.8 and 3.1. Risk ratings for TDI and MDI were high and average, respectively.Conclusion: In risk assessment the Singapore’s Workplace Safety and Health framework is used for prioritizing control actions. The main drawbacks of this method are lack of risk evaluation (determining acceptable or unacceptable risks) and not considering the effect of high concentrations in measuring the exposure rate.

Background and purpose: Musculoskeletal disorders (MSDs) are the most common occupational health problems that have high costs and lead to productivity loss in nurses. On the other hand, work-related stress is another important factor that could result in reduced productivity in organizations and may lead to physical and mental problems in personnel. This study aimed to evaluate the prevalence of MSDs among nurses and its relationship with occupation-related stress.Materials and methods: This descriptive-analytical study was performed in 940 nurses in Sari hospitals. Census sampling was used to select the subjects. Data was collected using Nordic Musculoskeletal Questionnaire (NMQ) and the HSE Indicator Tool. Data was then analyzed by ANOVA, t-test and Pearson’s correlation in SPSS V.18.Results: The results showed low back disorders were the more prevalent (60.9%) disorders in nurses. Significant association was found between work-related stress and musculoskeletal disorders (P<0.05). MSDs were significantly associated with age, gender, body mass index, and educational level.Also, there was a significant relationship between work experience, marital status and working system (different shifts or stable hours) with occupation-related stress (P<0.05).Conclusion: In this study, nurses had a relatively high prevalence of musculoskeletal disorders.Most of them had moderate levels of work-related stress. So, any intervention for preventing MSDs and job stress should focus on reducing physical and psychological pressures and lead to involvement of nurses in decision-making processes.

Background and purpose: The Activities of Daily Living scale (ADL) and instrumental activities of daily living scale (IADL) are two instruments that screen elderly respondents for physical functioning. They also assess whether they are dependent or independent in performing their activities.This study was conducted to investigate the reliability and validity of Iranian version of ADL and IADL.Materials and methods: ADL and IADL Persian versions were prepared by the forwardbackward method. Content Validity Index (CVI) was also used. The questionnaire was given to 300 individuals. To determine the criterion validity, sensitivity and specificity of the ADL and IADL were calculated. To assess the construct validity convergent validity and known groups were used and ADL and IADL mean scores were compared using the Mini Mental State Examination (MMSE). Internal consistency and reliability was assessed by Cronbach’s alpha and test-retest.Results: The content validity index was more than 0.82 for both ADL and IADL. Convergent validity showed that the mean scores of ADL and IADL in elderly individuals with normal and adverse normal cognitive ability were significantly different. Also, the studied instruments were able to differentiate between different age groups. The sensitivity and specificity of ADL and IADL were 0.75 and 0.96, respectively. Cronbach’ salpha and ICC were more than 0.75.Conclusion: The Persian version of ADL and IADL were found to be consistent and valid measures for assessing daily activities and instrumental activities of Iranian elderly. They are also easy to use and are recommended for research projects.

Background and purpose: This study aimed at evaluating the effects of different doses of Licorice extract on in vitro maturation (IVM) and in vitro fertilization (IVF).Materials and methods: In this study 32 female adult mice were randomly assigned into four groups. Group I was the control, group II were estradiol valerate-induced PCOS mice (0.2cc), and groups III and IV were induced PCOS that received Licorice extract at 100mg/kg/day and 150 mg/kg/day dosage, respectively for 3 weeks. Afterwards, blood sample were taken and the testosterone and esteradiol levels were measured. GV oocytes were isolated from ovaries and cultured in TEM199. The oocytes (MII) were inseminated with sperm. Then, the fertilization and blastocyst stage development were investigated under inverted microscope.Results: The serum testosterone and estradiol levels significantly decreased in treatment groups compared with PCOS mice (P£0.05). Also, the number of oocytes, fertilization, number of two-cell and blastocysts significantly increased in treatment groups compared to the PCOS group (P£0.05).Conclusion: The results showed that licorice is effective on sex hormones in induced PCOS mice and also it could improve IVM and IVF in induced PCOS mice.

Background and purpose: Phthalate esters (PEs) are a large family of industrial chemicals widely used as plasticizers. Phthalates can cause endocrine disruption and cancers. Nowadays, phthalate esters are commonly used in cosmetics, adhesives and toy industries and simply get into the surface water and groundwater. The aim of this study was to evaluate the performance of UV / Na2S2O8 / Fe2+ in DEP removal from aqueous solution.Materials and methods: In this study the effect of pH, concentration of persulfate, Fe2+ concentration and contact time on removal of diethyl phthalate were studied in laboratory scale using a cylindrical-shaped reactor containing a UV-C lamp (16 watts) by batch method. The residual concentrations of Diethyl phthalate (DEP) were determined by HPL. The effects of independent parameters on DEP removal were evaluated by Multi simplex and the response surface method (box Behnken method).Results: In this study the optimum condition was obtained at pH=11, persulfate concentration of 0.4 Mmol/L, 0.07 Mmol/L Fe2+ and 90 minutes contact time. The results showed that the DEP removal by UV / Na2S2O8 / Fe2+ process followed a first-order reaction kinetic.Conclusion: The results indicated high efficiency of UV / Na2S2O8 / Fe2+ process (95% removal under optimal condition) in removal of DEP from aqueous solutions. This efficiency demonstrates that this method is acceptable in DEP removal on industrial scale.

Background and purpose: In recent years, dust storms have affected many regions in Iran including Kurdistan province. Along with dust other pollutants such as heavy metals may also be transferred which pose a risk to human health. The purpose of this study was to determine heavy metals concentrations in atmospheric PM10 in Sanandaj, Iran and also assessing their health risk on the staff and students in Kurdistan University of Medical Sciences (KUMS).Materials and methods: KUMS was chosen as the sampling site and the samples were taken every six days and also on dusty days. Omni air sampler was used to determine the concentration of heavy metals, including arsenic, cadmium, chromium, cobalt, zinc, iron, copper, manganese, and nickel in PM10, from April to September 2013. Health risk assessment of cancerous and noncancerous diseases caused by these heavy metals was carried out using the guideline of United States Environmental Protection Agency (USEPA) for three groups including the staff, students using KUMS accommodation and students resident in other places.Results: The heavy metal with highest concentration was iron which was seen in both dusty and ordinary days. In dusty and ordinary days cadmium was found to have the least concentration in May and September, respectively. The overall risk of cancer for all the studied metals and for the three groups in dusty days was higher than non-dusty days (less than two per one million). Acute and chronic non-cancer risks of studied metals for the three studied groups were less than one.Conclusion: According to the baseline values of cancerous and noncancerous risks provided by the USEPA, it seems that, during the investigation period, the studied metals do not increase the risk of cancer and non-cancer diseases among individuals working and studying in KUMS.

Background and purpose: False positive in newborn hearing screening increases cost and maternal anxiety. We aimed to evaluate the effect of mode of delivery and screening age on false positive result of first screening test. Identifying and controlling these factors could reduce the rate of false positive tests.Materials and methods: In this study, 2784 infants were evaluated by otoacoustic emissions test. The test was performed before hospital discharge. Then, the rates of false-positive were compared in infants born by vaginal delivery and cesarean section based on the screening age.Results: False positive rate in the first screening test in neonates born through vaginal delivery was significantly higher than that of the newborns delivered by cesarean section. The rate of false positive significantly decreased with increase of screening age in infants born by cesarean delivery.Conclusion: Hearing screening test in neonates born through cesarean section should be conducted just prior to hospital discharge. In this way, false positive results could be reduced by about 6 times and the cost and concerns caused by the rate of false positives are also minimized.

Background and purpose: Biological pollution in indoor air is mostly created through bacteria and fungi which are harmful to human health. In the present study we evaluated the fungal diversity of air and air-conditioning systems in different schools of Mazandaran University of Medical Sciences.Materials and methods: The samples were collected from some rooms in different schools of Mazandaran University of Medical Sciences during spring and summer, 2014. The Quick Take 30 Pump-air sampler and carpet sterile fragments were applied for sampling of air and filter surfaces of air conditioners, respectively. The grown fungi were identified by routine mycological methods.Results: Aspergillus was the most frequently species isolated from air samples (408 colonies, 28.26%) and surface samples (347 colonies, 24.89%). The highest fungal concentration level was reported from School of Medicine with Aspergillus (1152 CFU/m3). Among the Aspergillus species, A. niger (43.2%) and A. flavus (34.8%) were the most frequent species from the air and surface samples, respectively.Conclusion: Both sampling methods showed that the School of Medicine had the highest level of fungal contamination over the study period. The high concentration levels of airborne fungi may increase the risk of respiratory diseases. Aspergillus which was commonly found in this study is one of the main mycotoxin producers in nature and is strongly associated with allergic respiratory disease, especially asthma.

Background and purpose: In activated sludge process large amounts of sludge are produced. The disposal and management of this sludge remains a big challenge due to environmental, economic, social and legal factors. Thus, selecting an appropriate process that could reduce sludge would be of great help in solving this problem. The aim of present research was to determine the effects of three processes including Fenton, ozonation and Fento-ozonation on excess sludge reduction in activated sludge process.Materials and methods: A bench scale study was conducted on three processes including Fenton, ozonation, and Fento-ozonation for reduction of dry solids (DS) and sludge volume (SV). The effects of pH, time and ozone dosage were also studied.Results: The results indicated that in ozonation process (ozone dose of 0.14 gO3gTSS-1) the maximum efficiency of dry solids and sludge volume reduction were 79.32% and 87.67%, respectively. The results also showed that the effect of reaction time on reduction of sludge volume was significant in all three processes. Moreover, significant effect of increase in ozone dosage (from 0.07 to 0.14 gO3gTSS-1) was observed on reduction of all parameters in ozonation and Fento-ozonation processes (P<0.05).Conclusion: Ozonation alone was found to be more efficient than Fenton and Fento-ozonation in sludge treatment. However, the combination of Fenton and ozonation processes did not improve sludge reduction.

Background and purpose: Scientific productions have been accelerated in Iran in past decades but their association with health problems and disease burden is doubtful. The aim of this study was to assess the relationship between Iranian scientific productions (published in 2010-2014) with disease burden in Iran using Scopus database.Materials and methods: Data was collected using Scientometric indicators, direct observation, and notetaking. The current research included all articles written by Iranian researchers during 2010 to 2014 which were published in Scopus- indexed journals. The search was limited to the affiliation ‘Iran’ and was performed using different keywords including road accident, ischemic heart diseases, major depression disorders, and cerebral vascular diseases. These were believed to have the highest disease burden. Then, the scientometric outputs were recorded and the relationship between scientific productions with disease burden was investigated.Results: In total, 2824 articles had been published in Scopus-indexed journals. Among them depression disorders and addiction had the highest (1530 records) and lowest (62 records) records, respectively. Major depression disorders were found to have the greatest h-index and the highest percentage of scientific productions with at least one citation was associated with addiction. There was a direct correlation between years of life lost due to premature mortality (r=0.8, P=0.2), years lived with disability (r=0.2, P=0.8), and mortality rate (r=0.9, P=0.205) with scientific productions.Conclusion: According to our results, Iranian scientific productions in Scopus database are not related to disease burden in Iran however, they reflect high mortality diseases.

Background and purpose: Recently studies have shown that main compound (Cyclotides) of Viola odorata has an inhibitory effect against proliferation of cancer cells. Also, melatonin reduces size and growth of tumor cells. The main purpose of this study was to compare the inhibitory effect of Viola odorata and melatonin on MDA-MB-468 cells proliferation.Materials and methods: In this exprimental study, triple negative human breast cancer cells (MDA-MB-468) were cultured in 96-well plates and incubated with different concentrations of Viola odorata hydroalcoholic extract and melatonin for 24h. Cell viability was measured using MTT assay. In the in vivo study Balb/c mice (6 group, n=6) received subcutaneous injection of 100 ml of cell suspension (4T1 cells) in the left hind flank. The animals were treated with different concentrations of Viola odorata extract (50, 150, 250, and mg/kg) and melatonin (40 mg/kg) for three weeks. Tumor volume changes were measured weekly and weight changes were measured at day 21.Results: The in vitro study showed that different concentrations (30, 40, 60, 80, 100, 150, and 200 mg/ml) of Viola odorata significantly decreased cell survival in cancer cells (P<0.05). Also, melatonin at concentration of 1mM significantly decreased cell viability (P<0.05). The in vivo study found that melatonin (40 mg/kg) and Viola odorata at 250 mg/ml concentration inhibited increasing of tumor volume after 21 days compared with control group.Conclusion: Treatment with melatonin and Viola odorata extract was found effective in reducing cell survival and tumor volume.

Background and purpose: The aim of the present study was to examine the validity, reliability and factor structure analysis of the Persian version of the Verran and Snyder-Halpern Sleep Scale (VSH). This scale is used to evaluate sleep quality in hospitalized patients and their perception of sleep for the preceding night.Materials and methods: The Persian version of the scale was provided using forward translation. Then, 220 hospitalized patients were randomly selected to complete the approved version of the VSH sleep scale. Face validity was confirmed by experts, and content validity and construct validity were confirmed by CVR and exploratory factor analysis, respectively. The reliability of the items was determined by Cronbach's alpha coefficient and bisection method.Results: Cronbach's alpha coefficient and reliability of the scale was 0.43 before the analysis. Exploratory factor analysis with principal components and varimax rotation led to the extraction of three factors. The first was sleep disturbance that included 6 items of the 7 items in VSH sleep scale. The second was sleep supplementation that included 3 items of the 4 items in the scale. The last factor was sleep effectiveness which included only a single item from 5 items thereby, being removed from the scale. The remaining two factors explained 55.31% of the total variance. Cronbach's alpha coefficient of the new questions was 0.83 and using Bisection test the correlation coefficient was 0.7.Conclusion: Reliability and validity of the Persian form of the VSH sleep scale proves that this version is appropriate for measuring the quality of sleep in Iranian hospitalized population.

Background and purpose: Satisfaction is an important indicator in measuring the quality of services. Improving the quality of services provided in subspecialized clinics requires an appropriate understanding of the situation and the problems that different sectors are faced with. This study aimed to determine the patients’ satisfaction level from services provided in Sari Tooba Clinic and associated factors using Hotelling's T2.Materials and methods: This analytical cross-sectional study was performed in 603 patients attending Sari Tooba clinic in 2015. The research instrument was a researcher-made questionnaire. The reliability and validity of the questionnaire was determined. Data analysis was conducted in SPSS V.20.Results: The overall levels of satisfaction were found to be poor (20%), moderate (27%), and good (52%). No significant relationship was found between patients’ satisfaction levels and place of residence, insurance, marital status, and age. Among five investigated dimensions, the patients were only satisfied with physicians and demonstrated significantly poor levels of satisfaction in other dimensions.Conclusion: The services provided to patients in Sari Tooba clinic was found to be relatively satisfactory, however, in the pharmacy (waiting time) and amenities (quiet area) high levels of dissatisfaction were observed. Therefore, more measurements should be taken to make a more relaxed environment. Also, increasing the number of staff in pharmacy could shorten the waiting time, thus increasing patients’ satisfaction.

Background and purpose: Fungemia is a significant cause of morbidity and mortality among immunocompromised patients such as severe burns. Due to low sensitivity and long turnaround time of the traditional biphasic BHI blood culture to detect fungemia we aimed to detect fungal elements in blood culture of these patients suspected with invasive fungal disease (IFDs) using panfungal PCR assay.Materials and methods: Four hundred blood cultures were obtained from 112 severely burned patients suspected with IFDs. DNA was extracted and a pair of fungal universal primers was used to amplify the 18SrRNA gene. The PCR product was sequenced and identified using the nucleotide Basic Local Alignment Search Tool (BLAST).Results: 44(39.2%) Blood culture of 112 patients (mean age: 31.9±14.7 years) were positive. In PCR positive patients, mean burn size was 42.6±19 % of total body surface area and average hospital length of stay was 21.8 ±10.3 days. In three patients, same species of fungi were determined in both sequencing of PCR products and the classical procedures of blood culture. Randomly sequencing of 20 PCR products revealed Aspergillus fumigatus (n=11 55%), Candida tropicalis (n=5 25%), C. albicans (n=1 5%), C. parapsilosis (n=1 5%), Agaricomycotina (n=1 5%), and Penicillium (n=1 5%) as causative agents.Conclusion: Panfungal PCR assay on blood culture seems to be a promising method for rapid detection of fungi in blood culture of patients at risk for IFDs.

Background and purpose: Cleft palate is one of the most common anomaly of face and hearing loss is one of its main complications. In this study, we evaluated the status of tympanometry and the need for ventilation tube (VT) in patients with cleft palate.Materials and methods: A descriptive study (during 11 years) was done in children between one to two years of age referring for cleft palate repair. Before operation, tympanometry was performed in all patients and results were recorded in the form of standard groups A, B, and C. If the tympanogram had shown type B or C, VT was placed in tympanic membrane. The type of middle ear discharge in the form of serosa, glue or purulent were recorded. Finally, these observations were compared with the results of tympanometry and type of cleft palate.Results: A total of 48 patients entered the study, of whom 22 were boys and 26 were girls. The mean age of the subjects was 15 months. Tympanometry before surgery had shown type A in 21 ears, type B in 68 ears and type C in others. In fact, 87.5% of patients had shown at least one abnormal ear that needed VT insertion. Middle ear effusion was seen in 93.3% of cases. The effusions were viscous or purulent in 80% of the cases, and there was a significant relationship between the type of discharge and tympanometry results.Conclusion: The majority of patients with cleft palate have impaired tympanogram, therefore, insertion of VT is acceptable even without performing initial evaluation by tympanometry.

Background and purpose: Tuberculosis (TB) is one of the most common diseases in this era that affect the quality of life (QOL). This study aimed to evaluate the QOL in patients with pulmonary tuberculosis attending Anti-TB Centre in Zabol, Iran.Materials and methods: In a cross-sectional descriptive research, 168 TB patients were selected through simple random sampling in 2015. Data was collected by a questionnaire including 40 items. It was then analyzed in SPSS V.21 applying Chi-square, ANOVA and t-test. Probability values less than 0.05 were considered as significant.Results: The majority of patients were female (55.35%). The mean age of the study group was 45.58±15.93. The mean score for QOL for all patients was 84.88±8.84. The t-test showed a significant difference between the QOL mean score and marital status (P=0.000), employment status (P=0.000) and history of smoking (P= 0.039). Also, the ANOVA test showed a significant difference between the QOL mean score and educational level (P=0.000). But no significant difference was found between the mean score for QOL and sex, place of residence and family history of the disease. Moreover, the Chi-square test showed no significant relationship between the quality of life and age in patients with pulmonary tuberculosis.Conclusion: Despite the treatment of tuberculosis, the disease leaves a negative impact on patients’ QOL. Family members and health care team can help the patients in coping with the disease and improving their quality of life by recognizing the factors influencing the QOL.

Background and purpose: Type I diabetes is an autoimmune disease. Nowadays, there is increasing interest in natural products for the treatment of diabetes. This study was done to investigate the effect of hydroalcholic extract of Cynodon dactylon on the biochemical aspects and histopahtological changes of pancreas in experimental autoimmune diabetes in C57bl/6 mice.Materials and methods: After stabilization of diabetes, mice were allocated in three therapeutic groups (n=10 per group) and orally treated with hydroalcholic extract of C. dactylon (100, 200 and 400 mg/Kg) for two constitutive weeks. The mice were euthanized at day 14 post streptozotocin administration and pancreases were collected and applied for histopathology. Furthermore, the levels of serum fasting blood sugar, triglyceride and cholesterol level were measured in 7 and 14 days after final streptozotocin dose. Nonparametric data (histopathological scores) were compared by Mann-Whitney U-test. Other parametric data were analyzed using the one-way ANOVA and Tukey’s post-hoc test.Results: The results indicated a significant decrease in the levels of fasting blood glucose, triglyceride and cholesterol compared to control group. Moreover, treatment with C. dactylon significantly decreased the levels of leukocyte infiltration in the treatment group compared to diabetes mice without treatment.Conclusion: It seems that hydroalcholic extract C. dactylon may have a therapeutic effect against destruction of &betaeta cells and insulitis in the animal model of type I diabetes. Thus, it may be a promising strategy to control this disease in human.

Background and purpose: Diabetes is a health problem worldwide with increasing prevalence in most countries. Nephropathy is a common microvascular complication of diabetes. Diabetes is directly associated with oxidative stress and mitochondrial damage that result in renal tissue damage. This study evaluated the efficiency of nanoceria in attenuation of oxidative damage in renal isolated mitochondria of STZ-induced diabetes mice.Materials and methods: In an experimental study, the mice were divided into five groups (n=6 per group). Diabetes was induced by a single dose of streptozocin (65mg/kg body wt, IP) and the mice with glucose concentrations exceeding 200 mg/dl were considered diabetic and were treated with nanoceria and vit E for 4 weeks. Afterwards, the animals were anaesthetized and kidney tissues were excised at 4°C and mitochondrial fraction was separated by different centrifuge technique. Finally, oxidative stress markers including measuring glutathione (GSH) content, lipid peroxidation (LPO), reactive oxygen species (ROS) and MTT test were assayed in isolated kidney mitochondria.Results: The level of GSH and mitochondrial function significantly decreased in diabetic mice compared to those in control group (P<0.05). Also, significant increase in LPO and ROS formation were observed (P<0.05) in the renal mitochondria of diabetic mice that decreased significantly after nanoceria administration (P<0.05).Conclusion: Our findings showed the protective effects of nanoceria against renal mitochondria damage. Therefore, it could be used as a complementary therapy alongside other blood glucose-lowering drugs to reduce the rate of complications resulting from diabetes.

Background and purpose: Extended Spectrum Beta Lactamases (ESBLs) are one of the most important health care issues all over the world. Uropathogenesis are responsible for life threatening infections in children. In this study we aimed at investigating the epidemiology of CTX, TEM and VEB genes in pediatric UTI.Materials and methods: Urine samples were collected during six months in Sari Bou Alisina Hospital. The samples were inoculated onto 5% blood agar and MacConkey’s agar and the E. coli isolates were identified by standard methods. Minimum inhibitory concentration (MIC) of fourteen routine antibiotics was determined by agar dilution method. Resistance to Cefotaxime and ceftazidime was considered as ESBL producing bacteria. These isolates were then tested by Polymerase Chain Reaction (PCR) for the presence or absence of CTX, TEM and VEB beta-lactamase genes.Results: Of 327 E. coli uropathogen, 100 (30.5%) were identified as ESBL producer. The ESBL-producing E. coli isolates were susceptible to carbapenems (66%) and amikacin (58%). The most prevalent ESBL genes were TEM (49%) following CTX (28%) and VEB (8%). TEM negative ESBL, were significantly more resistant to cefotaxime, ceftriaxone and amikacin (P< 0.05). VEB-producing strains were significantly more resistant to ceftazidime (P<0.05). ESBLs were associated with resistance to cefixime, colistin and cefepime.Conclusion: Regarding the high level of resistance to broad-spectrum antibiotics, more rational prescribing, empiric therapy assessment and TDM of broad-spectrum antibiotics are recommended.

Background and purpose: Embryos produced from in vitro assisted reproductive technologies (ART) manipulations, such as parthenogenesis, are less developmentally competent than in vivo-derived embryos. This study was designed to evaluate the effect of L-carnitine treatment during IVM on maturation of immature oocytes selected by Brilliant Cresyl Blue (BCB) staining, and their subsequent developmental competence after parthenogenesis.Materials and methods: Immature oocytes collected from NMRI mice ovaries were stained with BCB for 90 min. BCB+ oocytes (with blue color cytoplasm) were then cultured in tissue culture medium (TCM) 199 with 0.0, 0.3 and 0.6 mg/ml L-carnitine at 37oC and 5% CO2 under maximum humidity. After 24 hours, nuclear maturation (using Hoechst staining) and cytoplasmic maturation (by measuring the intracellular glutathione (GSH) concentration with monochlorobimane) were recorded in metaphase II oocytes. Cleavage rate, blastocyst development rates (BDR) and total cell number of blastocyst were also determined after parthenogenesis. Results: Both L-carnitine concentrations significantly increased GSH (P<0.01), nuclear maturation (P<0.01) and BDR (P<0.05) compared with those in the control group. L-carnitine had no significant effect on cleavage rate and total blastocyst cell numbers.Conclusion: These results demonstrated that L-carnitine supplementation during IVM of immature BCB+ oocytes could increase developmental competence of oocytes after parthenogenesis, possibly by improvement of nuclear and cytoplasmic maturation of oocytes.

Background and purpose: Population aging is one of the most important issues in demography that has attracted much attention. In Iran, the population is changing from young structure to an old structure. This fast transition calls for designing studies about population ageing in all provinces. This study was conducted to determine the population structure in Mazandaran province.Materials and methods: Four census data sources (1986 to 2011) were used and population ageing index was calculated by median age, fertility and mortality rates. Hierarchical cluster analysis which is an unsupervised classification method was used for grouping the cities in R package version 3.1-2 and thematic mapping was prepared using GIS software 10.Results: The number of clusters of cities considering population aging index, median age of the indices, general fertility and mortality rates in the census of 1986 and 1996 was 6 and in next censuses was 5. In all four censuses the highest aging index and the least number of cluster index were greater than the value of country’s old population. Bar graph indicator of the aging population showed a significant increase in the index during the 1986-2011 censuses.Conclusion: According to the results, population aging was found to have a dramatic increase in Mazandaran province during the censuses. This increase may have different reasons and could not be only due to decline in fertility rate. In some towns such as Savadkuh emigration from the region could be responsible for the increase of ageing population. Another cause of this increase in the province could be increase of life expectancy. Therefore, appropriate planning is required on this subject.

Background and purpose: Malocclusion which has great hazardous effects on oral function seems to have become more prevalent in recent years therefore, the present study was carried out to assess the prevalence of different malocclusions among 13-15 year-old female adolescents in Sari, Iran.Materials and methods: This study was conducted in September 2014 to March 2015. A total of 485 school girls aged 13-15 were randomly selected from 11 schools to determine the status of their occlusion. Students who had previous orthodontic treatment or extraction of any permanent teeth and craniofacial syndrome and mixed dentition were excluded from the study. Angle's classification was used to describe the type of malocclusion.Results: According to the results, only 12% of studied adolescents had normal occlusion, whereas 53% had Class I, 19.4% had Class II and 15.6 % had Class III malocclusion.Conclusion: Class I malocclusion was the most prevalent, while Class III malocclusion was the least prevalent among female students in Sari.

Background and purpose: Hospitals and health-care centers are the major sources of hazardous waste generation. Hospital wastes should be collected and disposed under certain conditions. The aim of this study was to investigate hospitals waste generation in Gorgan, Iran.Materials and methods: The study was performed in 8 hospitals including 3 educational hospitals and 5 non-educational hospitals in Gorgan, 2014. Waste generation was investigated in 4 consecutive months, three times a week. Weighting was performed 384 times (48 times in each hospital). Mann-Whitney and nonparametric correlation test were used for data analysis.Results: The results showed 40.27% hazardous and 59.73% general wastes were generated in hospitals. The mean rates of waste general and hazardous generation were 2.63 and 1.03 kg/bed/day, respectively. These rates in educational and non-educational hospitals were 3.75 and 1.96 kg/bed/day, respectively.Conclusion: Generation of hazardous waste was found to be high in Gorgan hospitals. Also, the educational hospitals generated more waste than non-educational hospitals. Therefore, necessary measures should be taken to reduce the generation of waste, especially hazardous waste.

Background and purpose: Meningitis is an infectious disease which could lead to mortality in case of outbreak in society, especially in dormitories, schools and resting houses. The aim of this study was to assess the geographical distribution of meningitis in Iran by Geographic Information System.Materials and methods: In a cross-sectional study all cases of bacterial meningitis in 30 provinces in Iran during 2013 were investigated using existing data. Initially, the national data from meningitis was collected from the disease management offices. The incidence of meningitis in each province was calculated by epidemiologic forms. Then, these data were arranged in a geo-referenced database at provincial level in the Arc-GIS software.Results: In 2013, 8411cases with bacterial meningitis were reported in Iran. In 250 cases (3%) meningitis was confirmed, in 1823 (22%) the disease was detected as probable and 6338 cases (75%) were suspected to have meningitis. The patients were 40.7% female. Most of the infected individuals were reported from Qazvin, Mazandaran and Kurdestan provinces.Conclusion: Based on maps, it seems that Qazvin, Mazandaran and Kurdestan provinces have either increased risk of meningitis or have a dynamic care system in which reports to the Centers for Disease Control and vaccine-preventable diseases management offices are fully made.

Background and purpose: This research was carried out to investigate the obstetrics, gynecology and midwifery malpractices reported to Ahvaz forensic center and medical council in order to reduce such incidences.Materials and methods: This study was performed on patients’ claims against obstetrics, gynecology and midwifery staff in Ahvaz hospitals, clinics, and health centers, 2006-2012.Results: The results revealed that most claims were due to gynecologists’ negligence, and the majority of malpractices occurred during night shifts.Conclusion: According to the findings, increasing the number of gynecologists and reducing the shift lengths along with more training on enhancing the awareness regarding official rules can reduce the incidence of malpractices.

Background and purpose: Speech intelligibility refers to how speech is understandable by listeners. This study examined speech intelligibility in children (Persian native speakers) with spastic cerebral palsy aged 8-12 years old.Materials and methods: A cross-sectional study was performed in 31dysarthric students (19 boys and 12 girls) in Tehran, 2014. A list of words and sentences were prepared and its content validity was examined. Speech samples were recorded when the participants repeated the words and sentences. The speech samples were transcribed by two groups of familiar and unfamiliar listeners (n=62).Results: The mean scores for word and sentence intelligibility in familiar listeners were 64.25 and 74.9, respectively and 64.51 and 79.3 in unfamiliar listeners, respectively. The mean intelligibility scores were significantly higher in familiar listeners compared with unfamiliar listeners (P<0.001). Average sentence intelligibility score was found to be significantly higher compared with words (P<0.001).Conclusion: Intelligibility of the words was higher than moderate and sentences intelligibility was fair. Unfamiliar listeners were more precise in words and sentences detection. Listeners used context for better detection.

Background and purpose: Self-efficacy and achievement motivation are amongst the most important predictors of academic achievement. The aim of this study was to investigate the relationship between self-efficacy and achievement motivation and academic achievement in students with learning disabilities.Materials and methods: The research population included 32 students with learning disabilities and the Self-efficacy Scale (Sherer et al) and Herman’s Questionnaire Measure of Achievement Motivation were completed by the participants. The descriptive results of the first semester were considered as a criterion for academic achievement. Data was analyzed using correlation and regression analysis.Results: The participants were 79.4% male and the mean age of students was 9 + 0.899. Most of them were grade two to five. Self-efficacy and achievement motivation were significantly correlated with academic achievement (P<0.05 and P<0.001, respectively). Achievement motivation was the most effective component in academic achievement (P<0.001)Conclusion: According to these results, self-efficacy and achievement motivation were the main factors affecting the academic achievement of students with learning disabilities.

Background and purpose: Previous researches indicated a relationship between impulsivity and Internet addiction. This study was conducted to compere the symptoms of attention deficit-hyperactivity disorder (ADHD) in Internet addicted and non-addicted university students.Materials and methods: This comparatevi study was performed in 311 individuals who were selected by convenience sampling. Data was collected using the Young’s Internet addiction test and Conners' Adult ADHD Rating Scales (CAARS). Data was analysed applying ANOVA in SPSS V.16.Results: The results showed higher scores of ADHD in Internet-addict students compared with students not addicted to Internet (P=0.001).Conclusion: Current results are consistent with previous findings proving that individuals addicted to Internet have more ADHD symptoms than those not addicted to Internet.

Pregabalin is used as a new drug in relieving neuropathic pain but it could have some side effects such as dizziness, drowsiness and peripheral edema. Other side effects are rarely reported. We report a patient who developed urinary incontinence following a single dose of Pregabalin. A 72 year old woman was diagnosed with depression and received treatment from two years ago but complained of scattered body pains. After further investigations she was diagnosed with fibromyalgia and was given Pregabalin75 mg daily. After a single dose of Pregabalin the following symptoms were presented: tearing, impaired concentration, and urinary incontinence. The symptoms were resolved within 4-5 hr and Pregabalin was stopped the next day. According to the Naranjo probability scale these symptoms were probably due to Pregabalin. Therefore, it should be prescribed cautiously in older adults.

Background and purpose: Internal inflammatory root resorption (IIRR) is an uncommon lesion in permanent tooth that could lead to destruction of root and the surrounding dental hard tissues if it is left untreated. This article describes treatment of an extensive perforating internal root resorption in a maxillary second premolar using mineral trioxide aggregate (MTA).Case report: After chemomechanical cleaning of the root canal and the resorption lacuna, calcium hydroxide was placed as an intracanal dressing. At next visit, the root canal and defect space were filled by MTA. After one day, coronal access was restored by amalgam. Radiography and clinical examination at the two year follow up showed that the tooth was in function and bone repair occurred.Conclusion: According to these findings, it is possible to have a successful treatment of extensive perforative internal root resorption by MTA without surgery.

Cutaneous leishmaniasis (CL) annually imposes high socio-economic burdens on societies. Although among diagnostic methods, microscopic and or culture methods are considered as golden standard due to their high specificity, but their sensitivities are variable. Today, present microscopic method is considered as the most valid and available method for diagnosis of CL. However, different methods with higher sensitivities are introduced for diagnosis of this disease amongst which improved micro culture has high specificity (100%) and sensitivity (98.4%). Moreover, among other diagnostic methods, various molecular and biochemical methods are developed for detection and characterization (typing) of Leishmania spp. Study of isoenzyme profiles (zymodemes) is considered as golden standard for typing and microsatellite is suggested as an alternative method. Recently, novel methods such as LAMP isothermal technique with high specificity, NASBA and HRM are also evaluated. The current study provides a more detailed overview of novel and routine diagnostic methods for cutaneous leishmaniasis.

Background and purpose: Dicroceliasis is a common disease in ruminants caused by various species of Dicrocoelium. This parasite is seen communally in bile ducts and gallbladder of ruminants and sometimes accidentally in humans. The parasite is considered to be important from both economic and veterinary aspects since it has a direct impact on liver damage and results in significant loss of protein in human diet because infected livers are removed in slaughterhouses. This parasite is prevalent in Iran, so, this study was performed to determine the rate of dicrocoeliasis infection in Iran.Materials and methods: We sought to conduct a systematic review of articles published on some databases such as Google Scholar, PubMed, Science Direct, IranMedex, Scopus, SID, IranDoc and Magiran, between 2000-2015.Results: Our search resulted in a total of 15 reports published about the prevalence of dicrocoeliasis infection. The random effect model was used for this meta-analysis. The relative prevalence rate of dicrocoelium was 3.1% (2.2-4.2%) in sheeps, 1.3% (0.9-1.9%) in goats, and 2.1% (1.1-3.5%) in cows.Conclusion: This study revealed high prevalence of dicrocoelium dentriticum infection among domestic animal in Iran, therefore, it is necessary to follow hygiene procedures in washing vegetables and adequate monitoring are also needed in Iranian abattoirs to ensure the infected livers are removed.

Background and purpose: Age related macular degeneration is the most common cause of sever visual impairment and blindness among adults over the age of 65 years in developed countries. The purpose of this study was to review the literature on using low vision aids in age related macular degeneration and their effects on their quality of life.Materials and methods: A comprehensive search of PubMed, Scopus and Ovid databases was conducted to identify suitable articles published until April 2015. The search keywords included: age related macular degeneration combined by optical low vision aids, non-optical low vision aids, quality of life, preferred retinal locus, telescope, and microscope. Finally 76 articles were selected.Results: Previous studies showed that age related macular degeneration can have profound effect on an individual’s quality of life, psychological wellbeing and ability to carry out daily tasks such as driving, face recognition, reading and so on. Although new medical treatments have improved AMD’s prognosis, but vision related disability remains a major problem and the majority of the treated patients do not regain their lost vision. So, optical devices could be used as alternative treatments to help these patients and improve their visual performance. Different low vision aids such as Implantable Miniature Telescopes are designed to help the involved patients.Conclusion: Many studies that were conducted to evaluate the efficacy of these systems indicated the potential benefit of optical devices for patients with age related macular degeneration in improving their quality of life.