Journal of Mazandaran University of Medical Sciences
Year:2014 | Volume:24 | Issue:114|Papers Count:30

Background and purpose: Royal jelly (RJ) is a substance synthesized by worker bee- is shown to have various biological activities on different cells and tissues of the human body. In this study the effect of RJ on peripheral blood mononuclear cells cytotoxicity against the K562 Erythroleukemia cell line was investigated.Material and methods: In this experimental study human PBMCs (106 cells/ml) were separately cultured in standard conditions. The cells were then incubated with different concentrations of RJ (5 mg/ml, 10 mg/ml, 25 mg/ml) for 72 hours. Subsequently, cytotoxic effect of PBMCs pulsed with RJ on K562 was evaluated by Anexin PI test (Flow cytometry).Results: In the Anexin PI test, apoptotic property and cytotoxic effect of PBMCs pulsed with RJ on K562 increased significantly compared to those of the control group.Conclusion: PBMCs pulsed with RJ increased survival rate of PBMCs after treatment with RJ. This compound could be beneficial in preventing and controlling carcinoma cells.

Background and purpose: Cancer is a major cause of death worldwide and gastric cancer with high mortality rate is one of the leading causes of cancer-related death. Understanding the epidemiology of gastric cancer could be of great benefit. However, no clear trend is available on incidence of this cancer in Iran, therefore, this study aimed at investigating the incidence of gastric cancer.Material and Methods: Data included the records from the cancer registry system in Iran during 2003 to 2009. The incidence rates were then standardized using direct method.Results: We found an increasing trend during 2003 to 2009 in Iran. A total of 42, 135 cases with gastric cancer were reported of which 4254 were recorded in 2003. However, this rate increased to 6886 cases in 2009. The highest and lowest rate of stomach cancer in male and female were observed in 2008 and 2003, respectively. The sex ratio was 2.51 in these years. Different regions in Iran were found with different rates of incidence. Men and women were more prone to suffer from gastric cancer in Ardabil and Semnan provinces, respectively. While the least number of diagnosed male were recorded in Kohkilooyeh Boyer Ahmad. Also, the incidences of gastric cancer were lowest in female living in Kohkilooyeh Boyer Ahmad and Hormozgan provinces.Conclusion: According to this study the prevalence of gastric cancer is increasing in northern and western regions of Iran. This could be caused by diet and Helicobacter pylori infection, hence, screening and early detection programs are highly recommended in high-risk areas.

Background and purpose: Waiting time to receive appropriate services in emergency departments is considered as an important indicator for evaluating hospitals. Triage is the most important and the first stage of patient’s management at the time of arrival to hospital emergency department. This study aimed at determining the length of waiting time to receive treatment and diagnostic services and related factors within 5 level triage system in Imam Khomeini Hospital in Sari.Material and Methods: This cross-sectional study was done in Imam Khomeini Hospital of Sari in December 2012. The subjects included 365 individuals who were selected through Morgan table. Waiting time for receiving treatment and diagnostic services for each patient was calculated by researcher from medical records of the patients and the triage sheet and entered in data collection forms. These forms contained two sections. The first part included demographic data and the second part contained information on the emergency department service delivery. The statistical analysis was performed in SPSS V.16Results: The mean time of first consultant by physician was 6.4±7.2 mins, the mean time to receive the first nursing service was 14.9±14.4 mins, and the mean time to determine the patients’ status was 136.6±143 mins. There was a significant relation between the working shift and the mean time of first consultant by doctor and determination of the patients’ status. The same relation was also found for triage level.Conclusion: This study indicated a good level of service provided by emergency department of Sari Imam Khomeini Hospital.

Background and purpose: The rate of infertility has increased throughout the world. Data mining is a new method for analyzing information from databases. Few studies are done regarding infertility and using data mining in describing and predicting different treatment methods and factors influencing these methods. This paper proposes a model for evaluating the efficacy of different drugs in treatment of infertility among patients treated with IUI.Material and Methods: The records of 26,035 infertile patients (from 1998 to 2009) in Sarim Hospital have been examined. Clinical data of patients were analyzed through data mining methods (Clementine V.12.0). To identify the factors influencing the efficacy of drugs classified data mining and clustering algorithms were used.Results: We identified the characteristics of patients with successful treatment using K-Means clustering. CHAID decision tree helped to indicate the result of different drugs in infertility treatments. The proposed model can predict the result of used drugs with 71 percent accuracy.Conclusion: Data mining techniques can improve the process of treatment in infertile patients by detecting the factors affecting the course of treatment.

Background and purpose: Digital radiography has led to many improvements in radiology. Despite many advantages there are different ideas in determining anatomical landmarks which results in some errors in cephalometric analyses. The aim of this study was to determine the degree of identification differences of anatomical landmarks by conventional and digital lateral cephalometric techniques using manual tracing of human skulls.Material and Methods: This descriptive-analytical study was conducted in 17 cases of human skulls in which metal radiopaque markers were attached to 9 landmarks as follows: N, S, ANS, PNS, A, B, Pog, the most inferior point of lower mandibular border, and Go. Conventional and digital lateral cephalograms were obtained from each skull with and without markers. The two cephalograms without markers were traced for landmarks by three orthodontists. Any difference between these landmarks and those of cephalograms with markers, were recorded and analyzed by student t-test.Results: The level of differences in S point was not statistically significant along both x and y coordinates. The measurement differences for the ANS and PNS points obtained by both radiographic methods were significant along the x coordinate but not significant along the y coordinate. Also, the measurement differences for the most inferior point of lower mandibular border, A, B, and Go points along both x and y coordinates were observed to be statistically significant. The measurement difference obtained for the Pog point was significant along the y coordinate and non-significant along the x coordinate.Conclusion: The difference in landmark identification between the two digital and conventional lateral cephalometric techniques was statistically significant for some points on both dimensions, however, the difference was not clinically significant.

Background and purpose: Anterior knee pain (AKP) is one of the most common disorders in young individuals and adults. Pathophysiology of AKP is not clear but chondromalacia patella is considered as the main cause. Different evidences show that physical therapy can alleviate Patellofemoral pain. Despite these therapeutic modalities the treatment of chondromalacia patella is not accurate and most cases are resistant to treatment. A novel and appropriate therapeutic modality is definitely required. This study compared the therapeutic effect of platelet-rich plasma (PRP) and physiotherapy in relieving the AKP.Material and Methods: A prospective non-randomized clinical trial was performed in 60 patients with anterior knee pain and chondromalacia patella. They were assigned into two groups to receive either physiotherapy or intra-articular (knee) injection of PRP (n=30 per group). Outcome was evaluated using Visual Analogue Score (VAS) and the complications of treatment were recorded.Results: There was no significant difference between the two groups in age, sex and the involved knee (right or left) (P<0.05). But duration of pain before treatment showed a significant difference (P<0.05). At 45 days follow up, the symptoms and level of pain in the group that received physiotherapy decreased significantly (P<0.05). We did not observe any treatment complication in the two groups.Conclusion: This study signifies the role of physiotherapy in decreasing the symptoms and relieving the anterior knee pain.

Background and purpose: Perineal lacerations are common complications of normal vaginal delivery which influence maternal health and quality of life of mothers. This study aimed at comparing perineal protection using hands on and hands off techniques on perineal lacerations during delivery.Material and Methods: This clinical trial included 600 nulliparous women who were randomly divided into hands on and hands off groups (n=300 per group). In hands on technique when the head was crowning, a midwife placed her index, middle, ring and little fingers on the infant’s occiput, simultaneously she placed her other hand (index finger and thumb) in a “u” shape exerting pressure on the posterior region of the perineum. In hands off technique during expulsive period the midwife’s conduct was expectant, as she only observed the successive movement of external rotation, delivery of shoulder and remainder of the body. The data was analyzed using chi –square and independent T-Test in SPSSV.16Results: The rate of Perineal lacerations was not different between the two groups (P=0.7). In both groups first degree lacerations were more dominant. Three degree lacerations (P=0.01) and episiotomy (P=0.003) were significantly lower in hands off group but the rate of periurethral lacerations was significantly higher in hands-off group (P=0.01). Second stage of labor and neonatal outcomes were similar in both groups.Conclusion: In present study the use of hands off technique reduced the rate of episiotomy and three degree lacerations of birth canal, therefore, it could be recommended as a safe method during labor.

Background and purpose: Nosocomial infections are a major health problem worldwide. Hospital environment is a reservoir for nosocomial pathogens. This study aimed at determining the prevalence of antimicrobial resistance pattern of bacteria isolated from the environment and medical equipment in Valiasr Hospital in Arak.Material and Methods: A total of 210 samples was collected from hospital and identified. Inducible clindamycin resistance in Staphylococcus was determined with D Zone and sensitivity to vancomycin was identified by using Mueller Hinton agar and E-test. The sensitivity of these strains to cefoxitin and oxacillin was determined by disk diffusion method. The resistance was confirmed by investigating the presence of mec A gene using PCR technique. To identify the ESBL producing gramnegative bacill standard method was used. Amp C beta lactamase resistance was assessed by Amp C disk test, and for carbapenemase resistant MHT was applied. E-test with imipenem and imipenem+EDTA were used to identify the resistance pattern of metalo beta lactamase.Results: There were 240 isolates of which 185 (77%) were Staphylococcus. Among these isolates 136 (73.5%) were resistant to oxacillin and cefoxitin. Inducible clindamycin resistance was found in 46 (25%) isolates. Two samples of the Staphylococcus epidermidis were vancomycin resistant. The presence of Sa442 genes in Staphylococcus aureus and the mecA gene of MRSA was confirmed in all isolates expect in two. The frequency of gram-negative bacteria was 55 (23%). ox51 gene was identified in acinetobacter baumannii. Fifteen nonfermenting gram-negative bacill and 40(65%) strains of Enterobacteriaceae were ESBL producers. Among the Klebsiella pneumoniae six (33.33%) were AmpC producers. MHT positive was found in nine (60%) nonfermenting bacills.Conclusion: According to this study presence of microorganisms in Valiasr Hospital environment and high incidence of antibiotic resistance are considered as major health problems. By determining potential pathogens in hospital setting and the pattern of antibiotic resistance markers physicians can perform more successful treatments.

Background and purpose: Autonomy in making decision is one of the most fundamental principles of medical ethics. Respect for patient autonomy is a moral duty, therefore, many doctors agree to perform unnecessary cesarean. This study was designed to determine the incidence of maternal demands for cesarean sections and influential factors on making decision among pregnant women in Tehran, 2010-2011.Material and Methods: This cross-sectional study was carried out in women attending some hospitals in Tehran for delivery. There were 850 pregnant women who delivered their babies through cesarean section. Data was analyzed using univariate logistic regression in SPSS.Results: The prevalence of cesarean delivery on maternal request was 11.2%. The cause of cesarean among 82.3% was fear of vaginal childbirth. Pregnant women aged < 21 years old were 3.2 times more interested in having a cesarean section (OR=3.200, CI 95%=1.15-8.89), and those who had higher education were 18.5 times more likely to deliver their babies through cesarean (OR=18.5, CI95%=2.45-139.35). Performing cesarean on maternal request was found two times more in working women compared to housewives (OR=2.39, CI95%=1/45-3.93). Moreover, the employment status of husband (OR=6.037, CI95%=2.33-15.99), delivery in private hospital (OR=7.13, CI95%=4.08-12.44), and the idea of medical team (OR=45.89, CI95%=25.39-82.93) increased the probability of cesarean delivery.Conclusion: The findings indicated several factors that influenced cesarean birth on maternal request. Social norms were found as the most influential factor, therefore, providing the society with more training and education is necessary in enhancing the public idea about unnecessary cesarean section.

Background and purpose: Hirsutism, the growing unwanted terminal hair, is one of the disorders which affect life style. Spironolactone is one of the common drugs used in treatment of hirsutism. Topical preparation has been focused in many researches due to side effects after oral administration. In this study, the effect of formulation ingredients on spironolactone emulgel characteristics was evaluated.Material and Methods: Carbopol TR2 was used as polymer in this study. The effects of aqueous and oily phase ingredients were also investigated. Physical properties of emulgels were studied for two months. Dissolution of drug was evaluated using USP apparatus No. II dissolution tester. Then the prepared material was filled in membrane sac (27 Kd) and drug release was studied for 24 hours. Diffusion cell and mice skin were used for percutaneous absorption evaluation. The drug release was determined by UV spectrophotometer method. The drug release and percutaneous absorption data were fitted in zero order, first order, and Higuchi model for kinetic evaluation.Results: The results showed that emulgels containing glycerin were not stable. We also observed the effects of polymer content on the quality of prepared material. The drug release was decreased by increase in polymer content (P<0.01). The pH of final preparations was near to skin pH value. The percutaneous absorption study showed that the dug was 39.61%±4.2 absorbed during 24 hours.Conclusion: This study showed polymer, type and amount of vehicle effect on spironolactone emulgel characteristics. The dissolution and transdermal absorption showed that this product could be used as suitable topical preparation.

Background and purpose: Resveratrol (RSV) is a naturally existing polyphenolic compound abundantly found in grapes and several plants. It has potent free radical scavenger and antioxidative properties with significant effects in reducing oxidative damage. Oxidative stress and mitochondrial dysfunction contribute to PQ induced tissue damage. In this study, the protective effect of RSV was investigated against PQ induced mitochondrial toxicity in lung and brain isolated mitochondria.Material and Methods: Mitochondria were isolated from fresh rat’s lung and brain tissues using differential centrifugation technique. Isolated mitochondria were divided into control group, PQ group, and PQ plus RSV-pretreated group. Mitochondrial viability was assessed using the MTT colorimetric assay.Results: Paraquat induced mitochondrial dysfunction was found in lung and brain isolated mitochondria in a concentration-dependent manner and higher toxicity was observed in brain isolated mitochondria. RSV prevented PQ-induced mitochondrial dysfunction in rat’s lung and brain isolated mitochondria.Conclusion: Considering the protective effects of RSV against mitochondrial toxicity of PQ, this compound can be used as possible agent for prevention and treatment of pathological condition due to oxidative stress and mitochondrial dysfunction.

Background and purpose: Chloroform is a disinfection byproducts (DBPs) that result from reactions between residual chlorine and organic compounds as precursors. The presence of these DBPs in chlorinated drinking water can pose a severe public health threat including potential carcinogenicity. In this study chloroform concentrations as an indicator of DBPs of chlorinated water was evaluated in Tehran’s drinking water system.Material and Methods: This study was a cross-sectional study in which the samples were taken from water treatment outlet and from certain points of the water distribution network in different seasons during 2009. The samples were analyzed for presence of chloroform compounds using standard methods. The temperature, pH, and residual chlorine concentration were measured as the most important factors associated with chloroform concentrations.Results: Total average concentrations of chloroform in the water treatment plant outlet and in the distribution network were 11.2 and 36.5 micrograms per liter, respectively. These amounts in distribution network concentrations were almost 3.3 times more than the amount of water treatment outlet concentrations.Conclusion: Evaluation of chloroform concentrations in the water treatment plant outlet and distribution network involving temperature, pH, and chlorine residual indicated a direct correlation between them, which was significant in distribution network system and non-significant in the water treatment plant.

Background and purpose: Anogenital distance is an accepted indicator for endogenous or environmental effects of androgens on development of reproductive system in fetus and newborns. This study was done to determine the relationship between penile length and anogenital distance in Iranian newborns.Material and Methods: In this cross-sectional study stretched penile length (PL) and anogenital distance (AGD) were measured in 427 healthy male newborn infants born in a Teaching Hospital (in north of Iran). Other variables included the age of mothers, and weight, height, and head circumference of neonates. Normal distribution of variables was measured by Shapiro-Wilk and data was analyzed using Pearson Correlation tests.Results: The mean of PL was 32.1±3.5 mm and the mean of AGD was 24.5±2.5mm. A weak correlation was observed between PL and AGD (r=0.097, p=0.046).Conclusion: The correlation between penile length and AGD showed that, AGD could be also used in assessing the genital system and even as a common indicator to assess the genital system in both sexes.

Background and purpose: Pollution of exploitation water resources is increasing throughout the world. Continuous monitoring of these resources could play a key role in reducing such pollutions. This study aimed at evaluating As, Zn, Pb and Cu concentrations in groundwater resources in Toyserkan Plain and preparing the zoning map through GIS.Material and Methods: Groundwater samples were collected from10 selected stations during two seasons in 2012. The samples were filtered (0.45 mm) and maintained cool in polyethylene bottles. Samples were taken for the analysis of cations, the former was acidified with HNO3 (suprapur Merck, Germany) to pH lower than 2. Minor elements (As, Zn, Pb and Cu) were determined using ICP-OES (Varian, 710-ES, Australia). All statistical analyses were performed using SPSS. Kriging method was used for preparing spatial distribution maps of elements in groundwater samples.Results: The results showed that mean concentrations of As, Zn, Pb and Cu in groundwater samples were 3.68±0.76, 3.85±0.84, 1.66±0.35 and 8.59±1.01 ppb, respectively in spring, and 3.99±0.83, 6.30±1.12, 1.85±0.71, and 12.49±1.85 ppb, respectively in summer. The mean concentrations of evaluated metals in groundwater samples were significantly different compared to those of the WHO and IranDOE permissible limits for drinking and agricultural use (p<0.05). In fact, the mean concentrations of aforementioned metals were significantly lower than the permissible limits.Conclusion: Currently the groundwater resources of Toyserkan Plain are not polluted with heavy metals, but long-term excessive use of agricultural inputs and construction of polluting industries can cause a threat to groundwater resources in this area.

Background and purpose: All forms of violence have mental and social consequences for women. The purpose of this study was to determine the relationship between dimensions of domestic violence and social structural determinants of health in women referred to forensic center in Tehran Material and Methods: This cross-sectional study was conducted in 196 women attending forensic center in Tehran using continuous sampling method in 2013. Data was collected through demographic questionnaire and CTS-2 and analyzed in SPSS V.16.Results: The results showed that the mean score of physical violence was the highest (37.29 ±16.80) among the subjects. ANOVA test also showed a significant correlation between verbal violence, age and husband’s job (p<0.0001), sexual violence and age (p=0.029), and emotional violence and husband’s age (p=0.003). Moreover, sexual violence was found to be significantly higher in working women.Conclusion: The relationship between violence and some social determinant factors such as husbands’ age and job indicates the necessity of identifying women at risk to provide them with enough care.

Background and purpose: Haemophilus influenzae type b (Hib), is one of the major causes of bacterial meningitis in children younger than five years of age, especially in countries that immunization against Hib is not conducted. In this study we have determined the serotype, encapsulated Haemophilus influenza strains isolated from clinical samples by polymerase chain reaction (PCR) method.Material and Methods: In this study, DNA of H. Influenzae spp was extracted through boiling method. The encapsulated strains were determined by bexA gene primers. The encapsulated strains serotype were then detected using type-specific primer sets “a to f”.Results: From the total of 50 strains of the Haemophilus influenzae isolated from clinical specimen, four strains have shown the bex A gene which all of them were encapsulated and all of four isolates have been determined as type b strains.Conclusion: It is well shown that H influenza spp were not detected by routinely culture method in many clinical laboratories. Despite the presence of pathogenic strains of Hib in different clinical specimens, molecular diagnostic such as PCR should be replaced and performed for miss detected bacteria.

Background and purpose: Recommended treatment for patients with carotid stenosis, is Carotid Endarterectomy (CEA) that is more effective in preventing stroke compared to other therapies. The purpose of this study was to evaluate morbidity and mortality rate in patients with carotid stenosis after CEA.Material and Methods: In this descriptive study, 138 patients undergoing CEA admitted in the Shahid Rajaei and Velayat Hospitals in Qazvin were studied. Sex, age, and percentage of stenosis, the cause of surgery and postoperative complications during and after surgery and mortality rates were recorded. Data was analyzed using SPSS 16.Results: Death occurred in three cases of which two were due to loss of consciousness and one was induced as a result of cardiac arrest. These cases also had severe carotid artery stenosis and myocardial infarction. Complication rate was 27.5% (38 subjects) of whom 34 individuals had severe stenosis and four suffered from moderate stenosis. Moreover, 72% of the complications were associated with cerebrovascular attack (CVA).Conclusion: Results showed acceptable rate of mortality and morbidity is after endarterectomy surgery compared to other studies.

Background and purpose: Toxoplasmosis is an infection caused by an intercellular protozoan called Toxoplasma gondii. Toxoplasma has global expansion and its prevalence is different in regions according to geographical conditions, habits and history of contact with cats. The present study determined the seroepidemiology of toxoplasma in pregnant women attending health centers in two cities in north of Iran.Material and Methods: In this cross-sectional study, 289 pregnant women who referred to health centers in Ramsar and Tonekabon were randomly selected. After the debriefing questionnaire, blood samples were taken from the subjects. Then IgG and IgM antibodies against T. gondii were examined by ELISA method. Finally the data was analyzed in SPSS.Results: Positive IgG and IgM anti-Toxoplasma antibody were found in 170 (58.8%) and 7 (2.4%) expectant mothers, respectively. Among the participants four (1.4%) were positive for both IgM and IgG and 116 (40.1%) were negative for both types of antibodies. There was no significant relation between the possible risk of T. gondii infection and pregnant women’s place of living, educational level, age, occupation, exposure to cats, and the consumption of raw meat.Conclusion: This study demonstrates a high prevalence of Toxoplasma among pregnant women in Ramsar and Tonekabon. Hence, more training are necessary to raise awareness especially in pregnant women.

Background and purpose: Self-medication is a major health problem which could be unsafe especially in pregnancy. Considering the importance of drug side effects during pregnancy, we studied about self-medication and supplement use by pregnant women.Material and Methods: This cross-sectional study was performed in 303 pregnant women attending kashan health centers in 2012. A researcher made questionnaire was used to collect the data. The questionnaire included questions regarding maternal demographic characteristics, supplement use, self- medication, and some associated factors. To analyze the data SPSS was used.Results: A total of 303 pregnant women were studied including 99 (32.7%) rural and 204 (63.2%) urban women. During pregnancy 99 individuals took iron, 82.2% used calcium, and 92.7% took multi vitamin supplements. The majority of women had extra drugs at homes (64.7%) and used them if necessary (60.1%). Some also purchased drugs from pharmacies, without prescription (64%). The rate of self-medication was significantly higher in rural women (P=0.04). We found a significant difference between buying drugs without prescription and number of pregnancies and the age of mothers. Selfmedication was observed more among those aged³30 years of old (P=0.03).Conclusion: Given the high prevalence of self-medication during pregnancy especially in rural areas, more training should be provided to healthcare workers, pharmacy staff, midwives, and pregnant women.

Background and purpose: Vaccination against hepatitis B is one of the most important ways to prevent this viral disease. However, some individuals vaccinated against hepatitis B do not show adequate defense. This study was designed to investigate the immune response towards this disease by assessing the level of hepatitis B antibody in vaccinated health care workers (HCWs) in north of Iran.Material and Methods: This descriptive– cross sectional study was carried out in 2013 in which 117 HCWs of Amol 17 Shahrivar Hospital were studied. Levels of hepatitis B surface antibody were measured in serum samples using ELISA kit. The results were analyzed considering elapsed time of vaccination, and age and gender of the subjects.Results: Among the studied HCWs 79 (67.5%) had complete vaccination while 38 (32.5%) had incomplete vaccination. Immune response was found in safe level in 98 (83.3%) and non-safe in19 (16.2%) (titer below 10mlu/ml). There was a significant correlation between hepatitis B surface antibody levels and elapsed time of vaccination (p<0.05). The antibody titers was higher in women and individuals younger than 40 years of age, however, this difference was not significant (p>0.05).Conclusion: Findings suggest that vaccination against hepatitis B does not guarantee a complete immunity and the level of immunity is very much affected by elapsed time of vaccination. Although women were found with higher antibody titers in this study.

Background and purpose: Juvenile delinquency is increasing in many countries including Iran. This study was designed to investigate the efficacy of forgiveness therapy in reducing aggression and enhancing forgiveness in adolescent boys in Tehran Correctional and Rehabilitation Centre.Material and Methods: This quasi-experimental study included pretest-posttest with control group. The research population consisted of all adolescent boys attending Tehran Correctional and Rehabilitation Centre in 2012. (almost 300 persons). Thirty accessible individuals were randomly selected and divided into experimental and control groups. The experimental group attended ten sessions of forgiveness therapy while the control group received no intervention. STAXI-2 and TRIM questionnaires were completed by subjects as pretest and posttest. Data was analysed performing MANOVA.Results: In this study forgiveness therapy based on Enright’s process model, reduced aggression and promoted forgiveness in experimental group.Conclusion: Forgiveness therapy either alone or alongside other treatments could improve mental health, thereby reducing many unwanted consequences.

Background and purpose: Job burnout as a syndrome includes physical and emotional exhaustion, negative attitude towards job, and lack of enthusiasm and motivation. Undesirable outcomes of job burnout include absence from work, reduced professional efficacy, and low levels of job satisfaction. The purpose of this study was to determine job burnout among health care workers in Golestan province.Material and Methods: This cross-sectional study was conducted in health centers in rural areas of Golestan among employed health care workers. They were selected using census method. Data was collected using Maslach Burnout Inventory and analyzed in SPSS.Results: The intensity of job burnout was in low level in 29.6%, average in 58.5%, and high in 8.11% of the health workers. The frequency of job burnout was found in in low-level in 30.3%, moderate in 53.5%, and high in 16.2% of the participants. There were significant relationships between the intensity and frequency of job burnout and age, years of experience, level of education and the place of residence.Conclusion: Burnout was observed to be moderate in studied health workers. However, some interventions are needed to improve the dimensions of emotional exhaustion and job involvement, especially in individuals with old age, higher years of services, and those with lower levels of education.

Background and purpose: The increasing prevalence of overweight and obesity in children and teenagers is a serious health concern which could result in physical, mental and social disorders in next years. Several factors contribute to overweight and obesity. This study aimed to determine the factors affecting overweight and obesity among high school students in Amol (north of Iran) in 2013.Material and Methods: In this descriptive-analytical study, 381 high school students in Amol were randomly selected. Data was collected in a questionnaire containing open and closed questions including three sections: demographic variables, contextual variables and dependent variables. The validity and reliability of the questionnaire were also confirmed. The obtained BMI (Body Mass Index) was divided into four categories: underweight, normal, overweight and obese. Data was then analyzed in SPSS.Results: In this study the BMI of the students showed that 76 (20.1%) were underweight, 215 (56.7%) were normal, 63 (16.6%) were overweight, and 25 students (6.6%) were obese. There was a significant relationship between high BMI and the time spent using computer (P= 0.041). No significant relationship was found between high BMI and sex, parent’s educational background, place of residence, type of school (private or state), consumption of fast food, having exercise, going for walk, and time spent watching television (p>0.05).Conclusion: The results showed that almost a quarter of the students with high BMI were not influenced by any social or behavioral factors. However, further intervention programs should be designed for all student groups to reach more accurate conclusions.

Background and purpose: Electron beams are extensively used in superficial cancer therapy. Unlike photon therapy, percentage depth dose curves (PDD) do not specify a maximum point in high energy electron therapy and include a depth range. The aim of this study was to obtain PDD by an analytical formulation which can be helpful to acquire the size of treatment area and other treatment factors such as the depth of maximum dose, the most probable energy (Ep), practical range (Rp), and the depth which the dose reaches the peak of 50% (R50).Material and Methods: Measurements of PDD was done in radiotherapy department of Ahvaz Golestan Hospital for Siemens Primus Plus accelerator, using ionization chamber CC13 dosimeter and a water phantom for energies of 6, 9, 12, 15, 18, and 21 MeV and different field sizes at various depths. Data was analyzed using MATLAB 7.8 software.Results: The function which had the best fit to the data was selected. This function was used to calculate the, Rp and R50 points for each field size and energy. The dependence of these points to field size and energy were also obtained.Conclusion: We found that 4 Gaussian function had the best fit to the data (r2=0.99). Rapid dose reduction was observed after a relatively flat area. The curve had a sequence that was due to photon contamination. R50 and Rp points obtained for the various fields and energies by analytical function revealed that R50 depends on the field size and energy. But, Rp depends only on energy and does not depend on field size variation.

Recently, despite the application of surgery and antifungal therapy, mortality rate of invasive fungal infections due to opportunistic fungi such as Candida and Aspergillus species has dramatically increased specially in immunocompromised host. The status of the immune system plays a key role in controlling the disease, yet antifungal therapy is of great benefit in saving involved patients. Today some efficient antifungal agents are available which are very expensive compared to amphotericin B deoxycholate. The empiric treatment of Candida bloodstream infections is fluconazole therapy which is the best choice for neutropenic patients with and without septic shock. However, amphotericin B deoxycholate and caspofungin therapy are the optional treatments for patients who previously used azole agents. These drugs are considered as the first choice of treatment in patients with neutropenia. Fluconazole therapy is recommended for fungal infections due to C. albicans, C. tropicalis and C. parapsilosis and amphotericin B deoxycholate or caspofungin are applied for C. glabrata and C. krusei. Primary teherapy for invasive aspergillosis includes combination therapy in critically ill patients. Voriconazole and caspofungin (if not used as primary treatment) and liposomal amphotericin B are recommended in patients resistant to conventional treatments. Moreover, combination therapy with caspofungin with voriconazole and liposomal amphotericin B should be considered in severely ill patients. In clinical decision making clinicians should consider the results of different studies and also the cost of treatment.