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Introduction: Normal growth of children is an index of their health. So growth monitoring is a routine service provided in most health care systems. This study has been performed in order to assess the effectiveness of growth monitoring regarding incidence of failure to thrive (FTT) and head circumference. Materials and methods: There was a historical cohort study in which the children who were 12 -14 months old at the time of study under the coverage of health service of Aboozar health center, Tehran medical university, were evaluated. We used linear, logistic and Cox modeling for detecting statistical association of the distinguished variables. Results: There was no significant association between number of growth monitoring visits and the size of head circumference (linear model). In addition to, there was a significant association between the number of growth monitoring visits and incidence of FTT (logistic model). Conclusion: According to our data, it seems that growth monitoring has a preventing role in growth of failure to thrive children.

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Introduction: Estimation of fetal weight is very important in preventing delivery complications and also in selecting delivery method. This is specially important in potential macrosomia, IUGR and also preterm labor. The objective of this study is to compare the accuracy of ultrasonic, clinical and mother, fetal weight estimation in pregnant women in Kerman. Materials and Methods: In this cross sectional study 246 women with singleton, term pregnancies admitted for cesarean section within the following week, were studied. Estimation of fetal weight (EFW) was done using sonography and then by two obstetricians and one senior resident who were unaware of the other clinical and ultrasonic results. Mothers' estimation of their baby weight was also asked. Statistical analysis was done by paired T and Chi square tests. We also used ROC (Radar Operating Characteristics) curve to compare the accuracy of different tests. Results: Fetal birth weight was 3339±443 gr. In the 2500-4000 gr birth weight the sensitivity of predicting clinical birth weight was 11.8% with 99.6% specificity and for sonographic EFW was 12.6% with 92.1% specificity. Conclusion: Clinical estimation of birth weight in term pregnancies is as accurate as routine ultrasonic estimation obtained in the preceding week of delivery.

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Introduction: The reason of infertility can have a direct influence on the plan and outcome of management. In this paper we intend to show the effect of tuberculosis (TB) history on female infertility among infertile couples attending to Rooyan infertility management center. Materials and methods: In this case-control study our cases were those who were diagnosed as infertile female and controls were those women whose husbands were infertile due to some male factor. We used logestic regression for analyzing the association of history of Tuberculosis and female infertility with attributable risk estimation. Results: 308 cases were compared to 314 controls. Considering the odds ratio and its 95% confidence interval, there was a significant difference between the history of TB and infertility (OR=4.7, 95% CI: 1.01-29.91). The attributable risk of TB for female infertility was 0.023±0.01 (which is significant at 5% level). Conclusion: These figures show that at least 2% of female infertility can be prevented by prevention and proper treatment of tuberculosis.

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Introduction: Kalleh-Pacheh is an Iranian food used in many part of Iran and many other countries such as Afghanistan, Pakistan and India. We found no information regarding the effect of this food on acute myocardial infarction. The aim of this study was to assess the effect of this food, together with diabetes and smoking on myocardial infarction in Arak district. Materials and Methods: This was a case-cohort study which was performed in Arak district. In this study the data of Arak sub-cohort was taken from Isfahan healthy heart project which was performed in 2001. Cases were myocardial infracted hospitalized patients who were resident in Arak at the time of study. We showed the effect of different exposure, on myocardial infarction by estimating relative risk and population attributable fraction and 95% confidence interval. Results: In this study 150 cases were compared with 6339 sub-cohorts. The population attributable fraction for Kalleh-Pacheh was 19% (95% CI, 6 to 30%). This measure for diabetes and smoking was 31% (95% CI, 23 to 39%) and 41% (95% CI, 31 to 49%) respectively. Conclusion: According to the results of our study smoking, diabetes and using Kalleh-Pacheh has significant effect on myocardial infarction

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Introduction: The objective of this study is to clarify the opinions of scientific board members of Sina university hospital about medical research and the ways of promoting these researches. Materials and Methods: This is a grounded theory study in which we used in-depth interviews and focus group discussions. Scientific board members and different authorities of the hospital such as the chief of hospital and the deputy of education were participated in the study. We used three different FGDs. Each group included about 5 people. We also interviewed the chief, the deputy of education and the head of clinical research center of the hospital. Results: Most of the participants in our FGDs believed that the most important factor for research promotion in the hospital was preparation of a data base of patients. They also mentioned that, different research workshops are important for empowering scientific board members in research. Conclusion: According to our study the most important strategies for research promotion in Sina hospital are data bank preparation, providing repeated research workshops, revising the bureaucratic process of proposal approvals, revising the manner of evaluation of scientific board members and more participation of the department of epidemiology in clinical researches

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Introduction: Nowadays drug abuse is an important problem in the world. Existing data show that using drugs especially pseudo-amphetamine compounds have increased and it seems necessary to determine the knowledge of high risk groups especially youths in this field. The aim of this study is to survey knowledge and attitude of students in Arak University of medical sciences based on Health Belief Model. Materials and Methods: This is a cross-sectional analythical study which was carried out on 100 students of medical, nursing- midway and pre-medical schools in 2006.This survey was done by completing a questionnaire including 53 questions base on health belief model. Data was analyzed using Chi square and Mann-Whitney U tests. Results: The mean age of samples was 22/3(±3/18) years which 67 persons were female. The highest obtained score was related to perceived sensivity and had a meaningful relationship with action (p<0.05). Based on student's opinion of cues to action, TV was the most important resoure in education about Ecstasy. Conclusion:Beased on findings and regarding the meaningful relationship of percieved susceptibility (the danger of using Ecstasy) with action, it is better to provide educational program to prepare youngsters minds about perceived sensivity.

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Introduction: Endocrinopathy is a known consequence of external beam radiotherapy to the brain tumors. The aim of this study was to find out the incidence of hyperprolactinemia in brain tumor patients treated with radiotherapy, when radiation portals included whole hypothalamus and pituitary glands. Materials and Methods: This descriptive study was conducted from December 2004 to February 2006 on about 42 patients with brain tumors. They were referred to radiation oncology center of Hamadan to be treated with external beam radiotherapy, whose radiation portals included whole hypothalamus and pituitary glands. Serum prolactin levels were measured at the beginning of treatment, and at one month, three months, six months and one year after completion of radiotherapy. Data was introduced using descriptive statistics. Results: Of 42 patients 6 were excluded one because of previous hypothalamus and pituitary radiotherapy, three because of nonadherence to follow up program and two because of previous endocrinopathy Of the patients attending the follow up clinic, 11% were found to have hyperprolactinemia at six months, and 22 at one year. This condition in women and men was 37% and 15% respectively. Conclusion: Abnormality in Prolactine secretion is a late complication of brain radiotherapy and a significant number of patients develop hyperprolactinoma following radiotherapy to the brain (hypothalamus and pituitary region). It seems this complication increases by increasing the radiation dose and is more prevalent in women.

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Introduction: Celiac disease (CD) or gluten-sensitive enteropathy is a malabsoption of nutrients due to hyoersesitivity of gluten. Some etiologic facrors are environmental, immunologic and genetic factors. The frequancy of Celiac disease is not studied in western regions of Iran, therefore this study is done to determine the frequancy of Celiac disease in general population of rural regions of Arak. Materials and Methods: This is a descriptive, cross-sectional study in which 700 people between 20-56 years old in rural regions of Arak were selected by multistage random sampling (364 male and 336 female). After completing questionnaires, blood samples were collected and serum IgA levels (to rule out IgA deficiency), and serum t-TG Ab were assessed. All cases that had positive serologies and those who had high clinical probability of having Celiac disease underwent second duodenal segment biopsy. Data was presented using mean, standard deviation and frequency distribution. Results: Serum IgA levels were normal in all samples. 8 cases were positive for t-TG Ab, 38 cases had high normal levels of t-TG Ab and the others had less than 6 Au/ml t-TG Ab. Only in patients with high normal serology, histology was positive. 1% (10 in 1000 people) of all studied subjects demonstrated intestinal lesions due to Celiac disease. Most of them were asymptomatic. Conclusion: CD frequency in rural regions of Arak in people between 20-65 years old was 10 among 1000 cases. This frequency is the same as studies done in northern and southern regions of Iran but was higher comparing to the other parts of the word. This amplifiles the importance of screening of CD in Iran. Also the sensitivity and specificity of t-TG Ab was found high because all cases with high normal levels of t-TG Ab were approved by histology.

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Background: According to the report of Iranian Center of Disease Control, in the summer of 2005 an outbreak of cholera (Inaba serotype) occurred in Iran. The outbreak lasted the mid of September. The aim of this study was to use the result of different studies performed during this period to determine source of infection. Methods and Materials: This is a meta-analysis study, which studies performed in Qum, Arak, Karaj, Golestan and Ghazvin were eligible. All of these studies were case control ones performed during the August 2005. The total of cases were 531. Pooled odds ratios was used to estimate by fixed and random method. All computations were performed by Stata 8 software. Results: The estimated pooled odds ratios resulted from 5 differemt studies were used in the meta-analysis as the following: travelling (1.64 95% CI: 0.98-1.88), non-pasteurized ice cream (0.88 95%CI: 0.48-1.61), post toilet hand washing (3.72 95% CI: 0.86-16.05), eating meal outside home (2.38 95% CI: 1.46-3.90), raw fruit eating (0.98 95% CI: 0.42-2.18) and raw vegetables use (5.36 95%CI: 2.4-12). Conclusion: According to the results of this study raw vegetable use and having meal outside home were significantly associated to the cholera in mentioned provinc

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Background: In the recent years, oxidative stress was attended as one of the causal factors of ischemic stroke. In terms of the role of genetic, geographic and ethnic factors in the prevalence of stroke, This study was designed to compare the oxidative stress indexes of stroke patients with normal healthy subjects in this geographic area. Methods and Materials: In this case-control study, 36 patients older than 50 years with ischemic stroke and 45 healthy subjects with same age and sex, were enrolled. Five milliliter blood were drawn from all subjects. Samples were centrifuged and plasma was separated. Total antioxidant capacity, lipid peroxidation and thiol levels were measured respettively by FRAP, TBA and HU methods. Then the result was analyzed using t-test. Results: Results showed total antioxidant capacity and thiol plasma levels were lower in stroke patients in compare to healthy subjects, but only the thiol group had significant difference(P=0/001). Although lipid peroxidation showed a slight but non-significant difference in stroke patients in compare to control group. Conclusion: These findings suggest oxidative stress in patients with acute ischemic stroke may be conseaqence of an imbalance in oxidant/antioxidant homeostasis. Therefore it may be useful to recommend antioxidant medications or diet for these patients.

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  Background: Stroke is one of the important causes of death. However the prognostic factors are not clearly defined. There are many evidences which show the role of inflammatory factors during the progression of stroke but the relation of CRP and stroke is still vague. This study was designed to determine the relation between CPR Level and WBS with severity of stroke (according to CNSS score) and volume of infarct in stroke patients.

  Methods and Materials : This is a cross sectional study performed during the winter and spring of 2007 on 49 patients with stroke hospitalized in Vali-e-Asr hospital of Arak.Clinical examination was done by using CNSS scoring. The CRP and WBC were measured in the first 72 hour of onset of the disease. The CT scanning together with infarct volume estimation was performed at the same time.

  Results : There was no correlation between the volume of infarct with CRP serum level (r=-0.14, p=0.39 ) and WBC (r=-0.17, p=0.92 . Also there was no correlation between CNSS score with CRP level (r=-0.04, p=0.81) and WBC (r=-0.124, p=0.40) too, but there was a significant correlation between CNSS score and stroke volum in brain CT scan (r=-0.43, p=0.006 ).

  Conclusion: According to data in this study there was no correlation between serum acute phase reactant, the volume and severity of infarction.

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Background: Providing health not only is responsibility of governmental organizations but also is responsibility of Community Health Vounteers help to health staff in health centers and try to promote people's knowledge and practice about their health. This study is conducted to determine knowledge and practice of the volunteers before and immediately after education and evaluated long – term education effects. Methods and Materials: This interventional (semi- experimental) study was carried out on 78 health communicators Arak with census method. In Arak axis education were included check of vital signs and rescue method during disasters. Methods of education were lecture, smallgroup, problem solving, and practical training in Skin lab. Data were gathered with questionnaire and check list and were analyzed with Paired T-test and Pearson correletion coefficient. Data was analyzed using paired t-test and Pearson correlation coefficient. Results: There was a significant difference between mean of knowledge and practice scores before and immediately after training (p<0.001). But the relationship between scores immediately after training and one year later, was not significant. Conclusion: It seems updated knowledge and practice of health volunteers change health behavior, promote knowledge and practice and decrease health care expenses.

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Background: Tension headaches are the most basic reasons for referring to physicians throughout the world. Iron anemia, on the other hand, is the most common type of anemia among women who are in productive age in the world. This study was done to investigate the relationship between vascular headaches and iron anemia and to see the effect of iron tablets administration on the treatment of these headaches in women who are in productive age. Materials and Methods: In this quasi-control study, 50 women in reproductive age who had iron anemia and vascular headaches, referring to the neurologic clinic of Vali-asr Hospital in Arak, were selected and treated with ferrous sulfate tablets for three months. For verifying the treatment, patients' hemoglobin was monitored after one month, and in case of any significant increases in this value, the patients discontinued participating in the study. The number of headache attacks and the number of analgesics used before, through and three months after beginning the administration of ferrous sulfate were noted for all of the patients. Results: The mean number of the headache attacks one month before treatment, during the treatment and three month after the treatment were 19.6±28 , 14.2±11.2 , 13.3±11.8, respectively (p=0.0001) . In addition, the mean number of used analgesics before the treatment, through the treatment and three month after the treatment were 30.1±14.1, 14.3±11.2, 13.1±16.1, respectively (p=0.0001). Conclusion: It seems that using iron tablets can be useful in treatment of vascular headaches.

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Background: Nowadays, the use of inflammatory biomarkers in the diagnosis of appendicitis is on the rise. On the other hand, the role of oxygen free radicals in various inflammatory states has been verified. Noticing the high prevalence of negative appendectomy (9.3-22.2%), the aim of this study was to investigate the level of blood total antioxidant capacity (TAC) as a biomarker for early diagnosis of acute appendicitis. Materials and Methods: In this prospective analytical trial, over a one-year period, 407 patients, with preoperative diagnosis of acute appendicitis who had undergone operation, were studied. After measuring the TAC level, data were analyzed through the analytic ROC curve and parametric mean comparison tests. Results: Of all the patients, 298 were identified with appendicitis. TAC levels in adult female and male groups were respectively 663.9±164.75 and 752.58±167.37 µm/L which revealed a significant difference (p<0.0001). Also, in children, the mean of TAC level in perforated appendicitis sub-group was significantly greater than those in gangrenous and suppurative groups. Conclusion: TAC level can be used as a predictive factor for the diagnosis of perforated appendicitis in children however, it cannot be used as a biomarker for the diagnosis of appendicitis. Because of the significant difference existing between the level of TAC in male and female patients, further studies are suggested to investigate the level of inflammatory biomarkers with respect to menstrual cycle in women.

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Background: Diagnosis of acute appendicitis is one of the challenges that surgeons face in the emergency ward. Although Alvarado score has been recommended in the diagnosis of acute appendicitis, this criterion has some limitations in terms of age, sex, and race. The aim of this study was to evaluate the effectiveness of Alvarado score in the diagnosis of acute appendicitis based on the age and gender. Materials and Methods: In this cross-sectional study, 407 patients who underwent operation with the preoperative diagnosis of acute appendicitis from June 2008 to August 2009 were included in the study. The patients’ data were recorded by the investigators. The data were compared by parametric tests. The sensitivity and specificity were determined by the optimal cut-off point on ROC curve using MedCalc software version 10.2.0.0. Results: The optimal cut-off point for women was lower than men (6 and 7, respectively). The rate of negative appendectomy in the group with Alvarado scores 9 and 10 was 11.8%, while the negative appendectomy rate in the other two groups with Alvarado scores 7 and 8 and 5 and 6 were 29.9% and 52.8%, respectively. Conclusion: The diagnostic value of Alvarado score of 8 and less in physical examination is lower than the abdominal tenderness exam alone. Also, the cut-off point for the diagnosis of acute appendicitis in women should be considered lower than that in men. On the other hand, the cut-off point in adolescents and children is higher than adults.

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Background: Influenza is an acute respiratory disease caused by influenza virus. Influenza epidemics are reported every year and worldwide pandemics occur with varying frequencies. The majority of mortalities are due to underlying diseases and complications associated with influenza. In this study, we evaluated ten fatal cases caused by the established type A influenza (H1N1) infection in the 2009-2010 pandemic. Materials and Methods: This mortality survey was compiled by a review of the deceased patients’ files. The assessed variables were demographic data, underlying diseases, secondary infections, delayed commencement of therapy, and non-medication. Collected data were analyzed by measures of central tendency and dispersion using SPSS software. Results: In the ten deaths due to the established H1N1 virus, the median of age was 30 years and 90% of the cases had underlying diseases. Ninety percent of the deaths occurred during October and November and the rest took place in December and February. Conclusion: The main cause of death was the delayed commencement of antiviral treatment. This emphasizes the importance of timely treatment in high risk patients. In flu pandemics, physicians should swiftly start specific therapy in at-risk groups to reduce the mortality rates.

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Background: Prevention, control, or eradication of brucellosis in a country or region needs policy-making, decision-making, and possessing accurate epidemiological data and information. Therefore, this study was done to review the epidemiology and some factors affecting the interval between the onset and diagnosis of brucellosis in Markazi Province, Iran. Materials and Methods: In this cross-sectional study, data on patients diagnosed with brucellosis during 2010-2011 in Markazi Province were studied. Data were analyzed by descriptive statistics as well as chi-square test, Fisher's exact test, t-test, and Kolmogorov-Smirnov test using SPSS software. Results: Out of all cases (907), the interval between the onset of symptoms and diagnosis was more than a month in 363 cases (41.7%). The interval between the onset and diagnosis was significantly associated with location (urban or rural) (P=0.001), city of residence (P=0.001), career (P=0.002), and type of disease (new or failure case) (P=0.008). Conclusion: Since the interval time between the onset and diagnosis of brucellosis among rural residents, ranchers, housewives, and farmers is more, greater attention should be paid to this new class.

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Background: Differentiation of M. tuberculosis complex organisms were assigned to one of three genotypic groups based on the combinations of polymorphisms at katG codon 463 and gyrA codon 95. Early identification of strains belonging to any particular group is very important. This study was planned to identify major genetic groups of clinically isolated Mycobacterium tuberculosis. Materials and Methods: In this cross sectional study 33 sputum samples were collected from tuberculosis patients of the Markazi province. DNA purification from isolated samples was performed by Chelex 100. Identification of isolates was confirmed by detection of katG gene and the mutation in KatG463 by using PCR method and RFLP respectively. Finally 620-bp of katG gene and 194-bp of gyrA gene purified from PCR product were sequenced. Results: Amplification of 620-bp fragment of katG gene was a good way to confirm the detection of bacteria as a molecular approach. Results of sequencing codon GyrA95 in combination by results of PCR-RFLP determined type of the major genetic group (MGG). Therefore it showed that among the 33 Mycobacterium tuberculosis isolates 12 samples were MGG 1, 15 Samples were MGG2 and 6 samples were MGG 3. Results revealed that MGG 2 was dominant form of M. tuberculosis strains of Markazi province by frequency of 45.5%. Conclusion: Based on the results of this study MGG2 occurrence was more frequent among clinical strains in Markazi province that its accordance with susceptibility of these strains to conventional antibiotics is notable. In this study, three applicable benefits from the test as: MGG typing, molecular detection of M. tuberculosis and bacterial resistance to Isoniazid were proven.

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Background: Funnel plot is a graphical tool for investigating publication bias in meta-analysis studies. The aim of this study is to introduce another application of funnel plot that is monitoring one of the Iranian family performance indices and determining the position of each health center of Markazi province in terms of patient referral rates by general practitioners to specialists and to compare it with bar and caterpillar plots.

Materials and Methods: In order to draw the funnel plot, the average monthly percent of referrals for each district of Markazi province in 2011 was computed. In this study, Iranian Ministry of Health and Medical Education standard figure of 10% was considered as the limit of referral to the second level of Iranian health services. The 99% confidence interval of the control limit for each district was computed according to 3 standard deviations of the percent of referrals relative to the total patient visits.

Results: Based on funnel plot results, five out of ten districts were in the expected range of referral (Ashtian, Saveh, Tafresh, Khomein, and Komijan). However, in other five districts, the referral rate was greater than the expected rate (Arak, Shazand, Zarandiyeh, Delijan, and Mahallat). Mahallat district had the highest rate of referral.

Conclusion: The funnel plot was more informative than the other two plots Thus, it can be viewed as a useful tool in monitoring health programs throughout the country.

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Background: Survey and control of nosocomial infections in the world is a global priority that The objective is to minimize infections in addition to decreased length of hospitalization And also significantly reduce the cost of health care .The aim of this study was evaluating the knowledge, self-efficacy and Practice of nursing staff in Disciplines Standard Precautions in order to prevention of nosocomial infection.

Materials and Methods: This Cross-sectional and analytical study that was carried out on 130nursing staff selectedin in Arak university of medical sciense in 2013. Data collected with validity and reliebility questionnaire including of knowledge, self-efficacy and Practice of nursing staff in Disciplines Standard Precautions in order to prevention of nosocomial infection. Data was analyzed by using descriptive and analytical statistical methods and pearson correlation.

Results: The mean knowledge was 46.92±14.66 and Practice 49.46±6.96 and average self-efficacy was 52.2±10.81 about infection prevention. There was not significant relationship between knowledge and Practice. But there was a significant relationship between self-efficacy, knowledge and Practice and marriage. Moreover there was a significant relationship between knowledge and gender. (p<0.05).

Conclusion: Despite moderate self-efficacy majority of Nurses do not have appropriate knowledge about prevention of nosocomial infection based on the findings of this study. Considering the important role of nurses in nosocomial infection prevention, training is necessary to increase nurses prevention behaviors. Therefor paying more attention by authorities to apply the necessary actions for training of nurses.