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Introduction: The protein-energy malnutrition is the most prevalent cause of malnutrition and always occures in infants and children under 5 years old. According to the harmful effects of malnutrition, such as high mortality, inability of learning and decrease of mental and physical ability, reconnoite and study of malnutrition qualification is very important.
Material and Methods: This analytic cross-sectional study was carried out on 811 children under 5 years old who were living in rural zone of Arak. Based on health files, clinical inspections and interview with mothers a checklist was fulfilled for every child. Data were analysed by EPI6 software
Results: In this study, none of the children had stricken with Kwashiorkor or Marasmic-Kwashiorkor. Undernourished were seen in 7.39% and Marasmus were also seen in 1.1% of subjects. The prevalence of malnutrition was 7.5% in Wellcome, 33.55% in Waterlow-Stunting, 23.05% in Waterlow-Wasting and 30.94% in Gomez classification. There was statistically correlation between malnutrition and respiratory infection rate, milstones, birthweight, maturity and begning of helpfood (P<0.05).
Conclusion: Considering the results, the most rate of malnutrition in each classification was mild. It is suggested that increasing of familial awareness is an important factor for preventing from next damages and additional treatment costs.

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Background: Job satisfaction is regarded as an individual's opinion of his or her job. Noticing the key role of hospital personnel in giving health services to patients, this study was designed to determine job satisfaction of hospital personnel in Arak. Materials and Methods: This cross-sectional study was carried out on 702 hospital personnel through simple sampling method. The means of gathering data were demographic and Herzberg's job satisfaction questionnaires. Job satisfaction was categorized in three levels. Results: Results in eight domains showed that most personnel's satisfaction of job environment (%75.2), relationship with co-workers (%49), salary and benefits(%75.1), job position(%60.5), job security (%64.6), supervision(%64),management policy(%59.2)and personal life relations (%65.7)were at average levels. Overall, %82.2 of the personnel had an average satisfaction with their jobs. The greatest level of satisfaction was with relationship with co-workers and the lowest level of satisfaction was related to job difficulty benefits, establishment of justice and fairness, discrimination and lack of facilities. X2 statistical test revealed significant differences amolay sex, level of education, type of employment, type of job and work shift. Conclusion: Overall, Job satisfaction in this study was at an average level. Increasing salaries, job difficulty benefits, on time payment and providing welfare facilities are essential for the improvement of job satisfaction in this group.

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Background: This study was designed to investigate the quality of life in staff and hospital personnel of Arak University of Medical Sciences and to gain basic information for carrying out interventions for improving their quality of life. Materials and Methods: This cross-sectional study was done to determine quality of life of 300 staff and hospital personnel in Arak University of Medical Sciences. Data gathering tools were demographic and standard quality of life (SF-36) questionnaires. Results: Of the 275 participants who had completed the questionnaires, 127 (%46.2) were staff and 148 (%53.8) were hospital personnel. The means of age and years of experience were 36.797.02 and 12.297.39 years, respectively. The mean of different dimensions of quality of life in the staff was significantly much higher than that in the hospital personnel (p<0.05). In terms of physical performance, vitality, social performance, general health, physical and mental health domains, significant differences were found among personnel with different employment status. There was also a significant difference between men and women in terms of physical restriction factors, physical agony, vitality, sanity, mental and physical health. Conclusion: The mean of different dimensions of quality of life in hospital personnel was lower than the staff while this value was lower in women than men. Specific longitudinal studies are needed for investigating the causes of these differences.

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Background: Hospital wastewater usually contains pathogenic micro-organisms, drugs, radio active materials, and toxic chemical elements that in case of being disposed without filtration, will result in pollution and spread of diseases. Therefore, evaluating the status of wastewater disposal in hospitals is necessary for proper planning. Materials and Methods: In a cross-sectional descriptive study in 2008, data collection was done by means of interviews, observations, and questionnaires in all hospitals of Markazi Province. Noticing the 33 items in the questionnaire, the overall conditions of the hospitals and the methods of using the sewage system were studied, and at the same time, filtration installations and wastewater disposal systems were inspected. Results: Of all the 19 hospitals, 10 used a conventional method of direct disposal of sewage to subterranean shafts, and of the 4 hospitals with filtration installations, three were practically out of order or were not efficient. Five of the hospitals were directly linked to the city sewage system without any pre-filtration. None of the hospitals had a specialized operator of sewage filtration and disposal system. Conclusion: Wastewater disposal in hospitals of Markazi Province is not desirable therefore, such acts as conducting more specific surveys, creating a positive attitude in planners, and providing sufficient funds for filtering wastewater in some of the hospitals are suggested.

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Background: Brucellosis is a zoonotic disease in humans and animals that its control is dependent on the prevalence of diseases in animal populations. The purpose of this study was to compare the sensitivity and specificity of common diagnostic tests for brucellosis. Materials and Methods: In an analytical cross-sectional study, 297 serum samples from an infected herd that had a history of abortion were prepared and evaluated through standard tube agglutination, Rose Bengal, 2-Mercaptoethanol, complement fixation, and ELISA tests. In addition, microbial culture was done for positive serum samples, lymph nodes, and infected organs. Results: Based on the total 297 serum samples tested, the sensitivities for standard tube agglutination, Rose Bengal, 2-Mercaptoethanol, complement fixation, and ELISA tests were 89, 81.5, 75.3, 89.7, and 93.2% , whereas specificities were determined to be 97.4, 94, 96, 98, and 99.3%, respectively. Conclusion: The findings of this study show that the standard tube agglutination test, complement fixation test, and ELISA are more sensitive than other tests. Moreover, ELISA test was the most sensitive and specific serological test for diagnosis of brucellosis in the present study

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Background: Nowadays, one of the basic problems of tuberculosis treatment is drug resistance. This study was done to determine the drug resistance of mycobacterium strains isolated from patients with pulmonary tuberculosis to anti-tuberculosis drugs and determine the affecting factors. Materials and Methods: In a cross-sectional study, all patients with tuberculosis who were covered by Markazi Province Health Center (917 persons) during 2005 to 2010 were included in this study. For all patients with resistant pulmonary tuberculosis, culture and antibiogram by standard method (proportional) were done. Effective factors in drug resistance were identified by logistic regression model using SPSS software. Results: Overall, the rate of resistance in patients with smear-positive was 7.3% and the rate of MDR-TB was equivalent to 4.3%, and 0.5% of smear positive patients were resistant to all five drugs. The most resistant strains were isoniazid (68.8%), rifampin (62.5%), pyrazinamide (25%), ethambutol (21.9%), and streptomycin (21.9%), respectively. The highest rate of resistance was in the 15-45 years age group. The incidence of resistance was significantly associated with sex, grade of smear positivity, relapse of TB, and HIV infection. Conclusion: The study of drug resistant mycobacterium strains over six years showed a growing trend. Therefore, close attention to prevent the production and dissemination of resistant strains is very essential.

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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: Tuberculosis is an old problem that is currently considered a great challenge. Noticing Iran’s borders with Afghanistan and Pakistan, which are among the 22 high burden countries around the world, the present study was conducted to analyze the current molecular epidemiology of TB and survey genetic diversity of Mycobacterium tuberculosis strains in Markazi province, Iran. Materials and Methods: In this experimental study, 57 sputum specimens from smear positive patients admitted to health centers in Markazi province were cultured on specific mycobacterial culture media. Genomic DNA was extracted by standard protocols of WHO and digested separately by PvuII and AluI. Electrophoresis was performed and DNA fragments were transferred to positively charged nylon membrane by southern blotting method and hybridization by PGRS probe. The hybridized strains were subsequently detected by enzymatic reaction and analyzed. Results: Genotyping of the isolates by PGRS-RFLP with Pvu II and AluI displayed a wide range of genetic diversity so that 50 and 45 genotypes were identified, respectively. Conclusion: Noticing the great diversity of PGRS in the Mycobacterium tuberculosis strains, it can be concluded that in the study population, the majority of the patients hadtuberculosis with different etiologies. Therefore, it seems that reactivation of latent infection has had the main role in the spread of tuberculosis

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Background: Measurement of service quality is a basic prerequisite for improving quality. Studies show that consumers are in close contact with services quality better than any other group. This study was conducted with the aim of measuring service quality based on patients’ expectations and perceptions teaching hospitals in Arak, Iran. Materials and Methods: This cross-sectional study was done on 260 patients at under auspices of Arak University of Medical Sciences. For data collection SERVQUL questionnaire was employed to measure quality of services. The reliability and validity of this questionnaire had already been confirmed by studies both in Iran and other countries. Results: The results showed that there were significant differences between patients’ expectations and perceptions in all dimensions of quality. The accessibility dimension constituted the most serious problem at hospitals. Conclusion: The negative scores show that it is necessary to promote all quality services dimensions at hospitals. For reducing the qualitative gap among all dimensions, it is recommended that hospital managers take patients’ needs into account and provide desirable services for them.

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Background: Some clinical trials have revealed the effects of Matricaria chamomilla on premenstrual syndrome symptoms. This study was done to compare the effects of Matricaria chamomilla extract and mefenamic acid on the severity of premenstrual syndrome symptoms.

Materials and Methods: In a randomized double-blind clinical trial, 90 students completed daily rating form for the diagnosis of premenstrual syndrome symptoms and its severity for two consecutive cycles. After verification, they were randomly divided into two equal groups. The participants received one 100 mg capsule of Matricaria chamomillaor 250 mg mefenamic acid three times daily from day 21 of menstrual cycle till the beginning of the menstruation. They completed the daily symptom rating form at the same time.

Results: General severity reduction of symptoms was significantly greater among Matricaria chamomilla extract users (25±13.8 and 28±14.5%) than that among mefenamic acid users (14.8±18.5 and 16.2±18.2%) after the first and second cycles (p<0.05). Severity of emotional symptoms was significantly higher among Matricaria chamomilla extract users (30.1±26.6 and 33.4±25.3%) than that among mefenamic acid-users (11.6±25.7 and 10.7±26.8%) after two cycles intervention (p>0.05).Reduction of physical symptoms was not significantly different between the two groups (p>0.05).

Conclusion: Matricaria chamomilla reduces the severity of symptoms of premenstrual syndrome symptoms during treatment. Matricaria chamomilla effect on the severity of general and emotional symptoms of premenstrual syndrome symptoms is greater than that of mefenamic acid.

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Background: Heavy menstrual bleeding is one of the leading causes of low quality of life and iron deficiency anemia in women of reproductive age. This study was conducted to compare the therapeutic effects of mefenamic acid and the hydroalcoholic extract of Urtica dioica on the volume of bleeding in heavy menstrual bleeding.

Materials and Methods: In this clinical trial, 90 women with heavy menstrual bleeding were selected and after a control cycle for evaluating the primary bleeding volume, using Excel software, were randomly allocated to Urtica dioica or control groups. Both groups were subjected to mefenamic acid treatment with 500 mg every 8 hours, from the first day to the end of bleeding, up to seven days, for two consecutive cycles. In Urtica dioica group, in addition to mefenamic acid, Urtica dioica capsules, five per day, two in the morning, two at noon, and one at night (every eight hours), from the first day to the end of bleeding, up to seven days, were prescribed. In the control group, instead of Urtica dioica capsules, placebo of Urtica dioica was prescribed with the same order. Data on the amount of bleeding (using PLBAC chart) was checked and compared by SPSS software.

Results: The amount of bleeding before and after treatment, between and within groups, was compared. The obtained results showed that the amount of bleeding reduced significantly in both groups after treatment (p=0.001). The reduction of bleeding amount in the Urtica dioica group was significantly higher than that in the control group (p=0.010).

Conclusion: It seems the extract of Urtica dioica can be effective in reducing the amount of bleeding in women of reproductive age with heavy menstrual bleeding. This drug, due to its short course of prescription, fewer side effects, and not having hormonal effects, seems to be an effective drug for treating heavy menstrual bleeding.

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Background: Mycobacterium Tuberculosis usually infects the lungs but organs other than the lungs may also be involved. This study is an analysis of the situation of extra-pulmonary tuberculosis in the central province of Iran.

Methods and Materials: In this cross-sectional study, the information in the registration software of tuberculosis in health centers collected and for analyzing of data statistical software SPSS16 was used.

Results: In the survey a total of 1787 TB patients were identified, of which 24.2% were diagnosed with extra-pulmonary tuberculosis and 1.9% of patient with extra-pulmonary TB were associated with HIV infection. Female to male sex ratio is equal to 1.3. The 82.5% of the patients were Iranian citizen and mean age of patients were 43.3 years. Tuberculosis of the lymph nodes, skletal and pleural tuberculosis had the highest prevalence. Also extra-pulmonary tuberculosis in females, age 15-55 was more and the diagnosis delay was more in extra-pulmonary tuberculosis and relapse was more in pulmonary tuberculosis.

Conclusion: Because of more diagnosis delay in extra-pulmonary tuberculosis it is necessary to train physicians and other healthcare workers in the field of extra-pulmonary TB diagnosis and more planning to do about learning of it.

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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.

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Background: The importance of maintaining and enhancing the quality of life in (tuberculosis TB) patients is essential. The purpose of this study was to use N - acetylcysteine to improve the quality of life in patients with tuberculosis.

Materials and Methods: This study is a double-blind clinical trial that performed on 88 patients on anti-TB treatment that aged over 50 years in the central province of Iran within 15 months. Data collection tools included a demographic questionnaire and the Short Form Quality of life (SF12). Data were analyzed using SPSS software and t-test, Chi-square, Mann-Whitney, ANOVA and Pearson correlation analysis were used. p less than 0.05 was considered significant.

Results: This study showed that the two groups before the intervention in different features were not significantly different, but in quality of life at the end of the first month. The intervention group compared with the control group in physical subscale score (p=0.0068) and psychological subscale scores (p=0.0284) and quality of life score (p=0.0112) were better. Also, our study showed that age of patients (p=0.0331), duration of disease (p=0.0416), and serum CRP mean (p= 0.0234) and type of tuberculosis (p=0.0372) were significantly related to total score of quality of life at the end of the first month in the intervention group.

Conclusion: According to this survey results we hoped to combine the use of adjuvant therapy with N-acetylcysteine and standard tuberculosis treatment improves quality of life and increase life expectancy of patients.

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Background: Treatment failure and relapse is a major problem in the treatment and control of brucellosis. The present study directed to determine risk factors for failure of treatment and relapse in patients treated for brucellosis.

Materials and Methods: This study was a descriptive - analytic and prospective study and were conducted in 72 patients with acute brucellosis.Patients were followed up during treatment and for six months after completion of therapy, and patients with treatment failure or relapse were analyzed. All data analyzed using SPSS software and P-value of less than 0.05 was considered significant.

Results: The mean value of age in patients was 40.2 ± 16.5 years. Treatment failures was 6.9% and the relapse at the end of the ninth month was 12.5% that recurrence of symptoms were associated with increased titers of serological tests and 80.6 percent had successful treatment. In this study gender of male (P = 0.026), occupational exposure (P = 0.005), delayed treatment in less than two weeks (P = 0.016), hepatosplenomegaly (P = 0.003), thrombocytopenia (P = 0.023), CRP &ge +2 (P = 0.017) and Wright &ge 1/320 and 2-ME &ge 1.160 at the end of the sixth week of treatment (P = 0.004 and P = 0.010) were risk factors of treatment failure and relapse in brucellosis.

Conclusion: The diagnosis and treatment of relapse and treatment failure in acute brucellosis is not clear, therefore, the prediction of relapse may be useful in preventing recurrence and treatment of patients.

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Background: Staphylococcus aureus is one of the important pathogens can cause infections in hospitals specially in intensive care units (ICU). It seems that nasal carriage is important risk factor for developing l infection at ICU units. This study was designed to investigate the frequency of S. aureus nasal carriage and its virulence in patients admitted to ICU units in Vali-Asr hospital at Arak university of medical sciences.

Materials and Methods: In this cross-sectional study, nasal swab samples were obtained from all the patients hospitalized in ICU unit of Vali-Asr hospital from July-December 2014 at admission. After identification, methicillin resistance and the frequency of pvl and acme genes determined by PCR. Demographic data were collected using questionnaire and were analysed using SPSS 20 software.

Results: Out of 390 patients, 81(20.8%) and 31(12.9) patients had been colonized with MSSA and MRSA, respectively. The result of culture was negative for 278 patients (71.3%). 77.4% of MRSA and 54.3% of MSSA isolates were positive for acme gene. Also, 11.11% of and 6.45% of MSSA MRSA isolates were positive for pvl gene.

Conclusion: The application of medical supportive devices like cv line, ventilator, history of surgery operation and antibiotic use significantly was associated with S. aureus nasal carriage. High prevalence of S.aureus shows that these bacteria settled in the hospital. Hence, infection control measures must be performed to reduce the risk of hospital infection.

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Background: Heavy menstrual bleeding has a negative impact on quality of life. In this study, the effect of hydroalcoholic extract of capsella bursa pastoris on menorrhagia is evaluated.
Materials and Methods: This clinical trial was carried out on 90 women with complaint of heavy menstrual bleeding. Samples, after a control cycle of primary bleeding, were randomly divided to capsella bursa pastoris and control groups. Both groups were subjected to mefenamic acid treatment with 500 mg every 8 hours, from the first day to the end of bleeding, up to seven days, for two consecutive cycles. In capsella bursa pastoris group, in addition to mefenamic acid, capsella bursa pastoris capsule 500 mg every12 hours, from the first day to the end of bleeding, up to seven days, was prescribed. In control group, instead of capsella bursa pastoris capsules,it^,s placebo was prescribed with the same order. Data were checked and compared before and after treatment using SPSS software.
Results: The average amount of bleeding reduced in capsella bursa pastoris group from 135.27 in control cycle to 69.13 in third cycle and in control group reduced from 133.91 to 75.44 in third cycle(p<0.001). The average duration of bleeding was reduced in capsella bursa pastoris group from 7.38 in control cycle to 5.40 in third cycle and in control group was reduced from 6.91 to 5.31 in third cycle(p<0.001).
Conclusion: It seems that the extract of capsella bursa pastoris can be effective in reducing the amount and duration of bleeding in women of reproductive age with heavy menstrual bleeding.

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Background: Brucellosis is one of the most important diseases among humans and animals. Clinical management of brucellosis due to an increased rate of treatment failure and recurrence is extremely worrying. The aim of this study was to determine the antimicrobial susceptibility pattern of the brucella isolates.

Materials and Methods: From April to September 2014 a total of 30 brucella isolates that were cultured on brucella agar has been studied. The species identification was carried out and to determine the effect of antibiotics on bacteria antibiogram testing was performed by disk diffusion.

Results: In this study, 30 brucella strains were isolated from cultured specimens and antibiogram testing was performed. All microbial positive specimens were sequenced by PCR. All isolates were Brucella melitensis. According to the tests, suceptibility to tetracycline, minocycline, gentamicin, tigecyclin was 100%, to doxycycline 93.3%, co-amoxiclave 66.7%, rifampin 44.7%, streptomycin 86.7%, ciprofloxacin 80%, cotrimoxazole 76.7% and ceftriaxone 73.3%.

Conclusion: This study shows that the predominant strain in our patients was Brucella melitensis. Also, due to high levels of resistance to rifampin to use the other effective drugs like gentamicin, streptomycin, ciprofloxacin or cotrimoxazole in combination with doxycycline or tetracycline.