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Introduction: The existence of acoustic trauma secondary to drill noise during chronic ear surgeries has not yet been clearly demonestrated. This investigation aims to document the hearing loss that occures in patients who underwent mastoidectomy.
Materials and Methods: Sixty-three (38 male and 25 female) consecutive patients (11-57 years) who underwent modified radical mastoidectomy were included. In a concurrent clinical trial design, we measured bone conduction thresholds before and after (1 week and 1 month) operation on both sides.
Bone conduction thresholds were assessed in 250, 500, 1000, 2000, 3000 and 4000 Hz frequencies.
Results: Paired-test results showed a satistically significant temporary (TTS) and permanent threshold shifts (PTS) were occured in the 2000-4000 Hz region for operated (on addition to 1000 Hz) and non-operated ears, but clinically PTSs were not remarkable and TTSs were important only for operated ear (P<0.05). The correlation between duration of noise exposure and magnitude of threshold shift was only significant in operated ear in 2000-4000 Hz region (P<0.05).
Conclusion: We could not demonestrate any permanent hearing loss caused by drill-generated noise, but resultant noise is able to produce TTS in the operated ear in 2000-4000 Hz region. We found poor relationship between duration of noise exposure and magnitude of threshold shifts.

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Introduction: Coffee is a diuretic plant, cause vascular expansion and reduce free radical oxygen. There is evidence that show its effects on kidney. Low dose of coffee reduces blood urea and cratinine but its overdose may lead to glomeruloschelrosis. In this study, the effect of high dose of coffee on rat kidney was evaluated by stereological method.
Materials and Methods: In an experimental study, 48 Sprgue-Dawley rats 230-250 gr were selected and divided randomly into 4 groups. The control group was fed with only tap water and the experimental groups were fed with different doses of aqueous extracts of coffee (0.25, 0.5, 0.125 gr/kg) twice daily. After 48 hours, the animals were deeply anesthetized and right kidneys were removed. The Sum slides were prepared and stained with Hematoxyline. Eosin. From each kidney, 15-17 glomeruli were selected and means of glumerular volume were estimated, according to Cavalieri principle and point counting methods.
Results: Our findings revealed that low dose of coffee extraction were led to increase in glomerular volume, but higher doses decreased these volumes. These results were significantly different form control group (p<0.05).
Conclusion: It seems that decrease in glomerular volume leads glomeruloschlorosis and reduction of glomerular filtration rate. However, there should be more investigation such as urea and cratinine measurement to calrify the exact mechanisms.

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Introduction: Diabetes  is  one  of  the  most  important  problems in  all  countries.  This  study  is  designed  to  determine  the  prevalence  of  diabetes  or  glucose  intolerance  in  central  areas  of  Iran.
Materials  and Methods: In  a  descriptive  study  in  Arak, Isfahan  and  Najafabad  cities, 12514  samples  over  19  years  old  were  selected  by  a  multistage  random  sampling  method. FBs  and  GTT  were  done. Lipid  tests  were  also  done  in  fasting. weight, height  and blood  pressure  of  samples  were  measured  by  standard  methods.  FBs>-126  or  2  hoursglucose >-200  was  considered  diabetes. Fasting  glucose  disturbance  was  considered  with  FBS <126  and  glucose  intolerance  with  2  hours  glucose >-140-200.  Data  was  analyzed  by  SPSS  software, t  test, chi  square  and  Fisher  test.
Results: Of  12514  samples  under  investigation 51.1%  were  female. The  overall  diabetes  incidence  in  urban  and  rural  areas  was  6.7%  and  5.3%  and  in  male  and  female  5.4%  and  7.1%  respectively .Mean  of  blood  glucose  was  increased  by  age  in  both  sexes. This  was also  increased  in  women  of  urban  areas against  women  in  rural  parts.  It  was  also found  that glucose  intolerance, known  diabetes  and  newly  diagnosed  diabetes  was  increased  by  age. More  than  half  of  diabetes  cases  in  all  age  groups  were  newly  diagnosed. Blood  pressure, age, BMI  and  abdominal  obesity  were  higher  in  diabetics  and  those  with  glucose  intolerance. These  problems  were  more  incident  in  women.
Conclusion: Regarding  to  the  fact  that  diabetes  is  one  of  the  major  risk  factors  for  noncommunitable  disease  and  also  its  relative  high  incidence  in  central  areas  of Iran, it  is  necessary  to  have  expanded  programs  for  prevention  and  treatment  diabetes  family  history.
 

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Introduction: Diabetes  during  its  progress can  result  in  nephropathy.  Some  of  its  symptoms  are  increasing  kidney  size  and  weight  and  its  components.  Regarding  useful  components  of  onion  and  its  antioxidant, decreasing  stress  oxidative  and b decreasing  blood  glucose  effects. This  investigation  is designed  to  study  the  effect  of  onion  water-alcohol  extract  in  preventing  nephropathy  and  its  effect  on  kidney  structure  based  on  stereology  method.
Materials  and  Methods: Four  groups  of  matured  vistar  rats (n=8)  were  selected randomly (control  group, control + extract  group, diabetic  only  group, diabetic + extract  group). Diabetes  was  induced  by  injecting  interperitoneal  sreptozotocin  (60mg/kg). The  control+ extract group  and  diabetic + extract  group  were  treated  by  onion-water  extract (50 mg/rat)every day  for  four  weeks. Then  all  groups  were  anesthetized  and  their  left  kidney  was  removed  and  fixed  in  Bouin  fixative. After  histologic  passage  and H & E  dying, using  stereologic  techniques, qualitative  measurement  was  performed  by  Cavalier  method  for  cortex, medulla, glomerulus  and  kidney  size.  Data analysis  was  done  by  SPSS  software  using one  way  anova, tukey  and  paired  test. p<0.05  was  considered  significant.
Results: The  primary  and  secondary  weight  of  rats  in  only  diabetic  group  and  diabetic  + extract  group  was  not  different, but  in  control  group  and  control  + extract  group  was  significantly  different (p<0.05). Medulla, cortex  and  whole  kidney  size  in  only  diabetic  group  in  comparison  with  diabetic+ extract  group  had  no  difference, but  total  glomerular  size  in  diabetic  only  group  and  diabetic + extract  group  was  significantly  different (p<0.001).
Conclusion: Experimental  induction  of  diabetes  by  STZ  in  a  short  period  showed  that  onion  extract  can  prevent  glomerular  hypertrophy  and  increasing  kidney  weight  in  diabetic  rats, but  had  no  effect  on  overall  kidney  size. So  the  study  of  onion  extract  effects  on  kidney  structure  during  a  long  period  is  recommended.      
 
 
 

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Introduction: A high prevalence of HCV infection among hemodialysis patients has been reported worldwide. Risk factors such as history of blood transfusion, duration of hemodialysis and recently nosocomial transmission of HCV in hemodialysis units have been identified. In this study the prevalence of Hepatitis C virus antibody and risk factors in hemodialysis patients in Markazi province is investigated. Materials and Methods: In this cross-sectional analythical study, blood samples were obtained from all 204 hemodialysis patients. Samples were tested for anti-HCV antibodies by using third generation enzyme immunoassay. The reactive samples on ELISA were confirmed by the third generation RIBA. Risk factors were evaluated by a questionnaire. Data was analysed using Chi square and logistic regression. Results: The prevalence of anti-HCV antibody among hemodialysis patients was 4.9%.Duration of hemodialysis was identified as a major risk factor in transmission of HCV (p=0.004). There was a significant relationship between anti-HCV positivity and previous renal transplantation (p=0.032). Female sex was another risk factor for HCV infection (p=0.030). There was no significant relationship between anti-HCV positivity and history of blood transfusion. Conclusion: Nosocomial transmission of HCV within hemodialysis units seems to be a route of infection in patients on hemodialysis in Markazi province. Application of dialysis precautions recommended by CDC can reduce the prevalence of HCV infection among hemodialysis patients in this province.

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Background: Permanent pacemakers are applied to treat some 2nd and 3rd degree AV blocks. Previous studies have shown the hemodynamic changes that may occur after pacemaker implantation. In this study, we have evaluated these hemodynamic changes from a different view point, with measurement of urinary sodium and blood pressure. Materials and Methods: This is a before and after clinical trial study in which 30 patients, who were hospitalized for permanent pacemaker implantation for the first time in Tehran heart center during 3 years, including 12 women (mean age 62.92 years) and 18 men (mean age 60.07 years), were tested for urinary specific gravity and sodium, blood pressure, blood sodium and potassium, before and after pacemaker implantation. Paired sample T test and Chi Square test were used for statistical analysis. Results: Systolic blood pressure was 136.5 mmHg and 120.6 mmHg before and after pacemaker implantation, (P<0.001). Also, after pacemaker implantation, urinary sodium rose from 83.45 meq/L to 106.61 meq/L (p=0.018). Conclusion: This study is consistent with previous studies, which showed hemodynamic changes after permanent pacemaker implantation including decrease in blood pressure and elevation of serum neuropeptides.

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Introduction: Sodium arsenite is an environmental pollutant which its amounts in industrial cities are more than other places because of its use in chemical industry. Human populations are exposed to this chemical compound through food, soil, air and water which has toxic and histopathological effects on different body organs including kidney. The aim of this investigation is to study the quantitative histopathological effects of sodium arsenite on the kidney structure of rats. Materials and Methods: 12 male Wistar rats with mean body weight of 200±20 g were randomly divided into 2 groups (n=6). One treated with sodium arsenite (8 mg/kg/day in drinking water) and the other one (the control group) received drinking water only. 2 months after treatment the rats were weighed, anesthetized with ether and dissected. The left kidney was taken out, cleaned, weighed and then fixed in 10% formaldehyde solution. After obtaining 1mm thick slices, tissue processing was carried out, then 5µm thick sections were prepared and stained using H&E method. Slides were finally studied stereologically and data was statistically analyzed using paired sampled t-test and the means were considered significantly different at p<0.05. Results: The results of this investigation indicated significant reduction in the total mean volume of kidney (p<0.001), cortex (p<0.001), and medulla (p<0.003) in sodium arsenite treated group compared to the control rats. The mean volume of tubules and interstitial tissue as components of cortex reduced significantly compared to the control group (p<0.003).The mean volume of glomeruli and Bowman's capsule was significantly reduced in treated group (p<0.001), while the other components did not show a significant reduction in volume. A significant reduction was also found in the kidney (p<0.002) and the body weight (p<0. 01) in the treated group compared to the control ones at the end of the experiment. Conclusion: It was concluded that exposure to sodium arsenite leads to histopathological changes in kidney structure, however more studies are needed to determine the effects of these structural changes on the kidney function.

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Background: Diabetic patients face many challenges related to their illness and treatment in their life. So they need to use coping strategies for adjustment. The purpose of this study was determined the coping styles among diabetic Iranian patients. Methods and Materials: In a case-control study, 100 consecutive diabetic patients admitted to Amin and Sedigheh Taherah Medical Centers, Isfahan, were selected based on the inclusive and exclusive criteria and compared with one hundred normal people who selected from general population. Data collected by using demographic questionnaire, the Jalowiec Coping Scale, then MANCOVA and co-variance were used to analyze the data. Results: Difference between two groups in coping styles were significant (F=2.835, p=0.005). Significant differences was in supportant coping style (F=11.204, p=0.001). There was no significant difference in other coping styles between two groups. Conclusion: It seems that the diabetic patients likely differ from normal people only in supportant coping style when deal with daily stress. But they are similar to normal people in other coping styles. In addition, both groups use problem solving styles when deal with daily stress. The findings emphasis the role of illness representation to determine coping styles.

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Background: Hospitals need performance evaluation systems for development and competition in order to evaluate the effectiveness and efficiency of their plans, processes and human resources. The objective of this research is to design an evaluation system at hospitals through the use of the Balanced Scorecard. Methods and Materials: In this comparative study, the selected countries consisted of Australia, USA, Canada and New Zealand, and 34 public hospitals of Iran which were applying strategic planning. Performance evaluations were examined in terms of 6 aspects including mission, vision, strategies, perspectives, objectives and measures .A pattern was designed for performance evaluation of public hospitals in Iran and was validated using experts’ survey of DELFI method. Results: All countries had mission and vision as important aspects of their performance evaluation model while health effectiveness promotion was the most important strategy. High quality health services, resource development, innovation and guaranty in continuous services were other strategies. Perspectives of Balanced Scorecard included customer, internal processes, learning and development of staff and financial affairs. All of the countries had objectives and measures for each of the perspectives. Iranian hospitals had mission, vision, strategies and objectives but for them perspectives had not been defined and measures were not congruent with strategies and objectives. In the model, 4 perspectives were determined to describe hospital strategies and to use competition benefits as well. Conclusion: Applying measures of 4 perspectives including "Patients and Community", "Internal process and Productivity", "Growth and innovation" and "financial aspects" to doevaluation of Iranian public hospitals collates their performance, improves productivity of their resources and enhances patients and community satisfaction.

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Background: The respiratory symptoms in welding workers have been appeare by increasing use of welding various poisoning gases and fumes in machine industry. It is necessary to evaluating of frequency of respiratory symptoms with scientific methods. Methods and Materials: In this historical cohort study, 60 non-smoker welding workers with history of at least 6 months work in welding, and 60 non-smoker office workers who were not expoused to respiratory pollution were selected from machine industry factories of Arak. Data was gathered by questionnaire. Occupationalist performed physical exams and spirometery. Data was statistically analyzed. Results: There was a significant relationship between sore throat (p=0.02), cough (p=0.04), spectrum (p=0.01), and dyspnea (p=0.007) with working in welding. But in symptoms such as rinite, hoarsening, nasal congestion, epistaxis, respiratory assessment and spirometery results difference was not significant. Conclusion: Symptoms of upper respiratory tract stimulation in welding workers were significantly more than non-expoused workers.

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Abstract Background: Cartilaginous and movement diseases are the most prevalent problem in human. Various vitamins like A and C increase the process of regeneration and wound healing. In this research, the Alfalfa plant with scientific name Medicago sativa, that contains a lot amount of A, C, E and K vitamins, was used and effect of its extract on regeneration of pinna rabbit cartilage was studied. Materials and Methods: In this experimental laboratory study, 6 New Zealand male rabbits with 2.5-3 kg weight have been selected. After shaving hairs on ears with depilation cream, the ear were anesthetized by lidocaine 10% and 4 holes were punched with 4 mm diameter in medial situation of each ear. Test ears by extract of Medicago sativa and control ear were treated by normal saline every day. Holes era and the distance of two edges of cartilage were measured in various days of healing. Also, tissue sampling for microscopic observation by H&E color (day 0-50) was done. Results: Regeneration and healing of the treated holes with extract of Medicago sativa was faster than the control holes (p<0/004). Also, thickness of cartilage and cell density of chondrocytes and fibroblasts in the newly formed connective tissues in test were more than control. Conclusion: The extract of Medicago sativa because of A, C vitamins containing, probably increased the wound healing and regeneration of the rabbit ear cartilage and suggest the pharmacological usages.

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Background: Lead (Pb) brings about a variety of cognitive, mental, renal, and blood system disorders by inducing oxidative stress. The aim of this study is to compare blood and urine parameters in the workers exposed to Pb and zinc (Zn) with those in the control group. Materials and Methods: An analytical cross-sectional study was conducted with a total number of 134 subjects. The case group included 67 male workers with the age range of 22-65 who had at least worked a minimum of one work shift for two years in the Zn-Pb mine located in the southwest of Arak, Iran. Control subjects consisted of 67 farmers of a village near the mine who had no history of occupational exposure to Pb, Zn, and other metals. Mental disorders were evaluated through the standard Scl-90-R while cognitive disorders were evaluated via the Mini Mental Status Examination (MMSE). Results: The mean level of blood and urine parameters did not reveal significant differences between the two groups. The mean scores of physical complaints, anxiety, and aggression scales were significantly higher in the case group than the control (p<0.05), whereas the mean scores on MMSE did not reveal a significant difference between the two groups. Conclusion: The oxidative stress of Pb led to mental disorders as a result, the mine workers suffered from more psycho- pathology and are in need of greater care. Due to the impacts of Pb and Zn, the proper use of safety equipments and taking daily showers can reduce the risk of absorption of toxic agents and their subsequent hazards for workers.

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Background: Different studies have proposed the cognitive deficits as one of the main aspects of schizophrenia furthermore, the presence of psychosis in these patients can influence the degree of deficiency in executive functions .The purpose of this study is to compare the executive function in patients with schizophrenia, non-psychotic major depression and normal individuals. Materials and Methods: In this cross-sectional study, 28 patients with schizophrenia, 28 patients with non-psychotic major depression and 28 normal subjects were selected from hospitals in Tehran through available sampling method which were matched according to age, sex, and level of education. The executive functions of subjects were evaluated using Wisconsin Card Sorting Test, and data were analyzed using one-way ANOVA and Turkey post-hoc test. Results: Schizophrenic patients had poorer performance in comparison with non-psychotic depressives and normal individuals in all variables of Wisconsin test (P<0.001). Also, depressive patients showed more preservative error than normal subjects (P<0.001), but no significant difference was found between the two groups in the number of categories and specific error variables. Conclusion: Greater impairment in the executive functions in the Wisconsin card sorting test is mainly associated with psychosis which might be introduced as a special profile of schizophrenia. Noticing the amount of deficiency in executive functions in each group of patients, the positive or negative prognosis can be diagnosed initially.

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Background: Laryngoscopes are one of the potential mediators of infection transmission due to their blades contact with oral mucous membranes. Using single-use plastic blades is a method of preventing infection transmission. The aim of this study is to compare the efficiency of single-use plastic and reusable metal laryngoscope blades in orotracheal intubation during the rapid- sequence induction of anesthesia Materials and Methods: In this clinical-trial, 310 patients, more than 10 years of age, who were candidates for elective surgery, were selected. After anesthesia induction, orotracheal intubation was done by either single-use plastic or reusable metal blades for patients. Duration of intubation and arterial oxygen saturation were recorded before and after intubation. Data analysis was done using SPSS software. Results: Orotracheal intubation was done successfully in all patients. Mean differences of intubation time from the standard upper limit were 1.42±8.19 and 13.1±4.22 seconds in the plastic and metal blades groups, respectively. Also, the mean of difference in oxygen saturation of the low 90% after intubation were 6.07±2.71 and 7.16±1.21 in plastic and metal blades groups, respectively. Both parameters indicated statistically significant differences. Conclusion: In rapid-sequence induction of anesthesia, by using single-use blades, both intubation time and arterial oxygen saturation drop will increase in comparison with metal blades. This will cause complications such as aspiration in the patients.

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Background: Metastasis or compress effect of adjacent tumors and thyroid neoplasms are the most common causes for airway obstruction which may lead to emergent intubation or tracheostomy due to respiratory distress. Case: A 61 year-old, female patient with history of papillary cell carcinoma with metastasis to lung, trachea and vocal cords was referred to our hospital with complaint of dyspnea. In the early hours of hospital admission the patient suffered from attacks of apnea and gasping, and initial efforts to control the airway were performed immediately which were not successful. Then it was decided to perform broncoscopy and tracheostomy to provide a safe airway. Conclusion: In the absence of adequate equipment and emergency respiratory situation, it is better to provide a secure airway immediately. For this purpose, we can use low depth of anesthesia without use of muscle relaxants.

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Background: The use of propofol alone for insertion of supraglottic devices can lead to undesirable events such as cough, gagging, and laryngeal spasm. Narcotic drugs are used to improve the insertion of these devices. In this study, the effect of two narcotics, remifentanyl and sufentanyl, on ease of insertion of two types of supraglottic airway devices were evaluated. Materials and Methods: In this clinical trial, 200 patients undergoing general anesthesia were divided into four groups through blocked randomization. Induction of anesthesia was performed using propofol 2.5 mg/kg. Then the first group received remifentanyl and laryngeal mask, the second group remifentanyl and SLIPA, the third group sufentanyl and laryngeal mask, and the fourth group sufentanyl and SLIPA. The amount of jaw opening, ease of insertion of supraglottic devices, cough, laryngospasm, gag reflex, heart rate, and arterial blood pressure were recorded one, three, and five minutes after insertion of supraglottic devices. Results: No significant differences were observed in the amount of jaw opening, ease of insertion of supraglottic devices, cough, laryngospasm, gag reflex, and hemodynamic parameters between the four groups. Conclusion: The results of our study indicated that for controlling airways using supraglottic devices, use of laryngeal mask or SLIPA in the presence of remifentanyl or sufentanyl have no priority over each other and do not lead to hemodynamicimpairement

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Background: Post-anesthetic shivering is the most common cause of patient discomfort during recovery with a prevalence of 5 to 65%. Post-anesthetic shivering can increase pain, oxygen consumption, and cardiac output. The aim of this study was to compare the efficacy of various classes of drugs for preventing post-anesthetic shivering.

Materials and Methods: In this double-blind clinical trial, patients undergoing elective laparotomy were randomly divided into six groups, 40 each. The patients, respectively, received hydrocortisone, ketamine, tramadol, magnesium sulfate, pethidine, and normal saline. All patients were observed for body temperature and shivering for 20 minutes after arrival to recovery room.

Results: Seventy patients in the pethidine group did not have shivering upon arrival to recovery room which was significantly higher than other groups (&chi2=0.00002). Also, the patients in the pethidine group did not shiver 10 and 20 minutes after arrival to recovery room that was significantly lower than other groups.

Conclusion: According to the results, it can be concluded that pethidine is more effective than other drugs in prevention of post-anesthetic shivering.

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Background: Load lifting is the most stressful activity of the Manual Material Handling and can trigger of work-related musculoskeletal disorders of workers. Purposes of this study are determining the prevalence of musculoskeletal disorders, assessment lifting tasks by NIOSH lifting equation method, ergonomic design and assessment of its effectiveness.

Materials and Methods: This analytical and interventional study was performed on 30 workers in a Porcelain Health Manufacturing industry in Hamadan. Assessment of lifting tasks by NIOSH lifting equation and determining the prevalence of musculoskeletal disorders by Nordic questionnaire was conducted. Then, construction steps and determination of the effectiveness of ergonomic design was conducted.

Results: The results showed that the most frequent musculoskeletal disorders related to back. Results of the lifting index (LI) showed that the risk of lifting load in before intervention is high (greater than 3). This value after the conducting of ergonomic intervention (load-carrying cart) decreased to moderate level (between 1 to 3). The relationship of risk average amount before and after interventions were significant (p<0.001).

Conclusion: Load-carrying cart designed with shelves capable of moving vertically up and down has considerable role in safe making of lifting tasks and probability of reduce the prevalence of musculoskeletal disorders and lumbar injuries will bring in the near future.