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Background: One of the most important complications of tonsillectomy is laryngospasm which leads to airway obstruction, arterial hypoxemia, and hypercarbia. Thus the present study was carried out to compare the effect of propofol with sodium thiopental, as an induction agent of anesthesia, on the incidence and intensity of laryngospasm after extubation in tonsillectomy. Materials and Methods: This double-blind clinical trial was done on 60 3-12-year-old patients who were chosen for elective tonsillectomy at Qods Hospital in Qazvin. The patients were randomly divided into two equal groups. Method of anesthesia was the same in these two groups except for the induction of anesthesia one group received sodium thiopental and the other group received propofol. At the end of the operation, patients were extubated after the restoration of spontaneous respiration with adequate tidal volume and respiratory rate. Then the incidence and intensity of laryngospasm was evaluated. Data were analyzed by t-test, Chi-square, and Fisher's exact test using SPSS software. Results: Overall, 83% of the patients in the sodium thiopental group and 93% of the patients in the propofol group did not develop laryngospasm and there were no statistical differences between the two groups in terms of the incidence and intensity of laryngospasm after extubation in tonsillectomy (P=0.535). Conclusion: As an induction agent in general anesthesia, propofol has the same effect as sodium thiopental on the incidence and intensity of laryngospasm after tonsillectomy.

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Background: Gastric cancer is a common and lethal disease throughout the world. This study was designed and carried out to determine the five-year survival rate of gastric cancer patients who had undergone surgical treatment at Taleghani Hospital of Tehran, and to assess its associated factors. Materials and Methods: In this historical-cohort study, information obtained from a total of 213 gastric cancer patients who underwent surgery at Taleghani Hospital of Tehran between 2003 and 2008 was included. In the analyses, Kaplan-Meier method, log-rank test, Cox proportional hazards model, and Lin-Ying additive hazards model were used. Results: The five-year survival rate and the median life expectancy in the studied patients were 14.6% and 29.6 months, respectively. Two covariates showed significant impacts on the gastric cancer patients’ data in both models: age at diagnosis and tumor size. We found that pathologic stage was significant under the Lin-Ying model (P=0.043) however, it was not significant under the Cox model (P=0.069). Other clinicopathological characteristics were not statistically significant (P>0.05). Conclusion: Since Cox and Lin-Ying models consider different aspects of the association between risk factors and the study outcome, it seems desirable to use both of them as complementary models but not as alternative models to obtain a more comprehensive understanding of data. This study showed that the early detection of patients in younger ages and in primary stages is important to decrease the risk of death in patients with gastric cancer and to increase the survival rate.

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Background: Pseudomonas aeruginosa is a human opportunistic pathogen which is considered one of the agents causing nosocamial infection. Recent studies have reported increased resistance of Pseudomonas aeruginosa to imipenem. The aim of this study was to determine resistance to antipseudomonal antibiotics including imipenem in Pseudomonas aeruginosa strains. Materials and Methods: In this cross-sectional study, 100 Pseudomonas aeruginosa strains obtained from clinical samples of patients in hospitals in Arak, Iran, were identified and isolated through microbiological methods, including Gram staining, oxidase test, Indol test, and oxidative-fermentative test. Then antibiotic susceptibility test was performed for imipenem, meropenem, gentamicin, amikacin, ciprofloxacin, and ceftazidime by disk diffusion method according to NCCLS (National Committee for Clinical Laboratory Standards) .Minimum inhibitory concentration (MIC) was done for determining imipenem-resistant strains Results: Antibiotic susceptibility test showed that resistance rates to imipenem, meropenem, gentamicin, amikacin, ciprofloxacin, and ceftazidime were 35%, 35%, 14%, 9%, 23% and 15%, respectively. Also, MIC test showed that 30 strains were resistant to imipenem, 27 to ceftazidime, 35 to cefepime, and 35 to ciprofloxacin. Conclusion: The results of this study indicated a high rate of antibiotics resistant of Pseudomonas aeroginosa strains to different antibiotic groups. Therefore, new and more effective methods should be found for controlling Pseudomonas infections and preventing the outbreak of its antibiotic-resistant strains.

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Background: Addiction is undoubtedly one of the biggest problems of human societies that every year governments spend enormous amounts of money on fighting it. Most addicts, besides their addiction, cause many psychological problems in their families therefore, the aim of this study was to compare the presence of these disorders between the families of addicts and non-addicts. Materials and Methods: This case-control study was done on a sample of 650 persons of opium addicts' and non-addicts' families using random sampling method. Data were collected through SCL-90-R questionnaire and were analyzed by Chi-square and t-test using SPSS software version 18. Results: There was a significant difference in psychiatric disorders in addicts' and non-addicts' families (p=0.005). Among the 9 psychiatric disorders under assessment, only anxiety, aggression, paranoia, and depression disorders in three types, including pathologic, borderline, and combined (pathologic-borderline), were significantly higher in addicts' families compared with non-addicts' families (p=0.005). Conclusion: Drug dependence disorder in one member of a family has a very important effect on the mental hygiene of the other family members and requires prevention and treatment in both.

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Background: In addition to known environmental and acquired factors effective in cardiovascular diseases, polymorphisms of VKORC1 and CYP2C9 genes are identified as the main genetic factors involved in warfarin dosage requirement variations in these patients. With this approach, investigating the frequency of 1639 G>A in VKORC1 gene for determining the specific dosage required for each person was the main aim of this study. Materials and Methods: In this experimental study, peripheral blood samples were obtained from 200 patients with cardiovascular disorders in the northwestern areas of Iran (West and East Azarbayjan and Ardabil) and RFLP-PCR technique was used to determine the 1639G> A polymorphism of VKORC1. Results: Using Hardy-Weinberg law‏, polymorphism amounts of 1639G> A gene from VKORC1 in female and male patients with normal, heterozygote, and homozygote were determined 21.6%, 53.7%, 24.5% , and 22.3%, 60.6%, and 17.02% , respectively. Conclusion: VKORC1 genotyping is one of the important parameters that together with other confounding factors reduce the role of trial and error in patients with cardiovascular diseases. Genotypic variety and the high frequency of allele A in the studied population can justify varied responses to warfarin therapy and the importance of investigation before starting treatment with warfarin.

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Background: Multiple sclerosis (MS) is an autoimmune disease which demyelinates the central nervous system. Vitamin D, is a potential environmental factor which influences this disease. The majority of the biological activities of the polymorphism forms of vitamin D are done through its receptor gene (VDRG). The aim of this study was to examine the relationship between BsmI polymorphisms in VDRG and the incidence of MS. Materials and Methods: In this case-control study, the BsmI polymorphism in the VDRG was studied in 80 Iranian MS patients and 50 healthy controls of the same genetic background and age through polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method Results: There was a significant difference in the frequency of BsmI VDRG polymorphism genotypes between MS patients and controls (P=0.023). Conclusion: This study indicated that the VDRG BsmI polymorphism is associated with MS in this population.

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Background: Nausea and vomiting are prevalent after laparoscopic cholecystectomy surgery and physicians need to use drugs, such as ondansetron, propofol, metoclopramid, and ramostrogen, for controlling them. This study was done to evaluate the effect of gabapentin 300mg and 600mg administration on controlling nausea and vomiting after laparoscopic cholecystectomy surgery. Materials and Methods: In this clinical trial, 105 ASA patients (classes 1 and 2) were randomly divided into 3 equal groups including placebo group, 300 mg gabapentin group, and 600 mg gabapentin group. The same technique of anesthesia was used for all groups. The patients were controlled for nausea and vomiting each 2 to 6 hours and after that every 4 to 18 hours. Data were analyzed using SPSS software. Results: The mean degree of nausea in the control group was 2.8, in second group which took 300 mg gabapentin was 0.67, and in third group which took 600 mg of gabapentin was 0.55 (p<0.001). In addition, the severity of vomiting in the control group was 0.326, in second group was 0.126, and in third group was 0.053 (p<0.001). Conclusion: Administration of one dose of 300 mg gabapentin can reduce nausea and vomiting, and with increasing gabapentin dosage to 600 mg, these complications will decrease even more. Therefore, using gabapentin in laparoscopic cholecystectomy surgery is recommended

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Background: There is some evidence of antinociceptive effect of hydroalcoholic extract of Apium graveolens fruits in some recent studies. In present study, the possible mechanism of this effect of extract has been evaluated. Materials and Methods: In this experimental study, 48 male mice were examined. To evaluate the antinociceptive effect of extract, formalin test was used. The possible mechanism of extract was investigated with interaction of 3 drugs [Naloxone (2mg/kg), Dextromethorphan (20 mg/kg), L-NAME (20 mg/kg)] and Hydroalcoholic extract of apium graveolens fruits.(400 mg/kg) Results: Administration of Naloxone had no effect on antinociception of Hydroalcoholic extract of apium graveolens fruits. There was no significant difference between Dextromethorphan Plus extract and extract group in first phase. Pretreatment with L-NAME, decreased antinociceptive effect of extract in second phase of formalin test(p<0.05) Conclusion: Dextromethorphan has analgesic effect in acute phase and its interaction with hydroalcoholic extract of apium graveolens fruits shows at least, part of antinoceceptive effect of extract is via NMDA receptors in acute phase. On the other hand, it seems part of antinoceceptive effect of extract is via inhibition of NO syntheses in chronic phase. Extract of Apium graveolens may be effect via other neural pathways such as dopamine, noradrenalin or serotonin that need more research.

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Background: Enterococcus is known as an important pathogen in Iran like all around the world. The increasing use of vancomycin makes vancomycin-resistant enterococci (VRE) an important nosocomial pathogen. Vancomycin in combination with an aminoglycoside can provide effective treatment for severe enterococcus infections, while resistance to vancomycin antibiotic is increasing in enterococci. In this study, the pattern of antibiotic resistance and prevalence of vancomycin resistance enterococci have been explored. Materials and Methods: In this experimental study, after isolating and identifying 150 strains of enterococci from clinical specimens, the antibiotic resistance pattern of these strains to erythromycin, teicoplanin, vancomycin, ciprofloxacin, tetracycline, gentamicin, co-trimoxazole and linezolid was examined. The MIC test by using micro dilution broth method was performed for the vancomycin resistance enterococci specimens with the vancomycin and teicoplanin antibiotics. Results: Antibiotic susceptibility test showed 14% and 5.3% of the samples were resistant to vancomycin and teicoplanin respectively. Resistant to erythromycin, co-trimoxazole, ciprofloxacin, tetracycline, linezolid and gentamicin were 64, 40, 38.6, 6.6, 0, 38.76 percent respectively. Fourteen samples had high resistance to vancomycin which MIC were ≥ 256 µg/ml. Conclusion: Based on the results of present study, there are vancomycin-resistant enterococci in Arak as well as other parts of the world. The percentage of vancomycin resistance enterococci is high in Arak and appropriate treatment of infections caused by enterococcus is essential

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Background: Multiple sclerosis is a chronic and degenerative disease of the central nervous systemthat due to such reasons as its chronic nature, no prognosis, and absence of a definitive treatment causes stress in patients. Thus, this study was designed to examine the impact of peer educational program on stress in patients with multiple sclerosis in 2011. Materials and Methods: In this clinical trial, 110 patients with multiple sclerosis were randomly allocated to test and control groups (each group including 55 patients). After preparing 5 multiple sclerosis patients as the peer group, six training sessions forthe test group were held by the peer group over two months. Data collection tool was DASS 21 questionnaire that assessed patients’ stress before and after 4 months which was completed by both groups. In order to analyze the results, SPSS software 16 was used. Results: The results showed that before intervention, there was not astatistically significant difference between the two groups in stress score(p=0.24) while a statistically significant difference was seen between the two groups after intervention (p=0.001). Also, stress score in test group was statistically significant (p=0.001) but there was not a statistically significant difference between the stress scores of the patients in the control groups (p=0.39). Conclusion: Peer group educational program caused stress reduction in patients with multiple sclerosis. Hence, it is recommended that peer groups be used for education of multiple sclerosis.

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Background: Vibrio cholera is an important agent causing cholera in human. The expression of Flagellum and the movement of the bacterium are critical in the colonization and virulence of Vibrio cholera. FlaA gene is one the five genes encoding Flagellin which plays an important role in the activity and movement of the bacterium and its colonization which has a significant role in its immunogenicity. The aim of this study was to express and produce the recombinant FlaA protein in E.coli using Western blot method. Materials and Methods: In this experimental study, FlaA gene was proliferated by PCR method using the specific primers and cloned with BamHI and Xhol in pTz57R/T. Then it was proliferated and sequenced in DH5a vector of E.coli. The cloned FlaA gene was inserted into pGEX-4T-1 vector. The cloned vector was transformed to BL21-DE3 of E. coli and successfully expressed by induction of IPTG. The expressed protein was purified by GST affinity resin. For preparation of the primary antibody, the purified recombinant protein was injected to rats. Western blot assay method was used for determining the antigenicity of the recombinant FlaA. Results: Determination of gene sequencing showed that this gene has been proliferated properly and the antibody used in Western blot verified the production of the recombinant protein. Conclusion: The results of this study demonstrate that FlaA protein is immunogenic and can be evaluated in vaccine designing and as a diagnostic tool for detection of cholera infection.

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Background: Deaths due to cancer have been increasing in many countries in recent years. Probiotics are live microorganisms that have beneficial effects on consumer’s health. The aim of this study was to investigate antimutagenic and anticancer effects of Lactobacilli strains isolated from Tarkhineh in order to select potential probiotic strains. Materials and Methods: In this experimental study, 25 strains of Lactobacillus that had previously been isolated from Tarkhineh were used. Antimutagenicity test was performed based on proposed method of Ames. The results of the test were individuated after comparison between samples (suspensions of Lactobacilli) and positive (sodium azide) and negative (distilled water) controls. SPSS version 16 was used for statistical analysis. Results: Antimutagenic activity was observed only in four strains of Lactobacilli. The inhibitory percentage in the four strains of Lactobacilli, in its highest level was equal to 60.38 and in its lowest percentage equal to 39.37%. Also, the inhibitory percentage of mutation among the four strains in the presence of microsome were significantly different (P<0.05) than the absence of microsome. Adding the microsome of rat liver (S9) proved the anticancer effects of four Lactobacilli strains. Conclusion: Of the 25 strains of Lactobacilli, 4 strains which had the highest antimutagenicity effects were chosen as the potential probiotic strains.

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Background: Vibrio cholerae is a gram-negative bacterial pathogen that causes diarrheal disease cholera. One of the most pathogenic factors of Vibrio cholera is pili. Pili plays an important role in colonization and persistence of bacteria in small intestine. Materials and Methods: In this study, pili A (tcpA) gene was amplified by Polymerase chain reaction (PCR) method and sub-cloned into expression vectors such as pGEX4T-1. Escherichia coli competent cells were transformed by recombinant plasmids and the expression of protein with IPTG. The recombinant proteins were purified by affinity chromatography (GST) and immunoblot analysis was used for evaluation of new recombinant proteins antigenicity. The concentration of recombinant proteins was measured according to Bradford assay. Results: The results of this study indicated that recombinant proteins were expressed successfully in competent cell of E. coli, such as E. coli BL21 (DH3). The recombinant protein was purified by affinity chromatography (GST). The immunoreactivity pattern of anti-Tcp antibody with recombinant proteins of TcPA showed that the recombinant proteins had antigenic properties. Conclusion: Because these recombinant proteins are antigenic, these proteins may be considered as tentative candidates for designing cholera vaccine.

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Background: Nucleos(t)ide analogues, such as lamivudine and adefovir, are effective drugs for treatment of hepatitis B patients. However, long-term treatment with these drugs leads to the emergence of the nucleos(t)ide analogue resistant strains. The impact of nucleos(t)ide analogues on the emergence of HBsAg escape mutations is not clarified. Hence, the aim of this study was to determine HBsAg escape mutations in chronic hepatitis B patients treated with nucleos(t)ide analogues. Materials and Methods:A cross-sectional study was performed on 50 patients with chronic hepatitis B under treatment with nucleos(t)ide analogues (lamivudine and/or adefovir) and 50 naive chronic hepatitis B patients. HBV DNA was extracted from plasma and S gene of virus was amplified by Nested-PCR followed by direct sequencing. HBsAg gene sequence of the samples was evaluated for detection of HBsAg escape mutations. Results: Among the 100 patients, the following HBsAg escape mutations were identified: sQ101H, sG119R, sP120S, sP127S, sA128V, sG130N, sG130R, sT131I, sM133I, and sY134N. The frequency of HBsAg escape mutations in patients under treatment of nucleos(t)ide analogues was 16% and in naïve patients was 6% (p=0.2, OR=2.98). Conclusion:According to the obtained results, there seems to be no association between using nucleos(t)ide analogues and emergence of HBsAg escape mutations.

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Background: Chronic hepatitis B virus (HBV) infection is a multi-factorial disease that is accompanied with serious clinical complications. Host’s genetic background, especially immune–genetic factors, is critical in the pathogenesis of infection. Gamma interferon ((INF-γ) and its receptor have an important role in immune response to the virus and clinical course of the disease. The aim of this study is to investigate the association between single nucleotide polymorphism -611G/A located in promoter of gamma interferon receptor1 gene (INFGR1) and chronic HBV infection. Materials and Methods: In this Case Control study, genomic DNA from peripheral blood samples of 150 chronically HBV infected patients and 150 healthy controls was extracted by phenol-chloroform method. DNA analysis was performed by PCR-RFLP method and P<0.05 was considered significant. Results: After stages of genotyping and statistical analysis, a significant difference was observed between patient and control group, so that genotype GG was higher in the control group compared to the patient group. Conclusion: The host’s immune-genetic background can play an important role in the pathogenesis of infectious disease. Variations in INFGR1 were related to several diseases. The results showed that the presence of GG allele is accompanied by a decrease in susceptibility to chronic HBV infection.

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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: Cataract is the leading cause of blindness and visual impairment. This study was performed to compare effects of two different incision types in cataract surgery on dry eye symptoms and diagnostic test values. Materials and Methods: In this clinical trial, 300 patients with cataract requiring phacoemulsification were studied. The patients were randomly divided into two operative method groups: limbal and clear corneal (anterior to the vascular arcade) incision. A complete set of ophthalmic examinations and tear related tests were done for all of the patients before surgery and one week and one month after surgery. The collected data were analyzed using SPSS and EPI-Info softwares. Results: Overall, 149 men and 151 women were enrolled in this study. On the first postoperative week, the means of symptoms, and TBUT and TMH values in both groups significantly decreased compared with the preoperative values. These values returned to the preoperative levels one month postoperatively which werein contrast to the changes of debri, PEE, corneal and conjnnctival staining. There were statistically significant differences between the results of pre- and post-operative symptoms, PEE, debri, TBUT, conjunctival and corneal staining. Except for TBUT, the results of these tests were not statistically different according to incision location. Conclusion: Phacoemulsification cataract surgery affects dry eye symptoms and diagnostic test values. In addition, except for TBUT, the location of incision had no effect on other test results and symptoms.

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Background: Gastric perforation is a rare occurrence in newborns with unknown etiology and risk factors. This study reports a case of acute gastric perforation in a preterm neonate and its risk factors. Case: The patient was a preterm neonate (26 weeks) with NG tube feeding with GI bleeding. The patient underwent abdominal surgery and gastric perforation in the anterior wall was reported. The risk factors for gastric perforation in this neonate were probably prematurity, low birth-weight, N-CPAP, and frequent insertion of NG tube. Conclusion: It can be concluded from this study that identification of risk factors and reducing or eliminating them are vital to the prevention of this complication.

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Background: Postpartum women are a population at risk for sedentary life. Previous studies have shown that self-efficacy is an important determinant of stage of change and exercise adherence. This study evaluates the relationship between self-efficacy and stage of change and physical activity (PA) behavior in Iranian mothers. Materials and Methods: In this cross-sectional study, 300 postpartum mothers were selected randomly from all health centers in Arak. The instruments used in this study included the 7-day PA recall, stages of exercise adoption tool, and self-efficacy for exercise scale. Data analysis was performed using SPSS software. Results: Ninety-one percent of the participants were in the pre-contemplation, contemplation, and preparation stages of change. Mean score for moderate PA was 38.94±40.5 minutes a week. Significant relationships were found between the stages of PA behavior change and METs of weekly energy expenditure from moderate activities (r=0.60, P<0.001). Also, statistically significant relationships were found between self-efficacy and the stages of PA behavior change (r=0.50, P<0.001) weekly energy expenditure from moderate activities (r=0.40, P<0.001), and pre-pregnancy PA behavior (r=0.39, P<0.001). Conclusion: The level of PA of the participants was less than the recommended minimum level for regular PA behavior (150 minutes of moderately intense PA per week). In this population, self-efficacy plays an important role in PA behavior and it should be taken into consideration in designing interventions for improving PA behavior.

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Background: Atrazine is an herbicide used widely by farmers in controlling weeds. The aim of this investigation was to evaluate the effect of atrazine, as an herbicide, on sperm quality, sperm DNA damage, invitrofertilization (IVF), and embryonic development in mature male rats. Materials and Methods: In this experimental study, 42 mature male Wistar rats weighing 170±5g were divided into three groups, including one control and two treatment groups. The rats in the control group were administered corn oil (0.2 ml/day) and the rats in the test groups were orally gavaged with atrazine 150mg/kg (high dose) and 75mg/kg (low dose) body weight daily for a total of 45 days. Epidydimis tail was cut and placed in 1 ml of human tubular fluid (HTF) medium for 30 minutes in an atmosphere of 5% CO2 in air at 370C. The sperms were analyzed for sperm count, sperm viability, motility, DNA damage, immature sperm, and in vitro fertilization. Data were analyzed by One-Way ANOVA. Results: In this study, atrazine provoked a significant decrease (P<0.05) in sperm number, sperm viability, and sperm motility. The data suggest that the atrazine had a negative impact on sperm maturation and DNA integrity in a time-dependent manner, which consequently caused a significantly remarkable reduction in IVF ability (P<0.05). Conclusion: Atrazine is capable of inducing DNA damage and chromatin abnormalities of spermatozoa which can contribute to a low fertilization rate.