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Background: Mother and newborn's health is one of the important indexes in health services of every country and one of its main assessment indexes is the number of normal deliveries in each country. Identifying the effective factors in labor helps the right selection of patients the process of delivery. The main goal of this study was to assess the association between fetal sex and unsuccessful labor process which result in cesarean section. Materials and Methods: This observational cross-sectional study was conducted on 1537 pregnant women admitted for delivery to Taleghani Hospital of Arak during 6 months. Data were catch through a check list consisting of obstetric history, physical examination, labor process, and lab tests coupled with interview and observation. The results were analyzed through Chi2, chance ration analysis, and t-test. Results: Of the 1537 pregnant women, 74% had normal delivery and 26% underwent cesarean section. Of all infants, 35.1% of those delivered by normal vaginal delivery and 13.4% of those delivered by cesarean section were male sex while 38.9% of the infants in the normal delivery group and 12.6% of those in the cesarean group were female. These results did not show any association between fetal sex and type of delivery. Overall, 36.5% of the deliveries done through cesarean section were due to dystosia (18.1% male and 18.4% female) (P=0.934). Also,14.3% of the newborns delivered through cesarean sction due to fetal distress were male and 10.8% of them were female (P=0.162) while 10.5% of newborns delivered through cesarean section due to meconium were male and 8.5% of them were male (P=0.359). Conclusion: It appears there is no association between fetal sex and labor disorders which result in cesarean section.

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Background: Systemic and hemodynamic complications associated with stereotactic and Mayfield pin insertion pain and is one of the major problems in neuro-anesthesiology. The aim of this study was to decrease patients' hypertensive response to pain and stressful condition of the disease which may bring about problems during operation. Materials and Methods: In a randomized, double-blind clinical trial, thirty 16-65 year old ASA I and II patients at Al-Zahra Hospital of Isfahan were analyzed between September 2008 and November 2009. The level of pain according to VAS of pain was obtained from the patients in three stages: After pin insertion (stage 1), while returning from MRI (stage 2), and at the end of the procedure (stage 3) and recorded in the questionnaire. Data were analyzed through SPSS software. Results: The mean VAS of pin insertion pain for lidocaine in the three stages was 5.46, 5.00, and 2.46 and for bupivacaine was 5.76, 3.76 and 1.40, respectively (P<0.005). This indicated a significant difference between lidocaine and bupivacaine. Conclusion: As stereotactic operations take 3 to 3.5 hours on average, the use of bupivacaine instead of lidocaine is highly recommend during pin insertion.

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Background: This study was done to assess the validity and reliability of Najmie Job Satisfaction Questionnaire (NJSQ) in order to provide a suitable tool for measuring job satisfaction (JS). Materials and Methods: In this cross-sectional study, 212 staff members at Najime Subspecialty Hospital were selected by stratified sampling method. The participants took NJSQ. After evaluating content validity, confirmatory and explanatory factor analysis and Cronbach's Alpha were used to examine construct validity and reliability of the questionnaire, respectively. SPSS software version 16 was used to analyze the data. Results: The samples, 212 subjects, consisted of 181 (86.6%) women and 28 (13.4%) men. The explanatory factor analysis showed 4 factors with 54% total variance and 0.82% Kaser-Meyer-Olkin index. These factors were also verified by confirmatory factor analysis (P=0.368). In addition, the reliability of the questionnaire was reported to be 0.88% based on Cronbach's alpha method. Conclusion: Since validity and reliability indexes were reported suitable, NJSQ can be considered a valid and reliable questionnaire for measuring JS.

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Background: Different studies have shown that vitamin D may play a functional role in insulin secretion and sensitivity. This study evaluates the effect of vitamin D on insulin resistance. Materials and Methods: This clinical trial was done on 100 patients with type II diabetes mellitus that aged 30-70 years. The patients were randomly selected and different examinations were done on them. They received 50000 units of oral vitamin D daily for four weeks. Insulin resistance was measured before and after the intervention. Data analysis was done by paired t-test and Wilcoxon test using SPSS software version 17. Results: The participants consisted of 70 women and 30 men. Mean vitamin D was 43.03±19.28 ng/ml and 24% of the participants were vitamin D deficient based on the cut-off 25(OH) D <20 ng/ml. At the beginning and the end of the study, the mean levels for FPG, insulin, HOMA-IR were 138.48±36.74 and 131.02±39 mg/dl (P=0.05), 10.76±9.46 and 8.6±8.25 µIu/ml (P= 0.02), and 3.57±3.18 and 2.89±3.28 (P= 0.008), respectively. Conclusion: The findings of this study showed that vitamin D causes significant improvements in FPG, insulin, and insulin resistance, that was evaluated by HOMA-IR. It was also indicated that adding vitamin D supplements can improve glucose control in type II diabetes mellitus.

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Background: Brucellosis is an endemic infectious disease in Iran. The neurological involvement of the central nervous system in brucellosis patients is about 3 to 5 %. Case: The case was a 25-year old Afghan man with weakness and arthralgia for one year as well as terrible headache, vertigo, vomiting, cough, sputum, and disequilibrium. Brain CT-Scan indicated communicating hydrocephalus in four ventricles. Since hydrocephalus was idiopathic and noticing the prevalence of tuberculosis among Afghan immigrants that can also cause hydrocephalus, ventriculo-peritoneal shunt was inserted for the patient. Pressure in CSF increased and had a turbid appearance. Glucose value of CSF decreased (35 mg/dl), whereas protein value increased (724 mg/dl). Leukocyte count was 10 mm3 with 80% neutrophils and 20% lymphocytes. The presence of brucella species in CSF culture confirmed that subacute meningitis had caused hydrocephalus due to delay in diagnosis and treatment. The patient was treated for brucellosis and discharged after 10 days with oral medications. Conclusion: Noticing this case and other studies, it is recommended that patients with neurological symptoms, such as hydrocephalus, be evaluated for neuro-brucellosis in endemic areas for brucellosis.

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Background: Brucellosis is one of the zoonotic diseases that has always been considered a health problem in Iran. Since this disease is endemic in Arak and Markazi Province, this study was done to investigate its epidemiology during 2001-2010. Materials and Methods: In this epidemiological study, data on patients with brucellosis were obtained from the medical records in Arak Health Center during 2001-2010. The collected data were analyzed by SPSS software version 16. Results: During this period, 3880 new cases were reported. The mean incidence rate of brucellosis was 60 per 100000 people during 2001-2010. The greatest incidence was in 2004 (111.5 per 100000 people), whereas the lowest incidence was in 2006 (40.5 per 100000 people). Overall, 72% of the patients lived in villages, and 60% of them were male. The majority of the patients were in the second decade of their lives (10-19 years old). The majority of the patients had Wright test titer=1:320 and 2ME titer=1:80 in serology titration. Conclusion: Arak is one of the regions with high incidence of brucellosis. In this region, the patients are mostly male, live in villages, and age 10-19.

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Background: H. pylori infection is common worldwide involving 50% of the general population. The aim of this study was to compare the effect of two sequential regimen therapies on the eradication of H. pylori. Materials and Methods: In this clinical trial, 150 patients were allocated to two groups of 75 each: group A and group B. The eradication of H. pylori in groups A and B was based on azithromycin and ofloxacin sequential regimens, respectively, and the results were compared between the groups. The data were analyzed by t-test, Chi-square test, and Fisher’s exact test using SPSS software version 16. Results: Mean of the patients’ age was 39.3± 1.2 within the age range of 18 to 85 years. There were not significant differences between the two groups considering the type of peptic ulcer. In group A, Urea Breath Test (UBT) was negative in 67 (89.3%) patients while in group B, it was only positive in 8 (10.7%) patients. In group B, there were 64 (85.3%) negative and 11 (14.7%) positive UBT test results. There were no significant differences in H. pylori eradication rates between the two groups (P=0.31). Conclusion: Noticing the absence of a significant difference between the two groups in terms of H. pylori eradication, it can be concluded that ofloxacin-based drug regimens have no superiority over azithromycine-based regimens and each regimen can be prescribed considering drug complication rates in different patients.

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Background: Sodium arsenite has adverse effects on the reproductive system and vitamin E is a strong antioxidant and reproductive factor in the reproductive system. The aim of this study was to investigate the effect of vitamin E on the structure and the number of ovarian follicles during its development in rats treated with sodium arsenite. Materials and Methods: Pregnant Wister rats (n=4) were divided into 4 equal groups, including control, vitamin E (100mg/kg/day), sodium arsenite (8mg/kg/day), and sodium arsenite+vitamin E. Oral treatment of the pregnant rats started from the 7th day of pregnancy till the end of the weaning and continued till the age of 120 days. After the treatment period, the right ovary was removed and fixed, and then the mean number of ovarian follicles and atretic follicles, mean thickness of zona pellucida, and volume of oocytes and its nuclei in different types of follicle were determined. Data were analysed using one-way ANOVA and the mean difference was considered significant at P<0.05. Results: In the vitamin E+sodium arsenite group, significant increase(P<0.05) in the total number of follicles, mean number of primordial, primary, secondary, antral, and graafian follicles, significant reduction (P<0.05) in atretic follicles, and significant increase(P<0.05) in the thickness of zona pllucida in secondary and antral follicles as well as oocyte volume in parimordial and primary follicles and its nuclei in primary, secondary, antral, and graffian follicles were observed in comparison with the other groups. Vitamin E in the sodium arsenite+vitamin E group increased the number of different types of follicles and the thickness of the zona pllucida (P<0.05), decreased the number of atretic follicles, and increased the volume of oocyte and its nuclei to the level of the control group. Conclusion: Vitamin E can be administered as a supplement to compensate for the adverse effects of sodium arsenite.

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Background: Previous studies in Iran and around the world have indicated the high rate of medicines use. In recent years, medicine use has continued to rise in spite of attempts made by the Ministry of Health and Medical Education in Iran. Therefore, it seems that in addition to the reasons considered in previous studies, there are other reasons for this problem in Iran. One of the parameters involved in this problem is the high medicine use among the clinical staff. Thus the aim of this study is to compare medicine use among clinical and non-clinical staff members. Materials and Methods: In this cross-sectional study, information about the monthly use of medicines was obtained by means of a questionnaire administered to eight groups of clinical and non-clinical members: first-year medical students, first-year non-medical students, interns of medicine, forth-year non-medical students, general physicians, specialists, academic members with M.Sc, and academic members with PhD degrees. Results: The results showed that medicine use decreased with increase in education level in both groups. In addition, the comparison of medicine use between clinical and non-clinical groups showed that there is not a significant difference for most medicines among the first- and second-year students but medicine use significantly increased among general physicians and specialists compared to the control groups. Conclusion: The results of this study showed that medicine use among clinical staff should be considered in controlling medicine use in Iran.

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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: 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: Considering the lack of a standardized and validated questionnaire on oral health care for pregnant women based on a specific behavioral pattern, the aim ofthis study was development and psychometric assessment of an oral health instrument based on Health Belief Model in pregnant women. Materials and Methods: This cross-sectional study was carried out on 340 pregnant women in Arak city. After reviewing the related literature, the instrument was designed and its content validity ratio, content validity index, face validity, and exploratory factor analysis were measured. For measuring the reliability of the scales, three methods, including test-retest, internal consistency, and agreement, were used. Data analysis was done using SPSS software. Results: The reliability of the 61 items was evaluated with impact score of 1.5 and the content validity index of 0.79 and based on exploratory factor analysis were classified into seven categories. The overall reliability measured through Cronbach alpha was 0.84. The reliability of the questionnaire was 0.88, perceived susceptibility was 0.73, severity was 0.70, perceived benefits was 0.75, perceived barriers was 0.71, the cues to action was 0.72, and self-efficacy was 0.76. Kappa coefficients were determined with a high performance for checklists. Conclusion: This study provided good evidence of the strength factor structure and reliability of Health Belief Model structures about oral health behaviors in the vulnerable group of pregnant women, according to the study of psychometrics process.

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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: The presence of oxidant agents yields higher levels of free radical reaction products in erythrocyte membrane proteins and serum proteins. The aim of this study is to investigate the oxidative modifications of recombinant human coagulation factor VIII (rHFVIII) by spectrophotometric analysis. Materials and Methods: In this experimental study, rHFVIII was incubated aerobically with vitamin C and ferro ions in metal catalyzed oxidation (MCO) system for 4 to 28 hr. Carbonyl assay was used as an index of protein oxidation. For this purpose, 2,4dinitrophenyl hydrazine (DNPH) was used. Reaction of this reagent with carbonyl groups produces dinitrophenylhydrazone derivatives that their concentration was estimated by spectrophotometry. Results: Carbonyl groups in rHFVIII changed in the presence of vitamin C and ferro ions. Dose-dependent effects of vitamin C showed a decrease in carbonyl groups of rHFVIII whileferro ions increased oxidation and carbonyl group formation in this protein. Conclusion: These findings indicate that changes in carbonyl groups in rHFVIII are related to the generation of reactive oxygen species. Also, antioxidant mechanisms are activated in a dose- and time-dependent manner.

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Background: Diabetes mellitus is one of the most important health problems in the world. B-cells are susceptible to damage by free radicals. Noticing the mechanism of cupping, this study was carried out to evaluate the effect of cupping together with drug therapy on biochemical factors and oxidative stress. Materials and Methods: In this clinical trial, 5ml of intravenous blood was obtained from diabetic patients in beginning and late stages of this disease who referred to a diabetes center. In addition to receiving metformin and glibenclamide, the patients underwent cupping after one month and were analyzed one month later. Blood samples obtained one month before and after the treatment were compared in terms of diabetes and oxidative stress indicators. To evaluate lipid peroxidation, TBA method was used and FRAPS method was employed to measure total serum antioxidants and blood factors by Pars Azmon kit. Results: Hemoglobin A1C, fasting blood sugar, blood sugar 2 hours after fasting, triglycerides, cholesterol, and low-density lipoprotein as well as high-density lipoprotein showed significant increases. Aspartate transferase in diabetic patients significantly decreased after phlebotomy (p<0.05). Conclusion: Cupping improves blood factors in diabetic patients and it is recommended to be used as a complementary treatment in patients with diabetes type II.

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Background: The presence of nitrate in drinking water causes various health and environmental problems. The aim of this study was to evaluate the efficacy of nitrate reduction by Fe/H2O2 process and adsorption on activated carbon. Materials and Methods: This experimental study investigated nitrate oxidation by advanced oxidation process of Fe°/FeІІ/FeШ/H2O2 at pH 2-10, nitrate concentrations of 50-300 mg/L. After adjusting the pH, 0.5, 1, 2, 5, and 10 g/L values of GAC, PAC, H2O2/GAC, and Fe/H2O2/GAC together with H2O2 at retention times of 15, 30, 45, 60, and 90 minutes, respectively, were added and mixed. Results: At retention time of 10 minutes and 0.5 mL H2O2 and 1 g/L from Fe°, FeІІ, and FeІІІ, the removal efficacy was 88.5, 84 and 78%, respectively. At 50 mg/L nitrate and 0.5, 1, and 10 mg/L GAC concentrations, the removal efficacy was 56.5, 93.6, and 82.6%, respectively. The nitrate removal efficiency at pH=4 was approximately 50%, whereas at pH=3 with 30% efficacy, it increased to 80%. Conclusion: Modified Fe/H2O2 process with iron nano-particles and activated carbon adsorption can effectively reduce nitrate under optimal conditions. The use of activated carbon at a concentration of 1 g/L increased the removal efficiency of nitrate to 90%.

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Background: Today, global concerns about water pollution with chemicals and its adverse impact on health have increased. This study aims to evaluate the physical and chemical quality of water treated through domestic water treatment systems.

Materials and Methods: In this cross-sectional descriptive study, water samples were collected from 60 domestic water treatment systems and parameters, such as turbidity, total dissolved and suspended solid, total hardness and calcium, magnesium hardness, alkalinity, total alkalinity, carbonate, bicarbonate, nitrate, sulfate, nitrite and fluoride, EC, pH, and free chlorine residuals, were examined.

Results: The results indicate that the average concentration of chemical parameters in treated water were: chloride=0.1mg/L, nitrate=0.006mg/l, sulfate=5 mg/l, Nitrate=15mg/L, bicarbonate=49 mg/L, calcium hardness=18 mg/L, and fluoride=0 mg/l.

Conclusion: The overall results of this study indicated that the use of municipal water treatment reduced Cl2, sulfate, and bicarbonate concentrations than the optimal levels in urban areas water. However, nitrite concentration was significantly higher in the output of these systems than distribution systems, which is a source of concern.

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Background: In this research dosimetric parameters of mercury was investigated as a radiotherapy modulator and compared with cerrobend as a common beam attenuator material in most radiotherapy centers. Also several designs for mercury shielding system were evaluated.

Materials and Methods: In this experimental research transmission factor of different thicknesses of cerrobend and mercury at 6MV and 18MV photon beams was measured in order to investigate mercury as a beam modulator. Relative dosimetry was done with ionization chambers and then mercury modulating system for radiotherapy was designed with different cross sections.

Results: The result show that the transmission values increased with field size increment due to increased scatter contribution, for all cerrobend and mercury thicknesses at two energies. The procedure of mercury transmission factor is in agreement with cerrobend transmission factor. The second designed system with hexagonal cross section is in good agreement with patient contour.

Conclusion: The experimental investigation on mercury dosimetric parameters showed that mercury can be proposed as a modifier in radiotherapy because of its profit properties such as being liquid in room temperature, power of attenuation and …. So mercury can be proposed as a beam modifier (at closed system because of its poison vapor) in radiotherapy. Keywords: beam modifiers, Cerrobend, dosimetry, Mercury

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Background: Biosurfactants are amphiphilic biological compounds produced extracellularly by a variety of microorganisms. Because their use in various industries are of a particular importance. The aim of this study was to identify a strain of bacteria of the genus Bacillus Cereus biosurfactant producers and investigate the antibacterial effects of biosurfactant produced.

Materials and Methods: In this study, different samples of oil, water and soil contaminated with oil were prepared. Hemolytic activities, emulsification and measurement of surface tension were used and selected strains were identified by biochemical tests. The nature and effect of antibacterial biosurfactant were evaluated for strain selection.

Results: In this study, eighty eight bacterial strains were isolated. Among them, 24 strains were hemolytic activity. Among them, 14 strains have emulsification activity more than 70% and finally from among them four strains were able to convey to the surface tension of less than 40 mN/m. On the basis of biochemical tests, a strain selective in this study as B. cereus 43 strain, were identification and selection. The results of investigating the nature biosurfactant determined that the type of lipopeptide. Also, the produced biosurfactant has antibacterial activity against six bacterial infectious. The most sensitive and the most resistant bacteria than the impact of biosurfactant extract, of S. aureus PTCC1112 and of the Proteus mirabilis ATCC 2601 respectively. Also, the results of MIC, MBC showed that MIC extract were effective in a dilution of 63 mg/ml on S. aureus PTCC1112 and S.epidermidis ATCC 2405 and the MBC extract had the greatest effect in a dilution of 125mg/ml on Staphylococcus aureus, Staphylococcus epidermidis and Pseudomonas aeruginosa PTCC 1074 respectively.

Conclusion: Bacillus Cereus 43 had high potential in reducing the surface tension and biosurfactant extracted had high antibacterial effects. Therefore, Frequency of potential has for applications of biotechnology and the environment.