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

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

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

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

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

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

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Background: Subclinical hypothyroidism is the compensatory stage before overt hypothyroidism. In overt hypothyroidism, risk of ischemic heart disease increases due to elevation of lipoprotein (a) as atherogenic agent, but evidence for subclinical hypothyroidism is one of the controversial issues in researches. According to the atherogenic lipoprotein (a) and other serum lipids, this study is conducted to compare the serum lipoprotein (a) and other serum lipids in patients with subclinical hypothyroidism and euthyroidism.

Materials and Methods: In this descriptive - analytic study, 90 persons (60 with subclinical hypothyroidism and 30 euthyroid state) are participated and these referred to Imam Reza and Taleghani Hospitals which are located in Kermanshah. The sampling method is selected with available sampling methods. After differentiating data by age, sex and underlying disease (liver, kidney, drugs), then they were subjected to determination lipoprotein (a) and other serum lipids profile tests.

Results: In both cases and controls, 16/7% were men and 83/3% were women. Based on results, there is no significant difference between serum lipoprotein (a), triglycerides, cholesterol, HDL and LDL in both statistical groups (p>0.05). Also there is no association between lipoprotein (a) and other serum lipids (p>0.05).

Conclusion: Serum levels of lipoprotein (a) and other serum lipids in young patients with normal weight with subclinical hypothyroidism is not increase, thus it can be concluded early treatment is not necessary for them.

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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: Early detection and treatment are crucial to prevent mental retardation in congenital Hypothyroidism (CH). The aim of this study was to evaluating of screening program of CH in Markazi Province.

Materials and Methods: In cross sectional descriptive study we used recorded data in Markazi province health center. From 2006 to 2012,127112 newborns were screened by measurement of serum TSH level by heel prick. Neonates who had blood TSH&ge5MIU/L were recalled for more evaluation. Neonates with confirmed hypothyroidism underwent treatment.

Results: From127112 screened neonates, 414 were diagnosed as CH patients (both permanent and transient). The prevalence of CH was . Recall rate was 4.8%. In 94.4% of patients, treatment were begun before the 40th day of life. The coverage percent in the province was 100% from the second year of the program.

Conclusion: Recall rate and the incidence of CH were higher than those in other studies, both in Iran and other countries. The mean age of treatment initiation and coverage percent were in favorable range.

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Background: Solid waste is one of the environmental pollution. Therefore the aim of this study was to survey of knowledge, attitude and practice of student and teachers about weast management for developing methods of educational in Arak city.

Materials and Methods: This is a cross sectional and analytical study that was carried out on 1739 student and 149 teacher in school of Arak city in 2012. sampling with cluster and data collection with questionnaire including knowledge, attitude, practice and appropriate resource of education for waste management. Finally data analyzed with statistical tests.

Results: The mean knowledge and attitude student was 4.1±1.9 (out of 8) and was 20.63±5.9 (out of 35) respectively. Based on most educational methods for weast management viewpoint of student book 441 student (29% ) but impact of internet very low interest 487 (32%) of student. Moreover the most educational methods based on level of education significant difference was observed (p=0.001).

Conclusion: Due to a level of knowledge and attitude of student and accsses to educational resourse and huge of weaste in school educational program planned via book, teacher and peer education for student recommended.

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Background: The prevalence and incidence of cancer in different parts of the world have different patterns. To recognize the frequency of malignancies in different social groups according to climatic conditions is considered as the primary component of prevention programs at different levels. This study was conducted to investigate the epidemiology, survival rates and geographical epidemiology of breast cancer in Markazi province.

Materials and Methods: In this epidemiological study, needed data were obtained from cancer registration program and death registration data. The data were analyzed by using SPSS software version 16 and Winpepi and significant level was 0.05. And to draw a map to show the breast cancer incidence rate in Markazi district, Arc view software was used.

Results: Out of the 400 cases recorded during the 5-year, 8.5% died due to breast cancer. 5-year survival rate was 87% and there was a significant correlation between survival rate and age. Most records were related to the age group 49-40 years and the highest incidence rate was in Arak. The trends of incidence rate was not significant.

Conclusion: The results showed that 5-year breast cancer survival rate is more than some other places which could be due to new and improved methods of treatment and methods of screening and early detection of disease. Other aspects of the epidemiology of the disease is similar to other parts of Iran.

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Background: The main purpose of this study was to measure the level of lipids in ICU patients and its clinical outcome, specially the mortality rate and the relationship between level of lipids and APACHE IV score.

Materials and Methods: This descriptive and cross-sectional study was conducted on 100 ICU patients. Cholesterol level was measured on the first and second days after admission of patients. This was followed by examination of clinical outcome (e.g. mortality rate) and duration of their real and predicted stay through APACHI IV. The results were analyzed by Pearson correlation using SPSS.

Results: Mean serum of HDL, LDL, and cholesterol was lower than normal. These values for the first day were 33.16, 67.97, and 131.38 and for the second day were 23.63, 54.99, and 119.88, respectively. Mean APACH E IV score was 67.72. Result of Pearson correlation coefficient showed significant relationship (p<0.05) between APACHI IV score and cholesterol level of the first and second day, LDL level of the first and second day, HDL level of the second day. Moreover, there were significant relationships were observed between the real mortality rate and the cholesterol level of the first and second days, LDL level of the first and second days, and HDL level of the first day. There was a significant significant correlation between cholesterol level and LDL of the first and second days as well as HDL of the first day and duration of admission in ICU as predicted by APACHI IV.

Conclusion: The significant relationship between lipoprotein level of serum and APACHI IV indicates considering serum lipid beside other physiologic parameters for prediction of clinical consequences including mortality rate of ICU patients

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Background: Physical activity and overweight both changethe body homeostasis for this purpose, in this study effect of two models of high and moderate intensity aerobic exercises on the amount of Adiponectin and Resistin were compared inobese and overweight females.

Materials and Methods: In this experimental study, 15 obese and overweight female (Mean age: 22.93±0.54 years weight: 75.15±2.07 kg hight: 160.6±1.38 Cm BMI: 29.24±0.73kg.m-2) were randomly selected as sample. Subjects were placed into high (33 min exercise, 85-90% of max hearat rate) and moderate (41 min exercise, 50-70% of max hearat rate) intensity aerobic exercise groups. Exercises lasted three days a week for eight weeks with an equal volume of consumed energy. In order to analyze data, independent-t test and Repeated Measure analysis of variance were used at a significance level of p<0.05.

Results: The results indicate a significant increase in Adiponectin after eight weeks of high-intensity aerobic exercise compared to moderate-intensity exercise (p=0.02). A significant reduction in fat mass and percentage was observed after moderate intensity exercise (p=0.03), too. In Addition, moderate intensity exercise caused a considerable decrease in Resistin after eight weeks (p=0.06).

Conclusion: High-intensity exercise appears to provide necessary metabolic stress to enhance Adiponectin, even without weight and fat loss.

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Background: This study aimed to compare the efficacy and safety of insulin versus oral hypoglycemic drugs for gestational diabetes treatment, using evidence based medicine approach.

Materials and Methods: This secondary study was conducted by selecting a comprehensive systematic review through searching the Cochrane library. To calculate the number needed to treat (NNT), outcomes such as cesarean section, macrosomia, birth weight more than 90th percentile, operative vaginal delivery, labor induction, post partum hemorrhage, and shoulder dystocia has been considered while neonatal hypoglycemia, NICU hospitalization and fetal distress were considered for calculating number needed to harm (NNH). To calculate the likelihood of helped versus harmed (LHH), macrosomia and hypoglysmia were selected. Data were analyzed with Wilson score test.

Results: The NNT for above outcomes were 3, -14, -5, 16, -3, 31, and 32, respectively. Among them cesarean section was significance. Calculated NNH for side effects were 6, 15, and -17 which only was significance for neonatal hypoglycemia (p<0.05). The LHH was estimated -0.43.

Conclusion: Considering LHH, it seems that the benefit of insulin in management of gestational diabetes is more than metformin. But with respect to issues such as low sample size of trials, lack of assessment the maternal hypoglysemia as complication of insulin therapy, the findings should be considered cautiously.

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Background: Improvement of nutrition like fish and sea products is influential in preventing from non-contagious diseases. The transtheoretical model is one of the models for effective investigation on nutrition behaviors.  This study was done with the aim of investigating fish consumption among women 30 to 50 years old based on the transtheoretical model.

Materials and Methods: This study was an analytical and cross sectional analysis which was conducted in 2014 on 360 women 30 to 50 years in Arak city. The data have been collected by using researcher-made questionnaires which its validity and reliability was assessed in accordance to the transtheoretical model were obtained by visiting houses. Then the collected data were analyzed by pearson correlation test.

Results: The average age of the respondents was 39.34±7.5. The average of fish consumption was 0.62 ±0.83 times a week. 64 % of people in consumption of at least two servings of fish a week were in the two first stages of change (pre-contemplation and contemplation).The average score of self-efficacy in fish consumption was a total of 10.58 ±3.12 out of 15 and the average score of cons of fish was 26.35 ±4.78 and the average score of pros of fish was 21.6 ±2.67 out of 25. Pearson correlation indicates that the amount of fish consumption with constructs of the self-efficacy, stages of change and pros of fish had respectively the most positive correlation (p≤0.05). Fish consumption had no significant difference with age, education, Body Mass Index, occupation, monthly income and marital status.

Conclusion: Fish consumption despite its high level of perceived benefits is really low and to eliminate these barriers, education and cultural-building especially in women who are influential people in family nutrition is necessary.

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Background: Due to high prevalence of vitrectomy surgery, and the importance of anesthetic technique in conducting an uncomplicated surgery, we decided to do this study.

Materials and Methods: This prospective randomized study was conducted on 80 patients 40-80 years old candidating deep vitrectomy sugery under general anesthesia that were categorized into II and III Class by American Society of Anesthesiologist (ASA). Patients were randomly allocated to two groups of 40 members. Anesthesia was induced in both groups in the same manner. For maintaining anesthesia, patients from I group receiVed 1.2% isofluran with 50% O2 in air at 4L/min and infusion of remifentanil (0.1 mg.kg-1.min-1). But in the P group, we used propofol up to 10mg/kg /hr with infusion of remifentanyl. Propofol and isoflurane in fusion was discontinued with the last surgical stitches, but remifentanil infusion continued in both groups until the eye was covered with shield. Hemodynamic variables were recorded just before the induction of anesthesia and in different time intervals till discharging of the patients from the recovery room.  Then, data were compared.

Results: Results showed that there is a significant changes in propofol group compared to isofluran in deep vitrectomy surgery operations.

Conclusion: Hemodynamic changes are more significant in maintaining propofol anesthesia when compared with isoflurane.

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Abstract

Background: Family is the most important component of community and family health leads to spiritual excellence and intellectual growth. One of the debates in current society is to enhance the bases of marital life. More than half of the sexual problems which cause family life and marital relationships abolishment are due to insufficient knowledge or erroneous beliefs about sexual relationships. The aim of this study is to investigate the effect of acceptance commitment therapy (ACT)-based premarital counseling on the couples’ sexual function.

Materials and Methods: The study population of this clinical trial consisted of all couples referring to premarital counseling centers of Isfahan in 2015. Sixty couples were selected and then randomly divided into two groups, an experimental group(30 couples) and a control group(30 couples). Then they completed a questionnaire of sexual function. The data were analyzed by SPSS 21 using the Mann-Whitney test.

Conclusion: The results of this study with the aforementioned condition showed the lack of significant difference in the couple’s sexual function between premarital counseling and the approach based on acceptance and commitment. So, it seems that performing a research with more samples and a target group having 1-5 marital experience would be necessary.

Results: The results showed no significant difference between the effect of premarital counseling acceptance and commitment therapy – based approach on the couples’ sexual fanction in comparison with a premarital conventional approach(p>0.02).

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Background: The aim of this study was to compare the efficacy of ondansetron, Midazolam and metoclopramide with placebo in preventing PONV following strabismus surgery.

Material and Methods: 160 patients were allocated with simple randomization in 4 groups of 40: group ON received Ondansetrone 0.05mg/kg, MT group received Metoclopramide 0.15mg/kg, MD group received Midazolam 0.03mg/kg intravenously and group CT received the solution of NaCl 0.9% as placebo infused with the same volume and the same manner 30 minutes before the end of surgery. The patients were evaluated for nausea, vomiting, need and  dosage of anti-emetic drugs, time of liquid and solid diet tolerance, drug complications and satisfaction score for the initial 24 hours after anesthesia.

Results:  The frequency of nausea (p-value = 0.001< 0.05) and vomiting (p-value=0.084>0.05) was lower in ON group and both of these complications were lower in MD group compared with MT and CT group. Use of rescue antiemetic was higher in MT and CT group (p-value = 0.001 < 0.05). Patient satisfaction was higher in ON group compared with other 3 groups (p-value=0.001<0.05).

Conclusion:   Prophylactic use of Ondansetron is more effective with fewer side effects than Metoclopramide and Midazolam in the prevention of PONV following strabismus surgery. Furthermore, metoclopramide was less effective and was associated with more adverse effects.

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Abstract

Background: The aim of this study is to evaluate the impact of preemptive adding topical Ketorolac to Tetracaine drop on pain intensity and hemodynamic parameters during and after cataract surgery.

Materials and Methods: Eighty patients scheduled for elective cataract surgery under sedation and topical anesthesia, were randomly allocated to two equal groups: group T received Tetracaine 0.5%, and group TK received Tetracaine with ketorolac eye drops. One drop of each ophthalmic drug was applied every 10 minutes from 30 minutes before surgery. Pain intensity and hemodynamic parameters were assessed just before starting the operation and 5, 10, 15and 20 minutes during the operation, and then 0, 5, 10, 15 and 20 minutes after arrival of the patient to the recovery room.

Results: Mean pain intensity was significantly lower in TK group (1 ± 0.128) compared with T group (2 ± 1.54) during the surgery (p = 0.003), but there was no significant difference between the two groups in this regard during the recovery time (p =0.157). The number of patients requiring additional analgesic was not significantly different between the groups. There was no significant difference between the two groups regarding hemodynamic parameters except at 20th minutes and 15^th and 20^th minutes (heart rate and respiratory rate) after arrival to the recovery room.

Conclusion: Preemptive adding topical Ketorolac to Tetracaine drop is more effective than Tetracaine alone to reduce pain during cataract surgery.

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Background and Aim: Exercise aerobic is associated with increased creatine kinase and blood lactate immediately after exercise, leading to increased muscle damage and undesirable changes in many cellular markers including serum creatine kinase. In such situations, consuming nutrients and supplements such as coenzyme Q10 may prevent metabolic stress damage by increasing buffering power. However, comprehensive studies have not been performed on the effects of this nutrient on the index of muscle injury and fatigue caused by exercise.
Methods & Materials: For this purpose, 20 inactive volunteer men were randomly divided into two groups of 10-person Coenzyme Q10 supplement (2.5 mg/kg body weight) and quasi-drug (2.5 mg/kg body weight Dextrose). All subjects participated in the Bruce test exercise contract after 14 days of supplementation. Blood sampling was performed in four stages including baseline, after supplementation, immediately after exercise and two hours after exercise. Creatine kinase, lactate and cortisol indices of both groups were measured during these four stages. Data were analyzed by means of standard deviation and repeated measures ANOVA, Bonferroni post hoc and Independent T-test using SPSS V. 17 at the significant level of 0.05.
Ethical Considerations: This article has been approved by the ethics committee of Tabriz School of Medical Sciences with the ethics code IRCT 201203104663N8.
Results: The results showed that 14 days of Coenzyme Q10 supplementation had a significant effect on cortisol level (P<0.05). In addition, one session of exhausting aerobic activity increased creatinine kinase and lactate (P<0.05). On the other hand, creatinine kinase did not differ significantly after exercise (P>0.05). 
Conclusion: According to the results of the present study, 14-day supplementation of Coenzyme Q10 may reduce the cellular damage induced by exhaustive aerobic activity in inactive men and prevent an increase in blood lactate levels.

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Introduction: The present study was conducted to investigate the effectiveness of acceptance and commitment-based therapy on the lifestyle of improving the health and emotional distress of women undergoing infertility treatment with the in vitro fertilization (IVF) method.
Methods: The method of this study was semi-experimental with a pre-test-post-test design with a control group and a follow-up stage. The statistical population of the study included women undergoing infertility treatment with the IVF method referring to the infertility center of Imam Khomeini Hospital in Tehran in the first six months of 2012. In this research, 27 women undergoing infertility treatment with IVF method were selected by voluntary sampling method and replaced by random method in test and control groups. The experimental group underwent acceptance and commitment therapy (10 sessions) for two and a half months. A health-promoting lifestyle questionnaire (HPLP) and an emotional distress questionnaire (Lavibond and Lavibond, 1995) were used as research tools. The data were analyzed using a mixed analysis of variance and Bonferroni post hoc test.
Results: It showed that the treatment based on acceptance and commitment to the lifestyle level improves health (Eta = 0.56, F = 19.74) and has a significant effect on the dimensions of emotional disorders such as depression (P < 0.0001, Eta = 0.58, F = 0.58). F = 34), anxiety (P > 0001; Eta = 0.59; F = 35.69), and stress (P > 0.0001; Eta = 0.61; F = 40.12) of women undergoing infertility treatment with the IVF, and has been able to lead to increase a healthy lifestyle, reduce depression, anxiety, and stress in these individuals.
Conclusions: Acceptance and commitment therapy, utilizing six psychological acceptance processes, cognitive breakdown, self under context, interaction with the present, specified values, and committed behavior, can be used as an effective treatment to reduce emotional distress in women undergoing IVF infertility treatment.