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Background: APACHE IV scoring system is one of the most useful scoring systems for evaluating the quality of health care services in ICU. The aim of this study was to evaluate the quality of health care services in ICU wards of Valiasr and Amiralmomenin Hospitals of Arak. Materials and Methods: This cross-sectional study was conducted on 100 patients admitted to ICU wards in Valiasr and Amiralmomenin Hospitals of Arak. First, the predicted mortality and length of stay (LOS) in ICU were calculated by APACHE IV scoring system. Then the real mortality and the real length of stay in ICU were recorded. Data were analyzed by SPSS software version 11.5 and t-test. Results: Real mortality in men and women were 57.2% and 61.9%, respectively. The real length of stay in men and women were 11.58 and 11.62 days, respectively. Predicted mortality calculated by APACHE IV in men was 23.72% while it was 24.1% in women. Predicted LOS by APACHE IV in men was 15.02 days while it was 16.64 days in women. There was a significant difference between real mortality and predicted mortality (P = 0.001). Conclusion: The findings of this study indicate that the quality of health care services in ICU wards of Valiasr and Amiralmomenin Hospitals of Arak are far from international standards.

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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: 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: Cerebral venous sinus thrombosis is a rare form of brain stroke caused by thrombosis in venous sinuses of Dura. This study reports on a patient with venous sinus thrombosis and brucellosis who presented with uncontrolled seizure. Case: A 33-year-old woman with past history of controlled complex partial seizure who presented with headache, asthenia, and uncontrolled seizure for one month is described in this study. She was febrile and in brain CT scan hemorrhagic focus in left posterioparietal and temporal lobe was reported. MRI and MRV proved venous sinus thrombosis in left transverse sinus. In laboratory assessment, brucellosis was confirmed as well. The patient treated with anticoagulant, anti-brucellosis, and antiepileptic agents and discharged in good condition with medication orders. Conclusion: Clinical suspicion and accurate evaluation is the most important clue in the diagnosis and treatment of brucellosis and venous sinus thrombosis, especially in uncontrolled seizure in patients who had previously been under control.

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Background: Immune thrombocytopenic purpurais an acquired disorder. Conventional treatment of immune thrombocytopenic purpuraincludes prednisolone (1mg/kg/day). Customarily, steroidsareadministered for about 3-6 weeks however,steroids have several side effects. The aim of this study was to compare theefficacy of two and three-week prednisolone therapy in patients with immune thrombocytopenic purpura Materials and Methods: In this randomized clinical trial, 66 patients with confirmed immune thrombocytopenic purpurawho had referred to KhansariHospital, Arak, were randomly selected and administered prednisolone (1mg/kg/day) for two and three weeks alternatively. Patients’ platelet count and complications associated with the treatment (diabetes and hypertension) were compared. Results: At the end of the treatment course, there was not a significant difference in mean platelet count between the two groups (p=0.748). Side effects in two and three-week protocols were 15.2% and 18.2%, respectively however, distribution of the complications (side effect) in the two groups was equal (p=0.9). Conclusion: Considering the absence of significant differencesin mean platelet count between the two groups at the end of the two treatment protocols and the higherpercentageof side effects in the patients that had received the three-week prednisolone therapy protocol, it seems that the two-week course of immune thrombocytopenic purpuratreatment is as effective as the three-week protocol.

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Background: Multiple sclerosis is a chronic disease of the central nervous system which leads to myelin destruction. The aim of this study was to examine the effect of aerobic training on functional capacity and percent body fat in women with moderate multiple sclerosis.

Materials and Methods: In this clinical trial, 15 women with multiple sclerosis (aged 33.68±8.22 years) with EDSS<4 were randomly divided into experimental (n=8) and control (n=7) groups. An aerobic program prolonged for 8 weeks, 3 days/week, 20-40 minutes/day, with 60-80% of HRmax was run in the experimental group. Some functional capacities, such as speed running, walking endurance, balance, and VO2 Max, as well as BF% were measured before and after the training program in both groups.

Results: The results showed that aerobic training led to significant increases in walking endurance, walking speed, balance, and VO2max (p<0.001). These indices, however, decreased significantly in the control group (p<0.05). Additionally, after the training program, percent body fat decreased significantly in the experimental group (p=0.005), but it increased significantly in control group (p=0.002).

Conclusion: Considering the findings of this study, it can be stated that aerobic training can improve functional capacity and decrease percent body fat in multiple sclerosis patients

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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: Wolfram syndrome is a rare neurodegenerative autosomal recessive disorder. That occurs in association with diabetes mellitus, diabetes insipidus, and optic nerve atrophy, hearing loss, urinary tract infection and nervous complication.

Case: The present report belong to a 24 years old girl who was effected by diabetes mellitus in 10 years old & has been effected by Diabetes insipidus, recurrent UTI, hearing loss and other type of disorders in 20 years old.

Conclusion: Strict control of blood glucose and regular fundoscopy, for early detection of optic atrophy are important. Step in management of this syndrome and quality of life is improved with hearing and vision aid tools.

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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: There are few studies related to effects of exercise training, including concurrent training, on hormonal changes in children. Hence, the aim of this study was to Compare theeffects of 6 weeks of resistance training and concurrent resistance and endurance training on aerobic power (VO2peak) and resting levels of growth hormone and cortisol in healthy children.

Materials and Methods: The subjects ofthis quasi-experimental study were 35 healthy boys between 9-11 years old, which were randomly divided into three groups of concurrent training (n=12), resistance training (n=11), control (n=12). Experimental groups were trained during 6 weeks 3 times a week.Control group were performed only their routine activities. VO2peak test was taken 48 hours before and after implementation of 6-weeks protocols and samples were selected from all subjects.Measurement of resting levels of GH and cortical was performed with ELISA method. For data analysis, one way ANOVA and paired t-test were used.

Results: The results showed that VO2peak and resting levels of GH increased significantly in concurrenttraining group (p=0.001, p=0.003, respectively). Resting level of cortisol in concurrent group was significantly lower than the other groups (p<0.05) and it was reducedsignificantlyin concurrent training and resistance training groups (p=0.001, p=0.036).

Conclusion: It seems a concurrent training period has greater benefits on VO2peak and resting levels of GH and cortical in children in comparison with resistance training.

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Background: Rheumatoid arthritis is the most common inflammatory arthritis. Keratoconjunctivitis sicca, scleritis, and episcleritis are ocular complications of this disease. The aim of this study is to evaluate Sjogren’s syndrome in subjects with rheumatoid arthritis.

Materials and Methods: In this cross-sectional study, ninety patients diagnosed as rheumatoid arthritis that followed up in rheumatology clinic of Rasool Akram hospital for six months and no definite cause was found for their dry eye, enrolled in the study. Rheumatoid arthritis activity was evaluated by DAS28 index and the severity of dry eye was assessed by Japanese dry eye diagnostic criteria.

Results: Mean activity of disease according to DAS28 was 2.9±1.56 and 88.9% of patients had dry eye based on Japanese dry eye diagnostic criteria. Twelve patients (13.3%) had secondary Sjogren's syndrome. SSA antibody was positive in 13.3% patients and 10% patients had positive SSB antibody. There was significant correlation between rheumatoid arthritis activity based on DAS28 and severity of dry eye according to Japanese dry eye diagnostic criteria in the both Sjogren (p=0.045) and non Sjogren groups (p=0.001).

Conclusion: We found significant correlation between rheumatoid arthritis activity and dry eye in the both sjogren and non-Sjogren groups. Most of rheumatoid arthritis subjects do not have Sjogren’s syndrome but dry eye is common even in rheumatoid arthritis patients without Sjogren's syndrome.

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Background: Despite control, prevention and the availability of drugs to cure tuberculosis, TB remains an important cause of death from an infectious agent in Iran. Pulmonary tuberculosis is more than 80% of tuberculosis cases. Chest x-ray is sensitive, cheap and accessible instrument for the diagnosis of tuberculosis. The aim of this study was to determine the radiological changes in patients with pulmonary tuberculosis.

Materials and Methods: In this cross-sectional study, after consideration of inclusion and exclusion criteria, finally 477 radiographic patients referred to rural and urban clinics in recent decade were enrolled. The affected lobe or lobes of the left or right lung were recorded. The types of involvement were categorized based on patchy consolidation, cavitation, fibrosis, bronchiectasis, gohn lesion, bronchogenic spread and bronchopneumonia. Pearson correlation coefficient was used to measure the strength of association between continuous variables. For analysis of qualitative parameters, we use from Chi-square test. Data analysis was done in SPSS18 and p value below than 0.05 was significant.

Results: Out of 477 patients, mean age was 48.24±22 years old, male including 33.3%, Iranian and urban cases were 44% and 91.3% respectively. The most frequent involved site was the left upper lobe followed by the right upper lobe. The most frequent radiographic finding was patchy consolidation and then bronchogenic spread and pneumonic consolidation respectively. There was significant correlation between lung cavities in patients with nationality.

Conclusion: This study could  help to early diagnosis and treatment of suspect patients to pulmonary tuberculosis.

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Background: Phacoemulsification is a modern cataract surgery that developed surgery from large incisions into smaller incision size and lead to faster wound heal and earlier visual rehabilitation. The purpose of this study was to compare the outcomes and complications of 3.2 and 2.65 mm main Incisions in phacoemulsification .

Materials and Methods: In this clinical study in Amir Kabir Hospital of Arak, 78 patients with senile cataract were divided into two groups. Half of them experienced 3.2 mm main incision (first group) and the others were under main incision with 2.65 mm (group 2). Immediately after operation if patients had a wound leak, the standard stromal hydration was used and a suture was placed. A day after operation, the patients were examined in the light of iris prolapse, if it existed, then a suture would be palced.

Results: The occurrence of anterior chamber wound leak was 7.7% and 2.6% in group 1 and group 2, respectively. Stromal hydration was needed 5.1% and 3.2% in group 1 and group 2 respectively. In fact, suture was needed 2.6% and 0.0% in group 1 and group 2, respectively. There was no iris prolapse in both groups.

Conclusion: There was no statistically significant difference between two groups from the point of view of wound leak and the need for suture and the rate of iris prolapse (p>0.05). Also, in low or intermediate nuclear density grade, the smaller and the more permanent incision with 2.65 mm is preferred.

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Background: Cervical cancer is the third most common genital malignancy in women. In majority of developing countries the prevalence of this malignancy is high. The aim of this study was to determine the prevalence of cervical cancer among married wemon in Arak.

Materials and Methods: This cross-sectional and analytical study was carried out on 1000 married women. Demographic variables involving age, literacy, history of hysterectomy, nutrition statute, marriage age, history of abortion, smoking habits, etc were filled by questioners. Then Pap smear was done in all subjects and specimens were sent to the pathobiology laboratory. The data were analyzed with SPSS statistical software.

Results: The mean age of studied subjects was 39.38±10.1, the most freqrency of marriage once was 459(45%), the mean age of marriage was17.9±10.3, the mean age of first sexual intercourse was 15.1 (9.2%), the most frequency of the numbers of peregnancy was 2.6±2.1, and the mean times of abortion once was 153(15.3%). In this study, the prevalence of cervical cancer was 0.004(4 per 1000). There was a significant correlation between age, hysterectomy the time of marriage and painful sextual intercourse and cervical cancer (p<0.005). There was no statistically significant relation between smoking, food diet, pregnancy prevention drugs and the other variables of the study of cervical cancer (p>0.005).

 Conclusion: With attention to high prevalence of cervical cancer, promoting education and knowledge about the importance and necessity of pap smear and risk factors of cervical cancer and encouraging marriaged women to take part in screening programs is necessary.

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Background: Upper gastrointestinal bleeding is a common medical emergency condition which can be very costly with potential risks. Prompt evaluation of the patients’ status and determination of the risks involved are of utmost significance. Rockall score is one of the Methods determining the risk of bleeding. The aim of the present study was to determine sensitivity, specificity and negative and positive predictive values of Rockall scoring system during a 3-month follow-up period in patients with upper gestronintestinal bleeding.

Materials and Methods: 340 hospitalized patients with acute upper gastrointestinal bleeding in Imam Reza hospital were studied from December 2013 to September 2014. The full and clinical Rockall scores, sensitivity, specificity and negative and positive predictive values were specified for all the subjects who were followed for 3 months in relation to complications and mortality.

Results: Of all patients, 204 were males and 136 were females who 15.6% of the subjects had a clinical Rockall score under 3, with 84.4% having a score over 3. In relation to endoscopic Rockall score, 15.6%, 66.8% and 17.6% of the subjects had a score under 3, between 3-8 and over 8, respectively. During the 3-month follow-up period, in the low-risk group, 92.5% did not exhibit hemorrhage again, 3.8% had one recurrent episode of hemorrhage, 1.9% exhibited 2 hemorrhage episodes, with 1.9% having 3 hemorrhage episodes. In the moderate-risk group, 90.9% experienced no recurrence and 9.1% exhibited 1 case of recurrent hemorrhage (p=0.4). There was no mortality in the low-risk group. In the moderate-risk and high-risk groups, the mortality rates were 8.07% and 22.7%, respectively (p<0.001). The sensitivity and specificity of the test were calculated at 11.1% and 81.1%, respectively. The positive and negative predictive values were 5% and 91.4%, respectively.

Conclusion: With due attention to the specificity of 81.8% and negative predictive value of 91.4% for the Rockall score, it might be guaranteed the patient will not suffer from the complications resulting from recurrence of hemorrhage. Given the low sensitivity of the test, the test is not appropriate to rule out disease.

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Background: studies in adults have shown that external focus of attention is better than internal focus in motor learning. So, the aim of this study is to evaluate the effects of focus of attention- self talk on balance of women with multiple sclerosis.

Materials and Methods: In this semi- experimental study, statistical population included women with MS referred to MS Society of Arak. Whereas balance disorder in patients was diagnosed by neurologyist, they were invited to the study. Patients were accidentally divided into 3 groups each of 15 concluding control, self tak-external focus of attention and self talk- internal focus of attention groups and were evaluated by Berg balance scale. 42 samples completed executive steps of study. ANOVA and Tukey tests were used to compare balance score between groups with significant level of less than 0.05. All patients practiced balance tasks for 9 days and then they were undergone post test.

Results: Balance was improved in all groups. Although the external- self talk group was better than the two other groups, there was no significant difference between external and internal- self talk groups.

Conclusion: The findings of this study showed the effect of practice on improvement of balance skill and superiority of the experimental groups in comparison with control group. Probably, focus of attention with self talk has effect on balance of women with MS.

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Background: Breast cancer is one of the major causes of cancer-related death and the most common solid malignancy in women worldwide. Chemerin as a new adipokine has an inflammatory activity that initiates inflammation via chemotaxis of immature DCs and macrophages. This study aimed to evaluate the level of chemerin in patients with breast cancer.

Materials and Methods: In this cross-sectional study that was performed as a case-control study, we enrolled 45 patients with breast cancer in Vali-asr hospital from June to December 2015 (age range, 18-60 years) and 40 healthy volunteers as a control group (age range, 22-56 years). The patients with invasive breast were selected before mastectomy. The level of serum chemerin was measured by ELISA kit.

Results: The results showed that the mean serum chemerin level in the breast cancer patients (1536 ±608 ng/L) was significantly lower than the normal individuals (1919±544 ng/L),(p=0.04). There is no correlation between the level of chemerin with body weight, stage of disease, duration of disease and the number of white and red blood cells.

Conclusion: With due attention to the inflammatory role of chemerin, decreasing the serum chemerin level in patients with breast cancer may be related to the consumption of chemerin in the inflammatory responses or immunosuppression by tumor. The low level of chemrerin may be suitable for tumor growth and progression.

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Background: The renin-angiotensin system(RAS) has a major role in development of diabetic nephropathy and blocking of RAS by inhibitors and blocking of angiotesin receptors is standard treatment for preventing kidney disease and proteinuria. It is reported that VIT-D analogues are able to suppress renin exertion and improve proteinuria. The aim of this study is to evaluate the effect of VitD analogue (calitriol) on reducing proteinuria in patients with diabetic nephropathy.

Materials and Methods: In this clinical trial study, 132 eligible patients that had diabetic nephropathy and hadn’t vit D deficiency were selected. The patients were divided into two equal groups. First group received the combination of losartan 25mg twice daily and calcitriol 0.25mg and second group received losartan 25 mg twice daly alone for 3 months. The FBS, lipid profile, ESR-CRP BUN, Cr, HbA1c, Ca, P, and 24 hours urine protein were evaluated in all patients at beginning and end of study and the results were statistcally compared.

Results: The 24-hour urine protein in losartan and calitriol group was improved compared to losartan. This difference was statistically significant (p=0.003). As well as, in kidney function (BUN, Cr) in the losartan and calcitriol group compared to losartan alone was significantly improved(p<0.05).

Conclusion: Combination of calcitriol with angiotesin receptor blockers(ARBs) is more effective than ARBs alone in improvement of proteinuria and real function.

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