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Introduction: Basal cell carcinoma is the most common malignancy in humans. A number of treatment modalities are available. We performed this study in order to determine the efficacy of Mohs micrographic surgery in treatment of basal cell carcinoma.
Materials and Methods: This retrospective descriptive study was performed on 194 basal cell carcinoma (in 175 patients) were treated in Isfahan Al-Zahra Hospital from september 1999 to March 2003 with Mohs micrographic surgery. Data were obtained from patient's files and were analized by SPSS software.
Results: Of the 175 patients (with 194 basal cell carcinomas), 110 (62.85%) paticnls were male and 65 patients (37.14%) were females. The mean age of patients was 58±12.38 years. The majority of tumors were located on face and scalp. 180 of tumors were primary and 14 were recurrences. 17% of tumors were larger than 2cm. Recurrences of the tumor occured in 3 patients. The cosmetic results were excellent and good in 81%. The incidence of recurrnce rate was 0.9%.
Conclusion: Kecurrence rate is low when basal cell carcinomas treated with micrographic surgery so this treatment modality (when indicated) is also strongly recommended in Iran for the treatment of basal cell carcinoma.

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Introduction: Radius end fracture is one of the most common fractures of the upper limb, the treatment of which is controversial, and improper treatment can have significant side effects. In this study, we intend to examine the results of treatment with an external fixative method.
method: It was easy to study without control and sampling. The study was performed on 30 fractures (26 patients) for one year, based on radiographs of the fracture site of type 4 universal 5. Surgery with standard techniques was performed under general or regional anesthesia, and patients were followed up for up to one year after surgery and examined for shortness of breath, joint surface angle, range of motion, and pain.
Results: Twenty-four men and two women with a mean age of 5.28 years were examined. In all patients, clinical and radiographic effusion occurred. There were two cases of mild infection at the site of the pin, which were treated with medication. In one case, there was a slight sensation in the sensory branch of the radial nerve, which disappeared after a while, and in no case was there a tendon lesion. The mean deviation to the palm was 6.6.5.5 and the ulnar deviation was 4.5 to 12.5.
There were 4 cases of pain during strenuous activity, 2 cases of mild movement restriction and one case of severe movement restriction.
Conclusion: Compared to other studies, the results of this study are much better in many cases and it is recommended to use this treatment in the treatment of unstable fractures of the lower end of the radius and especially if it develops into the radiocarpal joint.

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Introduction: Cystic hygroma is a disorder in lymphatic vessel formation that involves the adjacent organs and can affect them due to its fast growing nature . The main treatment for cystic hygroma is surgical intervention that can have many complications after surgery. Treatments other than surgical interventions is the use of sclerosing agents. The goal of this study is to analyze the effect of Beliomycin in treating cystic hygroma . Materials and Methods: This quasi experimental study was carried out clinically at st-al Zahra and Kashanie hospitals of Isfahan from 1372 to 1383. A checklist including age, sex, cyst location, cystic hygroma volume before and after Beliomycin injection and/or surgery, was completed for each patient. Data was analyzed by T and paired T-Tests. p<0.05 was considered meaningful. Results:The study was carried out on 72 patients. 24 patients were treated with Beliomycin and 48 patient by surgery. Patients age was below 1 month up to 18 years old . Cystic hygroma was mainly located at neck region(46.8%). The average size of cystic hygroma was 103.9±29.66cm3 before Beliomycin injection and 34.91 16.19cm3 after that (p=0.004). and 43.511±7.81cm3 before surgery and 1.39±1.39 cm3 after that(p=0.006). The rate of recurrence of lymphingoma in the surgery treated group was 25.1% and in the group treated with Beliomycin was 29.2% with no significant difference. Conclusion: Regarding the considerable decrease in cyst volume after Beliomycin injection and it,s low complication compared to surgery, this method can be used as a primary treatment or supplementary to surgery.

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Introduction: Flexor tendon entrapment of the digits (FTED) is a disorder characterized by snapping or locking of the thumb or fingers (with or without pain) and called trigger finger. Corticosteroid injections are one of the most commonly used treatments for chronic tendon disorders. Despite their popularity, the systematic evidence for their benefits are largely lacking. This study tries to determine the efficacy of local corticosteroid injection in treatment of trigger finger. Materials and Methods: This is a clinical trial research. Variables including local tenderness, trigerring stage, pain during isometric flexion and passive stretching of the tendon (based on VAS) were evaluated before local injection of corticosteroid and then 3 weeks, 3 months and 6 months after the injection. Data was collected by special forms and analyzed using Chi square and ANOVA Tests. Results: The difference between persence of A1 pulley tenderness in 4 examinations was significant (p<0.0001). The difference between pain induced by isometric flexion and pain induced by stretching the tendon passively in extension was also significant (both p<0.0001). The difference between frequency distribution of triggering was significant (p<0.0001). Patients satisfaction was 90% . Conclusion: The rate of success in local corticosteroid injection was 90% (only with one injection). The high rate of success and low side effects, make this method a suitable treatment for trigger finger.

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Introduction: Clubfoot is one of the most common foot deformities in children. The initial treatment of clubfoot is nonsurgical. The succes rate of this treatment is 5-80%. If clubfoot does not respond to this treatment, surgery is indicated. Surgical treatment of clubfoot has several complications. The preferred method of surgical release in textbooks is a modified Mc Kay procedure with Cincinnati incision but it may have various complications such necrosis, excessive scar, infection, dehiscence and recurrence. The purpose of this article is to investigate surgical treatment of clubfoot with two incision procedure instead of Cincinnati incision. Materials and Methods: In this descriptive study 50 children (81 feet) with clubfoot disease who did not respond to nonsurgical treatment, since 1999 until 2002, in Al-Zahra hospital were selected and underwent soft tissue release procedure by posteromedial and lateral incisions. After operation they were followed for at least two years. Every six months patients were assessed for early postoperative complications, clinical and radiologic recurrence. Data was presented using descriptive statistics. Results: 74% of patients were male. Their mean age was 3.40.69. There was positive family history in 14% of patients. Clinical recurrence was seen in 6 patients, (9 feet) (5 male, one female) that all had bilateral involvement. The most common type of recurrence was metatarsus adductus. There was no skin necrosis or deep wound infection after surgery but 2 cases of superficial infection was seen which were treated by drugs. Conclusion: Regarding the excellent results of this procedure and obtained correction and the least skin complications in comparison to textbooks we suggest the two incision procedure instead of Cincinnati incision in treatment of most club foots

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Introduction: Delivery of immediate medical interventions appropriate to the severity of clinical status of patients is a main public expectation of emergency departments. Waiting time and length of stay are the key measures to asses the quality of care in emergency departments. This study is done to investigate the waiting time and length of stay of attendants to emergency department of Vali-e-Asr Hospital, Arak-Iran. Materials and Methods: This analytical cross-sectional research was conducted in a general emergency department of a teaching hospital in Arak to asses the waiting time and length of stay of patients. In the first stage of the study all attendants during a 6 weeks period were classified regarding to the severity of their clinical status by an educated nurse and a general practitioner using a three category scale (guideline) presented by ministry of Health and Medical Education (2001). Also waiting time for a general practitioner visit was measured and documented by the resident general practitioner. In the second stage, a sample of 100 documents of patients in group 1 and 2 admitted for specialist visit were assessed for the waiting time and length of stay in emergency department. Mean of waiting time according to patients clinical status and the specialty of the first physician were analyzed by t-test and ANOVA (p =0.05). Results: During a 6 weeks period, of 1963 patients, 179(9.1%) were categorized as emergent (category 1), 391(19.9%) urgent (category 2) and 1393 (71%) non urgent. The mean waiting time for general practitioner visit was 5 minutes. The median and mean of waiting time for specialist visit in group 1 and 2 of patients were 225 and 262±156, 220 and 227±153 minutes, respectively. The median and mean of length of stay was 1 and 2 days, respectively. No differences were found between waiting time of various specialties visit in patients of categories 1 and 2. Conclusion: Regarding the long waiting time for specialist visit, using triage in emergency departments is necessary. This needs planning and organization for the presence of specialists in the hospital, over the time. Also regarding the large number of nonurgent patients, 24 hours presence of a general practitioner is necessary.

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

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Background: Bacterial vaginosis is one of the most common infections in women at reproductive age. Although metronidazole is recommended as the first-line treatment, it has various side effects which make it difficult for patients to continue the treatment. Thus, the need is felt for finding a medication with fewer side effects. The aim of this study is to compare the effects of micosin vaginal cream (made of garlic) and metronidazole vaginal gel on treatment of patients with bacterial vaginosis. Materials and Methods: This study was a clinical trial which was conducted on 100 married women, aged 18-44, whose infection with bacterial vaginosis was diagnosed through clinical Amsel criteria. The participants were randomly divided into two groups of 50 persons each: Micosin vaginal cream and metronidazole vaginal gel. Patients identified with tricamona or candidiadis infections were excluded from the study. Treatment period in each group lasted for seven days. Clinical Amsel criteria and patient complaints were again checked 2 to 7 days after completion of the treatment period, and the side-effects were registered. Results: Following the treatment with micosin vaginal cream and metronidazole vaginal gel, patient complaints and clinical Amsel criteria showed a significant decrease (p<0.05), in a way that clinical recovery rates in micosin and metronidazole groups were 80% and 70%, respectively. Conclusion: Micosin vaginal cream seems to be an appropriate alternative for metronidazole vaginal gel in treatment of bacterial vaginosis.

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Background: Quran views sleep as a divine sign with deep meaning and interpretation. The aim of this study was to investigate the content of dreams from the perspective of Quran and psychology, as an appropriate method for understanding human characteristics and presenting a proper treatment approach. Materials and Methods: The present study is a descriptive, content analysis one. First a collection of psychology and interpretation books on this issue were considered. Then 75 students at Arak University of Medical Sciences were asked to report their dreams on daily or weekly basis which totaled 5688 dreams over a 6.5 month period. The dreams were analyzed using content analysis method and descriptive statistics, including the number of dreams, age, mean, and frequency of the reported parameters. Results: Noticing the nature of dreams, the interpretation of their content and concepts is of significance to the understanding of human traits and provision of treatment methods. The content of the reported dreams were, respectively, indicative of a high percentage of ethnic (93.33%), university and professors (89.33%), family (88%), religious beliefs (86.66%), friends (86%), nightmares (66.66%) returning to the past (61.33%), lucid dreaming (42.7%), and neurosis (41.33%). Conclusion: In the view of commentators on divine verses and psychologists, the elements present in the content of dreams can be utilized in obtaining a better understanding of the unconscious stream of human mind, knowing more about human beings, and treating mental disorders. The difference between these two perspectives, religious and psychological, is in dreams known as "true dreams" which are emphasized in Quran and Islamic sources, while psychology has failed to recognize them.

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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: Menopause being the most critical period, the unfavorable changes in anthropometric and metabolic parameters associated with CVD risk. Metabolic syndrome is the key factor for cardiovascular disease and has become major problem in many countries. With the high prevalence of metabolic syndrome, especially in women after menopause, this study was performed to investigate the relationship between the menopausal age and metabolic syndrome in non-obese postmenopausal women.

Materials and Methods: This cross sectional study on 140 healthy non-obese postmenopausal women who had a BMI less than30 Kg/m2, at 2009 in Ahvaz the data were contained demographic information, menopausal age, BMI, values of HDL-C, FBS, TG serum after 12 houres fasting, blood pressure and waist circumference. We used the Pearson correlation and multiple regression analysis by SPSS15 software.

Results: Menopausal age with FBS (p=0.04) was negatively significant. But there was not any correlation between menopausal age with other Components of metabolic syndrome. [triglycerides (p=0.28), systolic blood pressure (p=0.80) diastolic blood pressure (p=0.48), waist circumference (p=0.08), HDL-C(p=0.65)].

Conclusion: Late menopause has favourable effect on fasting glucose.

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Background: According to the toxoplasmic retinochoroiditis leading to loss of central vision, corneal opacity, tearing, photophobia, and is, therefore early treatment is very important. This study aimed to evaluate the efficacy of intravitreal injection of toxoplasmic retinochoroditis clindamycin in comparison with conventional therapy (oral drug) was performed.

Materials and Methods: In this clinical trial, target population was all patients with the toxoplasmic retinochoroiditis referred to clinics in ophthalmology Arak city, that stratified randomly into two groups, interventional group “A” was received treatment with intravitreal injection clindamaycin " and control group “B” was received standard oral treatment (Pyrimethamine and sulfadiazine and clindamaycin). Tool for data gathering was questionnaires and medical records of patients in which visual acuity based on the Senllene Chart and retinal thickness with use tomography layers of the retina (OCT). Results of measurement were recorded by specialist retina before and after intervention (weekly and monthly until complete resolution of lesions in retina) during one year. The data entered into the SPSS 16 software and after matching age &sex of patients, was final analysis the using descriptive and inferential tests such as t-test was performed.

Results: Of the 26 patients with toxoplasmic retinochoroditis, 16 (61.5%), urban and number 10 (38.5%) were rural. The average improvement in visual acuity between the two groups in mean time to lesion healing (A) and (B) was different. The visual acuity in before and after treatment (separation of treatment) was significant difference in both groups (p<0.05). Also central macular thickness (in patients with toxoplasmic retinochoroditis) between before and after treatment in each group was different (p= 0.001), but the changes mean central macular thickness (in cases of toxoplasmic retinochoroditis) There was no significant difference between treatments (p=0.452).

Conclusion: Although any two methods of treatment are effective, but intravitreal injection clindamaycin method due to shorter lesion healing time and increase higher visual acuity, is better than the alternative similar way .

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Background: Treatment failure and relapse is a major problem in the treatment and control of brucellosis. The present study directed to determine risk factors for failure of treatment and relapse in patients treated for brucellosis.

Materials and Methods: This study was a descriptive - analytic and prospective study and were conducted in 72 patients with acute brucellosis.Patients were followed up during treatment and for six months after completion of therapy, and patients with treatment failure or relapse were analyzed. All data analyzed using SPSS software and P-value of less than 0.05 was considered significant.

Results: The mean value of age in patients was 40.2 ± 16.5 years. Treatment failures was 6.9% and the relapse at the end of the ninth month was 12.5% that recurrence of symptoms were associated with increased titers of serological tests and 80.6 percent had successful treatment. In this study gender of male (P = 0.026), occupational exposure (P = 0.005), delayed treatment in less than two weeks (P = 0.016), hepatosplenomegaly (P = 0.003), thrombocytopenia (P = 0.023), CRP &ge +2 (P = 0.017) and Wright &ge 1/320 and 2-ME &ge 1.160 at the end of the sixth week of treatment (P = 0.004 and P = 0.010) were risk factors of treatment failure and relapse in brucellosis.

Conclusion: The diagnosis and treatment of relapse and treatment failure in acute brucellosis is not clear, therefore, the prediction of relapse may be useful in preventing recurrence and treatment of patients.

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Background: Vesicoureteral Reflux (VUR) is the most common urologic anomaly in children. In spite of prescribing prophylactic antibiotics in children with VUR, in some cases breakthrough infection (BTI) occurs while receiving prophylactic antibiotics which may cause pyelonephritis that can ultimately lead in renal scarring.

Materials and Methods: In this discreptive-analytic study, 288 children with primary vesicoureteral reflux under Cotrimoxazole(2mg/kg) treatment have been under supervision for duration of at least one year. Based on the collected data, predictive effect of some factors like gender, mean age of VUR diagnosis, VUR grade, unilateral versus bilateral and presence of abnormal renal scar on the breakthrough infection under prophylactic treatment, were examined.

Results: Breakthrough infection while receiving prophylactic antibiotics was observed among 111(38.54%) patients consisting of 88 girls (79.28%) and 23 boys (20.72%). The moderate to high VUR grades (grade III-V), presence of renal scar and female gender were found to be the important risk factors for BTI. However, no statistically significant relationship between mean age of VUR diagnosis and unilateral versus bilateral VUR with BTI was found.

Conclusion: Results of the current study will help improving parents' and physicians' awareness of the risk factors associated with BTI which may potentially lead to renal damage.

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Background: Allergic rhinitis is a common disease which is present in 20% of general population. Major symptoms include sneezing, rhinorrhea, nasal congestion, and nasal pruritus. It seems that tricyclic antidepressants blocking histamine receptors may be used as an effective treatment in allergic rhinitis.

Materials and Methods: In this clinical trial study, 84 patients with allergic rhinitis entered the study and randomly divided into two groups. Patients of 1st group received cetirizine and 2nd group received doxepin for 2 weeks. After 2 weeks patients were evaluated about sneezing, rhinorrhea, nasal congestion, and nasal pruritus.

Results: The results of our study showed that clinical score of patients after 2 weeks was not different in both groups (p=0.261). The only symptom that was affected by the kind of treatment and was significantly different between groups was sneezing (p=0.005).

Conclusion: It seems that there is not much difference in using cetirizine and doxepin in treatment of seasonal allergic rhinitis sympotoms. It is recommended that future studies use TCAs with more potent blocking anti-histamine receptors feature and on more samples.

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  Background: The prevalence of constipation in childhood is 0.7% to 29.6%. Inorganic causes are considered as the most common cause of constipation in children. Polyethylene glycol (PEG) is the most effective and safest laxatives which is usable in children in the long-term. This study was conducted to evaluate and compare the effect of PEG treatment and probiotic bacilluscoagulans and bifidobacterium and probiotic to enhance the growth of probiotics.

  Materials and Methods: In this double blind clinical trial study(interventional study), 120 children aged 2-16 years with chronic functional constipation enrolled the study based on ROME III criteria. The bowels became empty by using liquid paraffin. Then, children were randomly divided into three groups of polyethylene glycol+placebo and Probiotics+placebo and polyethylene glycol+probiotics recipients. After 6 weeks of treatment, treatment success rates between the three groups were compared before and after the study Data analyzed by SPSS 20 software.

  Results: The results of the study conducted on the three groups for treatment of constipation showed that the effect of polyethylene glycol and probiotic on treatment was considerable before and after treatment but the levels of effect was similar in the comparison of groups. The simultaneous use of two drugs was more effective than a single drug.

Conclusion: Overall, the results of our study showed that concurrent use of polyethylene glycol and probiotics is much more effective in the treatment of constipation.

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Background: The growth of population, improvement of quality of life and the development of industries have led to increase in the rate of urban and industrial waste. As the leachate of the waste has a lot of pollution, influences harmfully human health and the environment. Researches have shown that the advanced oxidation processes (AOPs) such as Fenton and Fenton-related processes can reduce chemical oxygen demand (COD) of the leachate effectively.

Materials and Methods: In this paper, the rate of decrease in the total suspended solids (TSS) of leachate from a composting facility in Isfahan was studied using electrochemical, Fenton and electro-Fenton processes. These processes were conducted at reaction times 0, 20, 40, and 60 minutes, with the currents of 0.5, 1 and 1.5A and hydrogen peroxide dosages 1000, 2000, and 3000 mg/L.

Results: In the three mentioned processes, the most TSS removal was observed at the first 40 minute of the reactions. Among the studied processes, the electro-Fenton removed up to 92.4% of the TSS and was recognized as the most effective method. Furthermore, electrochemical and Fenton removed 41.7% and 60.3% of the TSS, respectively.

Conclusion: Therefore, decreasing the TSS of leachate could change its qualities and reduce the leachate pollution and the adverse environmental effects.

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Background: The aim of this study was to test  the proposed model  for the impact of self-efficacy beliefs on parent’s anxiety and marital adjustment with mediating role of cognitive emotion regulation strategies among parents of chronically ill children of ahwaz city.

Materials and Methods: The statistical universe was all the parents of chronically ill children who was selected by Convenience sampling method.The research tools are included the self-efficacy questionnaire (SES), anxiety questionnaire (STAI), Spanier marital adjustment questionnaire  and Garnesfki cognitive emotion regulation strategies questionnaire.Amos 18 program software was applied for structural equation modeling (SEM).The indirect relationship was tested with bootstrap Amos 18 program software.

Results: The results revealed that the tested model had good fit indices.

Conclusion: Results revealed that self-efficacy beliefs directly influenced on parent's anxiety, marital adjustment, and adaptive and nonadaptive cognitive emotion regulation strategies. Also, adaptive cognitive emotion regulation strategies have a direct relation with parent's anxiety and marital adjustment. In addition, there was a direct relation between nonadaptive cognitive emotion regulation strategies and marital adjustment. Alternatively, self-efficacy beliefs directly influenced on anxiety and marital adjustment with mediating role of adaptive cognitive emotion tegulation strategies and indirectly influenced on adjustment with mediating role of nonadaptive cognitive emotion regulation strategies.

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Background: The prediction models for infertility treatment success have presented since 25 years ago. There are scientific principles for designing and applying the prediction models that is also used to predict the success rate of infertility treatment. The purpose of this study is to provide basic principles for designing the model to predic infertility treatment success.

Materials and Methods: In this paper, the principles for developing predictive models are explained and then the design of such models in infertility treatments is described in more details by explaining one sample.

Results: The important principles for models that firstly are described are: identifying and defining the purpose, expected function of model, input data that will be used to develop a model: type of intervention or diagnostic procedures that can lead to changes in the samples and output definition or expected result of model function. Further, characteristics of predictive factors in final model, drawing the information flowchart, internal and external validation and attention to the analysis programme of results are the important subjects that have been described.

Conclusion: If predictive models are used properly, can help treatment team and patients to achive best treatment in ART.

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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).