Internal Medicine And Medical Investigation Journal

Introduction: Nitrofurans and nitroimidazoles are broad-spectrum antimicrobial agents, which affect the microbial DNA. The aim of the present study was to evaluate the new derivatives of these two groups of antimicrobials against certain Gram-positive and Gram-negative bacterial strains. Materials and Methods: Seven new derivatives of nitrofurans and nitroimidazoles were synthesized, and 6.4 mg of each derivative was dissolved in dimethyl sulfoxide. Then, 8 serial dilutions (0.5, 1, 2, 4, 8, 16, 32, and 64 μg/ml) of each derivative was prepared using Muller-Hinton broth, and the minimum inhibitory concentration for each derivative was measured and compared to ciprofloxacin (standard). Results: All the derivatives had no antibacterial effects against Gram-negative bacteria (minimum inhibitory concentration > 64 μg/ml); only 2-(5-nitro-2-furyl)-5-(n-pentylsulfunyl)-1,3,4-thiadiazole exhibited mild antibacterial effects against Klebsiella pneumonia (minimum inhibitory concentration of 16-32 μg/ml). The antibacterial effects of the derivatives against Gram-positive bacteria also showed variations from complete inhibition of the growth of Staphylococcus epidermidis and Bacillus subtilis (minimum inhibitory concentration < 0.5 μg/ml) by 2-(5-nitro-2-furyl)-5-(n-buthylthio)-1,3,4-thiadiazole to no inhibition of S. epidermidis and streptococcus pyogenes. Conclusion: These compounds have weak antibacterial effects; only two derivatives showed antibacterial effects similar to that of the positive control.

Background: Acne vulgaris is a common skin disease that can affect people in any ages. The development of acne have adverse effects on life quality. Psychological disorders increased in these patients and their psycho social activities have been affected. Since few studies have been done regarding illness perception in people with acne in Iran, this study aimed to investigate the association of perception of acne disease and quality of life in central of Iran Methods: we analyzed 200 patients Acne Vulgaris referred to Khatam-Al Anbia in 2013-14 by questionnaire of perception of disease (Brief IPQ) and quality of life (DLQL. the data was analyzed using t-test and Chi-square by SPSS-16 Results: Mean age of patients was 24.3 years and 158 people (79%) were women and 42 people (21 %) were men. Mean quality life score in women was 8.79±5.3 and in men was 8.69±5.18. Most patients had moderate acne and duration of their disease was between 1 to 5 years. 136 people were 18 to 25 years old and 64 persons were higher than 25 years. The mean perception scores in men and women were 51.83 and 53.26 respectively In this study, there was a relation between sex (P=0.03), Acne severity and duration with quality of life score. Conclusion: Women and patients with severe acne and longer duration of symptoms had higher quality life score that had more disorder in life.. There was relation between perception and sex and duration of symptoms.

Introduction: ESR (Erythrocyte Sedimentation Rate) is the sedimentation rate of red blood cells per unit of time that is expressed in millimeters. ESR test is simple and inexpensive and fast and can be somewhat diagnostic manual to confirm the diagnosis, rule out the diagnosis, follow-up course of the disease and so on, so it is of interest to practitioners. Methods: Descriptive and cross-sectional study on 124 patients in all wards of Shahid Sadooghi hospital in the second 6 months of 1393, that had raised ESR of 100 at least one time. All information including gender, age, diagnosis of the presence or absence of fever and indigenous of them cases in the archive hospital patients were taken. Results: 56% female and 44% were male. 16% of patients in the age range 0-19 years, 56% aged 20-64 years and 28% were aged over 64 years. 41% of patients were admitted with fever. 59% were native and 41 % were non-native. Infectious causes (45.9%), malignancy (14.5%), collagen vascular disease (16.9%), internal disease and hematology (16.9%) and other causes (5.6%) were formed cases. Diabetic foot (7%), pneumonia (7%), RA (6%), ESRD (5.6%), metastatic lung cancer (4%), TB (3%) formed the majority of cases. In feverish cases pneumonia (11.5%), diabetic foot (7.6%), tuberculosis (5.7%), pyelonephritis (5.7%) and RA (5.7%) were the most frequent form. Infectious causes of fever (65.3%), collagen vascular (13.4%), malignancies (5.7%) and other causes (15.6%). conclusion: In patients with extremely high sediment in terms of gender segregation is almost the same of hospital commiunity.

Introduction and background: MS as a chronic CNS disease is very prevalent in all around the world. Its epidemiology is different region by region and most of geographical and environmental factors may play a role in its incidence. To analyze demographic characteristics of the disease we designed this study. Methods and Materials: This Survey has been conducted in East-Azerbaijan province, North-West of Iran. Prevalence of the disease has been measured using data of Committee for diagnosis and Treatment of Multiple Sclerosis in 2014. Age, gender and type of the disease also been investigated in this research. Independent T Test, Chi square, Pearson and Fisher exact test used to analyze data. Results: We had 2774 MS patients in 2014. 726 were male (26%) and 2003 were female (73%). Mean age of males was 38±9 and mean age of females was 37.09±9. Mean age in male patients was more than in females significantly (P=0.001). We measured 73.26 prevalence per 100000 populations in East-Azerbaijan. Conclusion: Prevalence of the disease showed significant increase in 5 years compared to previous studies. Because of disease's disabilatating entity more interventional investigations are recommended to perform in preventing disease incidence or improving quality of life of sufferers and increasing their life expectancy.

Background: The most common cause of hyperthyroidism in areas without iodine deficiency is Graves’ disease. There are reports of some hematological alterations in hyperthyroidism. This study was designed to measure the hematologic profile in the patients with Graves’ disease before and after the treatment. Methods: In this cross-sectional study, 100 patients were selected with convenience sampling that diagnosed as autoimmune Graves’ disease in our academic endocrinology clinic during 2014-2015. Inclusion criteria included autoimmune hyperthyroidism in patients who were referred to this center during the study period. Patients who refused to take part in the research, had recent infections disease, malignancies, surgical procedures, severe trauma, received immunosuppressive drugs or corticosteroids, high erythrocyte sedimentation rate (ESR) values during the last six months, and not responded to treatment with methimazole were excluded from the study. The simple sampling technique was used to select the patients. A complete blood count (CBC) was taken before and after treatment. The P-value less than 0.05 was considered as the statistical significance level. All data were analyzed using the Statistical Package for the Social Sciences 16.0 (SPSS Inc., Chicago, IL, USA) software. Results: One hundred patients with a mean age of 38 ± 9.8 years were included. There were no significant changes in the white blood cells (WBC) count, red blood cells (RBC) count, and platelets. Mild anemia (Hb=12.16±1.23) present before treating the hyperthyroidism that was significantly improved after treatment (P= 0.000). Conclusions: Our results showed that the only significant hematologic change in patients with Graves’ disease was mild anemia that improves after treating the underlying thyroid disorder.

Introduction: Air pollution induced by human activities is one of major challenges faced by Iran, as well as the world . The AirQ model was used to evaluate the cardiovascular and respiratory diseases attributable to the exposure to suspended particles of less than 10 µm in Urmia city of West Azerbaijan Province, Iran, in 2015. Materials and Methods: This descriptive-analytic study was conducted in Urmia in 2015. The hourly data of the PM10 (particle matter up to 10 µm) pollutant were extracted as the raw material from the Environmental Health Center. The health effects of suspended particles of less than 10 µm were estimated by statistical analysis using the World Health Organization’s AirQ model. Results: According to the results concentration of PM10 was higher in the cold seasons compared with the warm seasons. The annual average of PM10 concentration was 3.9 times higher than that prescribed as per the standards of clean air in Iran. In addition, the cumulative numbers of cardiovascular and respiratory diseases in the city of Urmia in the median estimate were 287 and 744 cases, respectively. Conclusion: As a consequently, air pollution in the Urmia city has contributed significantly to the rate of hospitalizations and deaths of people in 2015. Therefore, authorities should make appropriate, sustainable, and applicable strategies based on comprehensive research to control the Urmia air pollution crisis.

Background: Pain is a distressing feeling as well as a discomfort which triggers as the result of a special stimulation of nerve endings.This study aimed to investigate the amount of sufficient pain management among patients referring to the emergency department in Besat Hospital in the city of Sanandaj in Iran. Material and Methods: in this descriptive-analytical study, 175 patients with severe pain intensity higher than 3 and definite causes of pain with physical origins admitted to the emergency department were included. Before and after analgesics injection, pain intensity was assessed by a 10-point scoring system. Results: No significant correlation showed between pain intensity in patients, administration of painkillers, and age (P>0.05).There was a statistically significant relationship between pain intensity, gender, and the type of analgesics received (P 0.05). Conclusion: Failure to control pain among patients can lead to physical, mental, psychological, and social health-related problems. Therefore, proper examination of pains can provide suitable interventions in order to control and manage pains among patients and consequently promote their quality of life.

Introduction: Cancer and myocardial infarction are lethal diseases. Their prevalence is increasing worldwide. In both diseases, the level of oxidative stress rises because of tissue damage. The aim of this study was to evaluate the serum levels of heat shock protein 27 and heat shock protein 60 in patients with cancer and myocardial infarction, and then compare them with healthy individuals. Materials and Methods: After blood samples were collected from the participants, plasma and serum were separated from these samples for further examination. The serum levels of heat shock protein 27 and heat shock protein 60 were measured with related kits in 30 patients with cancer and 30 patients with acute myocardial infarction, followed by 30 healthy individuals. The collected data were then analyzed in the Statistical Package for the Social Sciences software (version 22). Results: The mean serum levels of heat shock protein 27 in cancer patients (25.21 ± 5.57 ng/mL) and in patients with myocardial infarction (45.23 ± 7.43) were significantly higher than those in healthy individuals (10.61 ± 3.11; P

Osteoporosis and osteopenia are common worldwide problems leading to potentially life-threatening consequences. Omega-3 supplementation for treating osteoporosis is less studied and less valued by physicians. We aimed to ascertain the appropriate dosage of omega- 3 supplementation to prevent osteoporosis. Google scholar database was searched in May 2017 using the keywords: n-3 fatty acids, omega-3 polyunsaturated fatty acids, essential fatty acids, eicosapentaenoic fatty acids, docosahexaenoic acid, docosapentaenoic acid, alpha-linolenic acid, linoleic acid, osteopenia, osteoporosis, bone density, and fracture. We reviewed English language reports of randomized controlled trials with intake of omega-3 polyunsaturated fatty acids, in which subjects were over 60 years and supplemented with a quantified dosage of omega-3; and outcome was indicated by bone mineral densitometry medical record of fractures and radiological imaging, and serum biomarker to evaluate bone metabolism. We reviewed 110 papers, which only eight articles met our conclusion criteria and concluded with curative effects. Three articles came up with no prophylactic or curative effect of omega-3 supplementation, three articles suggested a dosage of omega-3 supplement that non significantly increased bone mineral densitometry or decreased absorption, and thus, had prophylactic effects. One article just concluded the positive effects, not defining the exact results. It is suggested that a dosage of 4.5 to 6 g/d of eicosapentaenoic acid and docosahexaenoic acid can have curative effects, while 900-1000 mg/d can have prophylactic outcomes. N-3 fatty acids have positive effects on bone density, but to confine definitive dosage and formulation of omega-3 supplementation for reducing the risk of osteoporosis, further investigations are required.

The primary purpose of present study is to “prove” that the angle and distance between the superior mesenteric artery (SMA) and aorta are significantly correlated with the body mass index (BMI). This in turn indicates the strong etiological role of this factor for the causation of SMA syndrome. The superior mesenteric artery syndrome is characterized by the compression of the third segment of the duodenum by the mesentery at superior mesenteric artery level and a resulting duodenal (±gastric) dilatation. The disease is closely related with the depletion of the fat pad between the vessels narrowing the angle and reducing the distance between the vessels. A prospective study of 300 patients (163 males and 137 females) in the age range of 40-70 years (mean age 51 years) who had undergone multislice detector CT scan in Alzahra Hospital for various other complaints in the year 1395. CT scans had been performed with routine protocol comprising of plain phase followed by arterial and venous phases to measure the angle between the aorta and superior mesenteric artery,BMI was also calculated. Mean values for distance and angle were obtained with P value of 5% and 95 % confidence intervals. Pearson coefficients and T test were also calculated and results were tabulated. A strong positive correlation was observed between BMI and the angle between the aorta and SMA. With increment in BMI, the angle also increases leading to a smaller chance of developing superior mesenteric artery syndrome.

Introduction: Improving the quality of care for the elderly patients in the care units requires improving the performance of health care providers such as nurse-aids from the standard guidelines of caring in this area. In this regard, the present study was aimed to determine the performance of nurse-aids in the safe care of elderly patients admitted to Ali ibn Abi Talib hospital of Zahedan in 2016. MAterials and Methods: This quasi-experimental study was carried out with pre-test design on 50 randomly selected nurse-aids in the hospital. The data were evaluated using a researcher-made checklist of nurse-aid's performance regarding care of the elderly patients in the care unit. Data were analyzed using SPSS software version 16 using Chi-square, Mann-Whitney, One-way ANOVA tests. Results: The results showed that according to Kruskal–Wallis test, work experience of the nurse-aids had a significant correlation with their performance in preventing bed sores in elderly patients admitted to care units (p=0.01). According to the means comparison test, there was no significant correlation between the performance of the nurse-aids regarding the infection control standards with the age of the elderly patients in the admission wards (p = 0.46). Conclusion: According to the results of this study, work experience and education level are more effective in improving the level of performance of nurse-aids and improving their performance in care of the elderly in the care units.

Background: Skin health and mental health are highly correlated. Considering that less attention has been paid to multidisciplinary fields, we evaluated the prevalence of mental disorders and related problems in patients with acne vulgaris in the city of Rafsanjan, Iran.Methods: This was a cross-sectional study. The study population included all patients with acne vulgaris in Rafsanjan who were referred in 2016 to a skin and hair clinic. After the patients agreed to participate, they underwent a psychological interview. Using the Hamilton Anxiety Scale, Beck Depression Inventory, and suicide questionnaires, their data were recorded and collected. Data were then analyzed using the chi-square test and Fisher’s exact test.Results: Of 100 patients evaluated (48 women and 52 men), 8% had severe anxiety, 61% had moderate anxiety, and 31% had mild anxiety. Moreover, 64% of patients had mild depression, 29% had moderate depression, and 7% had severe depression. Of all patients, only one had a high risk for suicide attempts. We did not find any significant relationship between anxiety or suicide disorder and any of following variables: marital status, disease duration, amount of lesions, location of lesions, and expansion of lesions. We observed that with increasing duration of illness, expansion of lesions, and level of lesions, depression increased significantly in patients with acne vulgaris. Location of lesions was not associated with depression.Conclusion: The prevalence of anxiety and depression is high in patients with acne vulgaris. Acne disease is more significantly correlated with depression.

Introduction: Currently, various methods are being used for determining difficult laryngoscopy. The present study aimed to compare the acromioaxillosuprasternal notch index function with the old head and neck anatomic criteria in predicting difficult laryngoscopy with respect to trachea intubation under general anesthesia in children. Materials and Methods: In this cross-sectional study, 379 children under intubation with general anesthesia entered the study. Patients were divided into two groups: easy laryngoscopy (grades 1 and 2) and difficult laryngoscopy (grades 3 and 4) based on Cormack-Lehane score. The thyromental distance systems, height to thyromental distance, Upper-Lip-Bite test, neck circumference, and acromioaxillosuprasternal notch index were studied and compared. Results: Laryngoscopy was difficult in 48 subjects (38 were grade 3 and 10 were grade 4). Interestingly, no significant difference was detected between easy and difficult laryngoscopies based on the thyromental distance, neck circumference, height to thyromental distance, and acromioaxillosuprasternal notch index (P>0.05). height to thyromental distance , acromioaxillosuprasternal notch index , and neck circumference have a sensitivity of 32.2%, 47.9%, 51.1%, respectively, and the specificity was 52.7%, 45.6%, and 48.9%, respectively. Conclusion: Neck circumference and acromioaxillosuprasternal notch index outperform the height to thyromental distance. On the other hand, Modified Mallampati test is better than Upper-Lip-Bite test in determining difficult laryngoscopy in children.

Background: Acute coronary syndrome (ACS) is one of the most common heart diseases. Interventricular conduction disorders are complications of acute myocardial infarctions and have different types, such as left and right bundle branch blocks and left anterior and posterior hemiblocks. The prognosis of this disease can affect therapeutic methods, duration of hospitalization, and timely intervention decisions. Therefore, in this study, we evaluated the relationship between interventricular conduction disorders and the prognosis of patients with ACS. Methods: Using the convenience sampling method, this analytical case-control study was conducted on 140 patients with ACS (61 patients in the case group and 79 patients in the control group) who were treated from March to August 2013. The underlying variables of the risk factors for ACS were evaluated, along with prognostic evaluation factors, in two groups: a case group (patients with interventricular conduction disorders) and a control group (patients without interventricular conduction disorders). Data were analyzed with SPSS v. 17 software using the chi-squared test, the analysis of variance test, Student’s t-test, and Fisher’s exact test. Results: The mean age of patients was 64.1 ± 5.8 years in the case group and 62.9 ± 8.8 years in the control group. No significant relationship was observed between ACS risk factors, such as hyperlipidemia, diabetes, hypertension, previous myocardial infarction, and smoking, and the prognosis of patients with ACS. The mean ejection fraction was 39.7 in the case group and 45.1 in the control group, so a significant relationship existed between the two groups (P

Introduction: The most common complications following anesthesia intubation include postoperative sore throat, post-extubation cough, and hoarse voice. Currently, the use of preoperative Dexamethasone has been effective in controlling these complications. Therefore, the present study aimed to compare the preemptive effect of intracuff and intravenous routes of Dexamethasone administration for postoperative sore throat and cough. Materials and Methods: In the present clinical trial, 96 patients who underwent general anesthesia intubation were randomly assigned to three groups. The first group received 4 mg intracuff Dexamethasone, the second group received 4 mg intravenous Dexamethasone, and the third group was administered a placebo. Cough frequency and severity of a sore throat after extubation were investigated in the three groups. Results: Any significant difference was not observed among the three groups regarding hemodynamic variables (P>0.01); however, the incidence of cough was significantly lower in all the three groups (P<0.01). Also, the average severity of a sore throat in PAR and 1 h after surgery in the three groups was significantly lower (P<0.05). Moreover, no difference was detected in the groups regarding the severity of a sore throat within 24 h post-surgery (P>0.01). Conclusion: The use of two methods of intravenous and intracuff Dexamethasone administration before surgery reduced the incidence of postoperative cough and the severity of sore throat in patients.

Over the past decades, due to a high number of cancer survivors, the demands for fertility preservation have been raised dramatically, and this might come from recent progress in the cancer prognosis and diagnosis procedures. For those who are involved in cancer diseases, there are multiple options regarding their fertility preservation which can be selected based on patient’s age, the risk of gonadal involvement, the time available and the type of cancer with different advantages and disadvantages. Among all possible options, embryo cryopreservation for females and semen freezing for males are the most applicable method, however other options such as gonadal tissue cryopreservation, and oocyte cryopreservation are other promising options which would be considered if the partner was not available. As conclusion, this is noteworthy that women with cancer must benefit from adequate consultations regarding their possible fertility preservation options and immediate correct consultations definitely can help families to make their mind to choose best available options.

Introduction: In India, HIV patients are at a high risk of developing hematological and dermatological adverse drug reactions (ADRs) leading to financial burden. Materials and Methods: A prospective observational study was conducted on hematological and dermatological ADRs in a South Indian teaching hospital from October 2011 to October 2012. The definition of ADRs established by the World Health Organization (WHO) was used to assess the causality. Predictability of ADRs was assessed by Micromedex database. Preventability of ADRs was assessed using the Schumock and Thornton criteria. Results: A total of 174 HIV patients were enrolled [133 (76.4%) males and 41 (23.6%) females], who reported 99 ADRs to HAART. Of the total ADRs, 70 (70.7%) were reported in males and 29 (29.3%) in females, indicating significantly higher reporting of ADRs in males. 67 of the 99 ADRs were hematological, while the remaining 32 were dermatological. A high number of hematological [40 (59.6%)] and dermatological [15 (46.8%)] ADRs were reported for zidovudine + lamivudine + nevirapine-based HAART regimen. In most of the reported ADRs, the suspected drug was withdrawn. The reported hematological ADRs were as follows: 1) anemia with zidovudine [35 (52.2%)]; 2) pancytopenia with zidovudine [20 (29.9%)]; 3) neutropenia with lamivudine; and 4) leucopenia, bicytopenia, and eosinophilia with zidovudine. Dermatological ADRs were maculopapular rash [7 (21.8%)] with nevirapine-, tenofovir + emtricitabine + efavirenz. Conclusion: Hematological ADRs was higher than that of dermatological ADRs. Physicians must focus on routine monitoring of all possible risk factors in PLW-HIV for early prevention of hematological and dermatological ADRs to HAART.

Introduction: Pseudomonas aeruginosa is a gram-negative, opportunistic pathogen causing infections in patients staying in the hospital and is resistant to multiple drugs. This study investigated the resistance to ciprofloxacin by the efflux system of Pseudomonas aeruginosa.Materials and Methods: For this purpose, the inhibitor of the efflux system phenylalanine-arginine beta-naphthylamide was used. In this study, 135 isolates of Pseudomonas aeruginosa were collected from the hospitalized patients of Imam Khomeini Hospital and outpatient clinics in Urmia during a ten-month period from June 2015 to March 2016. These isolates were re-identified by standard microbiological and biochemical methods. Finally, 51 isolates were selected for antibiotic susceptibility testing.Results: According to the antibiogram test, the Pseudomonas aeruginosa isolates exhibited highest resistance against ciprofloxacin (90.2%), tobramycin (88.2%), and gentamycin (86.3%) and the highest sensitivity towards colistin (76.4%), and imipenem (72.5%). The 51 isolates, which were selected for the minimum inhibitory concentration test, had multi-drug resistance regulators.Conclusion: The discovery and development of the efflux system inhibitors is an important strategy to deal with bacterial infections.

Introduction: Nurses are the first healthcare professionals who meet patients who attempt suicide, and their attitudes toward these patients may be important. The purpose of this study was to evaluate the effect of demographic factors on nurses’ attitudes toward patients who attempt suicide and the quality of nursing care that these patients receive.Materials and Methods: This descriptive-correlational study was performed using the convenience sampling method on 182 nurses working at selected hospitals of medical universities in Tehran, Iran. Data were collected using questionnaires that gathered information about demographics, nurses’ attitudes toward patients who attempted suicide, and the quality of nursing care provided. Data were analyzed by the Statistical Package for the Social Sciences v.20 software and by the Pearson test and t-tests.Results: Regarding social and mental aspects, we found no significant statistical relationship between age and work experience with respect to nurses’ attitudes toward and the quality of care provided to patients who attempted suicide, but women provided higher-quality nursing care than men (P=0.046). Although the relationship between education and quality of nursing care was statistically significant (P=0.007), we found no significant relationship between education and attitude.Conclusion: We found no significant relationship between age and work experience with respect to nurses’ attitudes toward, and the quality of care provided to, patients who attempted suicide, but women provided higher-quality nursing care than men. Furthermore, quality of care was higher from nurses who had a bachelor-level education, suggesting that higher-educated nurses should be recruited to care for critical patients.

In the United States, the prevalence and incidence of epilepsy are about 5 to 8.4 per 1000 and 35.5 to 71 per 100,000 persons per year, respectively. Epilepsy management is a personalized and multifactorial medical approach; it is based on the type of epilepsy syndrome, severity and frequency of epileptic seizures, antiepileptic drug’s (AED) side effects, drug-drug interactions, disease-related psychosocial problems, and the overall lifestyle of the patient. Aggressive behavior is a major side effect of many AEDs. It deteriorates patients’ health. In this study, we reviewed different mechanisms of aggression in patients with or without epilepsy, and eventually, we introduced medications that potentially managed both.

Traumatic brain injury is the first cause of death and disability in children and young adults in worldwide. During the acute phase of recovery from moderate to severe brain injury, a period of post-traumatic confusion state (PTCS) will arise that is a combination of cognitive and behavioral dysfunction(1).Seven key symptoms of PTCS are identified and measured by CAP(2,3) Agitation can be part of PTCS in the acute phase or, part of the recovery of consciousness in chronic phase. There are different hypothesis and classifications of acute and chronic post-traumatic aggressive syndromes. While post-traumatic aggression is common, its mechanism, assessment tool, outcome and treatment plans are not well-defined. Understanding the different aspects of post-traumatic aggression; mechanism, differential diagnosis, and treatment are reviewed in this article.

Background: The King Vision Video Laryngoscope is a relatively new device that has been incorporated in our daily surgical practice, intensive care unit, and remote areas. It has become one of the main alternatives to the rescue of a failed intubation, a tool to manage patients with difficult intubation predictors, and the first choice in ventilate and not-intubate situations. Case Presentation: In this case report, we present the management of two difficult airway cases: one in an induced patient and the other in an anticipated patient, according to the Canadian Airway Focus Group difficult airway recommendations. Conclusion: The King Vision Video Laryngoscope is effective in most adult patients and can be used with a mouth opening of at least 13 mm. Even is an effective dispositive, it has yet to show results in the management both conventional airway both difficult airway in routine clinical practice.

Introduction: A high prevalence of non-alcoholic fatty liver disease is associated with obesity and lifestyle disorders. The present study was conducted to compare the nutritional pattern of patients with and without non-alcoholic fatty liver disease referred to the hospitals affiliated to Tehran University of Medical Sciences in 2017.Materials and Methods: The present case-control study was performed on a total of 300 outpatients and inpatients, aged 18–65 years. These patients were referred to the ultrasonography section of the hospitals, and those recruited in the study were selected by the convenience method of sampling. According to the results of ultrasonography, these subjects were divided into two groups: case (100 patients) and control (200 subjects for increasing the statistical power of study). The data were analyzed using the Statistical Package for the Social Sciences (version 19), descriptive statistics, and the Mann–Whitney test. P<0.05 was considered significant.Results: A significant difference was detected between the mean consumption of unhealthy foods in the case group as compared to the control group (P=0.001), while those with fatty liver reported a low average intake of fruits and vegetables with a significant difference (P=0.001).Conclusion: The results showed that patients with fatty liver complied with poor dietary habits as compared to individuals without the disease.

Introduction: Alzheimer's disease is a neurodegenerative disease, which usually helps some biomarkers, such as amyloid proteins, to diagnose the disease. Therefore, the purpose of this study was to compare the expression of a protein binding protein to the adjuvant responder to circular adenosine monophosphate (CREB) in peripheral blood of patients to Alzheimer's and healthy elderly people as a biomarker for diagnosing Alzheimer. Materials and Methods: In this case-control study, 32 patients with Alzheimer's disease and 32 normal blood samples were taken. Using real time PCR, CREB expression was evaluated. Results: The mean CREB level in the case group was 0.89 ± 0.30 and in the control group was 1.01 ± 0.03. The mean of BDNF level in the case group was significantly higher than the control group (P <0.001). There was no significant relationship between the level of CREB with age, sex, MMSE score and Cornell scale for depression in dementia (P> 0.05). Conclusion: Reducing CREB levels in people with Alzheimer's disease can be a factor in diagnosis in comparison to healthy people.

Introduction and objectives: The prevalence of preoperative state anxiety is an unavoidable complication. Aside from its type and scope, the surgical operation is considered as a severe stressful situation for patients. Considering the importance of reducing the state anxiety in patients undergoing surgery, there are different methods, one of which is patient education; therefore the aim of the current study was compare the effect of written and planned training on the state anxiety among patients undergoing orthopedic surgery. Method: In this study, 81 patients candidate for orthopedic surgery were selected using convenience sampling and were randomly divided into 3 groups, including planned training, pamphlet and control groups. All patients answered 20 questions-State-Traits Anxiety Inventory (STAI) Questionnaire the day before surgery and the intervention was later carried out in the planned training and pamphlet groups. Then the effect of preoperative state anxiety was re-evaluated about half an hour after training in three groups. For data analysis, in addition to mean and standard deviation, independent t-test and ANOVA were used in Spss16. Results: The results of comparing pre- and post-training mean score of the state anxiety in three groups showed that the mean score of state anxiety reached from 50.41 to 41.03, 52.41 to 44.37 and 45.04 to 50.56 in planned, pamphlet and control groups, respectively. ANOVA test showed that there is a significant difference in this comparison. The results of Tukey's test also revealed that the mean score of state anxiety in the planned and pamphlet groups was lower significantly than the control group (p

Introduction: Central venous catheterization has been usually performed during major surgeries in order of central venous pressure assessment and fluid therapy. Variety of techniques has been performed for central venous catheterization previously but the information in this regard about pediatrics is limited. In the current study, the comparison of electrocardiographic technique with landmark one for central venous catheterization performance has been done. Methods: This is a cross-sectional study conducted on 75 patients underwent central venous catheterization for elective cardiovascular thoracic surgery. In the first step, the location of catheterization was estimated based on body surface landmarks. Then catheterization was done using electrocardiography. Then by cardio-surgeon aid, during open cardiac surgery, the catheter tip location was found (gold standard). Finally, chest X-ray was taken and catheter place based on radiological markers was recorded.Results: In the current study, 75 children with age under 18 years and gender distribution of 42.7% females and 57.3% males were assessed. Mean of central venous catheter depth in gold standard method was 7.5±1.35 centimeters. Significant association between central venous catheter placement in gold standard technique and both landmark and electrocardiographic was seen (P-value<0.001; r=0.94 and P-value<0.001; r=0.77). Logistic regression showed a significant association between weight and placement of catheter tip in landmark technique (P-value=0.038) as following formula (Depth of central venous catheter= 5.33+0.07*weight).Conclusion: Our study showed that the use of ECG for CVC considering carina-to-tip as reference was superior to the landmark. In addition, catheter tip correct position was affected by weight but not height based on landmark technique.

Introduction: In recent decades, diabetes has contributed significantly to the burden of disease in developed and developing countries, due to the considerable prevalence and involvement of various age groups in the communities.Today, a variety of ways to manage and control the disease are used, one of which is the use of personal electronic health records. Recently there has been a remarkable upsurge in activity surrounding the adoption of personal electronic health records systems for patients and consumers. personal electronic health records systems are more than just static repositories for patient data; they combine data, knowledge, and software tools, which help patients to become active participants in their own care.The present study was conducted with the goal of Health Technology Assessment the impact of personal electronic health records in Patients with Diabetes. Methods: Writing is based on PRISMA standards. This was a Health Technology Assessment study. It aimed to evaluate the technology of personal electronic health record . The scoping review was conducted to evaluate 8 dimensions (Health Problem and Current Use of the Technology, Description and technical characteristics of technology, Safety, Costs and economic evaluation, Ethical analysis, Organisational aspects, Patients and Social aspects, Legal aspects) of Personal electronic health record . This study was based on answering questions which were developed based on Health Diagnostics Technology Assessment Documents Framework and HTA Core Model 3.0 . A systematic review was conducted to evaluate the Clinical Effectiveness dimension of personal electronic health record in controlling diabetes. In order to gather evidences, Ovid databases, Cochrane Library, PubMed, CRD, Trip database and EMBASE, and Randomized Controlled Trial Registries, such as the Clinical Trial and Trial Registry, were searched using specific keywords and strategies. .Articles are evaluated on the basis of the quality criteria of JADAD.The data is analyzed by the STATA software. Dissemination:The results of the study will be published in a peer-reviewed journal and presented at relevant conferences.Policy makers and healthcare decision-makers can use these results.

Background: During the last two decades, the scale of computer use has been surprisingly increased. In 2000, 80% of workers stated that they use computer in their daily activities. The tendency to use computer is accompanied with healthy risk and the incidence of musculoskeletal disorders between 10 to 60 percent of computer users. Aims to study, risk assessment by RULA and ROSA methods, surveying the correlation of these methods, and evaluating the prediction ability of these methods in the incidence of musculoskeletal disorders among office workers. Methods: This analytic-descriptive study performed at Behbahan University of Medical Sciences and Imam Khomeini port office in 2016. The sample consists of 236 office workers through simple random sampling method. Body map questionnaire as well as RULA and ROSA checklists were used for data collection. Data analysis was carried out by SPSS software, version 22, and statistical tests including one way ANOVA, Pearson, and Chi-square. Results: The results demonstrated that most of the musculoskeletal disorders are related to trunk, neck and back regions by 40.4%, 39.7%, and 35.4% respectively. The furthest risk distribution in ROSA method is at warning level (67.2%) and at high and very high levels in RULA method (62%). Pearson Test showed a positive significant correlation between these methods (P

Introduction: This study aimed to explore the use of e-learning in medical education in Shiraz, Iran.Materials and Methods: A convenience sample of 300 medical students of Shiraz University of Medical Sciences was interviewed using a structured questionnaire. The questionnaire contained a series of questions on the demographic characteristics, accessibility to computer and internet, use of internet for medical education and training, familiarity with e-learning, and the reasons for use of computer.Results: A total of 270 participants completed their questionnaires, 30.7% students reported familiarity with e-learning, 21.3% found e-learning beneficial, 57.6% used internet for education, 43.4% considered e-learning useful for medical education, and 57.9% students thought e-learning must be more prevalent in medical education. Most of the students (78.5%) used their personal computer for e-learning, only 6.3% did not use the computer for education.Conclusion: Considering the increasing role of computer and internet in daily life, the current results indicate that the attitude of the participants towards e-learning was positive. However, medical students have to be made aware of the advantages of e-learning. Technological limitations were less compared to reports from the other developing countries.

Introduction Eye pain is common and initially managed by primary care physicians. In the rare refractory case or atypical appearance, consultation with ophthalmology is needed. Case presentationA 35-year-old Hispanic male patient with a history of pterygium presented with complaints of worsening left eye pain for months .Over the past two weeks, the patient had also noticed more redness and soreness that occurred all day. He noticed darkening in the medial vision of his left eye, persistence of left eye pain and visual changes. An excisional biopsy of the lesion was performed. The final biopsy reports revealed an ocular surface squamous cell carcinoma in situ arising from pterygium.DiscussionTopical application and injections of immunotherapy such as mitomycin C and 5-fluorouracil have been shown to be effective. Recurrence is high and follow-up examination by ophthalmology is essential.

Background:One of the goals of nursing is to provide safe patient care and medical errors are one of the most important threats in this field.Therefore, the purpose of this study is to assess the status of error reporting culture and determine its relationship with demographic characteristics.Methods:This descriptive,analytical and cross-sectional study was carried out among 239 nurses of amiralmomenin and bouali hospitals. First,face validity and then content validity were performed by 15 nursing experts and the questionnaire was distributed and collected. The normal distribution of data was confirmed by Kolmogorov-Smirnov test. The reliability and construct validity were performed with Cronbach’s Alpha test and exploratory factor analysis by PCM.The status of reporting culture was determined by computing descriptive statistics and its relation with demographic variables with Pearson correlation test and logistic regression test with SPSS software version 16.Results:The content validity with CVR &CVI of 0.820 and 0.920 were confirmed. The reporting culture was favorable with a mean and standard deviation of 2.674 and 0.475.The reliability with Cronbach's alpha of 0.747 and the construct validity with a KMO of 0.727 and Significance of the Bartlett test were confirmed and 3 subscales were extracted. The relationship between age and work experience with the reporting culture with a correlation of 0.009 and 0.013 with a significant < 0.05 were rejected But with the variable of gender(=female) with a chance of 2.536 and the significant of 0.006 was confirmed.Conclusion:Developing a safety culture in hospitals by implementing various health programs improves the reporting culture,but the mental climate is undesirable and requires major steps to reduce worries and negative outcomes after reporting.The presence of female nurses in comparison with men improves the error reporting culture.Perhaps the main reason is patriarchy in Iranian culture.

Background: High blood pressure is the most important public health problem in developed countries. It is one reason for early mortality and risk factors for cardiovascular diseases like stroke and kidney failure. This study aimed to determine the effect of educational intervention based on BASNEF in blood pressure control in 1395. Methods and Materials: This study was a quasi-experimental study on 160 patients in two groups (each n = 80) suffering from hypertension in urban health centers of Urmia. Data collection questionnaire included: demographic questions, knowledge base questions, self-control behaviors questions and structures of BASNEF model. Validity and reliability were respectively 80% and 79%. Intervention group had taken three 45 minutes sessions using speeches, questions and answers, posters, booklets, pamphlets and whiteboard. Before training, information collected through questionnaires and after training questionnaires were completed again after 3 months. The data were analyzed in SPSS software with chi-square tests, Fisher, independent and paired sample t-test. Results: The average age of case and control group were 99.11 ± 01.56 and 75.12 ± 66.53 years. That there was no statistically significant difference (p=0.1). After intervention average systolic blood pressure significantly decreased in the intervention group from 43.157 to 24.147 mm Hg and diastolic blood pressure significantly decreased from 21.93 to 52.87 mm Hg (P

Background and objectives: Multiple sclerosis is a chronic and progressive autoimmune disease of the central nervous system that causes motor and sensory impairment and physical disability in patients. This study was conducted to determine the demographic, clinical, and beyond clinical characteristics in patients with multiple sclerosis to help identify common disabilities and better understand of the specific needs of these ones. Materials and methods: This descriptive cross-sectional study was carried out on 50 MS patients in Rafsanjan, Iran. A definitive diagnosis has been done according to neurologist and McDonald criteria. The neurologist conducted examinations. The demographic data were recorded using questionnaire. MRI images were analyzed with the help of radiologist and all data were analyzed using SPSS software. Results: The mean age was 33.81±8.38 years and male/female ratio was 7/42. According to data, 66.7% of the patients were suffering from relapsing-remitting type (RR) disease, and most lesions on MRI in these patients were observed in pyramidal and JuxtaCortical areas. The mean EDSS scores of patients was 1.46. The duration of disease and the number of attacks had a significant correlation with educational level (P

Introduction: Osteoporosis is a systemic disease of the bone, which entails an increased riskof fracture, with high impact on morbidity, mortality and costs in the health system. Severalstudies have shown a relationship between muscle mass and strength with bone mineral density.Our objective is to determine the correlation between these variables in postmenopausalwomen. Materials and Methods: For the correlation study, 100 postmenopausal womenolder than 50 years were selected randomly and a sociodemographic survey was conducted,and muscle strength was determined by manual grip strength, which was measured with adigital dynamometer. Bone mineral density measurements and muscle mass were obtainedwith densitometry. The correlation between strength, muscle mass, and bone mineral densitywas determined by a Spearman correlation. Results: The average age was 62.8 ± 7.48. Femurand column bone mineral density were significantly related to the muscle mass index, weight,and body mass index. The prevalence of fragility fracture was 17%. The bone mineral densityof the femur was lower in patients with fragile fracture, and there was a negative and significantcorrelation between femur bone mineral density and skeletal muscle mass index. Conclusion:Bone health studies should include the study of muscle mass index and the skeletal musclemass index. The improvement of the muscle mass index can influence femoral and vertebralbone mineral density with significant impact on fragility fractures. This is the first study of itskind conducted in Colombia and South America.

Introduction: Breast cancer is the most common type of cancer that affects women. Human epidermal growth factor receptor 2 (HER2) is a gene that plays a significant role in the development of breast cancer. The aim of this study was to compare the survival of HER2-positive breast cancer patients who received Herceptin with those who did not receive it in Yazd, Iran. Materials and Methods: Our study was an analytical cross-sectional study. Sampling was done on all patients with HER2-positive invasive ductal carcinoma (HER2 positive) who were referred to Shahid Sadoughi Hospital or Shahid Ramezanzadeh Hospital from 2003 to 2014. The data were collected using a questionnaire, which included questions on age, type of tumor, tumor grade, recurrence history, tumor size, number of lymph nodes, and whethr Hercepin was received or not received. Data were then entered into SPSS version 18 and analyzed by statistical tests. Results: The mean age of the patients was 50.78 ± 10.75 years. The mean survival time was 61.61 ± 2.93 months, and the mean recurrence time was 104.104 ± 41.3 months. The results also showed that there was no statistically significant difference between the 2 groups, despite the higher mean survival time and less recurrence time in patients receiving Herceptin compared with those who did not receive Herceptin (P>.05). Conclusions: According to the results of this study, the efficacy of Herceptin as a neoadjuvant treatment in the survival of HER2-positive breast cancer patients has not been established.

Introduction: Breast cancer nowadays is one the major health issue especially in industrial population. Despite excessive researches in this regard, there is still no detailed and relevant information on the association between the risk factors of this cancer and its many outcomes. Due to increasing rate of breast cancer in Iran, including Yazd city, the present study was designed to evaluate the relationship between survival and recurrence rate with pattern of risk factors in breast cancer patients. Methods: This analytical study was conducted retrospectively on 333 patients with breast cancer during 8 years (2005-2013). Total survival and recurrence rates recorded in month for all samples, and then were analyzed and compared other obtained data. Chi-square and log rank were selected tests for analyzing and Kaplan-Meier was applicable curve for survival analyzing. Results: The mean age of subjects was 57.02 ± 12.32 years. The mean total survival rate was 93.15 ± 1.25 months (97.9%). The mean total recurrence rate was 84.59 ± 1.91 months (89.8%). The subgroups of breast cancer had no significant relationship with risk factors (P>0.05) though BMI and recurrence rate had significant relationship (P=0.045). Other risk factors had no significant relationship with total survival and recurrence rates. The mean duration of OCP (oral contraceptive pill) consumption was significantly more in the patients with ER-PR-Her2+ subgroup than other groups (P=0.03). Conclusion: According the findings, BMI lower than 25 is strong prognostic factor for recurrence rate in patients with triple-negative breast cancer. Because of high survival rate of patients with breast cancer during eight years, it is recommended to study on high survival period with larger sample sizes for accessing reliable evidence.

Proton pump inhibitors (PPI) are the most prescribed drugs globally, which are highly potent gastric acid suppressors, known for the management of numerous diseases. There is a notable correlation between Gastric cancer and PPI. It is highlighted that the underlying mechanism is in close association with a study conducted 30 years ago, which showed excessive inhibition of gastric acid secretion in rodents, with secondary hypergastrinemia, that led to enterochromaffin-like-cell (ECL) hyperplasia. In conclusion, based on the scarce literature, it is evident that the safety of PPI is under a dilemma. Developing countries like Pakistan, where there is an excessive prescription of PPI, often without justification, are a significant burden on the economy as well as a threat to life, keeping in view of the significant correlation between PPI and gastric cancer.

Background: Social capital, in general, is mutual relationships, interactions, and networks that emerge among human grouping and is the level of trust formed in the specific group as commitment and social norm. This issue is associated with many mental and physical disorders in the community. The objective of this study was to evaluate the level of social capital in some people with a primary headache in comparison with control group. Methods: This case-control study was performed on 60 patients with a primary headache who referred to one of neurology clinics in Yazd city, Iran, as the case group and 60 subjects without primary headache as the control group that had some similarities with case group in demographic features. Data was collected via social capital questionnaire containing demographic information. Results: The mean score of social capital in the case group was 193.5±30.82 while the mean score of social capital in the control group was 214.1±34.22 (P=0.001) that indicate a significant correlation between social capital level and catching primary headache. Conclusion: Further studies are needed on the effect of social capital on the level of response to treatment in patients with primary headache. It is also suggested to be conducted interventions regarding the impact of social capital on headaches and broader studies with larger scale (urban population) in this regard.

Introduction: Clostridium difficile infections have had significant morbidity and mortality in the last decade leading to high healthcare costs. Our prospective case-control study from October 2013 to May 2015 in a tertiary care hospital in rural India aimed to evaluate the risk factors, treatment, outcome, and complications of Clostridium difficile infections in hospitalized patients.Materials and Methods: The study involved a total of 183 patients, of which 61 were cases, and 122 were controls. Data was analyzed using multivariate logistic regression.Results: Antibiotic intake in the past four weeks (p=0.003), hypoalbuminemia (p=0.001) and duration of hospital stay before the onset of diarrhea (p<0.001) were proven to have significant risk. We subdivided cases into severe and non-severe cases, and we found that complications were statistically higher in severe cases (OR= 1.685, <0.001).Conclusion: Identifying severe cases and administering timely and appropriate treatment is prudent.

Introduction: Emergency department is one of the most important units of a hospital. In general, the most serious cases are referred to emergency department, and the highest numbers of hospital admissions occur in the emergency department. This study aimed to obtain a comprehensive estimate of the number of frequent visitors to the emergency department of Imam Khomeini educational hospital, Sari. Materials and Methods: This cross-sectional descriptive study was performed retrospectively by referring to the patient medical records at the Sari Imam Khomeini education hospital. The records were screened to identify frequent emergency department visitors in 2017. Data analysis was performed using SPSS 21. Results: The number of emergency department visitors in the Sari Imam Khomeini Hospital in 2017 was 29,765; of them, 594 (6.2%) were repeat visitors and were included in this study. The mean age of the frequent emergency department visitors was 56.17 years. The most common complaint was weakness and lethargy in 39.9% patients, abdominal pain in 30%, shortness of breath in 14%, and other causes in 14%. The most common underlying disorders were anemia, followed by obstruction pulmonary disease. Conclusion: We obtained detailed data of frequent emergency department visitors to aid the development of suitable evidence-based policies. New policies are necessary for the management of various sections of the emergency department and inpatient admissions. Such policies will allow better decision-making for non-emergency patients and outpatient admissions.

Introduction: Mustard gas is a known chemical weapon that was used in the 1980-1988 Iran- Iraq War. It causes many health problems, including serious respiratory damage. In this study, we used high-resolution computed tomography to assess the pulmonary complications after 20 years of veterans of the Iran-Iraq War who were exposed to mustard gas. Materials and Methods: This was a follow-up study conducted on 200 Iranian veterans with a history of exposure to mustard gas at least 20 years previously. High-resolution computed tomography was performed on all veterans and was interpreted by two independent expert radiologists who were blinded to the study. The frequency of high-resolution computed tomography ndings was reported. Data were analyzed with statistical package for the social sciences version 20 software. Results:One hundred twenty veterans (60%) showed HRCT abnormalities. The most frequent high-resolution computed tomography ndings were diffuse hyper-aeration, 63 (52.5%); interstitial opacity, 50 (41.7%); parenchymal opacity, 26 (21.7%); bronchiectasis, 15 (12.5%); sub-pleural air trapping, 13 (10.8%); and local brosis, 10 (8.3%). Generally, lower lobes were more frequently affected. Conclusion: This study showed a high frequency of abnormal high-resolution computed tomography ndings in veterans who were exposed to mustard gas, and most abnormalities were irreversible. These ndings included diffuse hyper-aeration, interstitial opacity, parenchymal opacity, bronchiectasis, sub-pleural air trapping, and local brosis.

In recent years the number of patients with temporomandibular disorders (TMDs) is on the rise, given this, this paper aimed to investigate the prevalence of jaw and TMDs and its relationship with malocclusions in children. This study was conducted as a review article. The study was a descriptive – library type in which by referring to all the resources and literature of the existing studies, their results have been summed up. The TMDs is referred to clinical problems that involve masticatory muscles, temporomandibular joints or both of them. Its prevalence is 12 to 20%, and including subclinical symptoms, it reaches to 65 %. The common age is reported to be between 20 and 40 years, and its prevalence is higher in women. The most common symptoms are masticatory muscle pain, and the most common cause of it is premature contacts. Its treatment includes two phases; the first phase includes reducing anxiety, medication, and physiotherapy. The second phase involves orthodontic treatment.

Background: Premature Rupture of Membrane (PROM) refers to the rupture of fetal membranes at least 1 hour before the onset of labor pain. The present study intended to determine the predictive value of maternal serum level of Procalcitonin in the early diagnosis of Chorioamnionitis in mothers with PPROM. Methods: In this prospective cohort study, a total of 48 patients with PPROM were selected as the intended sample size due limited financial resources and in accordance with previous articles in Kosar ward of Motahhari hospital of Urmia city, Iran. Inclusion Criteria were amniotic fluid leak, positive Nitrazine and Fern test, gestational age from 28 to 33 weeks and lack of fetal tachycardia. Exclusion Criteria were chronic and congenital heart disease as well as use of NSAIDs. Data were analyzed using SPSS 19 and descriptive statistics, independent t-test and Pearson test were performed. Results: The present study was conducted on 48 pregnant women and their neonates. About %39.6 of mothers was pathologically infected with Chorioamnionitis while %60.4 of the patients were not infected with the disease. Moreover, %68.8 of the neonates had a five-minute Apgar score of ≥7. There was a significant correlation between infection of mothers with histopathologic Chorioamnionitis and neonatal hospitalization in NICU (P

Background: Sarcopenia is defined as loss of muscle mass with attendant loss of muscle strength and physical function and is associated with advancing age. Inflammatory condition of chronic disease leads to more rapid progression of this syndrome, which may adversely affect quality of life. The aim of this study was to determine the relationship between chronic obstructive pulmonary disease (COPD) and sarcopenia. Methods: This study included 108 COPD patients who were treated in the pulmonary clinic at Masih Daneshvari Hospital. Patients were categorized into three groups based on Global Initiative for Obstructive Lung Disease criteria. Sarcopenic parameters including muscle mass, muscle strength, and physical performance were measured by Bioimpedance Analysis, hand grip dynamometer, and the Short Physical Performance Battery test, respectively. According to the European Working Group on Sarcopenia in Older People cutoff points and the definition of sarcopenic obesity, sarcopenic patients were diagnosed and categorized based on different COPD severity scores. Results: The relationship between sarcopenia and COPD grading, which was assessed using multiple regression models with adjustment of confounding factors, including age, chronic diseases, and smoking, was statistically insignificant. However, by using forced expiratory volume in 1 second (FEV1) or ratio of FEV1 to forced vital capacity in this model, the results were significant (P = 0.026). A positive linear correlation was observed between skeletal muscle index (SMI) and spirometric data, which was assessed by Spearman’s correlation test. By exploring the association between sarcopenia and obesity with the one-way analysis of variance test, sarcopenic patients represented to have the minimal spirometric measures. However, this difference was only significant for actual measurements. Conclusion: This study showed that sarcopenic COPD patients had smaller spirometric measurements and that sarcopenia and magnitude of SMI were positively correlated with obstruction severity.

Introduction: The lesions of the eyelid and conjunctiva are benign and malignant. The ratio of benign lesions is more than the malignant, increases with age, and are easily diagnosed clinically. However, in some cases, the clinical diagnosis of malignant tumors is impossible, necessitating the final diagnosis by histopathological examination. The incidence of benign and malignant tumors differs between countries according to the genetics of the racial population or environmental factors. Materials and methods: This cross-sectional descriptive study was conducted on 424 patients with eyelid and conjunctival lesions from the Farshchian Hospital of Hamadan between 2010–2014. The final pathological report, clinical diagnosis, demographic variables including age and gender, site of lesions, and clinical appearance were extracted from medical records. Results: The lesions consisted of 159 (37.5%) eyelid and 265 (62.5%) conjunctival lesions. The predominant location was bulbar conjunctiva (35.1%), and the least was external canthus (1.7%). The most frequent lesion based on clinical diagnosis was pterygium (51.7%), and the least frequent was sebaceous glands carcinoma. The most frequent lesion based on histological diagnosis was pterygium (52.5%), and the least frequent was xanthelasma. In this study, the concordance between clinical and histological diagnosis was 90.3% that indicated the physician’s accurate diagnosis. Conclusion: According to this study, the frequency of eyelid and conjunctival lesion was similar in males and females. The prevalence of lesions in >60-year-olds is more common than that in other age groups. The benign lesions of eyelids and conjunctiva are common than malignant lesions. Despite high clinicopathological concordance, the physician should always consider the rare cases, and the pathological diagnosis must be considered for all specimens.

Colon cancer is the third most common type of cancer in the USA and accounts yearly for 11% of all cancer deaths (Center for Disease Control and American Cancer Society). Thus, identifying strategies that reduce its incidence is critically important. Calcitriol, the most active form of vitamin D, is a pleotropic hormone with a wide range of biological activities. Due to its ability to regulate calcium and phosphate metabolism, 1,25D3 plays a major role in bone health. In addition, 1,25D3 binds to the vitamin D receptor and thereby regulates the expression of a number of genes which control growth, differentiation and survival of cancer cells. Although a well-recognized physiological role of vitamin D is the regulation of calcium and phosphate metabolism, recent studies suggest a much broader range of biological functions of vitamin D, including potential anti-neoplastic effects. Garland et al. discovered in 1980 that colon cancer mortality rates in the U.S. were highest in places where populations were exposed to the least amount of sunlight, and proposed that vitamin D might be a protective factor against colon cancer. Since then, extensive studies have reported anti-neoplastic actions of vitamin D, particularly in colorectal cancer.

International law globally plays a key role in the surveillance and control of communicable diseases. Throughout the nineteenth century, international law played a dominant role in harmonizing the inconsistent national quarantine regulations of European nation states; facilitating the exchange of epidemiological information on infectious diseases; establishing international health organizations; and standardization of surveillance. Today, due to changed forms of infectious diseases and individuals' lifestyles as well as individuals' proximity caused by increased air travels, communicable diseases are in an international and cross-border form. In this regard, binding regulations and inconsistent rules adopted in international multilateral institutions like the World Health Organization, World Trade Organization, Food and Agriculture Organization can be of great use in surveillance and control of communicable diseases. With the globalization of public health, international law can be used as an essential tool in monitoring global health and reducing human vulnerability and mortality.

Backgrounf: Hyperlipidemia is one of the chronic diseases whose current solutions are the proper diet and chemical drugs. Evaluation of accessible medicinal plant recourses has an important role to prevent and treat the hyperlipidemia. The present study aimed to investigate the effect of sumac (Rhus coriaria) extract on blood lipid profile in white Wistar rat. Methods: This laboratory animal experiment was conducted on 21 white Wistar rats during four weeks. The research units divided into three groups separately were fed by normal diet, fatty diet without sumac extract and fatty diet with sumac extract. The samples were excluded after appearing sick-like behaviors. Finally, data were analyzed in SPSS ver. 16 software using ANOVA and LSD tests. Results: The mean weight of rats was 310±26 gram. The mean blood cholesterol had significant difference in fatty diet with sumac group in compared with control group from the second week to the end of study (P0.05). Conclusion: According to the findings of this study, the use of sumac with fatty diet can be effective to reduce blood cholesterol in prevention and treatment of hyperlipidemia.

Introduction: Through new and expanding technologies, the development of health information technology in today’s society is indisputable, and the use of this technology has led to the production of various products with a variety of capabilities. One of these products is the Hospital Information System. Regarding the impact of organizational factors on the successful implementation of hospital information systems and the lack of comprehensive criteria for assessing them, the purpose of this study was to determine the criteria of hospital information systems involved in organizational evaluation. Methods: Data sources included the following databases: pubmed, scopus and cochrane library. In addition, other sources were searched for ongoing studies and grey literature. Studies were independently screened for eligibility by 2 reviewers and data extraction was done by 2 people. The language limitations for article wasn’t considered, the reference of the articles that selected, review and related articles were selected. After completing the search, all the articles were entered in to EndNote, and duplicates were deleted. The Prisma protocol was used to report. Results and Dissemination: A specific and precise checklist was being prepared and developed, which is an appropriate guide to assess hospital information system from an organizational dimension in health technology assessment. The results of the study were published in a peer-reviewed journal and presented at relevant conferences. Policy makers and healthcare decision-makers can use these results.