---

Background and purpose: Anesthesiologists have become the first priority since they can play an important role in crisis situations to support respiratory and cardiac urgencies. In this survey, the effects of the resident anesthesiologists were studied on the death of patients having been hospitalized in the Intensive Care Unit of Imam Khomeini training and treatment center, Sari from 2000 to August 2004.
Materials and Methods: In this survey, the subjects of the "case group" (passed-away patients during the residency of the anesthesiologist) have been compared to the subjects of the "control group" (having no resident anesthesiologist). The following variables were considered for analysis: age, gender, hospitalization reasons, the original ward, reason of and the service of reference to the Intensive Care Unit, the cause of death, hospitalization period in the original ward and Intensive Care Unit, as well as the number of the visits paid by anesthesiologist. Other interfering variables (such as facilities) were not taken into account, since they had been the same for both groups. Data were analyzed using the SPSS software and the descriptive and analytical (X2,Z,T) statistical tests.
Results: The findings of this survey showed that men have died more than women (61.9% vs 38.1%) in the intensive care unit. The total hospitalization period reduced from 14 to 11 days, having an anesthesiologist residing in this ward. It was revealed that the presence of an anesthesiologist reduced the death rate from 24% to 14%.
Conclusion: According to the findings of this survey, it has been revealed that the presence of an anesthesiologist can have an outstanding effect on the reduction of the death rate. It is taken for granted that choosing patients must be done in accordance with Classic Indications since there are limited number of beds in ICU and the admission request for different patients. In equal situations, those patients who have better opportunity and less mortality probability and better prognosis in this unit have priority.

---

Background and Purpose: Hospital admission for surgery is an important event for patients. Canceling surgical procedures produce several unpleasant results for patients such as waste of time, including payment. The aim of this study is to identify the prevalence and causes of canceling surgical procedures, in order to achieve problem solving methods.
Materials and Methods: This is a descriptive cross-sectional study. Statistical data regarding all surgical procedures (without sampling) performed during 2006 to 2007, were recorded in a checklist. Study variables were identified based on surgical procedures that were canceled during this study. Data was analyzed using SPSS software and statistical analysis tests.
Results: Of 4,711 scheduled patients, 510 (10/9%) surgical operations were canceled. The highest number of patient candidates for surgical operation was related to gynecology, orthopedic, urology, while the least were related to reconstructive and vascular surgery groups respectively. The most canceled surgical procedures were related to neurosurgical operation 32/4% (68 from 207 cases) while the least canceled cases belonged to gynecology 4/4% (48 from 1094 cases).
Conclusion: The results of our study showed that 54/2% of canceled cases were preventable. The results of this study and similar studies demonstrate that traditional pre-operative preparation for surgical scheduling, day before surgery is in need of serious consideration. We recommend a fundamental change by discarding traditional methods and creating a new committee including specialized bed or resource groups, monthly management meetings to discuss causes of canceling surgical procedures, in order to reduce its occurrence. Thus, decreasing the rate of canceling surgical operations can save hospital financial resources, preventing time wasted, while reducing anxiety in patients and their family.

---

Abstract Background and purpose: Infertility as a major source of stress influences numerous aspects of couples' life like sex and sexual attitude. So the aim of this study was to compare sexual attitude among fertile and infertile couples. Materials and methods: In a cross-sectional study, fifty infertile couples who referred to St.Mary’s infertility center in Sari and fifty fertile couples were selected by non-random sampling method. They completed the demographic inventory and sexual attitude questionnaire. The data was analyzed by descriptive statistics, independent-sample t-test, one-way ANOVA, Pearson correlation and Duncan test using SPSS- 16 all at significant level of P<0.05. Results: The results showed that fertile couples had more positive attitude toward sex in the behavioral aspect of sexual attitude than infertile couples. However, no any significant difference was found in sexual attitudes of fertile and infertile women and also fertile and infertile men. Either fertile or infertile, there was a positive significant between women’s sexual attitude with their partners. Neither fertile nor infertile, there was not a significant correlation between age and education with sexual attitude in women, and between age, period of marriage and job with sexual attitude in men. In addition, there was a negative significant correlation between fertile women’s sexual attitude with their period of marriage, and a positive significant correlation between men’s sexual attitude with their education on both fertile and infertile couples. Conclusion: This study indicates that sexual attitude and its cognitive and emotional aspects are not affected by infertility, however, there is a decrease in behavioral aspect of infertile couples.

---

Background and purpose: Stroke is one of major causes of disability and self care. Therefore, it is important to introduce and develop new treatment approaches in order to improve and enhance post stroke recovery process for medical, social and economical purposes. The aim of this study was determine the effect of mirror therapy on self care of patients with stroke. Materials and methods: This Randomized Controlled Trial was conducted on 50 patients with stroke hospitalized randomly allocated in two groups of control (25 patients) and mirror therapy (25 patients). In experimental group, twenty 30 –minute sessions were done daily or every other day patients did range of motion of upper and lower extremities of healthy side in front of mirror and observed just its mirror image. In additional to mirror therapy in both groups, the routine program (physiotherapy and neuromuscular stimulation) was performed. Ability of self care was assessed before, 5th, 10th, 15th and last sessions of intervention using barthel index scale. Finally data analyzed in different phase by t-test and repeated measure. Results: Two groups showed no significant difference in terms of ability of self care and confounding variables before intervention. In 5th, 10th and 15th were significantly different (p<0.05) but in last sessions of intervention in mirror therapy group were not significantly improved in comparison with control group after intervention (P>0.05). Repeated messure showed significant independently effect of group and step on self care of patients with stroke (P<0.05), however this effect was not interactional (P>0.05). Conclusion: Mirror therapy can improve self care of patients with stroke as a simple, inexpensive and patient-oriented treatment.

---

Background and purpose: Post stroke depression is one of the common emotional disorders affecting stroke survivors. Stroke is one of neurological diseases and is a public health problem. The purpose of this study was to investigate the relationship of possible risk factors in prevalence of post stroke depression. Material and Methods: This descriptive study was performed using relevant sampling method on 116 inpatient ischemic stroke admitted in neurology department of Boali Sina hospital in Sari. The diagnosis of brain ischemic stroke was made based on the clinical findings of a neurologist and confirmed by Brain.C.T.S and M.R.I. Frequency of depression was determined using DSM IV criteria and HADS inquiry. The risk factors were recorded after being confirmed by a physician based on paraclinical testes along with demographic information. Data was analyzed applying Chi Square and logistic regression in SPSS V.16. Results: Finding revealed that 47.4% of the patients suffered post stroke depression. Frequency of depression was significantly higher in women (29.3%) compared to that in men which was (18.1%). There was no significant relation between depression and age and educational level. But we found a significant correlation between post stroke depression and gender, diabetes mellitus, and hypertension. Conclusion: This study showed a high incidence of depression after stroke which is found to be more prominent among women. There is a significant correlation between depression and sex, diabetes, and hypertension. Early diagnosis and proper interventions can help in decreasing the rate of post stroke depression especially in women, hence, the quality of life and expectancy of life will increase in these patients.

---

Background and purpose: The most important underlying cause of death in diabetic patients is the lack of self-care. One way to assess self-care skills in diabetic patients is the measurement of glycated hemoglobin (HbA1c). Different training programs are implemented to improve self-care behavior, however, the role of nurses in such trainings and counseling is neglected. The aim of this study was to compare the effect of group education versus group counseling for self-care on HbA1c in patients with diabetes type II. Materials and methods: In a clinical trial, 112 patients with type II diabetes mellitus attending Mashhad Parsian Diabetes Clinic in 2014 who were selected by convenience sampling. They were randomly allocated into three groups, counseling (n= 37), education (n = 37) and control (n= 38). Group counseling and group education were held for five sessions (1.5 hours each) every three days, in groups consisting of 8 to 10 patients. HbA1c test was performed before and two months after the intervention. Data was analyzed in SPSS V. 11.5 applying Paired sample T Test and ANOVA. Results: The groups did not show any significant differences in HbA1c levels before the intervention (P=0.133). But after the intervention, the HbA1c levels decreased significantly in patients who had group counseling (8.3±0.9) and group education (8.5±1.1) compared to the control group (9.1±1.4) (P=0.016). Conclusion: This study showed that group education and group counseling improved self-care behaviors in patients with diabetes, therefore, they could be highly beneficial when integrated into an educational program.

---

Background and purpose: Kidney transplant is the most cost-effective strategy in treatment of patients with kidney failure. But allograft dysfunction is still discussed as one of the main problems in these patients. The aim of this study was to identify the factors associated with the development of complications after kidney transplant. Materials and methods: This correlation- descriptive study was performed in kidney transplant recipients (2002-2006) in Mashhad Imam Reza Hospital. Data was recorded in a researcher-made check list including type of dialysis, history of dialysis, cause of kidney disorder, donor kidney anatomy, parathormone hormone level, and complications after kidney transplant including length of hospitalization, urinary infection, and post-renal transplant diuresis. Results: The results showed relationships between age of recipients and wound infection, donor kidney anatomy with lynfocel, deceased or live donor with length of hospitalization, and post-renal transplant diuresis with acute tubular necrosis. We found relationships between history of transplant with length of hospitalization, lynfocel, and acute tubular necrosis. Also, a significant correlation was found between history of dialysis with length of hospitalization (B=0.153, P=0.002) and acute tubular necrosis (B=-0.137, P=0.002). Moreover, there was a significant association between parathormone hormone level with length of hospitalization and post-renal transplant diuresis (B=0.473, P= 0.004 and B=0.398, P=0.011, respectively). Conclusion: Old age recipients, high frequency of dialysis, low level of parathormone hormone, deceased or live donor, and donation of right kidney were amongst the main factors in development of post-transplant complications.

---

Background and purpose: Cyclophosphamide (CP) is a chemotherapy drug extensively used as an antineoplastic agent in treatment of various cancers. However, it is known to cause several adverse effects including reproductive toxicity. Achillea millefolium (AM) is a medicinal plant with potential antioxidant properties. The aim of this investigation was to evaluate the effects of different doses of AM extract on body weight, sperm parameters, and apoptotic changes in CP treated mice.

Materials and methods: Sixty four male NMRI mice were arranged into 8 groups. Group1 received normal saline, and groups 2, 3 and 4 received AM extract in low, medium and high doses, respectively. Group 5 received CP and groups 6, 7 and 8 had low, medium and high doses of Achillea millefolium extract, respectively plus CP. Treatments were continued for 35 days. Afterwards, the animals’ weight, sperm quality and apoptosis rate were evaluated.

Results: CP decreased body weight and testicular weight, imposed negative effects on sperm parameters and increased sperm apoptosis compared to the control group. The high-dose of AM produced deleterious effects. Medium doses of the extract did not show any significant effect, but low dose of the extract was able to compensate the toxic effects of CP.

Conclusion: In this study, AM had dose-dependent manner. In other words, at low dose it prevented CP toxicity, in medium dose it had no effect, but in high dose it improved CP toxicity.

---

Background and purpose:The emission of hydrogen sulfide (a malodorous and toxic pollutant) into the atmosphere is considered a public health concern due to its potential hazardous effects on human health. Therefore, the removal of hydrogen sulfide from polluted air streams is of paramount importance. This study aimed to evaluate the role of a polyurethane foam/palm fiber-based biofilter in the removal of hydrogen sulfide.

Materials and methods:Air stream containing H₂S was introduced into the biofilter at a flowrate of 7 L/min and an empty bed retention time (EBRT) of 47 seconds. The inlet and outlet concentrations of H₂S were measured. Moreover, the amount of sulfate and pH in bed, leachate from the biofilter and pressure drop along the biofilter height were monitored.

Results:In this study, the biofilter provided 100% removal efficiency for inlet H₂S concentration of 288.0 mg/m³ at EBRT of 47 seconds. The maximum elimination capacity (EC_max) of the biofilter was 24.1 g/m³.h at a loading rate of 28.0 g/m³.h, corresponding to a removal efficiency of 86.1%. As the elimination capacity of H₂S increased the sulfate content of packing bed increased to 10.8 mg/g bed and the pH reduced to <2.1. The pressure drop along the biofilter column remained <5 mm throughout the operational period.

Conclusion:The polyurethane foam/palm fiber mixture could be considered as a potential biofilter carrier, with low-pressure drop, to treat air streams containing H₂S.

---

Background and purpose: Traumatic brain injury (TBI) is a public health problem around the world. The Glasgow Coma Scale (GCS) and Full Outline of Unresponsiveness (FOUR) score are the most common tools in this patients. This study aimed to assess time-related GCS and FOUR scores evaluation in predicting outcome in TBI patients.

Materials and methods: The present prospective cross-sectional study was conducted on 120 TBI patients admitted to an intensive care unit. GCS and FOUR scores were evaluated in four times, including the first hour, and then 24, 48, and 72 hours later. For the analysis of data, SPSS V. 22 and MedCalc v13 were used. The receiver operating characteristic (ROC) curve, sensitivity, specificity, and positive and negative predictive values of GCS and FOUR score were evaluated to predict the patients' outcome. Patients' outcome was measured two weeks after hospitalization and for patients who were discharged earlier than this time the evaluation was done at the time of discharge using modified Rankin Scale (mRS).

Results: Sensitivity and specificity of the FOUR score in predicting the outcomes were 80% and 84.4% at first stage, 83.6% and 92.2% at second stage, 83.2% and 92.2% at third stage, and 96.4% and 79.7% at fourth stage, respectively. These values for the GCS were 81.8% and 90.6% at first stage, 87.3% and 93.8% at second stage, 85.5% and 93.8% at third stage, and 87.3% and 93.8% at fourth stage, respectively

Conclusion: Time-related GCS and FOUR scores evaluation did not have a considerable effect on predicting the outcome in this patients.

---

Background and purpose: Among different cancers, breast cancer has a high prevalence among women and radiotherapy is used as a treatment modality in which radio sensitizers are used to increase its efficiency. Nanoparticles are such sensitizers that enhance the efficiency of radiotherapy via creation of free radicals and induction of oxidative stress. This study aimed at evaluating the synergistic effect of radiation therapy and TiO₂ nanoparticles on animal models of breast cancer.

Materials and methods: After induction of breast adenocarcinoma tumors in Balb/C, the animals were divided into several groups as control, rutile and anatase injections at 5mg/kg and 10mg/kg doses/with and without radiotherapy. Then, the efficiency of treatment was evaluated. 

Results: In groups receiving anatase nanoparticles with and without radiation, the values for tumor volume, relative volume and relative volume percentage showed a small increase and a considerable reduction, respectively. In rutile groups with and without radiation, these values showed a small increase and a considerable increase, respectively. IR value reduced to negative value and then increased to zero and positive in anatase groups with and without radiation. This parameter had little changes in rutile groups with and without radiation.

Conclusion: Titanium dioxide nanoparticles increased sensitivity of tumor cells to radiation therapy due to ROS production. Compared with rutile crystals, anatase crystals have intense effect because of having a larger surface area and higher photocatalytic activity.

---

Background and purpose: Atrazine causes some biological effects including atresia in ovarian folicules. Essense and aqueous extract of Achillea milifolium and vitamin E are important due to prevention of atresia. Therefore, the effects of these substances were evaluated in ovarian tissue.

Materials and Methods: 42 adult female rats were used. 1^st and 2^nd groups were received atrazine at rates 300 mg/kg/day and 150 mg/mg/day respectively. 3^rd and 4^th groups were received atrazine at rates 300 mg/kg/day and 150 mg/mg/day respectively along with 150 mg/kg/day water extract of A. milifolium. 5^th and 6^th groups were received atrazine at rates 300 mg/kg/day and 150 mg/mg/day respectively along with 100 mg/kg/day essence of A. milifolium. 7^th and 8^th groups were received atrazine at rates 300 mg/kg/day and 150 mg/mg/day respectively and on first day 150 mg/kg a single dose of vitamin E. Microscopic sections were prepared from ovaries. Data were statistically analyzed.

Results: Histomorphometric studies revealed that, the severity of changes in untreated groups with essence and aqueous extract of A. milifolium were more than those groups had been treated with these substances. The results showed highly significant differences (p< 0.001) between treated and untreated groups. The most follicular rescue was in groups treated with aqueous extract of A. milifolium.

Conclusion: The essence and aqueous extracts of the A. milifolium and vitamin E is effective in reduction of adverse changes of ovarian follicles following atrazine exposure. 

---

Background and purpose: Postpartum depression is a serious preventable problem with various effects. According to previous studies, 44% of mothers with infants in neonatal intensive care units (NICU) show emotional symptoms such as depression and restlessness. Religion has always been regarded as a complementary approach and praying is usually used by people in harsh conditions. The aim of this study was to evaluate the role of prayer on depression in mothers with premature infants admitted to NICU.
Materials and methods: In a clinical trial, 60 mothers of premature infants were randomly divided into a control group (n=30) and an intervention group (n=30). In the intervention group a prayer program was conducted for mothers one day after NICU admission for 7 days. Data was collected using a demographic questionnaire, SCL90 scale, DASS 21, and the Prayer Questionnaire. Data was analyzed in SPSS V11.5 applying Independent t-test, Mann-Whitney U, Paired t- test, and ANOVA.
Results: The two groups were homogenous for all demographic factors (mother’s age, type of delivery, gravidity, number of childbirth, abortion, number of children, etc.) and that of the neonates (gender, Apgar Score, etc.) except infant birth weight (P=0.045). At the end of the intervention, there was no significant difference between the two groups in depression score (P=0.118) but one month later the scores revealed a significant difference between two groups (P=0.047).
Conclusion: Prayer can be effective in prevention of depression in mothers with premature neonates.
 

---

 The cell culture technique is one of the tools used in cellular and molecular biology such as cancer cell culture, regenerative medicine, and drug discovery. In recent years, three-dimensional (3D) cell culture has gained attention in cancer research. Scaffolds are porous structures that are used in 3D cell culture to mimic the 3D architecture of tissues and provide more accurate information about tumor cells, extracellular matrix (ECM), and tumor characteristics. These scaffolds are based on synthetic polymers or ECM components and can promote the signaling pathways, survival, and proliferation of cancer cells. Natural and synthetic polymers, hydrogels and microspheres can be used to make 3D scaffolds. 3D cancer cell culture technology can improve cancer treatment. This review article discusses recent advances in the field of scaffold-based 3D models in cancer tissues.
 

---

Do Children of Mothers with Depression During Pregnancy and the First 12 Months Postpartum Face a Higher Risk of Lower IQ? A Review of the Best Available Evidence