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Pulmonary alveolar proteinosis (PÂP) is a rare pulmonary disease and is rarer in children in which abnormal accumulation of surfactant in alveoli, causes pulmonary signs and symptoms which gradually progresses to pulmonary fibrosis and respiratory insufficiency. There are some modalities for treatment of PÂP but its only effective treatment method, is whole lung lavage (WLL) under general Ânesthesia and one lung ventilation. Because of some technical difficulties, it is some times impossible to do one lung ventilation in children to perform WLL hence in these situations the only preffered way for WLL is doing it under cardio pulmonary Bypass (ÇPB). Ïn this report we present 2 pediatric cases with PÂP in whom WLL was done successfully under ÇPB for the first time in ÏRÂN.

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Background and purpose: Despite the introduction of an effective vaccine more than 30 years ago, measles is a public health problem worldwide. This project was designed and conducted to determine the incidence and characteristics of measles cases in Mazandaran province.
Materials and methods : Reported measles cases to the health center for diseases control and prevention from March 2000 to March 2002 were reviewed . Demographic data, vaccination status and the relation in occurrence of the disease and serological confirmation of the reported cases were analyzed. Âge specific incidence rates calculated based on health center census data.
Results : Ïn this period, totally 729 cases (280 females), were reported. From ~ serologically tested cases, 135 were confirmed. Âge specific incidence rates were : 9.2% , 8.5% , 18.4% , 42.7% and 21.2% in each age group of < 1 , 1-4 , 5-9 , 10-19 and > 20 years , respectively . The annual incidence rates were : 7.1 , 11.9 and 12.7 for each 105 population . Âlso 46.5% of the cases occurred in full vaccinated subjects and 39.9% of the cases had not been vaccinated .
Çonclusion: Because of the high incidence rate of measles in unvaccinated 10-20 years old individuals, paying more attention to vaccination status of children at school entry ,increasing vaccine coverage especially for children in suburban areas, case survey, confirmation of reported cases by serological methods and catch-up immunization for increasing immunity are recommended.

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The purpose of this study is to investigate the relationship between stress & time management skills. In this descriptive study, 103 personnel were selected from Sari Health Center, by stratified random sampling, and data was gathered by two questionnaires from samples. Results: There is a significant negative relationship in two component study. Also, females´ stress level was higher than in males. However, these groups did not have a significant difference in time management. Regression analysis showed there is a significant relationship between gender, with stress and time management scores. For reducing stress and increasing organizational productivity, it is recommended to train these skills in orientation and employee training.

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Background and purpose:Leptospirosis is an infrequent zoometric bacterial disease which is caused by pathogenic bacteria called Leptospira. The risk factors of the disease include living in tropical and rural areas, contact with contaminated water, living near sewers and sanitation work. The disease may cause symptoms such as chills and fever, severe headache and myalgia. Costal region of Caspian Lake has desirable conditions for occurrence of this disease. The aim of this research is to study this disease in the North of Iran, by using and analyzing a 6-year set of recorded cases in Mazandaran province between 2003 and 2008, that provides more completed information.
Materials and methods: This study is a descriptive, retrospective (case series) study. All of the recorded information concerning to patients with leptospirosis in Mazandaran Health centre from 2003 to 2008 were collected and checklist forms were completed, followed by data related to three characteristics including patients, living conditions and then the disease was analyzed.
Results:Of the 102 patients, 76.5% were males, 46.6% were farmers and the mean age was 48.8 + 15.5. The prevalence of the disease was at the highest in 2007 and in summer seasons. The most common symptoms were fever (74.5%), myalgia (68.6%) and icter (47.1%). The greatest number of the cases was from Ghaemshahr city (37.3%), the majority of the cases (88.2%) had history of working farm. Over-all, 97.1% of the patients were cured.
Conclusion: According to the findings, leptospirsis affects farmers in their working season in Mazandaran province. It is necessary to provide information to the medical practitioners, especially general practitioners and also, to develop diagnostic and therapeutic facilities in the province.

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Background and purpose: Tuberculosis is an acute/chronic, infectious and necrotizing disease involving different organs of the body, particularly the lungs. Since controlling, screening, and treatment of people infected with smear positive pulmonary tuberculosis has been highlighted in national and global objectives, this study aimed at conducting an epidemiological investigation of smear positive pulmonary tuberculosis patients and describing and analyzing the conditions to provide efficient suggestions to improve the status quo. Materials and methods: The present study described and analyzed the existing data. A checklist consisting of variables such as age, gender, nationality, place of residence, results of mucus smears at the beginning, at the end of the second month and at the end of the treatment, was used for data collection. Descriptive statistics and univariate and multivariate regression of the collected data were carried out using Excel and SPSS 16. Results: The total number of identified tuberculosis cases during the study were 1296 among which 48.2 percent were smear positive pulmonary tuberculosis, 24.5 percent were smear negative pulmonary tuberculosis and 27.3 percent suffered from extra-pulmonary tuberculosis. The incidence of smear positive pulmonary tuberculosis was 4.3 in one hundred thousand people. It was shown that 57.5 percent of the identified smear positive pulmonary tuberculosis was males, while 42.5 percent were females the mean age of the participants was 49.67 ± 21.60 years. Conclusion: Epidemiological pattern observed in this study was consistent with other similar studies. In order to achieve the millennium development goal (50 percent decrease in tuberculosis prevalence and eliminating the disease up to the year 2050), and the national goals of tuberculosis controlling program, it is suggested that educating, screening and on time treatment of the smear positive pulmonary tuberculosis patients be considered at all levels of the health network as well as private sectors and physicians' offices.

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Abstract Background and purpose: Video-assisted thoracoscopic surgery (VATS) has been developed as a minimally invasive alternative approach for various diagnostic and therapeutic thoracic operations that previously required open thoracotomy. Postoperative pain is less after VATS than after conventional thoracic surgery, yet its relief is still important. The purpose of this randomized double blind clinical trial was to compare the effect of interpleural morphine analgesia with traditional intravenous morphine administration on pain and supplemental analgesic usage after VATS. Materials and methods: Thirty patients of class I and II of American Society of Anesthesiologists when underwent VATS under general anesthesia were randomly divided into two equal groups. By the end of the operation, a catheter was placed in the pleural space under thoracoscopic vision. Patients received a single bolus of 0.1 mg•kg-1 of morphine either interpleurally or intravenously. During the first 8 hours after operation, pain score at rest and on coughing, supplemental analgesic requirements, mean arterial pressure, heart rate, arterial blood oxygen saturation, degree of sedation, and side effects were monitored every hour. The pain severity was evaluated by visual analogue pain scales (VAS, 0-10). Results: No statistically significant difference was observed between the groups in relation to pain intensity, hemodynamic variables, or side effects during the study. Conclusion: Interpleural morphine did not provide superior analgesia compared with intravenous morphine after thoracoscopic surgery.

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Background and purpose: The incidence of postanesthesia shivering varies between 5 and 65 % and patients report it as one of the leading cause of discomfort after operation. Ït may also induce a variety of physiological consequences such as increased oxygen consumption and cardiac output. This study was performed to find out the incidence of postanesthesia shivering in women and to report the influence of several clinical variables on its incidence.
Materials and methods: This prospective observational study was carried out on 448 female patients who underwent gynecologic operations under general, regional or sedation anesthesia techniques at Tehran Javaheri hospital over a period of 7 months in 2005. The incidence of postanesthesia shivering was assessed in these patients. Âlso, several clinical variables including patients’ demographics, surgical and anesthetic data as well as preoperative and postoperative core temperatures were recorded.
Results: Ôf 448 women, 83 (18.5%) experienced shivering. The minor versus major and moderate operations, as well as the conscious sedation versus general and spinal anesthesia techniques significantly reduced the incidence of postanesthesia shivering. While the use of halothane and N2Ô for maintanance of general anesthesia, and intravenous administration of atropine and prostigmine to antagonize the muscle relaxants, as well as the intraoperative administration of larger volumes of intravenous crystalloid solutions were associated with increased postanesthesia shivering.
Çonclusion: The use of halothane for maintenance of general anesthesia, the intraoperative administration of larger crystalloid volumes and applying spinal anesthesia technique, increase the risk of postanesthesia shivering, while no correlation was found between hypothermia and the occurrence of shivering.

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Background and purpose: HbA1c is one of the best important markers in controlling of diabetic patients. Today, long-term assessment of blood glucose in diabetic patient's takes place by measuring glycosylated hemoglobin (HbA1C) .One of the main causes of death in diabetics is cardiovascular diseases that the increase in blood lipids and atherosclerosis is a major causes of these diseases. The aim of this study was investigated the relationship HbA1C with the Risk factors of blood lipids. Materials and methods: This cross-sectional study on the records of 173 patients with type 2 diabetes (female: 132 and male: 41), which were chosen based on non-probability sampling that mean age were 51.8±11.5 years. HbA1C levels and lipid profile were determined respectively by Column chromatography and enzymatic methods. Values of LDL-C/HDL-C ratio, risk factor (TCH / HDL-C) and Atherogenic Index of Plasma or AIP (Log TG / HDL-C) was calculated. Data were analyzed with statistical software SPSSver.16. Results: TG levels were significantly higher in males and HDL-C levels significantly higher in females, but the other variables did not differ between the sexes. HbA1C was showed a significant direct correlation with the TCH, TG, AIP, LDL-C, and the risk ratio. But there is not significant correlation in age, HDL-C and LDL-C/HDL-C ratio. Conclusion: Our findings indicated that HbA1C levels not only can be used as an indicator of long-term control of blood glucose but also can serve as an early warning of heart complications - cardiovascular disease in diabetics.

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Abstract Background and purpose: In recent years non communicable diseases risk factors such as tobacco consumption, overweight and obesity, high blood pressure, insufficient exercise, and improper diet, which all take root from bad lifestyle, have been increased due to lifestyle change, industrialization and epidemiological transition. Research findings based on epidemiological studies indicate that worldwide prevalent diseases are the result of some risk factors. Hence, this study aimed to determine the frequency of risk factors of the main non communicable diseases among inhabitants of Mazandaran province. Materials and methods: This study was carried out according to step by step approach suggested by WHO among Iranian population of rural and urban regions of Mazandaran province. One thousand individuals (500 male) in fifty strata of twenty and in five age group of 15-24, 25-34, 35-44, 45-54 and 55-64 years were studied. Data on variables such as tobacco consumption, nutrition, exercise, height, weight, and blood pressure were collected by means of observation and interview and were registered in the questionnaires. Data were entered to Epi6 and data analysis was carried out by Stata 11. Results: Mean of BMI was 26.2 kg/m2, 23.8 percent were obese, 16.1 percent had high blood pressure, 10.3 percent were smokers, 26 percent had low exercises and 90.3 percent of them had 5 or less units of daily fruit and vegetables intake. 28 percent of male and 24.9 percent of female were high risk. Conclusion: Five risk factors contributing to non-communicable diseases are of high prevalence in Mazandaran province. Since these risk factors have cumulative effects on each other and almost all of them take root from improper behaviors, so by modifying these behaviors as well as lifestyle change, their prevalence might decrease, which in tarn may cause a significant decrease in cardiovascular diseases, diabetes, chronic obstructive pulmonary disease and cancers.

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Background and purpose: Coronary artery disease (CAD) is the first cause of death in modern societies. It is also the first cause for individual health care cost. Multiple risk factors are mentioned for its development among which elevated uric acid is recently introduced as an inflammatory factor. This study was performed for evaluating the serum uric acid level and severity of CAD determined by coronary angiography in patients with chronic stable angina after considering and adjusting other risk factors such as age, smoking (C.S), hypertension (HTN), hyperlipidemia (HLP) and diabetes mellitus (DM). Materials and methods: This cross-sectional analytic study was performed in 200 patients with chronic stable angina to determine the relationship between the level of serum uric acid and severity of coronary atherosclerosis in angiography. Other common cardiovascular risk factors including age, DM, HTN, HLP and C.S were also considered. Results: A total of 78 women (39%) and 123 men (61%) were included in the study. There were no significant differences between sex and risk factors including DM, HTN, HLP, C.S, age and serum uric acid level. In the studied population, the mean severity of coronary atherosclerosis score measured by Gensini score was 15.8± 10.7 and the mean level of uric acid was 10.5±6mg/dl. Significant correlation was seen in severity of coronary atherosclerosis and level of serum uric acid in the study population (r=0.51, 0.537, respectively P<0.0001). Also, there was significant correlation between coronary atherosclerosis severity and HTN, age, DM and HLP. Multivariate analysis showed 15% contribution of serum uric acid level in developing coronary atherosclerosis. Conclusion: This study showed an independent relationship between serum uric acid level and severity of coronary atherosclerosis.

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Background and purpose: Recommended treatment for patients with carotid stenosis, is Carotid Endarterectomy (CEA) that is more effective in preventing stroke compared to other therapies. The purpose of this study was to evaluate morbidity and mortality rate in patients with carotid stenosis after CEA. Material and Methods: In this descriptive study, 138 patients undergoing CEA admitted in the Shahid Rajaei and Velayat Hospitals in Qazvin were studied. Sex, age, and percentage of stenosis, the cause of surgery and postoperative complications during and after surgery and mortality rates were recorded. Data was analyzed using SPSS 16. Results: Death occurred in three cases of which two were due to loss of consciousness and one was induced as a result of cardiac arrest. These cases also had severe carotid artery stenosis and myocardial infarction. Complication rate was 27.5% (38 subjects) of whom 34 individuals had severe stenosis and four suffered from moderate stenosis. Moreover, 72% of the complications were associated with cerebrovascular attack (CVA). Conclusion: Results showed acceptable rate of mortality and morbidity is after endarterectomy surgery compared to other studies.

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Background and purpose: Presence of extended spectrum β -lactamase (ESBL) genes plays an important role in spreading β -lactam antibiotic resistance in the producing strains of these enzymes. The resistance of gram-negative bacteria, such as Escherichia coli, to different antimicrobial agents, has increasingly been reported. This study was conducted to determine the prevalence of ESBL in Escherichia coli isolates Material and Methods: This analytical cross-sectional study was carried out between March 2013 and February 2014 on 131 bacterial of Escherichia coli which were isolated from clinical patient specimens in general hospitals in Urmia (northwest Iran). The frequency of ESBL producing strains was determined via the combined disk method. The presence of β- lactamase gene of CTX-M-15 in ESBL was assessed by PCR method. Results: clinical presentations of infection were UTI in 108 cases (82.44%), septicemia in 15 cases (11.45%), wound infection in 7 cases (5.34%), and meningitis in 1 case (0.76%). Frequency of ESBL positive in Escherichia coli isolates was 55 cases (41.98%) of which 23.63% were positive for CTX-M-15 β -lactamases resistance gene. Conclusion: The rate of ESBLs producing strains is highly increasing, therefore, using an appropriate treatment protocol based on the antibiogram pattern of the strains is highly recommended

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Background and purpose: Low health related quality of life is one of the most important consequences of diseases. Patients’ believes about different aspects of new situation influences the consequences of illness and their quality of life. This study aimed at investigating the relationship between illness perceptions and quality of life after coronary artery bypass graft surgery (CABG). Materials and methods: In a cross-sectional survey research, 102 patients were studied after CABG in Alzahra Hospital in Shiraz. Patients were selected according to convenience sampling. Illness Perception Questionnaire (IPQ) and global Quality of Life questionnaire (WHOQOL-BREF) were used to collect the data. Results: Significant association was observed between patient’s illness perception and quality of life. Among illness perception subscales, time line (r= 0.501, P< 0.001), causal representation (r= 0.210, P< 0.05), illness coherence (r= 0.210, P< 0.05), personal control (r= 0.467, P< 0.001), treatment control (r= 0.380, P< 0.001), and emotional representations (r= 0.312, P< 0.001) had the most significant correlation with quality of life. Also, quality of life was significantly associated with sex (P<0.001), level of education (P<0.03) income (P<0.001), and occupation (P< 0.001). Conclusion: Illness perception about coronary artery disease has significant effects on disease outcomes and quality of life of patients after treatment. Therefore, psychological interventions focusing on this factor are recommended in involved patients.

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Background and purpose: The purpose of this study was to investigate the effect of family-based cognitive behavioral therapy in modification of self-image associated with obesity in children.

Materials and methods: A randomized controlled trial was performed in children with obesity (BMI ≥ 95^th percentile (aged 8-15 years old. Using convenience sampling, the participants were recruited from Children Hospital and Morsali clinic in Arak, Iran. They were randomly assigned to either the experimental group (n= 15) or control group (n= 15). The children in experimental group received family-based cognitive behavioral therapy (6 group sessions) and their parents attended 5 group sessions. All participants completed Body Parts Satisfaction Scale-Revised (BPSS-R) and Standard Figural Stimuli Scale (SFSS) in pretest, posttest and follow-up. BMI was calculated in all three stages.

Results: Family-based cognitive-behavioral therapy was found effective in improving the body parts satisfaction (P=0.023) and body image satisfaction (P=0.0001). The improvement maintained only in body image at follow-up (P=0.0001).

Conclusion: According to these results, family-based cognitive behavioral therapy is effective in modification of self-image in children.

(Clinical Trials Registry Number: IRCT2014010116029N1)

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Background and purpose: Iran is one of the top ten countries in the world with disaster. Hospitals have a major role in dealing with disaster-related injuries. The purpose of this study was to assess the level of preparedness in Mazandaran province hospitals in dealing with disasters in order to identify the deficiencies and comparing current conditions with national standards.
Materials and methods: In this cross-sectional study, all hospitals affiliated with Mazandaran University of Medical Sciences and Mazandaran Social Security Organization (n=28) were evaluated in 2017. Data were collected using the National Standard Toolkit for Hospital Preparedness. The overall score and the scores for every component were recorded and the level of preparedness were presented according to four levels.
Results: The relative preparedness level of hospitals in dealing with disasters was moderate (65.5%). The overall levels of disaster preparedness in the hospitals affiliated with Mazandaran University of Medical Sciences and the social-security hospitals were moderate (63%) and favorable (75%), respectively. The hospitals affiliated with Mazandaran University of Medical Sciences, were found to have good (n=4), moderate (n=14), and poor (n= 5) levels of preparedness. The hospitals of the Social Security Organization were ranked as good (n=2) and moderate (n=3) in disaster preparedness. 
Conclusion: Most of the hospitals in Mazandaran province, like other regions in Iran, have poor level of disaster preparedness. Therefore, more planning is needed to enhance the hospital’s level of readiness in all dimensions.
 

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Background and purpose: Oral manifestations and their prevalence are of great importance in patients with HIV infection due to their diagnostic value and role on prognosis and monitoring patients’ immunity. All these influence patients' quality of life. The goal of this study was to investigate oral manifestations in patients with HIV/AIDS infection.
Materials and methods: This descriptive-cross sectional study was conducted in patients attending counseling center for behavioral diseases in Sari, Iran 2019. Data analysis was done in SPSS V25.
Results: Oral manifestations were observed in the majority of patients (96%) ranging from one to six oral lesions.  The most common lesions were coated tongue (80.4%), mucosal hyper pigmentation (38.9%), periodontitis (26.8%), frictional hyper keratosis and fissure tongue (24.3%), and gingivitis and erythomatous candidiasis (19.5%).
Conclusion: In this study, the prevalence of oral lesions in patients with HIV/AIDS was relatively low, but there were poor periodontal conditions. Hence, appropriate oral hygiene, providing high quality dental services, and prosthodontic care are needed in these patients.

 

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  Background and purpose: Artificial sweeteners are increasingly used in food products, so, it is necessary to study the effects of these additives on liver.
Materials and methods: In this experimental study, 30 immature male rats were divided into five groups (n=6 per group) and acesulfame k at 50, 100, 200, and 400 mg/kg were injected intraperitoneally to all groups for 30 days. One and 30 days after the last injection, blood samples were taken from the rats' eye, and the levels of FBS, HDL, LDL, AST, ALT, ALP, triglyceride, and cholesterol were measured. A number of rats were dissected in each group and their livers were removed to prepare tissue sections. The slides were examined by optical microscopy and data were analyzed applying ANOVA.
Results: The study showed that acesulfame k for 30 days, at 200 and 400mg/kg caused a significant increase in glucose level (P<0.05) and at 100, 200, and 400mg/kg significantly decreased LDL levels (P<0.001). Also, tissue disorders such as congestion, sinusoid abnormalities, and hepatocytes lysis were observed in liver samples in a dose-dependent manner. However, no significant changes were seen in other factors.
Conclusion: It seems that acesulfame k even at doses greater than 50 mg/kg for 30 days does not cause serious toxicity to immature male rats, due to the lack of changes in most liver factors, and liver tissue disorders may be restored over time.

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Background and purpose: Heart failure (HF) is characterized by decreased ability of the heart to provide sufficient blood flow or fill with the blood. Hyponatremia is the most commonly seen electrolyte abnormality in patients with heart failure that is associated with increased morbidity and mortality. The aim of this study was to assess the correlation between hyponatremia and high risk clinical and echocardiographic features in patients with acute HF.
Materials and methods: This cross-sectional analytic study was performed in 271 patients with acute systolic heart failure admitted to Sari Fatemeh Zahra hospital, 2018-2019. Patients were divided into two groups: hyponatremic and normonatremic groups. Vital signs, echocardiographic variables, body mass index (BMI), and common cardiovascular risk factors were compared between the two groups using SPSS V18.
Results: This study included 130 males (48%) and 141 females (52%) and the patients’ mean age was 69.90±14.02 years. Patients with hyponatremia had lower BMI and systolic and diastolic blood pressure levels and higher platelet counts compared to other group (P =0.01, 0.002, 0.005, and 0.047, respectively). Also, these patients, were found with higher frequency of moderate to severe functional mitral regurgitation (P= 0.076). Linear regression analysis showed hyponatremia as an independent predictor of hypotension and hemodynamic instability in patients with hyponatremia.
Conclusion: This study showed that patients with acute HF and hyponatremia are at higher risk of developing hypotension, cachexia, and increased platelet counts which put them at greater risk for cardiovascular morbidity and mortality.

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  Background and purpose: Pulmonary problem is one of the non-cardiac causes of exertional chest pain in children. The aim of this study was to evaluate and compare pulmonary function in children with exertional chest pain during rest.
Materials and methods: This descriptive analytical cross sectional study was conducted in 200 children aged 10-15 years old in Arak, Iran 2018. The case group (n=100) included children with exertional chest pain and control group (n=100) were healthy children (without exertional chest pain). Respiratory function was assessed using spirometry after complete training and one test session. Data analysis was done in Stata 11.
Results: The mean values for forced expiratory volume in the first second (FEV1), the forced vital capacity (FVC), FEV1/FVC, and peak expiratory flow (PEF) were 3.98±1.56 and 4.31±2.1 L/s, 4.81±2.16 and 5.2±2.8 L, 0.73±0.13 and 0.75±0.11, and 6.89±1.65 and 7.24±1.59 L/m in case group and healthy group, respectively. The values did not show significant differences between the two groups (P=0.209, P=0.272, P=0.242, and P=0.128, respectively).
Conclusion: According to current study, spirometry evaluation in children with exertional chest pain during rest does not seem to be helpful for diagnosis of exercise-induced bronchospasm.