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Background and purpose: There has not been enough attention towards the domains of development in pediatrics,so there are many deficiencies in monitoring the achievement of developmental milestones in our country. One of the important ways for the improvement of this problem is to use screening method. PEDS questionnaire is one of the screening tools for development. The aim of this study was to investigate about parents' evaluation of developmental status for their children.
Materials and Methods: This was a cross-sectional descriptive study. The population included infants and children under the age of 6 in day care centers of Sari. Sampling method was clustering. The tool for data collection was PEDS questionnaire (Parents' Evaluation of Developmental Status) which consisted of 38 questions about demographic data and medical history of children as well as parents' concern about different developmental domains along with ''Yes'' , ''No'' and ''little'' answers. The data were analysed using SPSS11 software. Chi square and Wilcoxon were used. P<0.05 was considered significant.
Results: Out of 829 questionnaires, 736 were returned (88.7%). The Sample age was 4.23 ± 1.32 gl . Fifty percent of participants were male. By average, in each developmental domains, 3.2% of parents had major concern and 9.5% had partial concern. The most common domains of concern were communication with others (6.4%), behavior (6.1%), speaking (4.3%), preschool and school education (3.1%), children's understanding (2.5%), the self care (2.1%), the use of fingers (1.4%), the use of legs and arms (1.1%). Parents' concern had a significant relationship with parent's education, residence and history of illness in children (P<0.05). Out of 23.4% of the infants and children who had later returned to the diagnosis center, 80% had behavioral disorder, 87.6% had speech disorder and 16.6% had hearing impairment..
Conclusion: A considerable percentage of parents was concerned about developmental domains of their children, but follow up at referral centers was low. Parents' concern led to the diagnosis of an illness for a child in most cases.

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Background and Purpose: Conventionally, the architecture of the artery wall is based upon the close-packed smooth muscle cells, endothelial and adventitial cells in both sides of internal elastic lamina (IEL). However, the adventitia and endothelium are now viewed as key players in vascular growth and repair. Recent work raises fundamental questions about the cellular heterogeneity of arteries, time course, triggering of normal and pathological re-modeling.
Materials and Methods: Twelve wild type mice were employed. After killing with CO2 inhalation, dissected mesenteric arteries were removed and cleaned with adipose tissue. Arteries were mounted in the perfusion pressure myograph under normal pressure (70mmHg) in Kreb’s solution, which bubbled with 95% O2 and 5% CO2 to pH 7.4, at 37°C. After staining with fluorescent ligands (Syto 13) for nuclei and (DIO 1µM) for cytoplasm, arteries were scanned with the Laser Scanning Co focal Microscopy (LSCM) under (488nm/515nm), (484nm/501nm) and (543nm/580nm) Argon-Helium ion laser wavelength.
Results: Three dimensional images of computer observation suggest that there may be a close relationship between the helical organization of smooth muscle cells and the underlying pattern of endothelial cells (myoendothelial connection).
Conclusion: Tight junctions between cells must be broken and remade during the remodeling process. This suggests a carefully controlled defensive structure for intra-cellular connections, that is capable of withstanding the acute stresses of normal function, but which must be capable of modification to adapt to a new state, when the bio-physical conditions dictate. Endothelial mosaicism related to spiral arrangements of underlying smooth muscle cells, are associated with the functional cell connections. Taken together, these issues provide an exciting new phase in understanding the physiological modeling of the vascular wall, producing a new view of the dynamic nature of vascular structure.

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Background and Purpose: To compar the efficacy of lithium carbonate &sodium valproate in treatment of bipolar children and adolescents in acute phase (mixed &mania) in 6 week treatment at Roozbeh hospital .
Materials and methods: A double-blind & randomized controlled clinical trial in 30 patient (8-18 years) for a 6 week trial .patients were diagnosed based on DSM_IV criteria through clinical interview & K_SADS .MRS & CGAS were used to measure the severity of symptoms and the level of functional impairment .patients categorized into 2 groups randomly.
Results:In both groups means of MRS decreased (at the end of 3rd&6th weeks) and there was no significant difference between two groups. Means of CGAS had significant difference between two groups at 3rd week (p

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Background and purpose: Attention Deficit Hyperactivity Disorder is one of the most common psychiatric disorder of children and adolescents .studies show that depression and other psychiatric disorders are common in families having children with ADHD. Maternal depression affects the prognosis of ADHD. Therefore assessment and management of depression in mothers can play an important role in treatment and prognosis of children with ADHD. Methods: 100 cases of children referred to psychiatric clinic for children were selected .Diagnosis of ADHD were based on DSM-IV-TR and Kaner’s parental scale. Beck’s questioner was used for assessment of mothers’ depression. Results: Prevalence of mothers' depression was 40 %. (32% = mild, 7%= moderate, 1%=severe). The most common symptoms of depression were lack of energy (77%), decreased libido (70%), lack of self satisfaction (62%), difficulty in making decision (57%), guilt feeling (54%), feeling penalties (42%), loss of interest in other people (30%). Conclusion: Findings showed that depression in mothers of children with ADHD is more common than general population of women. Correlation between depression and mother’s academic level was statistically significant. Mothers with higher academic level, have milder depression than others. there is not a significant statistical difference in mothers' depression between two groups of children who received drug for ADHD and those who did not. The number of depressed mothers in the second group were higher than in the first one though

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Background and purpose: Impact of peer education on transformimg the health of sensitive information, such as HIV among adolescents has been shown but there were no studies on its effects on the transmission of insensitive information. Materials and methods: The experimental study on 885 ninth-grade students in 10 schools, from school girls in Tabriz (selected randomly quota) was in 2012 was. Schools equally, randomly matched in each of the training groups were directly or peer. Data collecting tools include a questionnaire containing demographic data and 18 questions to assess knowledge and 6 questions to assess practice. Knowledge and performance of students at baseline and three months after the intervention, and the distribution of iron in the samples was measured. And individual scores range from 0-100 score was calculated. Data using software SPSS.version13, Independent and paired t- test analysis were performed. Results: Mean knowledge score after training in peer education groups increased from 50/1 to 69.7 and in the direct teaching increased from 54.5 to 70.5, (P<0.001 in both groups). Average rating practice after training in peer education groups increased from 41.7 to 46.4 and in the direct teaching increased from 44.5 to 46/4 (P<0.05 in both groups). Compare before and after intervention in both groups showed. Effective peer education and awareness training direct enhance performance scores after the intervention than before it has been and this increase was significant points (p<0.05). Conclusion: Peer education can be an effective approach to increase student’s knowledge and practice in iron deficiency and using iron supplement. So this training method is simple and inexpensive to use in schools to promote adolescent health. Lack of satisfactory performance in both groups after the intervention, further studies on the causes of and intervention studies are necessary to improve performance in this area.

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Background and purpose: Nowadays delivery of unnecessary medical interventions has led to adverse outcomes in mother and infant. This study compared maternal outcomes in nulliparous women in labor, in two methods of physiological and traditional delivery. Materials and methods: This single blind clinical trial was performed in 370 nulliparous mothers in Talesh Shahid Nooraani Hospital. The subjects were randomly assigned into physiological and conventional delivery (group A and B) through RandList. The intervention for both group included aromatherapy, pelvic exercises with ball, back and stomach massage during contractions using Lavandula oil, and an accompanying person in active phase of labor. The data was collected through observation and interviewing the mothers using a checklist of five parts including: profile of subjects and assessment of first, second, third, and fourth stages of delivery and also ten days after delivery. T-test and chi-square were used in SPSS (ver13) to analyze the data. Results: The rates of cesarean section in groups A and B were 11.4% and 35.1%, respectively (P<0.05). The incidence rate of infection was significantly lower in group A (5.9%) compared with that of the group B (14.1%) (P<0.05). Conclusion: Attention to the physiological process of labor and avoiding unsuitable medical interventions could reduce maternal outcomes. Therefore, prenatal care educations could inform the mothers about normal delivery process.

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Background and purpose: Proteinurea is the commonest symptom of chronic kidney disease. The most risk factors for proteinurea are diabetes and hypertension. Other researchers showed that serum level of some metals might change in proteinurea. In this study we checked the changes of zinc and copper serum concentration in non-diabetic proteinuric patients. Materials and methods: This case-control study was performed during 2010-2011 to compare the zinc, copper, iron and selenium serum level in two groups, including 46 cases of healthy control group and 46 cases of non-diabetic patients with proteinurea which were matched for age and sex. The levels of metals (Zn-Cu) were analyzed by atomic absorption spectrophotometer. The data was analyzed with SPSS software using independent-sample t-test and Pearson correlation coefficient. Results: The number of female cases was 26 and male cases were 20 in each group. The mean serum level of Cu in healthy women was 1.167±0.46 and in patient women was 1.232±0.58. These mean numbers were 1.142±0.43 and 0.962±0.46 for healthy and patient men, respectively. The mean serum levels of Zn in healthy and patient women were 1.201±0.38 and 0.918±0.43, respectively. These mean numbers were 1.163±0.35 for healthy men and 0.828±0.503 for patient men. Significant decrease was observed in serum Zn and Cu level in patient group compared with healthy group (p˂0.05). Conclusion: This study revealed that the cause of reduction in zinc and copper plasma concentration in proteinurea could be the excretion of protein and albumin from urine. Therefore, edema, disturbance in oxidative process, and renal disorders might occur.

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Background and purpose: Attention deficit hyper activity disorder (ADHD) is a serious disorder for childhood and adolescents that disables and retards the patient in social relationship. This research aimed to determine the prevalence of ADHD in High-School Students of Sari, Iran. Materials and methods: In this cross-sectional description-analytical study, the study population was 14-17 years old students of high-schools in Sari town. The data-collection tool was Conners parent questionnaire completed by the students’ parent after sending their home. The collected data were analyzed using SPSS software. Results: The mean age of the cases was 15.8 ± 2.1 years. The prevalence of the ADHD prevalence was 14.2% the prevalence in boys was more but the difference was not significant. Conclusion: Considering the prevalence of ADHD in Sari, the screening, treatment and follow-up programs should be planned to improve the situation.

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Background and purpose: Extended Spectrum Beta Lactamases (ESBLs) are one of the most important health care issues all over the world. Uropathogenesis are responsible for life threatening infections in children. In this study we aimed at investigating the epidemiology of CTX, TEM and VEB genes in pediatric UTI.

Materials and methods: Urine samples were collected during six months in Sari Bou Alisina Hospital. The samples were inoculated onto 5% blood agar and MacConkey’s agar and the E. coli isolates were identified by standard methods. Minimum inhibitory concentration (MIC) of fourteen routine antibiotics was determined by agar dilution method. Resistance to Cefotaxime and ceftazidime was considered as ESBL producing bacteria. These isolates were then tested by Polymerase Chain Reaction (PCR) for the presence or absence of CTX, TEM and VEB beta-lactamase genes.

Results: Of 327 E. coli uropathogen, 100 (30.5%) were identified as ESBL producer. The ESBL-producing E. coli isolates were susceptible to carbapenems (66%) and amikacin (58%). The most prevalent ESBL genes were TEM (49%) following CTX (28%) and VEB (8%). TEM negative ESBL, were significantly more resistant to cefotaxime, ceftriaxone and amikacin (P< 0.05). VEB-producing strains were significantly more resistant to ceftazidime (P< 0.05). ESBLs were associated with resistance to cefixime, colistin and cefepime.

Conclusion: Regarding the high level of resistance to broad-spectrum antibiotics, more rational prescribing, empiric therapy assessment and TDM of broad-spectrum antibiotics are recommended.

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Background and purpose: Damage caused by ischemia/reperfusion (I/R) is one of the major causes of liver failure during surgeries. Endothelin as the main vasoconstrictor has two receptors; ET_A and ET_B. Increased number of ET_B during ischemia-reperfusion, reduces tissue damages by sinusoidal dilation. This study investigated the effects of dexamethasone against liver endothelial glycocalyx injury and ET_B receptor gene expression during hepatic ischemia/reperfusion in rats.

Materials and methods: Thirty two male Wistar rats were divided into four groups; a SHAM-operated group that received normal saline, DEX; which had dexamethasone injection (10 mg/kg), the I/R; received normal saline during ischemia/reperfusion, and the DEX + IR with I/R that received dexamethasone (10 mg/kg, 60 minutes before ischemia and immediately after reperfusion). After 1 hour of ischemia and 3 hours of reperfusion the blood samples and liver tissues were collected. The relative gene expression of ET_B was assessed by real time PCR. Serum samples were used to measure the level of ALT and AST and hyaluronic acid (HA).

Results: The level of ALT, AST and HA significantly increased in I/R compared with those of the SHAM-operated group (P<0.001). Injection of dexamethasone in the DEX+IR caused a significant reduction in serum indicators compared to those of the I/R group (P<0.001). Elevated ET_B receptor gene expression reduced by dexamethasone injection (P> 0.05).

Conclusion: Dexamethasone decreased ET_B receptor gene expression during liver I/R. In addition, it significantly protected the parenchymal cells and sinusoidal endothelial glycocalyx. Therefore, dexamethasone could play an important role in reducing liver injury during I/R.

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Branchio-oculo-facial (BOF) is a rare genetic disorder inherited as an autosomal dominant trait resulting from maldevelopment in the branchial arches. This paper presents a case of sporadic BOF for the first time in Iran. He was 2 years and 9 months old that was born in the first pregnancy (normal birth). His parents were healthy and they were 3rd degree relatives. The patient had normal intelligence. His obvious symptoms were holes in both sides of the neck (he had surgery at 6 months of age), broad nasal bridge, nasal duct obstruction, pseudocleft of the upper lip, submucos cleft palate, microphthalmia, and squint eye (more dropping in right eye). He also had hypernasal speech. This rare syndrome is accompanied with different anomalies, and physical and mental disorders, therefore, a team of specialists is needed in treatment of such patients. 

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Background and purpose: Painful stimulation during laryngoscopy and endotracheal intubation results in increased hemodynamic side effects. The aim of current study was to compare the effects of intranasal dexmedetomidine and remifentanil on reduction of hemodynamic changes following endotracheal intubation in children undergoing general anesthesia.
Materials and methods: A double-blind clinical trial was performed in 104 children aged 6-12 years old, undergoing general anesthesia in Isfahan Imam Hossein Hospital, Iran, 2017-2018. Patients were randomly assigned into three groups to receive intranasal (IN) remifentanil 4µg/kg, dexmedetomidine 2µg/kg (IN), or normal saline 1mL, 0.9% (IN) before the induction of anesthesia. Hemodynamic changes were recorded at one and five minutes following intubation. ANOVA and Chi-square were applied to analyze the data.
Results: Heart rate was higher in patients receiving normal saline and lower in patients
receiving dexmedetomidine (p=0.22). Mean arterial blood pressure (p=0.98) and arterial oxygenation (p=0.81) were not significantly different between the three groups. No significant side effects were observed in any group.
Conclusion: Administration of pre-intubation intranasal dexmedetomidine, results in heart rate stabilization following intubation.
 
(Clinical Trials Registry Number: IRCT20160301026866N7)
 
 

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Background and purpose: Attention deficit hyperactivity disorder (ADHD) is the most common psychiatric disorder in children that affects the health of parents. The aim of this study was to determine the effect of mindfulness education on psychological capital of parents of ADHD children.
Materials and methods: This semi-experimental study was of pretest-posttest control group design which was carried out in 80 parents of ADHD children. The participants were selected using convenience sampling from Sari Zare Clinic, Iran, 2018. They were randomly divided into intervention group (n=40) or control group (n=40). Mindfulness education was done in 8 sessions of 90 minutes twice a week for the intervention group. Data were collected using demographic questionnaire and Luthans psychological capital questionnaire. Data were analyzed using Chi-square, t-test and covariance test.
Results: Before and after the intervention, significant differences were found between the mean values for psychological capital (60.65 ± 7.61 vs. 80.58 ± 7.59), hope (15.86 ± 3.37 vs. 21.36 ± 3.37), resilience (14.34 ± 2.85 vs. 19.34 ± 2.68), optimism (15.65 ± 2.70 vs. 20.22 ± 2.76), and self-efficacy (15.2±2.35 vs. 19.89±2.59) in intervention group. The scores after the intervention showed the significant effect of mindfulness education on psychological capital of parents of children with ADHD (P <0.05).
Conclusion: Mindfulness education is recommended to increase the psychological capital and its dimensions in the parents of ADHD children

 

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 Background and purpose: Human papillomavirus (HPV) infection is the main cause of cervical cancer. Awareness of the prevalence of different HPV genotypes in Iran will facilitate implementation of national prevention and vaccination programs. The aim of this study was to investigate the prevalence of HPV infection and the association of different genotypes with Pap smear results.
Materials and methods: In this cross-sectional study, 502 married women attending Central Laboratory of Academic Center for Education, Culture, and Research in Mashhad were selected by non-probability easy sampling in 2018-2019. Cervical cytology specimens were examined for 32 different HPV genotypes using PCR and hybridization. Descriptive statistics, Chi-square and Fisher's exact tests were used to analyze the data.
Results: Out of 502 samples 26.5% were infected with HPV. The most common genotypes in all HPV+ samples were the low risk genotype 6 (35.3%) and the high risk genotype 16 (17.3%). According to findings, HPV infection and the HPV genotype were significantly associated with progression of cellular changes to abnormality (P<0.05).
Conclusion: Due to the high prevalence of HPV in population studied, earlier diagnosis and genotyping of HPV could be helpful in preventing cervical malignancies.

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Background and purpose: Systemic conditions, such as diabetes or cardiovascular disease are associated with periodontal disease. Recent studies suggested a link between periodontitis and gastrointestinal cancers. Due to the importance of this issue, this study aimed to evaluate the prevalence of chronic periodontitis in patients suffering from gastric, esophageal, and colorectal cancers attending Sari Imam Khomeini Hospital, 2017-2018.
Materials and methods: In this cross-sectional study, clinical examination of 100 patients was performed by assessing clinical attachment loss (CAL), bleeding on probing (BOP), and tooth loss. After recording the periodontal pockets' depth and gingival recession, the CAL was calculated. Chronic periodontitis was categorized as mild, moderate, and severe based on classification of periodontal disease. Chi-Square and ANOVA were applied for data analysis.
Results: According to findings in patients with gastric cancer (n= 23) mild, moderate and sever periodontitis were seen in 8.7%, 26.1%, and 26.1%, respectively. There were 10 patients with esophageal cancer of whom 40% were healthy, 40% had moderate periodontitis, and 20% had severe periodontitis. Among patients with colorectal cancer (n=67), 7.5% had mild periodontitis, 46.3% had moderate periodontitis, and 1.5% had severe periodontitis.
Conclusion: In patients with moderate to severe chronic periodontitis, due to the loss of periodontal support of the teeth that leads to loosening the teeth, the chances of tooth loss increase which naturally disrupts the patient's eating process and causes digestive problems.

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Background and purpose: Human papillomavirus (HPV) often infects humans through sexual contact. Men are carriers of the HPV virus and inadvertently transmit the virus to their sexual partners while being asymptomatic. In many countries strategies are focused on controlling the virus in women and the role of men is ignored. The aim of this study was to determine the prevalence of HPV infection and its common genotypes in men in order to facilitate designing and implementing national prevention programs.
Materials and methods: In this cross-sectional study, PCR and hybridization methods were used to determine 37 different HPV genotypes. The participants included 188 men attending Central Laboratory of Academic Center for Education, Culture, and Research, Mashhad Branch between autumn 2020 and winter 2021.
Results: In this study, 56.9% of the total population were infected with at least one of the HPV genotypes. Overall, 26 different HPV high-risk and low-risk genotypes were identified. The most common low-risk genotypes were HPV6 (50.5%), 11 (15%), 42 and 91 (11.2%). The most common high-risk genotype was HPV66 (9.3%).
Conclusion: Men play an important role in transmitting the virus and are considered as the reservoir of HPV infection. The prevalence of HPV was high in current population, therefore, HPV screening in men can be very helpful in preventing the spread of infection.
 

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Background and purpose: Healing burn wounds is considered to be a prominent medical issue, and the identification of a drug or substance that can effectively heal these wounds with minimal side effects is of great importance. The aim of the present study was to investigate the anti-inflammatory, antioxidant and restorative effects of the glandular sorrel plant on the experimental burn wound model in BALB/C mice.
Materials and methods: In this experimental-laboratory study, a total of 60 BALB/C mice were randomly assigned to 5 groups, each consisting of 12 mice. These groups included the control group, the cold cream sham group, the cream group containing the extract of the glandular sorrel plant, the Laagex cream group, and the group of the glandular sorrel leaf group. After second degree burns on days 3, 7, 14 and 21, wound healing variables include comparison of wound closure speed, inflammation, vascularization, epithelial regeneration, number of hair follicles, and number of strands. Collagen levels, inflammatory cytokines, antioxidant enzymes and liver enzymes were also examined.
Results: The results of the study indicated that the average inflammation, vascularization, epithelial regeneration, the number of hair follicles, the amount of collagen fibers and also the average of apparent wound closure in the groups treated with the cream containing the extract and leaves of the Rumex Tuberosus L. And Lajex cream has a significant difference (P<0.05) compared to the sham and control groups. In addition, the results showed a significant difference (P<0.05) in the serum level of inflammatory cytokines and antioxidant enzymes in the groups treated with the cream containing the extract and leaves of the Rumex Tuberosus L. and the Lajex cream compared to Sham and control groups. With regard to the liver enzymes, no significant changes were found between the studied groups (P<0.05).
Conclusion: Based on the findings of the study, it can be concluded that the tuberous sorrel plant is very efficient in the treatment of second degree burns and can be a good substitute for the currently available product.
 

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Background and purpose: Antibiotic resistance remains a serious problem for human health and continues to impact patients in hospitals worldwide. Carbapenem antibiotics are frequently used as the last line of treatment for infections caused by Gram-negative bacteria. The primary mechanism of resistance to carbapenems is the production of carbapenemase enzymes. This study aimed to determine the frequency of carbapenemase-encoding genes including OXA-48 and KPC, in antibiotic-resistant Gram-negative bacilli isolated from infectious samples collected from cardiovascular patients hospitalized in the wards of Fatemeh Al-Zahra Heart Hospital in Sari in 2022.
Materials and methods: In this descriptive cross-sectional study, conducted from January 2022 to June 2022, 61 samples were collected from hospitalized cardiovascular patients. All bacterial isolates were identified using standard biochemical methods. The antimicrobial susceptibility pattern of the isolates was assessed using the disc diffusion test (DDT) in accordance with Clinical and Laboratory Standards Institute (CLSI) guidelines. Polymerase chain reaction (PCR) was employed to confirm the presence of OXA-48 and KPC genes.
Results: A total of 61 clinical samples were analyzed. The most frequently collected samples from patients included urine (52.45%), trachea (29.50%), wound (11.47%), and surgical site secretions (3.27%). The most common types of bacteria isolated were E. coli (86.27%), Enterobacter (67.19%), Pseudomonas (67.19%), and Citrobacter (16.39%). Additionally, highest rates of bacterial resistance were observed against ceftazidime (100%) and imipenem (96.72%). The frequency of OXA-48-encoding genes was detected in 8 clinical isolates (13.11%). The bacteria harboring the OXA-48 gene exhibited 100% resistance to ceftazidime and imipenem. In contrast, the KPC gene was not detected in any of the isolates. Among the bacterial species analyzed, the highest frequency of the OXA-48 gene was observed in Enterobacter isolates.
Conclusion: The present study demonstrates that the rate of drug resistance as well as the production of beta-lactamase enzymes, is significantly high in Gram-negative strains, including members of the Enterobacteriaceae family and Pseudomonas aeruginosa. As a result, the management and treatment of infections caused by these bacteria may pose substantial challenges.