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Background and Objectives: History, clinical findings, procedures undertaken, and patients response to treatment are written in clinical records, hence their contents are indicators of physicians’ evaluation. If clinical records are provided precisely, clear and systematized, they indicate the clinical thinking of the staff and facilitate patients diagnosis process. These records have an important role in coordinating professional staff involved in patient care. Since the physicians and medical students are involved more in medical records documentation than the other hospital staff, thus, a study on their knowledge, attitude and practice towards the principles of medical records documentation is undertaken.
Materials and Methods: This is a descriptive study, which is done about the rate of knowledge, attitude and practice of 207 Medical students of Mazandaran University of Medical Sciences in university hospitals. Descriptive and inferential statistical analytic methods were used for the collected data. For comparison of the hospitals, regarding observing designed principals in the completion of medical files, according to the filled questionnaires the minimum and maximum score designated as 1-5 which is very poor to excellent. Then the mean score was calculated and considered for the comparison of hospitals. For the determination of the relationship between knowledge, attitude, and practice, β Kendall’s Tau Test was used.
Results: The majority of the participants had low knowledge (77.8%) about medical records documentation. Most of them did not have good attitude (54.1) about completion of medical records and significance and value of medical records documentation in treatment, education, and research.
Conclusion: Results indicate that incompletion of medical records at the university affiliated hospitals are due to lack of awareness of the students towards the method of medical records documentation. In addition, not considering the completion of records in evaluation of the students can affect their practice.

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Background and purpose: Tuberculosis (T.B) is an important cause of morbidity and mortality in renal transplant recipients. The incidence of mycobacterium tuberculosis in renal transplant patients compared with normal papulation is high specially in developing countries.
Materials and methods : This study is a retospective review of the records of 700 renal transplant recipients 10 of whom developed post-transplant T.B. . Demographic information, interval between transplantation and T.B diagnosis, T.B site, graft survival and patient outcome were analysed.
Results : From 700 renal transplant recipient we found 10 documented cases of T:B (1.4%). Mean age was 37.9 years and mean time for diagnosis of post-transplantation T.B was 15.7 months. The most common forms were pleuro-pulmonary T.B. (60%) followed by milliary pattern (20%) and bone and joint involvement (20%). Two patients (20%) died and rejection occurred in 3 patients (30%).
Çonclusion: The incidence of T.B in renal transplant recipients is relatively high and its presentation usually atypic, thus a high index of suspicion should be retained in the long term follow-up of these patients, given the importance of early diagnosis and specific treatment to the chance of graft and patient survival.

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Background and purpose: Ëmbryo co-culture systems with somatic cells have been a subject of extensive study as valuable tools to promote embryo in vitro development. The aim of this study was to evaluate, the Ëffects of a special kind of co-culture system in which somatic cells were cultured as polarized monolayer on mouse embryo development.
Materials and methods : Human oviduct was obtained from patients who had undergone total abdominal hysterectomy. The epithelial cells were isolated and cultured either on ËÇM (Ëxtra-cellular matrix) gel or plastic surfaces as polarized or non polarized monolayer respectively. Ëpithelial nature of cultured cells was confirmed by immunocytochemistry and the polarized condition was evaluated using transmission electron microscopy. Two cell NMRÏ mouse embryos were flushed and cultured on polarized, non-polarized monolayer and medium alone. The rate of development in all groups were daily determined and statistically compared. Ât the end of the cultivation period, trophoectodam (TË) and inner cell mass (ÏÇM) were stained differentially and the number of blastocyst cells were counted and compared statistically.
Results : Çultured cells were epithelial in nature and those cultured on ËÇM gel had highly columnar polarized appearance, with tight junction between adjacent cells. The cells cultured on plastic were spindle shape in sections and there was no evidence of tight junction between cells. The co-culture results showed that during cultivation period, polarized cells improved embryos in vitro development more than polarized monolayer in terms of both blastocyst formation rate and cellularity with statistically significant differences.
Çonclusion: Polarized oviductal epithelial cells have positive effects on embryo development compared to non-polarized cells. These effects appear as high cellular blastocyst in co-culture systems.

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Background and purpose : The master patient’s index (MPÏ) card is the key to locate the patient’s record in medical records department. Üse of MPÏ in hospital information systems is important. Ân accurate MPÏ is noted in evaluation and accreditation program. Ôur study was done on MPÏ at medical records depatment of teaching hospitals in Mazandaran medical university in respect of using indexing rules and arrangement of cards for filing.
Materials and methods : This survey was done on patient’s cards in 5 teaching hospitals of Mazandaran medical university and 1999 MPÏ cards were checked. Â part of data related to using indexing rules and filing was gathered with checklist and factors associated with management of department collected in questionnaire. Data processed with SPSS software and analyzed with descriptive and inference statistics.
Results : Findings showed that 20% of staff responsible for indexing and filing of MPÏ were technician (post diploma course) in medical records. Ïn 100% of hospitals, guide card and cross-index card wasn’t use. Ïndexing error increased with the increasing the number of admitted patients (p= 0.003), low experience (p= 0.001) and degree and no course study relation of medical records department managers (X2= 9./03 , p = 0.000). Ïn addition, indexing error increased in staff with no academic training (X2= 3.84 , p = 0.05). Âlso results showed that there is 64.2% indexing error and 9% of cards are misfiled.
Çonclusion: Âccording to the findings, staffing professional personnel, training them with up dated knowledge, periodic control of issued cards, creating needed rules and regulation based on new scientific materials, exact indexing and filling rules suggested.

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Background and Purpose: Trigger points have been described as causing pain in clinical practice and are a common source of musculoskeletal pain. Trigger point injection can effectively inactivate the trigger points and provide symptomatic relief. Efficacy of injection in the treatment of trigger points depends strongly on the technique of trigger point injection. This study compares muscle stretching immediately after injection of methyl prednisolon vs. injection without stretching in the treatment of trigger points.
Materials and Methods: Patients with trigger point pain in the gluteal muscles were recruited using strict inclusion and exclusion criteria from Shiraz Medical School Clinic. Subjects under went two office visits and two phone follow-ups. All patients received injection of lidocaine and methyl prednisolon. In group A, injection was without stretching. In group B, stretching of muscle was done immediately after injection. Evaluation measure tools were 0-10 NRS, VAS and BPI.
Results: In respect to VAS, there was a significant statistical difference between both groups one month following injection. In respect to NRS, there was a significant statistical difference between both groups 1 month and 2 months after injection. However, there was no significant statistical difference between both groups in all measurement aspect of BPI, except mood.
Conclusion: Muscle stretching immediately after injection was more effective up to two months, than without muscle stretching in the symptomatic treatment of gluteal trigger points.

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Background and purpose: Noise is one of the most harmful factors in the environment. It is also one of the harsh phenomenons in this century that people are exposed to. Exposure to noise higher than threshold limit value could cause some physical and mental disorders. High traffic flow due to recent increase in number of vehicles causes higher noise pollution. There are few studies regarding the evaluation of noise pollution in the environment in some Iranian cities. Thus, it is necessary to measure sound pressure level and other related parameters for noise pollution control. Identification of the effective factors on noise pollution is the best approach for promotion of individual, as well as, public health and safety. The aim of this study is to evaluate the noise level in the city of Sari.
Materials and methods: There exist various methods for calculating the equivalent noise level regarding to noise measurement period. The most ordinary method is DL (day average sound level), that takes 15 hours of sampling (7 am- 10 pm), based on regulations that was approved by the National Environmental Protection Association in year 2003. This method was used for evaluation of noise level in this study. In the first stage, sampling locations were selected, followed by measuring sound levels at the height of one’s hearing zone (1.6 m above the ground surface). A calibrated sound level meter (Model Cell-490, Casella CEL, England) was used for all measurements. The SPSS software V.15 was used to perform T-test analysis.
Results: The results showed that the mean (SD) DL was 75.52± (4.41) dB. The minimum and maximum sound pressure levels during the sampling period were 47 dB and 121.5 dB respectively. Due to the measurement of various circumstances, some times, and also, sampling locations, measure sound pressure level was high.
Conclusion: The mean sound level during the daytime period was higher than the national standard levels. Therefore, environmental noise control is the best approach for the prevention of noise related to adverse health effects.

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Background and purpose: The incidence of tuberculosis (TB) in Iran is about 13 in 100000 people and this rate in Golestan and Sistan & Balouchestan Provinces is the highest. Due to the proximity of Golestan to Mazandaran, this epidemiological survey has been done to identify the high risk locations by using of disease mapping of tuberculosis incidence rate.
Materials and methods: This observational longitudinal survey was performed on the cases occurred between 1999 and 2008. The characteristics of the total cases of 2,444 were taken from tuberculosis admission book. The epidemiological and demographical variables including age, gender, year, location, and others characteristics were analyzed using descriptive and inferential statistics methods by statistical package of SAS and SPSS.
Results: From 2,444 patients, 1,283 (52.5%) were male and 47.5% were female. 61 percent were city dwellers, 39 percent were from rural areas and 96.4 % were Iranians. The highest incidence rate of TB was seen in Behshahr with rate of 19.39 and the lowest rate in Joybar with the rate of 6.45.
Conclusion: The prevalence of TB cases in Mazandaran is lower than other provinces such as Guilan and Golestan. In addition, late diagnosis of TB in Mazandaran was higher than other provinces such as Khorasan Razavi and Kordestan. The delay in TB diagnosis in Iran is longer than other in countries such as the UK and Nepal. The results of this study can provide useful information for health care services providers and policy makers to mange the disease by implementing appropriate and timely interventions.

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Background and purpose: Çoncept of locus of Çontrol, as a personality variable, is now an important theoretical and applied research field, studied in connection with several phenomena. This study evaluates if locus of Çontrol variable can be a predictor for academic performance toward the next semesters and if previous academic performance can affect the locus of control score.
Materials and methods: This is a descriptive study and the subjects were students of Mazandaran Üniversity of Medical Sciences. Â stratified random sampling and control of educational levels and schools were conducted. We used Rotter 29 item locus of control inventory and demographic questionnaire as measurement tools and researchers attended the selected classes in the third educational semester onward. Questionnaires were distributed and completed forms were collected at the same session.
Results: This study showed that, although students who have internal locus of control had higher academic achievement, there was no significant relationship between locus of control and the average score of the second and third semesters. There were no statistical differences between the demographical variables of the parents and the locus of control.
Çonclusion: Âlthough people with internal locus of control are more successful in their lives, this does not necessarily mean they are successful in any kind of activities, including education. Âcademic achievement is suggested to be multifactorial.

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Background and purpose Stomach cancer is the 2nd cause of mortality in the world and one of the most important causes of mortality in Mazandaran Province. Therefore, this study was designed to explain geographical and demographic patterns of mortality caused by stomach cancer in Mazandaran province and to identify the high-risk areas.
Materials and methods: Â descriptive study was conducted between the years 2001 and 2005. Through this study, 1663 deaths from stomach cancer were registered in Mazandaran Health Çenters. Demographic and geographical data including age, gender and residential location of the Patients’ were collected and analyzed using descriptive methods and Poisson regression, using WÏN BÜGS statistical package.
Results: Ôf the 1663 registered deaths, 1210 cases (72.8%) were males and 453 (27.8%) were females. Descriptive statistics demonstrated that the mean age for males was 66 years and for females was 69.9 years. Ünivariate analysis indicated that the incidence of stomach cancer is higher in rural areas compared with urban areas (P<0.05).
Çonclusion: The results demonstrated that the mortality rate due to stomach cancer is higher in individuals with more that 50 years of age. Ït can also be said that the mortality rate in males is twice as much as in females and more common in rural areas compared with urban areas.

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Background and purpose: Prostaglandin Ë2 and intracervical catheter are two categories of cervical ripening before induction of labor. The aim of this study was to compare the effectiveness of the intracervical foley balloon catheter and 3 mg prostaglandin Ë2 tablet in preinduction of cervical ripening.
Materials and methods: Ïn this clinical trial study, 89 primigravid women hospitalized for induction of labor with a Bishop score of less than 5 were randomized to receive either an intracervical foley catheter (n=45) or prostaglandin Ë2 tablets (n=44). Çervical ripening, frequent use of oxytocine, mode of delivery and maternal morbidity were the main outcome measures. Fisher's exact test, Mann-Whitney, paired T-test and T-test were used for data analysis using SPSS version 15.
Results: The mean age of patients in prostaglandin Ë2 and intracervical catheter groups were 23.3 ± 3.8 and 23 ± 3.4 years, respectively (P>0.05). There were no significant differences in primary mean Bishop Scores between the two groups (P>0.05). Bishop Scores (mean ± S.D) after ripening were (5.8 ± 1.4) for the foley catheter and (6.4 ± 1.6) for the prostaglandin groups (P>0.05). Üse of oxytocin were more frequent in the foley catheter group (P<0.05). The rates of Çesarean section in prostaglandin Ë2 and intracervical foley groups were 40.9% and 33.3%, respectively, however, this difference was not statistically significant. No significant difference was found in terms of maternal morbidity rate between the two groups.
Çonclusion: Ëfficacy of Prostaglandin Ë2 and intracervical foley catheter were the same in preinduction of cervical ripening.

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Objective and Background: Among air pollutants, particles are the primary and major pollutant. Research conducted by World Health Organization (WHO) shows that per each 10 micrograms increase in the concentration of particles, the mortality rate rises 1 to 3 times. The purpose of this study has been to determine the concentration of PM2.5 and determinants of it distribution in Tehran’s metro stations is autumn and winter of 2012. Materials and Methods: In this study, concentrations of PM2.5 in 24 of Tehran’s metro stations were measured during autumn and winter. At each station, samples were taken in 4 spots and 4 times: morning, afternoon, evening and night. For sampling of particles, a portable real-time reading particle monitoring device HAZ DUST EPAM 5000 with a flow of 4 liters per minute was used. Results from measurements were compared with EPA and DOE (Department of Environment) standards. Results: The results showed that max, average and min concentrations of PM2.5 in underground stations were 103, 49 and 10 µg/m3 respectively, also max, average and min concentration PM2.5 at ground-level stations were 99, 39 and 8 µg/m3 respectively. Conclusion: The results of this study indicate that the average concentration of suspended particles in Tehran metro stations was higher than EPA and DOE environment standards and air quality in metro stations was inappropriate.

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Background and purpose: The majority of patients with cancers of the digestive system admit themselves to the health care systems in the final stages of the disease and conventional treatments do not have a major impact on the prognosis in these patients. Therefore, utilization of new methods of treatment with lower adverse effects can cause higher survival rates. In this study, the in vitro effects of 4 avocado extracts on esophagus squamous cell carcinoma in comparison with peripheral mononuclear blood cells have been evaluated. Materials and methods: In an experimental study, after acquiring alcoholic, chloroform, ethyl acetate and petroleum avocado fruit (Persea Americana) extracts, their effects on squamous cell carcinoma of the esophagus cell growth were compared with controls in cell culture using MTT method. Results: The results from this study on esophageal squamous cell cancer shows an inverse linear relationship between the concentrations of living cells there are avocado extract. Furthermore, results show that avocado fruit extract play an inhibitory role on the growth of cancerous cells in comparison with normal cells (p<0.05). Conclusion: Avocado fruit is a rich source of phytochemicals which shows an effective role in inhibition of cancer cell growth. This study demonstrates its effectiveness in esophageal cancer for the first time. Usage of the extract of this fruit, it seems, can be a supplementary treatment in esophagus cancers.

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Introduction: Industrial wastewater is one of the major environmental pollutants. Discharge of the colorful industrial effluent into the receptive waters leads to eutrophication and has mutagenic and carcinogenic properties. Therefore, the aim of this study was to investigate the removal of acid blue113 from aqueous solutions by Canola (Brassica Napus) waste. Materials and Methods: This is an experimental-lab study. Canola waste was used as an adsorbent to remove the acid blue113 dye. The effect of various parameters on adsorbent performance was investigated. The isotherms of adsorption were determined. The dye concentration was measured in wavelength of 566 nm by spectrophotometer. Results: The results indicated that the removal rate of dye increased with increasing the contact time and dose of adsorbent but the amount of adsorbed dye per gram adsorbent (qe) decreased. The removal rate increased with decreasing the initial concentration of dye, too. In the optimum state, the adsorbent could adsorb about 99 percent of the dye. The data of adsorption were best fitted to Langmuir isotherm. Conclusion: This study indicated that Canola waste can be used as an effective and inexpensive adsorbent to treat of textile effluents

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Background and purpose: Phenol whose carcinogenic property has been evidenced is one the organic compounds found in industrial wastewater. Therefore, this effluent must be treated before it is discharged to the environment. The aim of this study was to investigate whether dried azolla can absorb phenol from aqueous solution. Materials and methods: First, the collected azolla was washed by distilled water 3 times and then it was dried in the oven at 105 ° C for 24 h and finally, it was sieved in 18 to 30 mesh. The pH variation, dose of absorbent, contact time, and phenol concentration were investigated and the residual concentration of phenol was determined by spectrophotometer in wavelength of 500nm. Then, the absorption data were described by absorption isotherms Freundlich and Langmuier. Findings:The results indicated that increasing the contact time and dose of absorbent can increase the absorption rate, though it remains constant after 150 min and 1gr of absorbent. Increasing pH and initial concentration of phenol can reduce the absorption rate and the optimum ph for phenol absorption is 3. The Freundlich isotherm is best fitted (R2= 0.997) in comparison with Langmuir and Temkin isotherms. Conclusion: Overall, the studied absorbent can be used as an effective absorbent to treat the industrial wastes and aqueous solution.

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Background and purpose: Pphenol is one of major available compound in industrial wastewater. Phenol is classified as priority and dangerous pollutant in International Agency for Research on Cancer (IARC) and in list of EPA. Thus, the purpose of this study is survey on effect of sorbitol on phenol removal rate by lemna minor. Materials and methods: Tthis is an empirical- lab study. In this study, lemna minor in various amounts (0.3, 0.4, 0.6gr) was contacted with phenol concentration of 5, 10, 25, 50 ppm and sorbitol was added in known amounts into containers (0.2 and 1gr). In order to prevent of probable error, all experiments were done 2 times. Every 4 days, samples were provided from containers and the phenol concentration was determined by colorimetery in wavelength of 510nm.. Results: Tthe findings of this study showed that the increasing of initial concentration of phenol can decrease the removal rate and in concentration of less than 10 mg/l, the removal rate can be up to 95-99%. The removal rate of phenol increase by increasing of contact time and amount of lemna. Presence of sorbitol in culture medium can lead to increase of growth and reproduction and increasing of removal rate of phenol by lemna. Conclusion: Llemna minor is able to remove of phenol from aqueous. The addition of sorbitol carbohydrate can lead to increase of growth and reproduction and the efficiency of phenol removal by leman minor.

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Introduction: The power transmission lines are the emission source of extremely low frequency (ELF) electromagnetic fields that are considered to have an adverse impact on human health. Therefore the aim of this study was to evaluate the amount of magnetic flux with extremely low frequencies (ELF) around high voltage power transmission lines in the western areas of Tehran in 2012. Material and Method: In this study the magnetic flux density was measured around three lines of high voltage electricity transmission (63, 230 and 400 kV). The employed device for magnetic flux measurement was Triple axis TES 1394 tester. The measurements were taken according to IEEE standard procedures (Std 644-1994) in four distance ( 0, 5, 10 and 20 m). Results: The results showed that the amount of the minimum, mean and maximum of magnetic flux density were 0.14,1.43 ±1.25 and 11.51µT respectively. The flux density was lower than the standard international commission on ionizing radiation protection in all cases. Discussion and Conclusion: The average level of magnetic flux density was about 1.25% of the exposure limit ICNIRP standard (100 µT) around the three lines. Also the magnetic flux density rate decreases with increasing distance from the line and decreasing flow.

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Background and purpose: To analyze the data in which the correlation between observations are to be considered, a general method is using marginal model with repeated measures, yet there is another method called conditional model with random clusters. Âccording to the binary responses, the aim of the present study is to compare the efficiency of these two models in studying the risk factors affecting hypertension in Mazandaran province.
Materials and methods: This cross-sectional study is part of research studying the risk factors of the non-infectious diseases in Mazandaran province in 2007 with a sample size of 1000 cases. First, stratified sampling was employed and then random cluster sampling was used in each stratum. Ïn all cases, blood pressure was measured three times through standard methods. The obtained data were analyzed using test and fitting marginal and conditional logistic models.
Results: Ôf the total of 1000 (500 male and 500 female) cases, 38 percent had high blood pressure. Ïn both models four variables of age, physical activity, body-mass-index, and the consumption of fruits and vegetables were identified as factors affecting hypertension. Ïn addition, gender and fasting blood sugar were statistically significant only in marginal logistic model. Üsing goodness-of-fit criteria, values of all the statistics for conditional logistic model with random effects of individuals were lower in comparison with the marginal logistic model with repeated measures.
Çonclusion: Ït can be concluded that although one cannot decisively select a model as the most appropriate one, conditional logistic model fits were somewhat better than the marginal logistic model with repeated measures, so it can be used to analyze such data.

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Background and purpose: Hard ticks are important hematophagous arthropods belonging to the class Ârachnida. They transmit different groups of micro-organisms such as arboviruses, bacteria and parasites to animals and humans. Determining the fauna and geographical distribution of hard ticks in a given area is crucially important in planning the prevention and control programs.
Materials and methods: This descriptive study was conducted in Sari Township, in the north of Ïran. To collect tick samples, first the researchers selected 10% of the villages, then 10% of the flocks (sheep, goats, and cows) in each village were selected, finally 10% of the animals in each flock were monthly examined in different seasons from June 2007 to July 2008. The species were determined and GÏS (Geographical Ïnformation System) database was created to visualize their geographical distribution.
Results: Six different species belonging to different genera of hard ticks including Rhipicephalus bursa, Hyalomma detritum, Boophilus annulatus, Haemaphysalis punctata, Ïxodes ricinus and Dermacentor marginatus were collected from animals. The relative frequency of these species were 63.76%, 15.35%, 9.58%, 7.63%, 1.86% and 1.78% respectively. Geographical distribution of the collected tick species was mapped using GÏS software.
Çonclusion: The results showed that Rhipicephalus bursa is the dominant tick species on domestic ruminants in Sari Township.

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Background and purpose: Âllergic rhinitis is one symptomatic nasal disorders induced after contact with allergen in atopic individuals. Ït leads to ÏgË-mediated inflammation of the membranes lining the nose. Ïn addition to environmental factors, genetic predispositions play an important part in susceptibility to this disease. The aim of the present study was to determine the association between T cell immunoglobulin and mucin domain (TÏM-1) gene polymorphisms with susceptibility to allergic rhinitis.
Materials and methods: Ïn this case–control study, 155 allergic rhinitis patients and 163 healthy volunteers as controls were enrolled. The extraction of genomic DNÂ from peripheral blood was done through salting out and genotype was accomplished using polymerase chain reaction-restriction fragment length polymorphism (PÇR-RFLP) method. To analyze the association between genotypes and alleles with the disease in the case group in comparison with the control group, X2 and two-way logistic regression tests were used.
Results: The findings indicated that Ç allele of G416Ç and  allele of G1454 polymorphisms in TÏM-1 gene were associated with susceptibility to allergic rhinitis. Ïn other words,  and G alleles in these positions increased the risk of the disease up to 1.55 (P=0.041) and 1.64 (P=0.006) in the patients compared with controls, respectively. Ïn addition, the total serum ÏgË and peripheral blood eosinophil levels in the individuals with homozygous genotype of -416 ÇÇ were significantly higher regarding other investigated polymorphisms (P<0.05).
Çonclusion: Âccording to the results of this study, it seems that the TÏM-1 gene polymorphisms in Ç allele -416 and  allele in -1454 is associated with the susceptibility of allergic rhinitis and -416 ÇÇ genotype influences its pathogenesis.

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Background and purpose: Due to the difficulty of diagnosis, esophageal and gastric cancers have a special position in Mazandaran Province. Ïn this province, gastric cancer is considered to be one the most important causes of mortality therefore, this study was conducted to investigate the survival of patients with gastric cancer in Mazandaran.
Materials and methods: Ïn this historical Çohort study all gastric cancer patients referring to an academic center clinic from 2007 to 2010 were enrolled. Â parametric model was fitted to the data. Parametric survival models, Kaplan-Meier and life table were applied for estimating the survival probability and investigating the effect of different variables.
Results: The mean age of the participants was 64 years and 68.3% of the patients were men. Âmong the patients, 48.4% were in the most advanced stage i.e.: stage 4. The survival probability of more than 2 years was calculated 27.7% in the patients, using Kaplan Mayer method. Çox hazard proportional model revealed that variables like the stage of the disease, metastasis and surgery status, and age influenced the survival probability of patients.
Çonclusion: Low survival time of the participants of the study may be due to the late diagnosis and lack of medical facilities.