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Background and purpose: Anal fissure is a chronic condition characterized by painful defecation and rectal bleeding. The aim of this study was to compare the injection of botulinum toxin (BT), versus with surgical lateral internal sphincterotomy (LIS).
Materials and Methods: In this clinical trial, 40 patients enrolled with chronic idiopathic anal fissure (CIAF) and were divided into 2 groups (20 BT group and 20 LIS group). Both groups were compared according to complications and healing process during one week, following, 2 and 4 months after interventions.
Results: There were no statistical significant differences between 2 groups as a viewpoint of duration of disease, pain and other symptoms at the beginning of the study. The rate of healing in the LIS group was greater than the BT group within the first month (16/0), and second month (16/7) (p<0.05), however, there were no significant differences between the two groups in the 4th month (17/11) of the study (p>0.05). In comparison with the BT group, the severity of pain in the LIS group decreased significantly. There were no significant differences between the two groups regarding complications.
Conclusion: Healing in the BT group was approximately similar to the LIS yet it appears to occur slower than LIS. Therefore, according to the results of the study, injection of the BT is recommended within the first step of CIAF treatment. To obtain the maximum healing effects of BT, a minimum period of 4 months is needed.

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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: Ïdentifying the students’ attributional style and helping them to be responsible and have a proper view is of critical importance which can lead them to achieve greater success and creativity. Çonsidering its significant role in being an active or a passive, and demotivated person, the present study was conducted in order to determine the attributional style of the students studying in Mazandaran Üniversity of Medical Sciences.
Materials and methods: This is a descriptive study conducted in Mazandaran Üniversity of Medical Sciences in 2008-2009 with the population of 2582 students on 343 male and 428 female randomly selected students. The data were collected using the Âttributional Style Questionnaire. This is a descriptive study conducted in Mazandaran Üniversity of Medical Sciences in 2008-2009 on 343 male and 428 female randomly selected students among a population of 2582 students.
Results: The obtained data showed that 43.9% of the participants had internal, while 56.1% of them demonstrated external attributional style. Âmong the female participants, 42.3% used internal and the rest (57.7%) employed external attributional style, similarly, 45.8% of the male participants preferred internal and 54.2% of them tend to use external attributional style.
Çonclusion: Âccording to the results, the dominant attributional style of the participants is the external style which has a negative impact on their motivation, effort, and academic achievement which then, may negatively influence their success. Thus, it seems necessary to train them the coping strategies in order to reduce their external attributional style.

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Abstract Background and purpose: To determine the effect of intrasphincteric botulinum toxin injection to treat internal anal sphincter achalasia. Materials and methods: Twenty patients (11 boys, average age 4.95± 2.47 years) with definite diagnosis of internal anal sphincter achalasia received 20 units of botulinum toxin injection in 4 points of the internal anal sphincter (totally 80 units). Then during 8 months of follow up visits, profile and response to treatment and bowel movements criteria of the patients were recorded in a questionnaire Results: All patients except one had treatment response. On 1-month follow-up, response to treatment was excellent in 35% of patients, and average in 60%. Response to treatment after 8 months follow-up was excellent in 50% and average in 40% and 10% was poor. The effect of botulinum toxin in 14 patients continued by the end of follow-up, and in 5 patients lasted between 7 to 20 weeks. The therapeutic response of these people, except one, remained moderate. Transient fecal incontinency was the only complication observed in 3 patients that was resolved after 1 to 3 weeks. Conclusion: Injection of botulinum toxin into the internal anal sphincter is an effective and safe method of treatment for achalasia, with long lasting results and few transient complications.

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Background and purpose: Internal assessment is an introduction for improving the quality and the first step of accreditation. Identifying the competencies and the weaknesses enables the organizations to choose the strategies to face environmental forces. This study aimed to identify the strengths and the weaknesses of hospitals in Gorgan and the Gonbad-e Qabus cities, Iran. Materials and methods: This cross-sectional study was performed in Azar the 5th, Deziani, and Taleghani hospitals in the city of Gorgan and Shahid Motahari and Shohola hospitals in the city of Gonbad-e Qabus. Statistical Society was included 322 clinical and non-clinical staff of the hospitals. Data collection instrument was a questionnaire. The data were analyzed using ANOVA, t, and Pearson correlation tests. Results: 83.5% of respondents considered desirable internal hospital environment and 16.5% of them considered undesirable. The weakest area was rewards and the strongest area was target. There were significant relationships between internal environment of hospitals and years of services (P = 0.030), ward (P = 0.008), and hospital (P = 0.021) but there were not significant relationships between internal environment of hospitals and age (P = 0.371), sex (P = 0.559), employment status (P = 0.527), and level of education (P = 0.110). Conclusion: Internal environment status was good from employee's viewpoint but rewards need to improve. It is necessary for managers to give rewards to personnel practice-basely and individually.

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Background and purpose: Astigmatism is a common optical dysfunction, effective on various visual outcomes and one of the important criteria of refractive surgery. The aim of present study was to evaluate the correlation between refractive, corneal and residual astigmatism in refractive surgery candidates. Materials and methods: In this cross-sectional descriptive, analytical study, 200 patients referred to the Farabi hospital, Iran, for refractive surgery were enrolled. Refraction survey and topography were done to determine refractive, corneal and residual astigmatism for all of participants and statistical analyses were performed. Results: Overall, 400 eyes of 200 subjects with the average age of 28.2 ± 6.24 participated in this study. 62.7% of cases were women. According to spherical equivalent, 94.2% were myope, 3.3% were hyprope and 78.9% had refractive astigmatism more than 0.75 D. Mean spherical equivalent refractive errors was -3.59 ± 1.95 D in myopic group and 2.72 ± 0.97 D in hyperopic group mean astigmatism was 1.97 ± 1.3 D in myopic and 1.3 ± 1.37 D in hyperopic group. The correlation ratio was (r = 0.223) between lenticular and refractive astigmatism (P < 0.001), (r = 0.111) between lenticular and corneal astigmatism (P = 0.027), and (r = 0.942) between refractive and corneal astigmatism (P < 0.001). Conclusion: Significant correlations were found between refractive, corneal, and residual astigmatism there was a strong correlation between corneal and refractive astigmatism and 81% of the changes in refractive astigmatism could be justified with corneal astigmatism changes. Separating the type of astigmatism and determining its origin (cornea or lens) could be helpful for refractive surgery.

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Background and purpose: Psychodrama is a special approach that facilitates releasing trapped emotions in order to adopt new behaviors and recognize self-form. This study aimed at assessing the efficacy of psychodrama techniques in internalizing symptoms among guidance school girls bully/victims in Kermanshah. Material and methods: This study was a quasi-experimental with pre-test, post-test and control group. Data was collected using Olweus Bully/Victim questionnaire and the adolescents form of Achenbach behavioral problems questionnaire. Thirty girls who achieved higher scores in the Olweus Bully/Victim questionnaire were randomly assigned into experimental and control groups. The experimental group participated in eight psychodrama group sessions (1.5 hours- two times per week), while no intervention was done for the control group. To analyze the data descriptive and inferential statistical methods (analysis of covariance) were used. Results: ANCOVA test showed the efficacy of psychodrama techniques in reducing the youth internalizing symptoms (Eta=0.66–P<0.001) and its subscales: anxiety - depression (Eta=0.53–P<0.001), isolation - depression (Eta=0.31 – P<0.001), and physical complaints (Eta=0.60 – P<0.001). Conclusion: According to this study, using psychodrama techniques play an important role in improving mental health in young individuals.

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Background and purpose: Cerebral palsy is a common disorder in children leading to their dysfunction in many aspects. Therefore, to provide appropriate treatment plan that could improve the function of these children, a valid assessment tool is needed. Pediatric Evaluation Disability Inventory (PEDI) is designed to evaluate the performance of children with disabilities in three dimensions: self-care, mobility, and social function. The purpose of this study was to evaluate the reliability of the Persian version of PEDI in children with cerebral palsy aged 3 to 9 years old.

Materials and methods: In this study, 75 participants were selected by convenience sampling. Information was collected using demographic questionnaire and Gross Motor Function Classification System (GMFCS). The parents were interviewed and PEDI was completed. After two weeks, in order to evaluate the reliability of the test-retest, 22 parents were re-interviewed. Internal consistency was examined by Cronbach's alpha, and the reliability of the test-retest was assessed by intra-class correlation coefficient (ICC).

Results: In examining the internal consistency, Cronbach's alpha was found to be high (0.94-0.98).The results of test-retest reliability of the functional skills and caregiver assistance scale were excellent (0.96-0.97). Also, the results of test-retest reliability in modification scale were excellent in self-care and social performance (0.99 and 1, respectively) and good in mobility dimension (0.66).

Conclusion: This study proved the internal consistency and test-retest reliability of the Persian version of PEDI in evaluating the performance of Persian-speaking children with cerebral palsy. Therefore, PEDI could be applied in research and clinical settings for evaluation of children with cerebral palsy in Iran.

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Background and purpose: Internal inflammatory root resorption (IIRR) is an uncommon lesion in permanent tooth that could lead to destruction of root and the surrounding dental hard tissues if it is left untreated. This article describes treatment of an extensive perforating internal root resorption in a maxillary second premolar using mineral trioxide aggregate (MTA).

Case report: After chemomechanical cleaning of the root canal and the resorption lacuna, calcium hydroxide was placed as an intracanal dressing. At next visit, the root canal and defect space were filled by MTA. After one day, coronal access was restored by amalgam. Radiography and clinical examination at the two year follow up showed that the tooth was in function and bone repair occurred.

Conclusion: According to these findings, it is possible to have a successful treatment of extensive perforative internal root resorption by MTA without surgery.

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Background and purpose: Internal evaluation is the systematic process of collecting and analyzing information to determine the benefits and disadvantages of a program and the extent to which its objectives are achieved. The aim of this study was to investigate the status of internal evaluation in clinical departments of Mazandaran University of Medical Sciences in two consecutive academic years.
Materials and methods: This descriptive cross-sectional study was performed in all clinical departments of Mazandaran University of Medical Sciences during 2015-2016 and 2016-2017. Data from eight domains of internal evaluation were collected using a checklist and some researcher-made questionnaires. Then, we studied the status of departments in eight domains of internal evaluation in relation to the standards and the status of all departments in two consecutive academic years. The evaluations for the years were compared and the dynamic trend was assessed. Data analysis was done applying descriptive statistics in SPSS. 
Results: A good status of clinical departments was seen in most of the domains. Best performances within the two academic years studied were associated with courses, educational curriculum, and graduate affairs (74.53%, 78.66%, and 88.61%, respectively). Total scores for all clinical departments were 64.22% and 70.69% in 2015-2016 and 2016-2017, respectively.
Conclusion: Continuous internal evaluation reveals the strengths and weak points of the clinical departments. Therefore, more appropriate planning would be done and the departments could apply for further residency programs.  
 
 

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Background and purpose: Femoral neck fracture is associated with a high rate of side effects, especially in young people, who are usually affected by severe energy shocks. Results after injury depend on some factors, including displacement, fragility, bleeding rate, proper placement, and stable and strong fixation. The aim of this study was to compare dynamic hip screw (DHS) or multiple cannulated screws (MCS) in fractures of the femoral neck base.
Materials and methods: In this cross-sectional study, 78 patients with femoral neck fracture were treated by internal fixation: MCS (n= 26) and DHS (n= 52) in Babol Shahid Beheshti Hospital, 2016-2018. Complications, including pain and lameness, infection, avascular necrosis (AVN), and nonunion were investigated in both groups. The visual analog scale (VAS) score and Harris Hip Score (HHS) were also compared between the two groups.
Results: Mean ages of the patients in MCS group and DHS group were 54.19 ± 23.35 and
58.50 ± 21.06 years, respectively. In patients treated by MCS, infection, AVN, no welding, and pain and lameness were seen in 3, 2, 3, and 6 patients, respectively, while these complication were observed in 1, 1, 1, and 4 patients in the DHS group, respectively. The rate of complications were not found to be significantly different between the two group (P>0.05). The mean VAS score was significantly lower in the DHS group compared to that in the MCS group (P<0.05). The HHS scores were not significantly different between the two groups (P<0.05).
Conclusion: According to this study, MCS is more appropriate in the treatment of femoral neck fractures due to less bleeding and shorter operation time.

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