1397 28 167 0 207

راهنمای بالینی کشوری برای مدیریت تشخیص، درمان و پیگیری بیماران سکته مغزی Developing a National Guideline for Diagnosis, Treatment and Follow-up of Stroke 1 1 سابقه و هدف: کمبود حد و مرزهای مشخص و استاندارد در زمینه ارجاع بیماران سکته مغزی، تشخیص بیماری، ارزیابی‌های لازم، درمان‌های موثر، لزوم مداخلات به موقع و بجا موجب ناهمگونی و تنوع ارائه خدمات در این مقوله گردیده است. این مطالعه، با هدف تعیین راهکارهای عملی و بومی برای کاربران هدف، انجام پذیرفت. مواد و روش‌ها: در شروع کار به منظور استخراج راهنماهای بالینی موجود در زمینه سکته مغزی پایگاه‌های اطلاعاتی و وب‌گاه‌های مرتبط مورد جستجو قرار گرفتند. پس از بررسی کیفیت و نقد راهنماهای بالینی بر پایه سیستم امتیازدهی Agree سه راهنمای بالینی انتخاب شدند. به منظور بومی‌سازی، جداولی طراحی گردید که در آن‌ها توصیه‌های سه راهنمای بالینی منتخب در قالب سؤالات بالینی استخراج شد. شواهد پشتیبان هر توصیه بر اساس رفرنس ذکر شده در راهنمای بالینی مشخص شد و مقالات از نظر پیامدهای اولیه مورد مقایسه قرار گرفتند. هزینه مداخلات و عوارض جانبی و مزیت بالینی نیز مورد بررسی قرار گرفت. در نهایت راهنمای بومی، پس از جمع‌بندی، قضاوت و اجماع اعضای پانل تخصصی و در قالب مرور مقالات، همراه با شواهد و توصیه‌ها تدوین شدند. یافته‌ها: نتایج حاصل از بررسی‌های انجام شده در قالب توصیه‌های بالینی در سال 1395 ارائه شد. به‌عنوان مثال کنترل دقیق قند خون و تب در بیماران با خونریزی ساب آراکنوئید آنوریسمال توصیه می شود. استنتاج: با توجه به ارائه راهنمای بومی شده سکته مغزی برای جمعیت ایرانی، می‌توان انتظار داشت با به کارگیری این راهنما، مدیریت بیماران از ﻏﺮﺑـﺎﻟﮕﺮﻱ، ﺍﺭﺟـﺎﻉ، ﺗﺸﺨﻴﺺ، ﺩﺭﻣﺎﻥ ﻭ پیگیری استاندارد انجام شود.   2 Background and purpose: Lack of clear boundaries and standard reference about the diagnosis of stroke, necessary evaluations and interventions, effective treatments, and referral of stroke patients resulted in various inconsistent services. Therefore, this study aimed at developing practical national strategies for stroke in Iran. Materials and methods: Clinical guidelines about diagnosis and management of stroke were extracted from different guidelines. Three guidelines were selected according to AGREE scoring system after quality assessment and evaluation of clinical guidelines. In order to adapt the guidelines, recommendations of the three clinical guidelines were recorded in the form of clinical questions. Evidence supporting each recommendation was identified based on references and compared in terms of initial outcomes. Cost of interventions, the side effects, and clinical benefits were also studied. Finally, the national guideline for management of stroke was developed. Results: The results of this investigation were presented as clinical recommendations for diagnosis and management of stroke (2016). For example, strict control of blood glucose level and fever in patients with aneurysmal subarachnoid hemorrhage was recommended in the guideline. Conclusion: The current indigenous stroke guide for the Iranian population is believed to be of great benefit in screening, referral, diagnosis, treatment, and follow-up of stroke. 1 20 2017/03/7 1395/12/17 رزیتا داودی Rozita Davoodi دانشجوی PHD قلب، مرکز تحقیقات ایمنی بیمار، دانشگاه علوم پزشکی مشهد، مشهد، ایران ایران کاویان قندهاری Kavian Ghandehari دانشیار، گروه مغز و اعصاب، مرکز تحقیقات ایمنی بیمار ، دانشگاه علوم پزشکی مشهد، مشهد، ایران ایران محمدرضا قینی Mohammad reza Ghayeni استاد، گروه مغز و اعصاب، دانشگاه علوم پزشکی تهران، تهران، ایران ایران محمد حسین حریرچیان Mohammad hossein Harirchian استاد، گروه مغز و اعصاب، دانشگاه علوم پزشکی تهران، تهران، ایران ایران هومن بهار وحدت Homan Bahar vahdat استادیار، گروه جراحی مغز و اعصاب، مرکز تحقیقات ایمنی بیمار، دانشگاه علوم پزشکی مشهد، مشهد، ایران ایران ساسان نژاد Sasan Nezhad استادیار، گروه مغز و اعصاب، مرکز تحقیقات ایمنی بیمار، دانشگاه علوم پزشکی مشهد، مشهد، ایران ایران آزاده سلطانی فر Azadeh Soltani Far پزشک عمومی، مرکز تحقیقات ایمنی بیمار، دانشگاه علوم پزشکی مشهد، مشهد، ایران ایران گلناز صبوری Golnaz Sabouri پزشک عمومی، مرکز تحقیقات ایمنی بیمار، دانشگاه علوم پزشکی مشهد، مشهد، ایران ایران sabouriG1@mums.ac.ir شقایق رحمانی Shaghayegh Rahmani استاد، گروه مغز و اعصاب، دانشگاه علوم پزشکی تهران، تهران، ایران ایران محبوبه اسدی Mahboubeh Asadi کارشناس ارشد پرستاری، مرکز تحقیقات ایمنی بیمار، دانشگاه علوم پزشکی مشهد، مشهد، ایران ایران مریم زارع حسینی Maryam Zare Hosseini کارشناس ارشد پرستاری، مرکز تحقیقات ایمنی بیمار، دانشگاه علوم پزشکی مشهد، مشهد، ایران ایران محمد هادی سعید مدقق Mohammad Hadi Saied Modaghegh استاد، گروه جراحی عروق، مرکز تحقیقات ایمنی بیمار، دانشگاه علوم پزشکی مشهد، مشهد، ایران ایران الهه غایبی Elahe Ghayebie کارشناس ارشد پرستاری، مرکز تحقیقات ایمنی بیمار، دانشگاه علوم پزشکی مشهد، مشهد، ایران ایران فرهاد حیدریان Farhad Heydarian استاد، گروه اطفال، مرکز تحقیقات ایمنی بیمار، دانشگاه علوم پزشکی مشهد، مشهد، ایران ایران حوا عبداللهی Hava Abdollahi کارشناس ارشد پرستاری، مرکز تحقیقات ایمنی بیمار، دانشگاه علوم پزشکی مشهد، مشهد، ایران ایران مهدی فرهودی Mahdi Farhodi استاد گروه مغز و اعصاب، مرکز تحقیقات ایمنی بیمار، دانشگاه علوم پزشکی مشهد، مشهد، ایران ایران stroke localization clinical guide سکته مغزی بومی سازی راهنمای بالینی 1. 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بررسی اثر تزریق لیدوکائین/استرپتومایسین در درمان نورالژی تری‌ژمینال مقاوم به کاربامازپین The Effects of Local Streptomycin/lidocaine Injections on Treatment of Carbamazepine Resistant Trigeminal Neuralgia 1 1    سابقه و هدف: نورالژی تری‌ژمینال شناخته شده‌ترین نورالژی صورت است و درد شدید ناشی از آن تأثیر به‌سزایی در کیفیت زندگی افراد درگیر دارد. مداخلات مطرح شامل درمان دارویی، Microvascular decompression و نیز مداخلاتی که به شاخه‌های انتهایی عصب آسیب وارد می‌کنند؛ هیچ‌یک عاری از عوارض جانبی نیستند؛ از این رو دست‌یابی به درمانی با حداقل عوارض و تهاجم کم تر هم چنان مورد بررسی است. هدف از مطالعه حاضر بررسی اثر تزریق محلول حاوی استرپتومایسین و لیدوکائین بر نورالژی تری ژمینال مقاوم به کاربامازپین بوده است. مواد و روش‌ها: این مطالعه با طراحیRetrospective case series  و با ارزیابی آماری پرونده 40 بیمار با سابقه درمان دارویی ناموفق نورالژی تری‌ژمینال با کاربامازپین که تحت تزریق لیدوکائین/استرپتومایسین و متعاقباً بررسی وضعیت درد قرار گرفته‌بودند، انجام گرفت. تعداد 5 تزریق محلول لیدوکائین/استرپتومایسین، با فواصل یک هفته و در محل شروع درد انجام شد و میزان درد در فواصل 1 هفته، 1 ماه و 6 ماه بعد از تزریق مورد ارزیابی قرار گرفت. میزان درد در چهار زمان اندازه‌گیری‌شده با هم مقایسه گردید. یافته‌ها: میزان درد پس از یک هفته، یک ماه و شش ماه پس از آخرین تزریق، نسبت به قبل از مداخله، کاهش معنی‌داری نشان داد (001/0< P). درمان در گروهی که سابقه ابتلای آن‌ها به نورالژی، کم تر از 5 سال بود نسبت به بیماران با سابقه ابتلای بیش از 5 سال موفق‌تر بود. استنتاج: به نظر می‌رسد تزریق استرپتومایسین و لیدوکائین همراه باهم، ضمن داشتن موفقیت در کاهش درد ناشی از نورالژی تری‌ژمینال، عوارض ناچیزی دارد. مطالعات کنترل‌شده جهت تأیید و تجویز این روش در درمان نورالژی تری‌ژمینال ضروری است. 2    Background and purpose: Trigeminal neuralgia is the most common type of facial neuralgia. The pain would easily affect the quality of life according to its acute and severe nature. Treatment modalities include pharmacotherapy, microvascular decompression, and lesioning peripheral procedures targeting the trigeminal ganglion. These methods either have side effects or are partially invasive; therefore a minimally invasive method without the common side effects of medical interventions is more desired. The aim of this study was to investigate the effects of streptomycin/lidocaine injection on patients with carbamazepine-resistant trigeminal neuralgia. Materials and methods: In this retrospective case series, 40 subjects diagnosed with trigeminal neuralgia, who did not respond to carbamazepine, were investigated. The patients received five injections of streptomycin/lidocaine to the trigger zone with one-week intervals. Pain severity was recorded at one week, one month, and six months after the last injection. Results: The severity of pain significantly reduced in all follow-up appointments compared to the baseline (P< 0.001). Pain reduction was significantly higher in patients with a history of the disease for less than five years. Conclusion: Streptomycin/lidocaine injection seems to be an easy, effective, and a safe method for pain relief in patients with trigeminal neuralgia. Nevertheless, further controlled studies are needed to approve this method as a routine procedure. 21 28 2017/03/72018/06/30 1397/4/9 2018/10/20 1397/7/28 امیر هومن صدر حقیقی Amir Hooman Sadr Haghighi استادیار، گروه ارتودانتیکس، دانشکده دندانپزشکی، دانشگاه علوم پزشکی تبریز، تبریز، ایران ایران hooman_sadr7@yahoo.com سید احمد آرتا Seyed ahmad Arta مربی، گروه جراحی دهان و فک و صورت، دانشکده دندانپزشکی، دانشگاه علوم پزشکی تبریز، تبریز، ایران ایران محمد حسین آهنگر آتشی Mohammad Hossein Ahangar Atashi دانشیار، گروه ارتودانتیکس، دانشکده دندانپزشکی، دانشگاه علوم پزشکی تبریز، تبریز، ایران ایران atashim2006@gmail.com طناز عبدالله زاده بقائی Tannaz Abdollahzadeh Baghaei دستیار تخصصی ارتودنتیکس، دانشکده دندانپزشکی، دانشگاه علوم ‌پزشکی تبریز، تبریز، ایران ایران tannazabdz@gmail.com trigeminal neuralgia treatment streptomycin lidocaine نورالژی تری‌ژمینال درمان استرپتومایسین لیدوکائین 1. Zakrzewska JM, Linskey ME. Trigeminal neuralgia. BMJ 2014; 348(9): g474.##2. 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بررسی ریسک ابتلا به آپنه انسدادی خواب و خواب آلودگی روزانه در بیماران قلبی عروقی The Risk of Obstructive Sleep Apnea and Daytime Sleepiness in Patients with Cardiovascular Disease 1 1 سابقه و هدف: آپنه انسدادی خواب، شایع ترین اختلال تنفسی حین خواب است که ریسک ابتلا به بیماری های قلبی عروقی و مرگ و میر ناشی از آن ها را افزایش می‌دهد. با وجود نقش آپنه انسدادی خواب در بروز و پی‌آمدهای بیماری‌های قلبی عروقی، بیش تر این بیماران شناسایی و درمان نشده باقی می‌مانند. هدف از این مطالعه، بررسی میزان ریسک ابتلا به آپنه انسدادی خواب در بیماران قلبی عروقی می باشد. مواد و روش‌ها: این پژوهش مقطعی بر روی ۴۰۰ بیمار مبتلا به ۴ گروه بیماری قلبی عروقی (فشار خون بالا، نارسایی قلبی، بیماری عروق کرونری و بیماری دریچه‌ای) بستری در بخش‌های CCU بیمارستان فاطمه زهرا ساری در سال ۹۶-۱۳۹۵ می باشد. اطلاعات توسط پرسشنامه‌های معتبر STOP-BANG و پرسشنامه خواب آلودگی روزانه Epworth و پرونده بیماران استخراج گردید و داده‌ها توسط نرم افزار SPSS نسخه ۲۰ مورد تجزیه و تحلیل قرار گرفتند. یافته‌ها: ۵۴ درصد بیماران مرد (۲۱۶ نفر) بودند. میانگین سنی بیماران ۵۳/۱۱±۹۹/۶۲ سال بود. ۵/۶۲ درصد بیماران از نظر تست STOP-BANG در محدوده خطر بالا قرار داشتند و این مورد در بیماری کرونری (۶۷ درصد) و نارسایی قلبی (۶۶ درصد) بیش تر بود. اختلاف آماری معناداری بین گروه‌های بیماری قلبی عروقی از نظر OSA وجود نداشت (65/0=p). ۵/۸۶ درصد مردان ریسک بالایی برای ابتلا به OSA داشتند و این نسبت در زنان ۲۳/۳۴ درصد بود. افراد با ریسک بالای آپنه انسدادی خواب، بیش ترین میزان خواب آلودگی روزانه را داشتند (002/0=p). استنتاج: ریسک آپنه انسدادی خواب در بیماران قلبی بالا است. بررسی آپنه انسدادی خواب در این بیماران ضروری به نظر می‌رسد.   2 Background and purpose: Obstructive sleep apnea (OSA) is the most common type of sleep disorder which increases the risk of cardiovascular disease (CVD) and death. Despite the importance of OSA and its cardiovascular complications, most of the people with this disorder remain undiagnosed and untreated. The aim of this study was to evaluate the prevalence of at risk groups for OSA in cardiovascular patients. Materials and methods: This cross sectional study was performed in 400 patients with CVD (hypertension, heart failure, coronary arteries, valvular disease) admitted in critical care unit (CCU) in Sari Fatemeh Zahra Hospital, Iran 2016-2017. Data were collected by validated STOP-BANG, Epworth Sleepiness Scale (ESS), and the patients’ medical profiles. SPSS V20 was applied for data analysis. Results: The patients included 54% males (n=216). The mean age of patients was 62.99 ±11.53 years old. Among the patients 62.5% had high STOP-BANG scores. Patients with coronary disease (67%) and heart failure (66%) were at higher risk for OSA. There were no significant differences between the four groups of diseases investigated in the risk of developing OSA (P= 0.65). Compared with women, the majority of male patients were at high risk for OSA (86.5% vs 34.23%). Individuals with high risk of obstructive sleep apnea had the highest level of daytime sleepiness (P= 0.002). Conclusion: The risk of obstructive sleep apnea is high in cardiovascular patients, so, they should be investigated to prevent further complications.    29 41 2017/03/72018/06/302018/04/7 1397/1/18 2018/10/202018/11/6 1397/8/15 جواد ستاره Javad Setareh استادیار، گروه روانپزشکی، مرکز تحقیقات روانپزشکی و علوم رفتاری، پژوهشکده اعتیاد، دانشگاه علوم پزشکی مازندران، ساری، ایران ایران jsetareh@mazums.ac.ir مهدیه مهرنیا Mahdieh Mehrnia دانشجوی پزشکی، کمیته تحقیقات دانشجویی، دانشگاه علوم پزشکی مازندران، ساری، ایران ایران m.teke69dr@gmail.com علی میرابی Ali Mirabi دانشجوی پزشکی، کمیته تحقیقات دانشجویی، دانشگاه علوم پزشکی مازندران، ساری، ایران ایران alimir7292@gmail.com obstructive sleep apnea cardiovascular diseases sleepiness آپنه انسدادی خواب بیماری های قلبی عروقی خواب آلودگی 1. American Psychiatric Assiciation Publishing (APA). Diagnostic and statistical manual of mental disorders (DSM-5®). 5th ed. American Psychiatric Pub; 2013.##2. Schröder CM, O'Hara R. 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مقایسه تاثیر روش های نمودار حجم- زمان و استتوسکوپ در کنترل نشت هوا از کاف لوله تراشه بر فراوانی آتلکتازی در بیماران تحت عمل جراحی عروق کرونر Comparing the Effects of Volume-Time Curve and Stethoscope Methods in Tube Cuff Inflation on Frequency of Atelectasis Following Coronary Artery Bypass Graft surgery 1 1 سابقه و هدف: فشار نامناسب کاف لوله تراشه موجب آسپیراسیون ترشحات دهان به داخل راه هوایی می‌گردد که این امر سبب آتلکتازی در بیماران تحت عمل جراحی کرونر می‌شود. این مطالعه با هدف مقایسه دو روش پر کردن کاف لوله تراشه بر فراوانی آتلکتازی در بیماران بعد از عمل پیوند عروق کرونر انجام پذیرفت. مواد و روش‌ها: در این مطالعه کارآزمایی بالینی، 206 نفر از بیماران کاندیدای عمل جراحی پیوند عروق کرونر بستری در مرکز قلب مازندران انتخاب و با تقسیم تصادفی در دو گروه، مورد مطالعه قرار گرفتند. در گروه اول نشت هوا با استفاده از نمودار حجم- زمان و در گروه دوم با استفاده از استتوسکوپ کنترل شد. گرافی قفسه‌سینه جهت بررسی آتلکتازی بیماران انجام شد. برای ثبت اطلاعات فردی و طبی بیماران از چک لیست محقق ساخته استفاده شد و اطلاعات در نرم‌افزار SPSS نسخه 21 وارد و مورد تجزیه و تحلیل قرار گرفت. یافته‌ها: فراوانی آتلکتازی در گروه اول و دوم به ترتیب 67 و 6/80 درصد بود که نشان می‌‌دهد در روش حجم– زمان با نشت کم‌تر هوا، آسپیراسیون و به دنبال آن فراوانی آتلکتازی کم‌تر اتفاق می‌افتد (027/0 = p). استنتاج: با توجه به نتایج این مطالعه، فراوانی آتلکتازی در گروه منحنی حجم–زمان کم‌تر و به دنبال آن اکسیژناسیون و تبادلات گازی بهبود می‌یابد، لذا کاربرد این شیوه در مراقبت پس از جراحی قلب برای کاهش عوارض ریوی توصیه می‌گردد.   شماره ثبت کارآزمایی بالینی : 4N2017091319677IRCT   2 Background and purpose: Inappropriate pressure of the endotracheal cuff causes aspiration of oral secretions in airway resulting in atelectasis. This study aimed at comparing the effects of two methods of filling the endotracheal cuff on the frequency of atelectasis in patients following coronary artery bypass graft surgery. Materials and methods: In this clinical trial, 206 candidates for coronary artery bypass graft surgery in Mazandaran Heart Center were selected and randomly divided into two groups. In the first group, air leakage was controlled by volume-time curve and in the second group it was controlled by stethoscope. Chest x-ray was obtained to look for atelectasis. A researcher-made checklist was used to record the information. Data analysis was done in SPSS V21. Results: Frequency of atelectasis was 67% in first group and 80.6% in the second group (P=0.027) which showed that in volume-time method less air leakage occurred, therefore, aspiration and frequency of atelectasis decreased too. Conclusion: According to current study, volume-time curve method decreased the frequency of atelectasis resulting in better oxygenation and gas exchanges. Therefore, this low-cost and low-risk method is suggested for post-heart surgery care to lower pulmonary side effects.   (Clinical Trials Registry Number: IRCT2017091319677N4)   42 50 2017/03/72018/06/302018/04/72018/07/30 1397/5/8 2018/10/202018/11/62018/10/1 1397/7/9 سعید جعفری Saeed Jafari . دانشجوی کارشناسی ارشد پرستاری مراقبت ویژه، کمیته تحقیقات دانشجویی، دانشگاه علوم پزشکی مازندران، ساری، ایران ایران محمد علی حیدری گرجی Mohammad Ali Heidari Gorji دانشیار، مرکز تحقیقات دیابت، دانشگاه علوم پزشکی مازندران، ساری، ایران ایران آریا سلیمانی Aria Solaimani دانشیار، گروه آموزش بیهوشی، مرکز تحقیقات قلب و عروق، دانشگاه علوم پزشکی مازندران، ساری، ایران ایران سید نورالدین موسوی نسب Seyed Nooradin Mousavinasab دانشیار، گروه آمار زیستی، مرکز تحقیقات علوم بهداشتی، دانشگاه علوم پزشکی مازندران، ساری، ایران ایران روانبخش اسمعیلی Ravanbaksh Esmaeili استادیار، مرکز تحقیقات ارتوپدی، دانشگاه علوم پزشکی مازندران، ساری، ایران ایران r.esmaeili90@gmail.com endotracheal cuff pressure coronary artery bypass pulmonary atelectasis air leakage volume –time curve فشار کاف لوله تراشه بای پس شریان کرونر آتلکتازی ریه نمودار حجم–زمان نشت هوا 1. 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Am J Crit Care 2008; 17(5): 428-435.##12. Nseir S, Zerimech F, Jaillette E, Artru F, Balduyck M. Microaspiration in intubated critically ill patients: diagnosis and prevention. Infect Disord Drug Targets 2011; 11(4): 413-423.##13. Lorente L, Blot S, Rello J. New issues and controversies in the prevention of ventilator-associated pneumonia. Am J Respir Crit Care Med 2010; 182(7): 870-876.##14. Brooks D, Crowe J, Kelsey CJ, Lacy JB, Parsons J, Solway S. A clinical practice guideline on peri-operative cardiorespiratory physical therapy. Physiother Can 2001; 53(1): 9-25.##15. Scarci M, Coonar A, Routledge T, Wells FC. Core topics in thoracic surgery. Uk: Cambridge University Press; 2016.##16. Niyayeh Saffari NH, Nasiri E, Mousavinasab SN, Ghafari R, Soleimani A, Esmaeili R. Frequency rate of atelectasis in patients following coronary artery bypass graft and its associated factors at Mazandaran Heart Center in 2013-2014. Glob J Health Sci 2015; 7(7): 97-105.##17. Westerdahl E, Olsén MF. Chest physiotherapy and breathing exercises for cardiac surgery patients in Sweden-a national survey of practice. Monaldi Arch Chest Dis 2015; 75(2): 112-119.##18. Mali A, Solanki JA, Deshpande CM. Comparison of the endotracheal cuff inflation techniques and its postoperative laryngotracheal morbidity: an observational study. Int J Res Med Sci (IJRMS) 2017; 5(2): 491-495.##19. Nseir S, Zerimech F, Fournier C, Lubret R, Ramon P, Durocher A, et al. Continuous control of tracheal cuff pressure and microaspiration of gastric contents in critically ill patients. Am J Respir Crit Care Med 2011; 184(9): 1041-1047.##20. Atlas GM. A mathematical model of differential tracheal tube cuff pressure: effects of diffusion and temperature. J Clin Monit Comput 2005; 19(6): 415-425.##21. Souza Neto E, Piriou V, Durand PG, George M, Evans R, Obadia JF, et al. Influence of temperature on tracheal tube cuff pressure during cardiac surgery. Acta Anaesthesiol Scand 1999; 43(3): 333-337.##22. Bolzan DW, Guizilini S, Faresin SM, Carvalho AC, De Paola AA, Gomes WJ. Endotracheal tube cuff pressure assessment maneuver induces drop of expired tidal volume in the postoperative of coronary artery bypass grafting. J Cardiothorac Surg 2012; 7(1): 53.##23. Naveed A, Azam H, Murtaza HG, Ahmad RA, Baig MAR. Incidence and risk factors of Pulmonary Complications after Cardiopulmonary bypass. Pak J Med Sci 2017; 33(4): 993-996.##24. Woods SE, Noble G, Smith JM, Hasselfeld K. The influence of gender in patients undergoing coronary artery bypass graft surgery: an eight-year prospective hospitalized cohort study. J Am Coll Surg 2003; 196(3): 428-234.##25. Murugan A, Sharma G. Obesity and respiratory Respir Dis 2008; 5(4): 233-242.## ##

بررسی رابطه بین شاخص توده بدنی و فشارخون دربین کودکان زیر 7 سال Relationship between Body Mass Index and Blood Pressure in Children Younger than Seven Years of Age 1 1 سابقه و هدف: امروزه اضافه وزن و فشار خون در بین کودکان بسیار رواج پیدا کرده است. هدف از این مطالعه بررسی رابطه بین شاخص توده ی بدنی و فشار خون سیستولیک و فشار خون دیاستولیک در بین کودکان کمتر از 7 سال است. روش کار: دراین مطالعه مقطعی، 400 کودک 18 ماهه تا 7 سال به روش خوشه ای تصادفی از ۲۰ مرکز شهری و روستایی انتخاب شدند و اطلاعات فردی و پزشکی انها در پرسشنامه هایی ثبت گردید. سپس قد و وزن و فشارخون آنها مورد سنجش قرار گرفت. داده ها با نرم افزار spss v21 آنالیز گردید. یافته‌ها: از ۳۱۵ کودک مانده، 187 کودک (4/59 درصد) پسر و 128 کودک (6/40 درصد) دختر بودند. 162 پسر (4/51 درصد) BMI نرمال، 25 پسر(9/7 درصد) غیر نرمال، 114 دختر (2/32 درصد ) نرمال و 14 دختر (4/4 درصد) غیر نرمال بودند. در کودکان پسر 176 کودک فشار خون سیستولیک نرمال و 11 کودک فشار خون سیستولیک غیر نرمال داشتند. در بین دختران نیز 123 کودک از فشار سیستولیک نرمال و 5 نفر از فشار سیستولیک غیر نرمال برخوردار بودند. سطح معنی داری آزمون رابطه بین شاخص توده بدنی و فشار خون سیستولیک برابر با 032/0 و سطح معنی داری آزمون رابطه بین شاخص توده بدنی و فشار خون دیاستولیک 008/0 به‌دست آمد. استنتاج: با توجه به روند رو به افزایش اضافه وزن در میان کودکان و به تبع آن افزایش فشار خون، ضروری است که با اصلاح سبک زندگی به سمت کاهش اضافه وزن در میان کودکان پرداخته شود.   2 Background and purpose: Nowadays, overweight and abnormal blood pressure (BP) have increased among children. This paper aimed at investigating the relationship between body mass index (BMI) and BP in children younger than 7 years of age. Materials and methods: In this cross-sectional study, 400 children aged 18 months to 7 years old were selected through random cluster sampling from 20 urban and rural healthcare centers. Their personal and medical information was recorded. Then, the height, weight, and blood pressure were measured. Data were analyzed in SPSS V21. Results: The study was performed in 315 children whose parents agreed to complete the study. The participants included 187 (59.4%) boys and 128 (40.6%) girls. According to BMI, most of the male subjects had normal weight (n=162, 51.4%) but 25 (7.9%) were found with abnormal weight. Similar situation was also seen in girls (114 [36.2%] vs. 14 [4.4%]). Normal and abnormal systolic blood pressure in boys and girls were seen in 176 and 11, and in 123 and 5, respectively. In this study significant relationships were found between BMI and systolic blood pressure (P= 0.032) and BMI and diastolic blood pressure in children (P= 0.008). Conclusion: The increasing trend of overweight and consequently increased blood pressure among children call for life style modification to decrease the consequences caused by these health problems.    51 57 2017/03/72018/06/302018/04/72018/07/302017/11/1 1396/8/10 2018/10/202018/11/62018/10/12018/06/9 1397/3/19 رضا سعیدی Reza Saeidi 1. مرکز تحقیقات نوزادان، دانشگاه علوم پزشکی مشهد، مشهد، ایران 2. دانشیار، گروه بیماری های کودکان، دانشکده پزشکی، دانشگاه علوم پزشکی مشهد، مشهد، ایران ایران مریم سعیدی Maryam Saeidi کارشناس مامایی، دانشگاه علوم پزشکی مشهد، مشهد، ایران ایران بنیامین طراقی Benyamin Taraghi فوف لیسانس مدیریت بازرگانی دانشگاه بین المللی امام رضا، مشهد، ایران ایران Taraghi@imamreza.ac.ir body mass index hypertension overweight children شاخص توده بدنی فشارخون بالا اضافه وزن کودکان 1. Lo JC, Chandra M, Sinaiko A, Daniels SR, Prineas RJ, Maring B, et al. Severe obesity in children: prevalence, persistence and relation to hypertension. Int J Pediatr Endocrinol 2014; 2014(1): 3.##2. Schiel R, Beltschikow W, Kramer G, Stein G. Overweight, obesity and elevated blood pressure in children and adolescents. Eur J Medl Res 2006; 11(3): 97-101.##3. Nwachukwu DC, Nwagha UI, Obikili EN, Ejezie FE, Okwuosa CN, Nweke ML. Assessment of body mass index and blood pressure among university students in, Enugu, South East, Nigeria. Niger J Med 2010; 19(2): 148-152.##4. Burke V, Beilin LJ, Dunbar D, Kevan M. Association between blood pressure and overweight defined by new standards for body mass index in childhood. Prev Med 2004; 38(5): 558–564.##5. Bose K, Ghosh A, Roy S, Gangopadhyay S. The relationship of age, body mass index and waist circumferece with blood pressure in Bengalee Hindu male jute mill worker of Belur, West Bengal, India. Anthropol Anz 2005; 63(2): 205–212.##6. Saedi R, Ahmadian M, Bolbolian Ghalibaf M, Hashemian M. Survey on correlation between unplan pregnancy and low birth weight in new infants. Iran J Neonat (IJN) 2013; 4(2): 26-33 (Persian).##7. Kliegman R, Stanton B, Joseph St, Schor N, Behrman R. "Nelson Textbook of Pediatrics", 19th ed , Philadelphia: Saunders/ Elsevier, pp. 1639-1647, 2011.##8. Saeidi R, Rahmani S, Mohammadzadeh A, Shah Farhat A, Saeidi M, Ataei A. Developmental Outcomes of Premature and Low Birth Weight Infants. Iran J Neonat 2016; 7(1): 62- 66 (Persian).##9. Mehrdad M, Hosseinpanah F, Azizi F. Prevalence of metabolic syndrome among 3-9 years old children inTehran Lipid and Glucose Study. J Shaheed Beheshti Univ Med Sci Health 2006; 30: 337-346 (Persian).##10. Ataei N, Hosseini M, Iranmanesha M. The Relationship of Body Mass Index and Blood Pressure in Iranian Children 7 Years Old. J Trop Pediatrics. 2009; 55(5): 313-317.##11. Innocent O, ThankGod OO, Sandra EO, Josiah IE. Correlation between body mass index and blood glucose levels among some Nigerian undergraduates. HOAJ Biology 2013; 2(4): 1-4.##12. Chronic disease risk factor. (Homepage on the intrenct) c2011 (cited 2012 march 2011). Available from: http://www.phac-aspc.gc.ca/ cd/risk_factor-facteurs_risque_eng.php. Accessed May 2, 2017. ##13. Hosseini M, Baikpour M, Yousefifard M, Yaseri M, Fayaz M, Shirafkan H, et al. Blood Pressure Nomograms by Age and Weight for Iranian Children and Adolescents. Int J Pediatr 2016; 4(7): 2153-2166.##14. Kliegman R, Stanton B, Joseph ST, Schor N, Behrman R. Nelson Textbook of pediatrics: Systemic Hypertension. 19th ed. Philadelphia: Elsevier/Sunders; 2011. p. 1639-1647.##15. Polat M, Yıkılkan H, Aypak C, Görpelioğlu S. The relationship between BMI and blood pressure in children aged 7-12 years in Ankara, Turkey. Public Health Nutr 2014; 17(11): 2419-2424.##16. Aliyu SU, Ahmad JT, Oyeyemi AY. Relationship Between Body Mass Index And Blood Pressure Among University Students In Maiduguri, Nigeria. International Journal of Recent Advances in Multidisciplinary Research (IJRAMR) 2014; 1(11): 91-96.##17. Nanaware NL, Gavakare AM, Surdi AD. Study of Correlation of Body Mass Index (BMI) With Blood Pressure in School Going Children and Adolescents. International Journal of Recent Trends in Science and Technology 2011; 1(1): 20-26.##18. Behjati M, Barkhordari K, Lookzadeh MH. The Relation between Blood Pressure and Body Mass Index in Iranian School Age Children. Iran J Med Sci 2006; 31(1): 33-36.## ##

وضعیت پراکندگی لیشمانیوز جلدی در استان مازندران 1388-1396 Dispersal Status of Cutaneous Leishmaniasis in Mazandaran Province, 2009-2017 1 1 سابقه و هدف: لیشمانیوزها طیفی از بیماری‌ها هستند که به صور جلدی، جلدی- مخاطی و احشائی بروز می‌کنند و توسط گونه‌های پشه خاکی منتقل می‌شوند. لیشمانیوز جلدی به عنوان یکی از معضلات مهم بهداشتی در ایران محسوب می‌شود. مطالعه حاضر به منظور تعیین وضعیت پراکنش مکانی و زمانی لیشمانیوز جلدی در شهرستان های استان مازندران بر اساس سامانه اطلاعات جغرافیایی انجام گرفت. مواد و روش‌ها: این مطالعه توصیفی-تحلیلی گذشته‌نگر بر اساس اطلاعات دموگرافیک و اپیدمیولوژیک ثبت شده از بیماران مبتلا به لیشمانیوز جلدی در نظام مراقبت بیماری حوزه معاونت بهداشتی طی سال‌های 1396-1388 در دانشگاه علوم پزشکی مازندران انجام گرفت. با استفاده از اطلاعات ثبت شده از بیماران، پراکنش زمانی- مکانی بیماری در شهرستان‌های مختلف استان مازندران با استفاده از نرم‌افزار ArcGIS10.4 ترسیم شد. یافته‌ها: به طور کلی تعداد بیماران مبتلا به لیشمانیوز جلدی طی سال‌های مورد مطالعه 378 نفر بود. بیش‌ترین تعداد بیمار در شهرستان ساری (71 مورد) و کم‌ترین موارد در شهرستان عباس‌آباد (2 مورد) مشاهده شد. بیش‌ترین موارد در شرق و کم‌ترین موارد در غرب استان به ترتیب 182 و73 نفر گزارش شده است. میزان بروز در غرب استان کم‌تر از نواحی مرکزی و شرق استان بود. استنتاج: با توجه به نتایج این تحقیق و پراکندگی لیشمانیوز جلدی در ایران و شرایط استان مازندران از نظر فعالیت‌های کشاورزی، دامداری و مهاجرپذیر بودن منطقه، این بیماری می‌تواند معضل مهم بهداشتی مطرح شود و باید جهت کنترل بیماری برنامه‌ریزی‌های لازم انجام شود.     2 Background and purpose: The leishmaniases are a group of diseases that appear as cutaneous, mucocutaneous, and visceral leishmaniasis, transmitted by different species of sand flies. Cutaneous leishmaniasis (CL) is considered as a major public health problem in Iran. The current study was carried out to determine the spatial and temporal distribution of CL in Mazandaran Province, Iran according to Geographical Information System (GIS). Materials and methods: This retrospective descriptive study was carried out according to demographic and epidemiologic data collected from patients diagnosed with CL during 2009-2017 recorded in Health deputy of Mazandaran University of Medical Sciences. The spatial and temporal distribution of CL in different cities of Mazandaran Province was mapped using ArcGIS 10.4 software. Results: The number of patients with CL was 378 during the years studied. The highest and lowest numbers of CL patients were seen in Sari and Abbas Abad, respectively (n=71, n=2, respectively). Most of the cases (n= 182) were reported in east of Mazandaran and the least number of cases (n= 73) were observed in the west of province. The incidence rate in the west of the province was lower than that of the center and east of the province. Conclusion: Distribution of CL in Iran, agricultural activities, livestock breeding, and migratory status in Mazandaran Province call for appropriate planning to control this disease.   58 70 2017/03/72018/06/302018/04/72018/07/302017/11/12018/07/28 1397/5/6 2018/10/202018/11/62018/10/12018/06/92018/11/6 1397/8/15 لیلی قوی بازو Leila Ghavibazou دانشجوی کارشناسی ارشد، گروه حشره شناسی پزشکی و مبارزه با ناقلین، دانشکده بهداشت، دانشگاه علوم پزشکی مازندران، ساری، ایران ایران نصیبه حسینی واسوکلایی Nasibeh Hosseini-Vasoukolaei استادیار، گروه حشره شناسی پزشکی و مبارزه با ناقلین، مرکز تحقیقات علوم بهداشتی، پژوهشکده اعتیاد، دانشگاه علوم پزشکی مازندران، ساری، ایران ایران nasibeh.hoseini@gmail.com امیر احمد اخوان Amir Ahmad Akhavan دانشیار، گروه حشره شناسی پزشکی و مبارزه با ناقلین، دانشکده بهداشت، دانشگاه علوم پزشکی تهران، تهران، ایران ایران الهام جهانی فرد Elham Jahanifard استادیار، گروه حشره شناسی پزشکی و مبارزه با ناقلین، دانشگاه علوم پزشکی جندی شاپور اهواز، اهواز، ایران ایران جمشید یزدانی چراتی Jamshid Yazdani-Charati دانشیار، گروه آمار زیستی، مرکز تحقیقات علوم بهداشتی، پژوهشکده اعتیاد، دانشگاه علوم پزشکی مازندران، ساری، ایران ایران محمود فاضلی دینان Mahmoud Fazeli-Dinan استادیار، گروه حشره شناسی پزشکی و مبارزه با ناقلین، مرکز تحقیقات علوم بهداشتی، پژوهشکده اعتیاد، دانشگاه علوم پزشکی مازندران، ساری، ایران ایران cutaneous leishmaniasis Mazandaran province spatial-temporal distribution Geographical Information System لیشمانیوز جلدی استان مازندران پراکنش مکانی-زمانی سیستم اطلاعات جعفرافیایی 1. 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Molecular Detection of Leishmania major and L. turanica in Phlebotomus papatasi and First Natural Infection of P. salehi to L. major in North-east of Iran. J Arthropod-Borne Dis 2016; 10(2): 141-147.##6. Hosseini-Vasoukolaei N. Sand fly saliva: toward a vaccine against leishmaniases. Vacres 2015; 2(3-4): 86-92.##7. Roshanghalb M, Parvizi P. Isolating and Determining Leishmania major and Leishmania turanica in Phlebotomus papatasi in Golestan Province. J Mazandaran Univ Med Sci 2012; 21(1): 74-83 (Persian).##8. Oshaghi M, Maleki RN, Javadian EA, Rassi Y, Mohebali M, Sadraei J, et al. Detection and identification of leishmania parasites within sand flies using kdna , Rdna and Cpb LOCI. Modares J Med Sci 2008; 11(1-2):81-89 (Persian).##9. Azizi K, Rassi Y, Motazedian M, Javadian E, Yaghoobi-Ershadi M, Rafizadeh S, et al. Phlebotomus (Paraphlebotomus) alexandri, the probable vector of visceral leishmaniasis (kalaazar) in southern Iran. SJSPH 2006; 4(4): 39-48.##10. Veysi A, Yaghoobi-Ershadi MR, Rassi Y, Hosseini-Vasoukolaei N, Jeddi-Tehrani M, Rezaee-Node A, et al. Rearing and Biology of Phlebotomus sergenti, the Main Vector of Anthroponotic Cutaneous Leishmaniasis in Iran. J arthropod-borne dis 2017; 11(4): 504-514.##11. Maleki N, Javadian EA, Mohebali M, Dalimiasl A, Sadraei J, Zarei Z, et al. Natural infection of sand flies Sergentomyiia dentata in Ardebil to Lizard Leishmania. MJMS 2008; 10: 65-73 (Persian).##12. Doroodgar A, Asmar M, Razavi MR, Doroodgar M. Identifying the type of cutaneous leishmaniasis in patients, reservoirs and vectors by RAPD-PCR in Aran & Bidgol district of Esfahan Province during 2006-7. FEYZ 2009; 13(2): 141-146 (Persian).##13. Soleimani–Ahmadi M, Dindarloo K, Zare S. Cutaneous leismaniasis in Bastak, Hormozgan province, 2003. Med J Hormozgan 2004; 8(2): 85-89 (Persian).##14. Parvizi P, Moradi G, Amirkhani A. Comparison of molecular methods with other common laboratory methods in detecting leishmania parasites in animal reservoirs of rural cutaneous leishmaniasis Iranian J Infectious Dis Trop Med 2009; 14(44):13-19 (Persian).##15. Heydarpour F, Sari AA, Mohebali M, Shirzadi M, Bokaie S. Incidence and disability-adjusted life years (Dalys) attributable to leishmaniasis in Iran, 2013. Ethiop J health Sci 2016; 26(4): 381-388.##16. Hosseini-Vasoukolaei N, Mahmoudi A-R, Khamesipour A, Yaghoobi-Ershadi MR, Kamhawi S, Valenzuela JG, et al. Seasonal and Physiological Variations of Phlebotomus papatasi Salivary Gland Antigens in Central Iran. J Arthropod Borne Dis 2016;10(1): 39-49.##17. Mohammadi Azni S , RassiY, Oshaghi M , Yaghoobi Ershadi , Mohebali M , Abai MR , et al. Determination of parasite species of cutaneous leishmaniasis using Nested PCR in Damghan-Iran, during 2008. J Gorgan Uni Med Sci 2011;13(1): 59-65 (Persian).##18. Yaghoobi-Ershadi MR. Control of phlebotomine sand flies in Iran: a review article. J Arthropod Borne Dis 2016; 10(4): 429.##19. Sofizadeh A, Cherabin M, Mehravaran A. Cutaneous leishmaniasis in Gonbad Kavoos, North of Iran (2009-11): an epidemiological study. J Gorgan Uni Med Sci 2013; 14(4): 100-106 (Persian).##20. Mohajeri M, Shamsian A. Medical protozoology. Mashhad: Academic Center for Education, Culture and Research (ACECR) Publishers; 2010.##21. Clem A. A current perspective on leishmaniasis. J Glob Infect Dis 2010; 2(2): 124-126.##22. Khajedaluee M, Yazdanpanah MJ, Seyed Nozadi S, Fata A, Juya MR, Masoudi MH, et al. Epidemiology of cutaneous leishmaniasis in population covered by Mashhad University of Medical Sciences in 2011. MJMS 2014; 57(4): 647-654 (Persian).##23. Samadi Alinia H. Practical training Create descriptive and spatial map and database in ArcGIS. 2rd ed. Tehran: Noavar Publication; 2017.##24. Youssefi MR, Shojaei J, Jalahi H, Amoli SA, Ghasemi H, Javadian M. Prevalence of cutaneous leishmaniasis during 2010 in Mazandaran Province, Iran. Afr J Microbiol Res 2011; 5(31): 5793-5795.##25. Norouzinezhad F, Ghaffari F, Norouzinejad A, Kaveh F, Gouya MM. Cutaneous leishmaniasis in Iran: Results from an epidemiological study in urban and rural provinces. Asian Pac J Trop Biomed 2016; 6(7): 614-619.##26. Salname Amari Mazandaran, 2015, Available at: URL:https://mazandaran.mporg.ir.##27. Jahanifard E, Yaghoobi-Ershadi MR, Akhavan AA, Akbarzadeh K, Hanafi-Bojd AA, Rassi Y, et al. Diversity of sand flies (Diptera, Psychodidae) in southwest Iran with emphasis on synanthropy of Phlebotomus papatasi and Phlebotomus alexandri. Acta Trop 2014; 140: 173-80.##28. Afshar AA, Rassi Y, Sharifi I, Abai M, Oshaghi M, Yaghoobi-Ershadi M, et al. Susceptibility status of Phlebotomus papatasi and P. sergenti (Diptera: Psychodidae) to DDT and deltamethrin in a focus of cutaneous leishmaniasis after earthquake strike in Bam, Iran. 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بررسی فعالیت آنتی اکسیدانی در سه رقم برنج Analysis of Antioxidant Activity of Three Rice Varieties 1 1 سابقه و هدف: برنج یکی از منابع غذایی مهم در دنیا می‌باشد. امروزه توجه به واسطه خواص آنتی‌اکسیدانی به ارقام رنگی برنج معطوف شده است. در این مطالعه، فعالیت آنتی اکسیدانی در بخش های مختلف سه گونه برنج مورد بررسی قرار گرفته است. مواد و روش‌ها: عصاره‌گیری از برنج سفید، برنج قهوه ای، سبوس نرم و سبوس خام سه رقم برنج فجر، هاشمی و KB13 با روش ماسیراسیون، با کمک متانول انجام شد. محتوای تام فنلی و فلاونوئیدی و فعالیت آنتی اکسیدانی با سه روش ارزیابی شد. میزان فرولیک اسید و پارا کوماریک اسید با کروماتوگرافی مایع با کارکرد بالا تعیین گردید. یافته‌ها: عصاره سبوس خام برنج KB13 با 2/15 ± 83/319 mgGAE و 8/3 ± 58/77 mgQE در گرم عصاره بالاترین مقدار فنل و فلاونوئید تام را از خود نشان داد. درصد به دام‌اندازی رادیکال DPPH توسط عصاره‌های سبوس خام برنج‌های مختلف از بقیه اجزای برنج به‌طور معنی‌داری بالاتر بود. بیش‌ترین میزان مربوط سبوس خام هاشمی بود. درصد به دام‌اندازی رادیکال نیتریک اکساید توسط عصاره‌های سبوس خام برنج‌های مختلف از بقیه اجزای برنج به طور معنی‌داری بالاتر بود (001/0< p). نتایج HPLC نشان داد که سبوس خام هاشمی بیش‌ترین مقدار فرولیک اسید (21/26) و سبوس خام KB13 بیش‌ترین مقدار پارا-کوماریک اسید را با مقدار 66/3 mg/g extract دارا می‌باشند. استنتاج: رقم های فجر، هاشمی و KB13 از ایران به طور قابل ملاحظه ای دارای فعالیت آنتی اکسیدانی و محتوای تام فنلی و فلاونوئیدی بالاتری نسبت به نمونه‌های خارجی مرور شده در این بررسی دارد.   2 Background and purpose: Rice (Oryzasativa L.) is one the most important staple food in the world. There is an increasing interest for pigmented varieties, due to their antioxidant properties. In this research, the antioxidant activities in different parts of three varieties of rice were studied. Materials and methods: White rice, brown rice, husk, and bran of Fajr, Hashemi and KB13 were extracted by maceration method using methanol as a solvent. Antioxidant capacity was assessed by three different methods. The total phenolic and flavonoid contents were also determined. Ferulic acid and p-coumaric acid were detected by High-Performance Liquid Chromatography (HPLC). Results: KB13 rice bran showed the highest amount of total phenolics (319.83 ± 15.21 mgGAE) and flavonoid contents (77.58 ± 3.8 mgQE). The Hashemi crude bran extract was significantly different from other extracts in DPPH radical scavenging activity (P<0.001). The barn of three rice varieties showed the highest activity in nitric oxide radical scavenging activity (P<0.001). The bran of Hashemi and KB13 showed the highest amount of ferulic acid (26.21 mg/g extract) and p-Coumaric acid (3.66 mg.g extract), respectively. Conclusion: The Iranian Fajr, Hashemi and KB13 rice varieties were found to have significantly higher antioxidant activities and total phenolic and flavonoid contents compared with other foreign samples reviewed.   71 82 2017/03/72018/06/302018/04/72018/07/302017/11/12018/07/282018/05/18 1397/2/28 2018/10/202018/11/62018/10/12018/06/92018/11/62018/11/4 1397/8/13 علی کربلایی آقاملکی Ali Maleki دانشجوی داروسازی، کمیته تحقیقات دانشجوئی، دانشگاه علوم پزشکی مازندران، ساری، ایران ایران محمد تقی کربلایی آقاملکی Mohamad Taghi Karbalaii استادیار، موسسه تحقیقات برنج کشور، آمل ، ایران ایران محمدعلی ابراهیم‌زاده Mohammad Ali Ebrahimzadeh استاد، مرکز تحقیقات علوم داروئی، پژوهشکده هموگلوبینوپاتی، دانشگاه علوم پزشکی مازندران، ساری، ایران ایران zadeh20@gmail.com antioxidant phenol flavonoids rice bran ferulic acid coumaric acid آنتی‌اکسیدان ترکیبات فنلی فلاونوئید برنج سبوس فرولیک اسید کوماریک اسید. 1. Nascimento-Souza MA, Paiva PG, Martino HSD, Ribeiro AQ. 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Devi RR, Arumughan C. Phytochemical characterization of defatted rice bran and optimization of a process for their extraction and enrichment. Bioresour Technol 2007; 98(16): 3037-3043.##7. Tian S, Nakamura K, Kayahara H. Analysis of phenolic compounds in white rice, brown rice, and germinated brown rice. J Agric Food Chem 2004; 52(15): 4808-4813.##8. Arab F, Alemzadeh I, Maghsoudi V. Determination of antioxidant component and activity of rice bran extract. Scientia Iranica 2011; 18(6):1402-1406.##9. Heinemann R, Fagundes P, Pinto E, Penteado M, Lanfer-Marquez U. Comparative study of nutrient composition of commercial brown, parboiled and milled rice from Brazil. J Food Compos Anal 2005; 18(4): 287-296.##10. Ghasemzadeh A, Jaafar HZ, Rahmat A, Ashkani S. Secondary metabolites constituents and antioxidant, anticancer and antibacterial activities of Etlingera elatior (Jack) RM Sm grown in different locations of Malaysia. BMC Comp Alt Med 2015; 15(1): 335.##11. Pengkumsri N, Chaiyasut C, Saenjum C, Sirilun S, Peerajan S, Suwannalert P, (et al). Physicochemical and antioxidative properties of black, brown and red rice varieties of northern Thailand. Food Sci Technol 2015; 35(2): 331-338.##12. Moko E, Purnomo H, Kusnadi J, Ijong F. Phytochemical content and antioxidant properties of colored and non-colored varieties of rice bran from Minahasa, North Sulawesi, Indonesia. Int Food Res J 2014; 21(3): 1017-1023.##13. Ghasemi K, Ghasemi Y, Ehteshamnia A, Nabavi SM, Nabavi SF, Ebrahimzadeh MA, et al. Influence of environmental factors on antioxidant activity, phenol and flavonoids contents of walnut (Juglans regia L.) green husks. J Med Plant Res 2011; 5(7): 1128-1133.##14. Ebrahimzadeh MA, Nabavi SM, Nabavi SF, Eslami B. Antioxidant activity of the bulb and aerial parts of Ornithogalum sintenisii L (Liliaceae) at flowering stage. Trop J Pharm Res 2010; 9(2): 141-148.##15. Ebrahimzadeh MA, Nabavi SM, Nabavi SF, Eslami B, Ehsanifar S. Antioxidant activity of Hyoscyamus squarrosus fruits. Pharmacologyonline 2009; 2: 644-650.##16. Ebrahimzadeh MA, Nabavi SM, Nabavi SF, Eslami Sh. Antioxidant and free radical scavenging activities of culinary-medicinal mushrooms, golden chanterelle Cantharellus cibarius and angel’s wings Pleurotus porrigens. Int J Med Mushrooms 2010; 12(3): 265-272.##17. Khalili M, Ebrahimzadeh MA, Kosaryan M. In Vivo iron-chelating activity and phenolic profiles of the Angel’s wings mushroom, Pleurotus porrigens (Higher Basidiomycetes). Int J Med Mushrooms 2015; 17(9): 847-856.##18. Falleh H, Ksouri R, Lucchessi ME, Abdelly C, Magné C. Ultrasound-assisted extraction: effect of exraction time and solvent power on the levels of polyphenols and antioxidant activity of Mesembryanthemum edule L. Aizoaceae shoots. Trop J Pharm Res 2012; 11(2): 243-249.##19. Nabavi SM, Ebrahimzadeh MA, Nabavi SF, Eslami B, Dehpour AA. Antioxidant and antihaemolytic activities of Ferula foetida regel (Umbelliferae). Eur Rev Med Pharmacol Sci 2011; 15 (2): 157-164.##20. Laokuldilok T, Shoemaker CF, Jongkaewwattana S, Tulyathan V. Antioxidants and antioxidant activity of several pigmented rice brans. J Agric Food Chem 2011; 59(1): 193-199.##21. Pang Y, Ahmed S, Xu Y, Beta T, Zhu Z, Shao Y, Bao J. Bound phenolic compounds and antioxidant properties of whole grain and bran of white, red and black rice. Food Chem 2018; 240: 212-221.##22. Zaupa M, Calani L, Del Rio D, Brighenti F, Pellegrini N. Characterization of total antioxidant capacity and (poly)phenolic compounds of differently pigmented rice varieties and their changes during domestic cooking. Food Chem 2015; 187: 338-347.##23. Ti H, Zhang R, Zhang M, Wei Z, Chi J, Deng Y, et al. Effect of extrusion on phytochemical profiles in milled fractions of black rice. Food Chem 2015; 178: 186-194.##24. Paiva FF, Vanier NL, Berrios JD, Pinto VZ, Wood D, Williams T, et al. 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Phenolic acids, anthocyanins, proanthocyanidins, antioxidant activity, minerals and their correlations in non-pigmented, red, and black rice. Food Chem 2018; 239: 733-741.##35. Shao Y, Xu F, Sun X, Bao J, Beta T. Phenolic acids, anthocyanins, and antioxidant capacity in rice (Oryza sativa L.) grains at four stages of development after flowering. Food Chem 2014; 143: 90-96.##36. Jun H, Shin J, Song G, Kim Y. Isolation and identification of phenolic antioxidants in black rice bran. J Food Sci 2015; 80(2): 262-268.##37. Aliev G, Palacios HH, Lipsitt AE, Fischbach K, Lamb B, Obrenovich ME, et al. Nitric oxide as an initiator of brain lesions during the development of Alzheimer disease. Neurotox Res 2009; 16(3): 293-305.##38. Shan B, Cai YZ, Sun M, Corke H. Antioxidant capacity of 26 spice extracts and characterization of their phenolic constituents. J Agric Food Chem 2005; 53(20): 7749-7759.#### ##

آنالیز منحنی ذوب DNA با کیفیت بالا (HRM) به منظور شناسایی استافیلوکوک اورئوس و سویه مقاوم به متی سیلین Applying High-quality DNA Melting Curve Analysis in Identifying Staphylococcus aureus and Methicillin-resistant Strains 1 1 سابقه و هدف: آنالیز منحنی ذوب DNA با کیفیت بالا (HRM) یکی از حساس‌ترین و دقیق‌ترین روش‌ها جهت شناسایی استافیلوکوک اورئوس و مقاومت به متی سیلین است. این مطالعه با هدف آنالیز منحنی ذوب DNA با کیفیت بالا، به منظور شناسایی سویه های استافیلوکوک اورئوس مقاوم به متی سیلین انجام پذیرفت. مواد و روش‌ها: در این مطالعه تجربی، از سویه‌های استاندارد استافیلوکوک اورئوس ATCC25923 و ATCC 33592 استفاده شد. جهت شناسایی استافیلوکوک اورئوس از ژن ITS، و مقاومت به متی‌سیلین از ژن mecA استفاده گردید. با استفاده از نرم‌افزارهای StepOne Software v2.3 و HRM Software v3.0.1 تجزیه و تحلیل انجام شد و نتایج تعیین توالی به عنوان گلد ‌استاندارد مورد استفاده قرار گرفت. یافته‌ها: حساسیت آنالیتیکی روش PCR با استفاده از پرایمر ITS قادر به شناسایی CFU 104 باکتری بوده و برای ژن mecA تا CFU 103 باکتری را تشخیص داد. حسایت آنالیتیکی روش HRM نیز برای پرایمر ژن ITS تا رقت CFU 2-10 و پرایمر ژن mecA تا رقت CFU 5-10 قدرت شناسایی باکتری را داشته است. در تجزیه و تحلیل نتایج HRM نیز کم‌ترین مقدار خطا در منحنی‌ها ذوب DNA مشاهده گردید به طوری که، با در نظر گرفتن نزدیک ترین بازه دمایی به منظور تجزیه و تحلیل، دمای ذوب برای ژن ITS مقدار 5/0± 86 درجه سلسیوس و برای ژن mecA مقدار 5/0± 81 درجه سلسیوس به دست آمد. نتایج دما و تعیین توالی اختصاصیت بالای روش HRM را نشان داد. استنتاج: روش HRM از نظر تشخیص مقدار کم باکتری، دارای حساسیت و اختصاصیت بالایی می باشد.   2 Background and purpose: High Resolution Melting curve analysis DNA (HRM) is one of the most sensitive and precise methods for detecting Staphylococcus aureus and resistance to Methicillin. The aim of this study was to analyze the HRM for detection of methicillin-resistant S. aureus strains. Materials and methods: In this experimental study, standard strains of S.aureus ATCC25923 and ATCC 33592 were used. To identify S.aureus from ITS gene and methicillin resistance, the mecA gene was used. Analysis was performed using StepOne v2.3 and HRM v3.0.1. Sequencing results were used as gold standard. Results: The analytical sensitivity of the PCR method by ITS primer was capable of detecting 104 CFU bacteria and detecting bacteria for the mecA gene up to 103 CFU. The analytical sensitivity of the HRM method was also valid for ITS gene primer to dilute 10-2 CFU and the mecA gene primer up to a dilution of 10-5 CFU to detect bacteria. In HRM analysis, the lowest error rate was observed in the melting curves of DNA. Thus, considering the closest temperature range for analysis, the melting temperature for the ITS gene was 86 ± 0.5°C and for the mecA gene was 81± 0.5°C. The results of temperature and sequence determination proved the specificity of the HRM. Conclusion: The HRM has high sensitivity and specificity for detecting low levels of bacteria.   83 93 2017/03/72018/06/302018/04/72018/07/302017/11/12018/07/282018/05/182018/02/7 1396/11/18 2018/10/202018/11/62018/10/12018/06/92018/11/62018/11/42018/06/9 1397/3/19 حامد طهماسبی Hamed Tahmasebi کارشناس ارشد میکروب شناسی پزشکی، دانشکده پزشکی، دانشگاه علوم پزشکی زاهدان، زاهدان، ایران ایران ساناز ده باشی Sanaz Dehbashi دانشجوی دکتری باکتری شناسی پزشکی، دانشکده پزشکی، دانشگاه علوم پزشکی همدان، همدان، ایران ایران محمد رضا عربستانی Mohammad Reza Arabestani دانشیار، گروه میکروب شناسی، دانشکده پزشکی، دانشگاه علوم پزشکی همدان، همدان، ایران مرکز تحقیقات بروسلوز، دانشکده پزشکی، دانشگاه علوم پزشکی همدان، همدان، ایران ایران mohammad.arabestani@gmail.com Staphylococcus aureus Methicillin resistance DNA Melting Curve HRM استافیلوکوک اورئوس مقاومت به متی سیلین منحنی ذوب DNA HRM 1. Warren DK, Prager M, Munigala S, Wallace MA, Kennedy CR, Bommarito KM, et al. Prevalence of qacA/B Genes and Mupirocin Resistance Among Methicillin-Resistant Staphylococcus aureus (MRSA) Isolates in the Setting of Chlorhexidine Bathing Without Mupirocin. Infect Control Hosp Epidemiol 2016; 37(5): 1-8.##2. Taheri N, Abtahi H, Amozande-Nobaveh A, Zarinfar N, Ghaznavi-Rad E. The Antibiotic Resistant Determinant of Pathogenic Bacteria Isolated from Medical Equipment and Hospital Environment in Valiasr Hospital, Arak, 2013. J Mazandaran Univ Med Sci 2014; 24(114): 60-73 (Persian)##3. Tahmasebi H, Zeiyni B, Dehbashi S, Motamedi H, Vafaeifar M, Keramat F, et al. The Study of blaZ and mecA Gene Expression in Methicillin-Resistant Staphylococcus Aureus Strains and the Relationship between the Gene Expression Patterns. J Isfahan Med Sch; 2017; 35(443): 1062-1067 (Persian).##4. Bleiziffer I, Eikmeier J, Pohlentz G, McAulay K, Xia G, Hussain M, et al. The Plasmin-Sensitive Protein Pls in Methicillin-Resistant Staphylococcus aureus (MRSA) Is a Glycoprotein. PLoS Pathog 2017; 13(1): e1006110.##5. Dehbashi S, Tahmasebi H, Zeyni B, Arabestani M. The Relationship between Promoter-Dependent Quorum Sensing Induced Genes and Methicillin Resistance in Clinical Strains of Staphylococcus aureus. J Zanjan Univ Med Sci 2018; 26(116): 75-87 (Persian).##6. Rezai S, Peyravii Ghadikolaii F, Ahanjan M, Valadan R, Ahangarkani F, Rezai MS, et al. Prevalence of Nasal Carriage Methicillin-Resistant Staphylococcus aureus with mecA Gene among Healthy Primary School Boys in North of Iran; A Cross-Sectional Study. Int J Pediatr 2017; 5(12): 6515-6525.##7. Gurtler V, Barrie HD. Typing of Staphylococcus aureus strains by PCR-amplification of variable-length 16S-23S rDNA spacer regions: characterization of spacer sequences. Microbiology 1995; 141(Pt 5): 1255-1265.##8. Fujita S. Internal transcribed spacer (ITS)-PCR identification of MRSA. 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بررسی کارایی CoFe2O4 با پایه گرافن در فعال سازی پراکسی مونوسولفات و حذف آموکسی سیلین از محیط های آبی Performance of Graphene-based CoFe2O4 in Activation of peroxymonosulfate and Amoxicillin Removal from Aqueous Solutions 1 1 سابقه و هدف: امروزه آموکسی‌سیلین به عنوان مهم ترین و پرمصرف‌ترین آنتی‌بیوتیکی‌ محسوب می شود که به‌دلیل ایجاد مقاومت در باکتری‌ها مورد توجه خاصی قرار گرفته است. این ترکیب از مسیرهای مختلفی مانند دفع مستقیم فاضلاب، زائدات پزشکی و دام‌پزشکی و صنعت و غیره وارد محیط‌های آبی می‌شود. هدف از این مطالعه، ارزیابی کارایی نانوکاتالیست گرافن- کبالت مغناطیسی شده در فعال‌سازی پراکسی مونوسولفات برای حذف آموکسی‌سیلین از محیط‌های آبی بوده است. مواد و روش‌ها: در این مطالعه تجربی اکسید گرافن با استفاده از روش اصلاح شده Hummers از گرافیت سنتز گردید. سپس نانوکاتالیست گرافن-کبالت مغناطیسی شده طی چند مرحله ساخته شد. خصوصیات بافت و نظم ساختاری نانوکاتالیست ساخته شده با استفاده از روش‌های SEM و TEM، EDS و XRD  مورد آنالیز قرار گرفت. چندین پارامتر بهره برداری مورد بررسی قرار گرفتند که شامل دوز پراکسی مونوسولفات (PMS)، pH ، مدت زمان واکنش، غلظت کاتالیزور و غلظت اولیه آلاینده بودند. غلظت آموکسی سیلین با استفاده از دستگاه HPLC مورد سنجش قرار گرفت. یافته‌ها: در این مطالعه نانوکاتالیست G/CoFe2O4 به طور موفقیت آمیزی سنتز شد. براساس نتایج به دست آمده، شرایط بهینه برای غلظت پراکسی مونوسولفات Mm 3 ، دوز کاتالیست G/CoFe2O4 5/0 گرم بر لیتر، 6 pH ، زمان واکنش 60 دقیقه و غلظت آموکسی سیلین 10 میلی گرم بر لیتر به دست آمد. تحت این شرایط بهینه، درصد حذف آموکسی سیلین، اکسیژن مورد نیاز شیمیایی (COD) و کل کربن آلی (TOC) به ترتیب 27/99، 1/83 و 11/61 درصد به دست آمد. استنتاج: در این مطالعه، کاتالیست CoFe2O4 با فعال‌سازی موثر پراکسی مونوسولفات راندمان بالایی در حذف آموکسی سیلین داشت. بنابراین نتایج، فرآیند G/CoFe2O4/PMS می تواند به عنوان یک فرآیند موثر و با راندمان بالا در تصفیه محلول های صنایع مرتبط استفاده گردد.   2 Background and purpose: Nowadays, amoxicillin is one of the most important and most frequently used antibiotics that has received especial attention as it causes resistance in bacteria. This compound enters the aquatic environment through different routes including sewage and waste disposal of medical centers, veterinary centers and industries. The aim of this study was to evaluate the performance of graphene-cobalt nano-catalyst for activation of peroxymonosulfate and amoxicillin removal from aqueous solutions. Materials and methods: In this experiment, graphene oxide was prepared by Hummers method from natural graphite. Then, magnetic graphene-cobalt nanocatalyst was made in several steps. The structural order and textural properties of the magnetic graphene-cobalt nanocatalyst were studied by EDS, SEM, TEM, and XRD. Several operational parameters were examined including the peroxymonosulfate (PMS) dosage, solution pH, reaction time, catalyst dosage, and initial concentration of amoxicillin. The amoxicillin concentration was quantified by High HPLC. Results: In this study, the graphene-based CoFe2O4 was successfully synthesized. Optimum condition for removal of pollutants was achieved in 3 mM peroxymonosulfate, 0.5 g/L G/CoFe2O4, pH 6.0, 60 m reaction time, and amoxicillin concentrations of 10 mg/L. In this condition, the amoxicillin, chemical oxygen demand (COD) and total organic carbon (TOC) removal efficiency was 99.27%, 83.1%, and 61.11%, respectively. Conclusion: In this study, the graphene-based CoFe2O4 with effective activation of peroxymonosulfate had high efficiency in removal of amoxicillin. According to current study, G/CoFe2O4/PMS process can be used as an effective and efficient process for treatment of aqueous solutions in related industries.   94 109 2017/03/72018/06/302018/04/72018/07/302017/11/12018/07/282018/05/182018/02/72017/11/26 1396/9/5 2018/10/202018/11/62018/10/12018/06/92018/11/62018/11/42018/06/92018/05/21 1397/2/31 الهام بابایی لشکریانی Elham Babayi Lashkariyani دانشجوی کارشناسی ارشد، مهندسی بهداشت محیط، دانشکده بهداشت، دانشکاه علوم پزشکی ایران، تهران، ایران ایران روشنک رضایی کلانتری Roshanak Rezaei Kalantary استاد گروه مهندسی بهداشت محیط، دانشکده بهداشت، دانشکاه علوم پزشکی ایران، تهران، ایران ایران rezaei.r@iums.ac.ir احمد جنیدی جعفری Ahmad Jonidi Jafari استاد گروه مهندسی بهداشت محیط، دانشکده بهداشت، دانشکاه علوم پزشکی ایران، تهران، ایران ایران میترا غلامی Mitra Gholami استاد گروه مهندسی بهداشت محیط، دانشکده بهداشت، دانشکاه علوم پزشکی ایران، تهران، ایران ایران amoxicillin graphene-cobalt nano-catalyst peroxymonosulfate aqueous solution آموکسی‌سیلین گرافن-کبالت نانوکاتالیست پراکسی مونوسولفات محلول‌های آبی 1. 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تعیین غلظت استرهای فتالات در آب های بطری شده در ظروف پلی اتیلن ترفتالات(PET) تحت شرایط مختلف نگهداری  Concentration of Phthalate Esters in Polyethylene Terephthalate Bottled Drinking Water in Different Storage Conditions 1 1 سابقه و هدف: مصرف آب‌های بطری شده در دنیا رو به افزایش است و نگرانی‌های زیادی در زمینه مهاجرت استرهای فتالات به درون آب‌های بطری شده وجود دارد. این ترکیبات برای مصرف کنندگان مخاطره‌آمیز است. در این مطالعه غلظت استرهای فتالات در آب‌های بطری شده در ظروف پلی اتیلن ترفتالات تحت شرایط مختلف نگهداری تعیین و بررسی شد. مواد و روش‌ها: نمونه‌های آب بطری شده در شرایط مختلف، نگهداری و سپس استرهای فتالات پس از استخراج با روش میکرو استخراج مایع- مایع کمک شده با هوا (ALLME) توسط کروماتوگرافی گازی- طیف سنج جرمی (GC-MS) آنالیز و اندازه‌گیری شدند. تجزیه و تحلیل آماری داده‌ها به وسیله نرم افزار SPSS نسخه 24 انجام گرفت. یافته‌ها: نتایج این تحقیق نشان می‌دهد که میانگین 5 استر فتالات (DEHP,DBP,DIBP,DEP ,DMP) مورد بررسی در شرایط مختلف نسبت به سطح اولیه آن در نمونه‌های شاهد به طور متوسط 84/392 درصد افزایش داشته است. دی اتیل هگزیل فتالات (DEHP)، در بطری‌های آب آشامیدنی که در معرض 15 روز نگهداری در دمای انکوباتور (°C42) و 75 روز نگهداری در دمای انکوباتور (°C25)، قرار گرفته بودند به ترتیب 33/10 و 62/9 ppb و بالاتر از حد مجاز بود. استنتاج: غلظت استرهای فتالات اندازه گیری شده در آب تحت تاثیر شرایط نگهداری مختلف افزایش یافت. دمای بالا و افزایش مدت زمان نگهداری تاثیر بیش‌تری در مهاجرت استرهای فتالات داشته اند. بنابراین استفاده از ظروف PET برای بسته‌بندی آب‌های بطری شده جهت نگهداری در دمای بالا و زمان نگهداری طولانی مدت مناسب نیست.   2 Background and purpose: Consumption of bottled water is increasing in the world and there are many concerns about the migration of phthalate esters into bottled water. These compounds are risky for consumers. This study investigated the concentration of phthalate esters in bottled water in polyethylene terephthalate containers in different storage conditions. Materials and methods: Bottled water samples were stored in different conditions and then the phthalate esters were analyzed by gas extraction liquid-liquid-aqueous extraction (ALLME) method and gas chromatography-mass spectrometer (GC-MS). Data analysis was done in SPSS V24. Results: Findings showed that the average concentrations of 5 phthalate esters (DEHP, DBP, DIBP, DEP, and DMP) in different conditions increased by an average of 392.84% compared to the initial levels in control samples. Diethylhexyl phthalate (DEHP) concentrations in bottles of drinking water incubated at 42°c for 15 days and 25°c for 75 days were 10.33 and 9.62 ppb, respectively, which were higher than the limits. Conclusion: Current research showed increased concentration of phthalate esters in water samples in different storage conditions. High temperatures and prolonged storage time were found to influence the migration of phthalate esters. Therefore, PET packaging is not suggested for drinking water to be kept in higher temperatures and longer storage times. 110 120 2017/03/72018/06/302018/04/72018/07/302017/11/12018/07/282018/05/182018/02/72017/11/262018/06/11 1397/3/21 2018/10/202018/11/62018/10/12018/06/92018/11/62018/11/42018/06/92018/05/212018/10/31 1397/8/9 ذبیح اله یوسفی Zabihollah Yousefi استاد، گروه مهندسی بهداشت محیط، دانشکده بهداشت، دانشگاه علوم پزشکی مازندران، ساری، ایران ایران اسماعیل بابانژاد Esmaeil Babanezhad استادیار، گروه مهندسی بهداشت محیط، دانشکده بهداشت، دانشگاه علوم پزشکی مازندران، ساری، ایران ایران رضا علی محمد پور Reza Ali Mohammadpour دانشیار، گروه آمار زیستی، دانشکده بهداشت، دانشگاه علوم پزشکی مازندران، ساری، ایران ایران علیرضا علا Alireza Ala دانشجوی کارشناسی ارشد مهندسی بهداشت محیط، دانشکده بهداشت، دانشگاه علوم پزشکی مازندران، ساری، ایران ایران ala_alireza@yahoo.com phthalate esters polyethylene bottled water storage conditions استرهای فتالات پلی اتیلن آب های بطری شده شرایط نگهداری   1. Krachler M, Shotyk W. Trace and ultratrace metals in bottled waters: survey of sources worldwide and comparison with refillable metal bottles. Sci Total Environ 2009; 407(3): 1089-1096. ##2. Yousefi Z, Enayati A, Mohammadpoor R. Parasitic Contamination Of Wells Drinking Waterin Mazandaran Province. Iran J Environ Health Sci Eng 2009; 6(4): 241-246. ##3. Li X, Ying GG, Su HC, Yang XB, Wang L. Simultaneous determination and assessment of 4-nonylphenol, bisphenol A and triclosan in tap water, bottled water and baby bottles. Environ Int 2010; 36(6): 557-562. ##4. International Bottled Water Association (IBWA). Bottled Water Vs Tap Water. Alexandria: International Bottled Water Association; 2009 [updated cited 25 jun 2014]. Available from: Available from: http:/ /www.bottledwater.org/health/ bottled-water-vs-tap-water. ##5. Arfaeinia H, Nabipour I, Ostovar A, Asadgol Z, Abuee E, Keshtkar M, et al. Assessment of sediment quality based on acid-volatile sulfide and simultaneously extracted metals in heavily industrialized area of Asaluyeh, Persian Gulf: concentrations, spatial distributions, and sediment bioavailability/toxicity. Environ Sci Pollut Res Int. 2016; 23(10): 9871-9890. ##6. Moore NP. The oestrogenic potential of the phthalate esters. Reprod Toxicol 2000; 14(3): 183-1892. ##7. Scholz N. Ecotoxicity and biodegradation of phthalate monoesters. Chemosphere 2003; 53(8): 921-926. ##8. Amiridou D, Voutsa D. Alkylphenols and phthalates in bottled waters. J Hazard Mater 2011; 185(1): 281-286. ##9. Gonzalez-Castro MI, Olea-Serrano MF, Rivas- Velasco AV, Medina-Rivero E, Ordoñez-Acevedo LG, De Leon-Rodriguez A. Phthalates and bisphenols migration in Mexican food cans and plastic food containers. Bull Environ Contam Toxicol 2011; 86(6): 627-631. ##10. Oehlmann J, Oetken M, Schulte-Oehlmann U. A critical evaluation of the environmental risk assessment for plasticizers in the freshwater environment in Europe, with special emphasis on bisphenol A and endocrine disruption. Environ Rese 2008; 108(2): 140-149. ##11. Kamrin MA. Phthalate risks, phthalate regulation, and public health: a review. J Toxicol Environ Health B Crit Rev 2009; 12(2): 157-174. ##12. Beutler J, DerMarderosian A. The review of natural products. St Louis: Facts and Comparisons; 2004. ##13. Clark GS. An Aroma Chemical Profile: Menthol. 2007. ##14. Hoffmann D. The complete illustrated Guide to holistic herbal: A safe and practical guide to making and using herbal remedies. Shaftesbury, Dorset: Element Books;1996. ##15. Farahani H, Norouzi P, Dinarvand R, Ganiali MR. Development of dispersive liquid- liquid microextraction combined with gas chromatography-mass spectrometry as a simple, rapid and highly sensitive method for the determination of phthalate esters in water samples. J Chromatogr A 2007; 1172(2): 105-112. ##16. Farajzadeh MA, Mogaddam MR. Air-assisted liquid–liquid microextraction method as a novel microextraction technique; Application in extraction and preconcentration of phthalate esters in aqueous sample followed by gas chromatography–flame ionization detection. Anal Chim Acta 2012; 728: 31. ##17. Matsumoto M, Hirata-Koizumi M, Ema M. Potential adverse effects of phthalic acid esters on human health: a review of recent studies on reproduction. Regul Toxicol Pharmacol 2008; 50(1): 37-49. ##18. Cao XL-Liang. Phthalate esters in foods: sources, occurrence, and analytical methods. Comp Rev Food Sci Food Safety 2010; 9(1): 21-43. ##19. Parmar D, Srivastava SP, Seth PK. Effect of di (2-ethylhexyl) phthalate (DEHP) on spermatogenesis in adult rats. Toxicology 1986; 42(1): 47-55. ##20. Mortazavi S, Bakhtiari AR, Sari AE, Bahramifar N, Rahbarizade F. Phenolic endocrine disrupting chemicals (EDCs) in Anzali Wetland, Iran: elevated concentrations of 4-nonylphenol, octhylphenol and bisphenol A. Mar Pollut Bull 2012; 64(5): 1067-1073. 21. Preston MR, Al-Omran LA. Dissolved and particulate phthalate esters in the river Mersey estuary. Mar Pollut Bull 1986; 17(12): 548-553. ##22. Sirivithayapakorn S, Thuyviang K. Dispersion and ecological risk assessment of di (2-ethylhexyl) phthalate (DEHP) in the surface waters of Thailand. Bull Environ Contam Toxicol 2010; 84(5): 503-506. ##23. Zhang D, Liu H, Liang Y, Wang C, Liang H, Cai H. Distribution of phthalate esters in the groundwater of Jianghan plain, Hubei, China. Front Earth Sci China 2009; 3(1): 73. ##24. Van Wezel A, Van Vlaardingen P, Posthumus R, Crommentuijn GH, Sijm D. Environmental risk limits for two phthalates, with special emphasis on endocrine disruptive properties. Ecotoxicology and Environmental Safety 2000; 46(3): 305-321. ##25. Harris CA, Henttu P, Parker MG, Sumpter JP. The estrogenic activity of phthalate esters in vitro. Environ Health perspect 1997; 105(8): 802-811. ##26. Ankley GT, Jensen KM, Kahl MD, Durhan EJ, Makynen EA, Cavallin JE, et al. Use of chemical mixtures to differentiate mechanisms of endocrine action in a small fish model. Aquat Toxicol 2010; 99(3): 389-396. ##27. Parkerton TF, Staples CA. An assessment of the potential environmental risks posed by phthalates in soil and sediment. Berlin: Springer, Series Anthropogenic Compounds; 2003. ##28. Oishi S. Reversibility of testicular atrophy induced by di (2-ethylhexyl) phthalate in rats. Environ Res 1985; 36(1): 160-169. ##29. Botham C, Holmes P. Chemicals purported to be endocrine disrupters: A compilation of published lists. Leicester (UK): Institute for Environment and Health (IEH); 2005. ##30. Some chemicals present in industrial and consumer products, food and drinking-water. IARC Monogr Eval Carcinog Risks Hum 2013; 101(9): 549. ##31. Zare Jeddi M, Rastkari N, Ahmadkhaniha R, Alimohammadi M, Yunesian M. Carcinogenic and Non-Carcinogenic Assessment of Phthalates Exposure Through Consumption of Bottled Water During the Storage Time. IJHE 2015, 8(1): 97-108. ##32. USEPA. National primary drinking water regulations. United States Environmental Protection Agency; 2009. Available from: http://www.epa.gov/ogwdw/consumer/pdf/mcl.pdf. Accessed May 2 2016. ##33. WHO. Guidelines for Drinking-water Quality. 3rd ed. Geneva: World Health Organization; 2011. ##34. European :union: law E. Commission Regulation (EU) No 10/2011 of 14 January 2011 on plastic materials and articles intended to come into contact with food. Luxembourg: Official Journal of the European :union:; 2011; 3:42-130. Available from: http://eur-lex.europa.eu/legal-content/EN. ##35. Institute of Standards and Industrial Research of Iran, ISIRI. No:1035. "DrinkingWater-Physical and Chemical Specifications"; 5th revision. Tehran: ISIRI; 2010. ##36. 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ارزیابی کارکرد شخصیت در بخش سوم راهنمای تشخیصی و آماری اختلالات روانی (DSM-5): طراحی، تدوین و ارزیابی ویژگی های روانسنجی مصاحبه نیمه ساختاریافته کوتاه برای سنجش کارکردهای شخصیت DSM-5 (BSSIDPF)  Assessing the DSM–5 Levels of Personality Functioning: Development and Psychometric Evaluation of the Brief Semi-Structured Interview for DSM-5 Personality Functioning (BSSIDPF)  1 1 سابقه و هدف: در ویرایش پنجم راهنمای تشخیصی و آماری اختلالات روانی (DSM-5)، همراه با مدل مقوله­ای در بخش دوم، مدل جایگزین (ابعادی) نیز در بخش سوم برای تشخیص اختلالات شخصیت ارایه شده است. مدل جایگزین، وجود آسیب در کارکردهای شخصیت (ملاک A) و خصیصه‌های ناسازگارانه (ملاک B) را برای تشخیص‌گذاری ضروری می‌داند. به دلیل اینکه برای ارزیابی کارکردهای شخصیت ابزاری رسمی معرفی نشده و ابزارهای موجود عمدتاً در فرهنگ‌های غربی ساخته شده و طولانی هستند؛ این مطالعه با هدف طراحی، تدوین و ارزیابی روانسنجی مصاحبه نیمه‌ساختاریافته‌ کوتاه برای سنجش کارکردهای شخصیت DSM-5 در فرهنگ ایرانی انجام شد. مواد و روش‌ها: مطالعه حاضر از نوع مطالعات مقطعی بود. در این مطالعه دو نمونه در مرحله مقدماتی (34(N= و نهایی (346(N= مشارکت داشتند، که شامل دو گروه بالینی (زندانیان و مراجعین سرپایی) و گروه غیر بالینی بودند. این افراد با روش نمونه‌گیری در دسترس انتخاب شدند. جمع‌آوری داده‌ها از شهریور سال 94 تا اردیبهشت سال 95 در شهر تهران انجام شد. داده‌ها با استفاده از مصاحبه نیمه‌ساختاریافته کوتاه برای سنجش کارکردهای شخصیت (BSSIDPF)،SCID-II-PQ  و NEO-FFI گردآوری و با استفاده از آزمون t، آلفای کرونباخ و همبستگی تحلیل شدند. یافته‌ها: ضریب توافق میان ارزیاب‌ها برای سطوح چهارگانه شخصیت یعنی هویت، خود جهت‌دهی، صمیمیت و همدلی به ترتیب 94/0، 96/0، 84/0 و 81/0 بود (01/0= p). آلفای کرونباخ محاسبه شده در دامنه‌ای از 81/0 (صمیمیت) تا 89/0 (خود جهت‌دهی) بود. استنتاج: یافته‌ها نشان‌دهنده ویژگی‌های روانسنجی مطلوب مصاحبه نیمه‌ساختاریافته کوتاه برای سنجش کارکردهای شخصیت DSM-5، برای اهداف بالینی و پژوهشی است.     2 Background and purpose: The Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) offers an alternative model of personality disorders (PD) in section III alongside the categorical model in section II. In the alternative model of PD the presence of impairment in personality functioning (criterion A) and maladaptive personality traits (criterion B) are essential for diagnosis. There are no official tools for evaluating personality functioning and some current tools developed in Western cultures are taking considerable time. Therefore, this study aimed to develop a Brief Semi-Structured Interview for DSM-5 Personality Functioning (BSSIDPF) according to Iranian culture and evaluating its psychometric propertis. Materials and methods: This cross-sectional research was conducted in preliminary and final stages in 34 and 346 individuals, respectively. Participants were selected by convenience sampling in Tehran, Iran 2015-2016. Data were collected using Semi-Structured Interview-Breif Form for DSM-5 Personality Functioning (BSSIDPF), SCID-II-PQ, and NEO-FFI. Data were then and analyzed applying t-test, Cronbach's alpha, and correlation. Results: The scores for inter-rater reliability in personality functioning, identity, self-direction, intimacy, and empathy were 0.94, 0.96, 0.84, and 0.81, respectively (P= 0.01). The Cronbach alpha ranged from 0.81 (intimacy) to 0.89 (self-direction). Conclusion: Brief semi-structured interview for DSM-5 personality functioning was found to have good psychometric properties which could be used in clinical and research settings in Iranian population.   121 132 2017/03/72018/06/302018/04/72018/07/302017/11/12018/07/282018/05/182018/02/72017/11/262018/06/112018/03/1 1396/12/10 2018/10/202018/11/62018/10/12018/06/92018/11/62018/11/42018/06/92018/05/212018/10/312018/06/9 1397/3/19 مهدی امینی Mahdi Amini استادیار، گروه اعتیاد، دانشکده علوم رفتاری و سلامت روان (انستیتو روانپزشکی تهران)، دانشگاه علوم پزشکی ایران، تهران، ایران ایران مژگان لطفی Mozhgan Lotfi استادیار، دانشکده علوم رفتاری و سلامت روان (انستیتو روانپزشکی تهران)، دانشگاه علوم پزشکی ایران، تهران، ایران ایران lotfi.mo@iums.ac.ir اسفندیار آزاد Esfandiar Azad دانشیار، مرکز تحقیقات علوم رفتاری، پژوهشکده سبک زندگی، دانشگاه علوم پزشکی بقیه‌الله (عج)، تهران، ایران ایران عادل کرمی Adel Karami کارشناسی ارشد روانشناسی، دانشگاه آزاد واحد رودهن، رودهن ، ایران ایران personality disorder DSM-5 alternative model personality functioning brief semi-structured interview اختلال شخصیت DSM-5 مدل جایگزین کارکردهای شخصیت مصاحبه نیمه ساختاریافته کوتاه 1. Torgersen S. Epidimiology. In: The Oxford handbook of personality disorders. Widiger TA, ed. Oxford. Oxford University Press; 2013. p: 186. ##2. Tyrer P, Reed GM, Crawford MJ. Classification, assessment, prevalence, and effect of personality disorder. Lancet 2015; 385(9969): 717-726. ##3. Millon T, Grossman S, Millon C, Meagher S, Ramnath R. Personality Disorders in Modern Life. 2thed . New Jersey, John Wiley & Sons, 2004. ##4. Association AP. Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA2013. ##5. Simonsen E, Widiger TA. Introduction. In: Dimensional Models of Personality Disorders: Refining the Research Agenda for DSM-V. Widiger TA, Simonsen E, Sirovatka PJ, Regier DA .Washington, DC. American Psychiatric Association; 2006. ##6. Widiger TA, Trull TJ. Plate tectonics in the classification of personality disorder: shifting to a dimensional model. Am Psychol 2007; 62(2): 71-83. ##7. Bender DS, Morey LC, Skodol AE. Toward a model for assessing level of personality functioning in DSM–5, part I: A review of theory and methods. J Pers Assess 2011; 93(4): 332-346. ##8. Hopwood CJ. Personality traits in the DSM-5. J Pers Assess 2011; 93(4): 398-405. ##9. Christopher Fowler J, Sharp C, Kalpakci A, Madan A, Clapp J, Allen JG, et al. A dimensional approach to assessing personality functioning: examining personality trait domains utilizing DSM-IV personality disorder criteria. Compr Psychiatry 2015; 56: 75-84. 10. Amini M, Pourshahbaz A, Mohammadkhani P, Khodaie Ardakani MR, Lotfi M. The DSM-5 Levels of Personality Functioning and Severity of Iranian Patients With Antisocial and Borderline Personality Disorders. Iran Red Crescent Med J 2015; 17(8): e19885-e. ##11. Skodol AE, Morey LC, Bender DS, Oldham JM. The alternative DSM-5 model for personality disorders: A clinical application. Am J Psychiatry 2015;172(7): 606-613. ##12. Parker G, Both L, Olley A, Hadzi-Pavlovic D, Irvine P, Jacobs G. Defining disordered personality functioning. Personal Disord 2002; 16(6): 503-522. ##13. Parker G, Hadzi-Pavlovic D, Both L, Kumar S, Wilhelm K, Olley A. Measuring disordered personality functioning: to love and to work reprised. Acta Psychiatr Scand 2004; 110(3): 230-239. ##14. Few LR, Miller JD, Rothbaum AO, Meller S, Maples J, Terry DP, et al. Examination of the Section III DSM-5 diagnostic system for personality disorders in an outpatient clinical sample. J Abnorm Psychol 2013; 122(4): 1057-1069. ##15. Hutsebaut J, Feenstra DJ, Kamphuis JH. Development and Preliminary Psychometric Evaluation of a Brief Self-Report Questionnaire for the Assessment of the DSM-5 level of Personality Functioning Scale: The LPFS Brief Form (LPFS-BF). Personal Disord 2016; 7(2): 192-197. ##16. Morey LC. Development and initial evaluation of a self-report form of the DSM-5 Level of Personality Functioning Scale. Psychol Assess 2017; 29(10):1302-1308. ##17. Huprich SK, Nelson SM, Meehan KB, Siefert CJ, Haggerty G, Sexton J, et al. Introduction of the DSM-5 levels of Personality Functioning Questionnaire. Personal Disord 2018; 9(6): 553-563. ##18. First MB, Skodol AE, Bender DS, Oldham JM. Module I: Structured Clinical Interview for the Level of Personality Functioning Scale. In: First MB, Skodol AE, Bender DS, Oldham JM, editors. Structured Clinical Interview for the DSM-5 Alternative Model for Personality Disorders (SCID-AMPD). Arlington, VA: American Psychiatric Association; 2018. ##19. Preti E, Di Pierro R, Costantini G, Benzi IMA, De Panfilis C, Madeddu F. Using the Structured Interview of Personality Organization for DSM-5 Level of Personality Functioning Rating Performed by Inexperienced Raters. J Pers Assess 2018; 4: 1-9. 20. Hutsebaut J, Kamphuis JH, Feenstra DJ, Weekers LC, De Saeger H. Assessing DSM-5-oriented level of personality functioning: Development and psychometric evaluation of the Semi-Structured Interview for Personality Functioning DSM-5 (STiP-5.1). Personal Disord 2017; 8(1): 94-101. ##21. Thylstrup B, Simonsen S, Nemery C, Simonsen E, Noll JF, Myatt MW, et al. Assessment of personality-related levels of functioning: a pilot study of clinical assessment of the DSM-5 level of personality functioning based on a semi-structured interview. BMC Psychiatry 2016; 16(1): 298. ##22. Groth-Marnat G. Handbook of Psychological Assessment. Edition t, editor. New York: John Wiley & sons; 2009. ##23. Mohammadkhani P, Jokar M, Jahani-tabesh O, Tamannaei-far S. Structured Clinical Interview for DSM-IV Axis II personality disorders. Tehran, Danjeh; 2011. (Persian). ##24. Anisi J, Majdiyan M, Joshanloo M, Ghoharikamel Z. Validity and reliability of NEO Five-Factor Inventory (NEO-FFI) on university students. J Behav Sci 2011; 5(4): 17-18. ##25. Association AP. Diagnostic and statistical manual of mental disorders. 5th ed ed. Washington, DC.: American Psychiatric Publishing; 2013. ##26. Hopwood CJ, Good EW, Morey LC. Validity of the DSM–5 Levels of Personality Functioning Scale–Self Report. J Pers Assess 2018: 1-10. ##27. Few LR. Validation of the proposed dsm-5 dimensional diagnostic system for personality disorders. Georgia: University of Georgia; 2012. ##28. Buer Christensen T, Paap MCS, Arnesen M, Koritzinsky K, Nysaeter TE, Eikenaes I, et al. Interrater Reliability of the Structured Clinical Interview for the DSM-5 Alternative Model of Personality Disorders Module i: Level of Personality Functioning Scale. J Pers Assess. 2018 Aug 7:1-12. ##29. Bach B, Anderson JL. Patient-Reported ICD-11 Personality Disorder Severity and DSM-5 Level of Personality Functioning. J Pers Disord 2018; 1-19. ##30. Zimmermann J, Benecke C, Bender DS, Skodol AE, Schauenburg H, Cierpka M, et al. Assessing DSM-5 level of personality functioning from videotaped clinical interviews: a pilot study with untrained and clinically inexperienced students. J Pers Assess 2014; 96(4): 397-409. ##31. Gore WL, Widiger TA. The DSM-5 dimensional trait model and five-factor models of general personality. J Abnorm Psychol 2013; 122(3): 816-821. ##32. Amini M, Pourshahbaz A, Mohammadkhani P, Ardakani MR, Lotfi M, Ramezani MA. The relationship between five-factor model and diagnostic and statistical manual of mental disorder-fifth edition personality traits on patients with antisocial personality disorder. J Res Med Sci 2015; 20(5): 470-476. ## ##

ارتباط بین باورهای دینی و رفتارهای باروری در زنان سنین باروری شهر مشهد در سال 1395   Religious Beliefs and Fertility Behavior among Women of Reproductive Age in Mashhad, Iran 2016 1 1 سابقه و هدف: با توجه به کاهش اخیر باروری و مطالعات اندک انجام شده بر روی نقش عوامل مذهبی بر رفتار باروری در ایران، مطالعه حاضر با هدف تعیین ارتباط بین باورهای دینی و فرزندآوری در زنان سنین باروری شهر مشهد انجام شد. مواد و روش‌ها: در این مطالعه توصیفی- مقطعی در سال 1395، 844 خانم 49-15 ساله متاهل دارای قابلیت باروری، به روش نمونه‌گیری چند مرحله‌ای طبقه‌ای، خوشه‌ای و در دسترس از مراکز بهداشت در شهر مشهد انتخاب و پرسشنامه‌های عوامل دموگرافیک، رفتارهای باروری و باورهای دینی را تکمیل نمودند. تجزیه و تحلیل داده‌ها با استفاده از نرم افزار آماری (SPSS نسخه 16) و آزمون‌های کولموگروف- اسمیرنوف، تی مستقل، آنالیز واریانس یکطرفه و رگرسیون چند متغیره انجام شد. یافته‌ها: تحلیل‌های چندگانه نشان داد که نمره بالاتر باور دینی با افزایش معنی‌داری در تعداد مطلوب فرزندان در هنگام ازدواج، در حال حاضر و در شرایط ایده‌آل همراه است(همه موارد 001/0=p) و نمره بالاتر باور دینی بطور معنی‌داری  با  سن بالاتر  مادر هنگام تولد نخستین فرزند، افزایش فاصله واقعی بین ازدواج تا تولد اولین فرزند و  نهایتا  فاصله بیشتر بین تعداد فرزندان واقعی و ایده‌آل همراه است. (همه موارد 05/0>p). میانگین تعداد فرزندان واقعی در زنان دارای بالاترین نمرات باورهای دینی فقط 1/0 بیش‌تر از زنانی بود که پایین‌ترین نمرات را داشتند. استنتاج: باورهای دینی بالاتر با تمایل بیش‌تر به شروع زودهنگام باروری و باروری بالا همراه بود، در حالی که تعداد فرزندان در افرادی که نمره باور دینی بالاتری داشتند، افزایش ناچیزی داشت و شروع باروری در آنان با تاخیر بیش‌تری همراه بود. این یافته‌ها ضرورت شناسایی و رفع موانع باروری در افراد دارای باورهای دینی بالا را نشان می‌دهد.   2   Background and purpose: There is paucity of information on the role of religion on fertility behavior. This study aimed at evaluating the relationship between religious beliefs and fertility behavior among women of reproductive age in Mashhad, Iran. Materials and methods: This cross-sectional study was conducted in 844 women of reproductive age (15-49 years of age) who were selected via multi-stage and convenience sampling in Mashhad, 2016. The participants completed a demographic questionnaire, the Attitudes toward Fertility and Childbearing Scale, and Khodayari Religious Attitudes questionnaire. Data were analyzed in SPSS V16 using Kolmogorov-Smirnov tests, independent t-test, ANOVA, and multivariate regression analysis. Results: Multivariate regression analysis showed that higher scores in religious beliefs were significantly associated with childbearing desires at the time of marriage, at present, and in ideal conditions in all age groups (P= 0.001). Higher scores in religious beliefs were associated with older ages of mothers at the first childbirth, increased actual interval between marriage and first childbirth, and desired number of children and actual child (P= 0.05). The average number of actual children in women with highest scores in religious ­beliefs was just 0.1 higher than that of women with lowest scores. Conclusion: Higher levels of religious beliefs were associated with greater tendency towards fertility and high fertility. But, the number of children in these women was negligible and they had delayed childbearing. These findings highlight the need to identify and resolve the barriers for fertility in woman with higher levels of religious beliefs.     133 144 2017/03/72018/06/302018/04/72018/07/302017/11/12018/07/282018/05/182018/02/72017/11/262018/06/112018/03/12017/08/26 1396/6/4 2018/10/202018/11/62018/10/12018/06/92018/11/62018/11/42018/06/92018/05/212018/10/312018/06/92018/06/9 1397/3/19 طلعت خدیو زاده Talat Khadivzadeh استادیار، گروه بهداشت باروری، مرکز تحقیقات مبتنی بر شواهد، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی مشهد، مشهد، ایران ایران مروارید ایرانی Morvarid Irani دانشجوی دکترای تخصصی بهداشت باروری، کمیته تحقیقات دانشجویی، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی مشهد، مشهد، ایران ایران iranim931@yahoo.com religious beliefs fertility childbearing delayed childbearing باورهای دینی باروری فرزندآوری تاخیر در شروع باروری   1. Kheshavarz H, Bahramian M, Mohajerani AA, Hossein pour K. Factors affecting differences in fertility behavior of Resident and migrating tribes of Samirom. 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Patterns and Factors affecting between marriage and first birth in Iran. Demography Society 2010; 5(9): 75-105 (Persian). ##8. Khadivzadeh T, Latifnejad Roudsari R, Bahrami M, Taghipour A, Abbasi Shavazi MJ. “Caring for my family integrity”: Fertile couples’ first childbearing experience in the urban society of Mashhad, Iran .Hum Fertil (Camb) 2014; 18(1): 60-69. ##9. Khadivzadeh T, Arghavani E, Shakeri MT. Attitude toward Governmental Incentives on Childbearing and its Relationship with Fertility Preferences in Couples Attending Premarital Counseling Clinic in Health Centers in Mashhad. J Mazandaran Univ Med Sci 2014; 24(120): 1-13. ##10. Khadivzadeh T, Latifnejad Roudsari R. Bahrami M. The influence of mass media on couples’ fertility intentions. Women Health Congress. 17-19 March 2014, Isfahan, Iran. 2014. ##11. Rahmati R, Khadivzadeh T, Esmaily H, Bahrami HR. Evaluation of the Performance of the Health Care Workers in Giving Consultation about the Fertility Promotion. Journal of Midwifery and Reproductive Health 2017; 5(2): 911-918. ##12. Khadivzadeh T, Latifnejad Roudsari R, Bahrami M. The Influence of Gender Role and Women's Empowerment on Couples' Fertility Experiences in Urban Society of Mashhad, Iran. J Midwifery Womens Health 2014; 2(3): 170-179. ##13. Mahdi Shirzad M. Fertility Behaviour of Iranian Women: A Community-Based, Cross- Sectional Study. Arch Iran Med 2015; 18(1): 2-5. ##14. Khadivzadeh T, Arghavani E. Religious Beliefs and Fertility Preferences among Engaged Couples, Referring to Premarital Counseling Centers of Mashhad, Iran. Journal of Midwifery and Reproductive Health. 2014; 2(4): 238-245. ##15. Keshavarz H, Haghighatian M, Tavasoli Dinani K. A Study on the Factors Influencing the Space between Marriage and Having Children (Case Study: Married Women of 20-49 in Isfahan). Journal of Applied Sociology 2013; 24(2): 111-125 (Persian). ##16. Keim S, Klärner A and Bernardi L. Qualifying Social Influence on Fertility Intentions: Composition, Structure and Meaning of Fertility-relevant Social Networks in Western Germany. Current Sociology 2009; 57(6): 888: 907. ##17. Behrman J R, Kohler P, Watkins S. Social networks and changes in contraceptive use over timeEvidence from longitudinal study in rural Kenya. Demography 2002; 39(4): 713-737. ##18. Khadivzadeh T, LatifnejadR, Bahrami M, Taghipour A, Abbasi Shavazi J. The influence of social network on couples’ intention to have the first child. Iran J Report Med 2013; 11(3): 209-218 (Persian). ##19. Khadivzadeh T, Arghavani E, Shakeri MT. Relationship between Fertility Motivations and Preferences in Couples. Iranian Journal of Obstetrics, Gyneocology and Infertikity 2014; 7(114): 8-18 (Persian). ##20. Bahrian AM, Saadat R, Shakeri N, Azizi F. Evaluate the impact of patient attitudes toward spirituality in the healing process. Journal of Medical Ethics 1389; 4(14): 148-131. 21. Mahmoudain H, Noubakht R. Religion and Fertility.Social issues in Iran 2010; 1(1): 195-215 (Persian). ##22. Serour GI. Islamic perspectives in human reproduction. Reprod Biomed Online 2008; 17: 34-38. ##23. McQuillan K. When does religion influence fertility? Popul Dev Rev 2004; 30(1): 25-56. ##24. Khadivzadeh T. The process of formation of reproductive behavior in urban society of Mashhad, Iran. [dissertation PHD]. Mashhad University of Medical Sciences; 2014. (Persian). ##25. Webb AP, Ellison CG, McFarland MJ, Lee JW, Morton K, Walters J. Divorce, religious coping, and depressive symptoms in a conservative protestant religious group. Fam Relat 2010; 59(5): 544-557. ##26. Aghajanian A, Thompson V. Recent divorce trend in Iran. J Divorce Remarriage 2013; 54(2): 112-125. ##27. Kashesy JB, Neema S, Ekstrom AM, Kaharuza F, Mirembe F, Kulane A. "Not a boy, not a child": A qualitative study on young people's views on childbearing in Uganda. Afr J Reprod Health 2010; 14(1): 71-81. ##28. Doctor HV, Phillips JF, Sakeah E. The influence of changes in women's religious affiliation on contraceptive use and fertility among the Kassena-Nankana of northern Ghana. Stud Fam Plann 2009; 40(2): 113-22. ##29. Gyimah SO, Takyi B, Tenkorang EY. Denominational affiliation and fertility behaviour in an African context: An examination of couple data from Ghana. J Biosoc Sci 2008; 40(03): 445-458. ##30. Srikanthan A, Reid RL. Religious and cultural influences on contraception. J Obstet Gynaecol Can 2008; 30(2): 129-137. ##31. Kridli S, Libbus K. Contraception in Jordan: a cultural and religious perspective. International Nursing Review 2001; 48(3): 144-151. ##32. Abbasi-Shavazi MJ, Hosseini Chavoshi M, MC Donald P, Delavar B. Fertility Transition in Iran. Tehran. Departemant of Demography: University of Tehran; 2005 (Persian). ##33. Hosseini H, Askari Nodoushan A, Moradi N. A Comparative Study of Childbearing Desires of Shia and Sunni Kurdish Women in Rural Areas of Kamyaran. Journal of Woman and Family Studies 2016; 4(1): 63-84. ##34. Moghaddas A, Vaezzade S. Cultural Determinants of Reproductive Behavior of Afghan Refugees. XXV International Population Conference of the IUSSP; 2005 July 18-23; 2005. Tours, France. ##35. Saei Gharenaz M, Ozgoli G, Hajizadeh F, Sheikhan Z, Nasiri M, Jannesari Sh. The relationship between religious orientation with intention of desired fertility and actual and desirable number of children in working women of Tehran, Iran. J Res Relig Health 2017; 3(1): 79-90 (Persian). ##36. Kiani R.Evaluation of the fertility of the Holy Quran. Journal of Population 2006; (73): 118-126 (Persian). ##37. Sikandar R, Khwaja R, ShaiIkh F, Jatoi IN. Fertility preferences among women of reproductive age in an under developed country. Medical Channel 2012; 18(1):66-70. ##38. Moghaddas A, Vaezzade S (2004). Afghan Migrants in Mashad/Iran Fertility, Family Planning & Social Factors, Poster displayed at the XXVth IUSSP International Population Conference, Tours, France 18-23 July 2005. ##39. Langdridg D, Sheeran P, Connolly K. Understanding The reasons for parenthood. J Reprod Infant Psychol 2005; 23(2): 121-133. ##40. Frejka T, Westoff CF. Religion, religiousness and fertility in the US and in Europe. Eur J Popul 2008; 24(1): 5-31. ##41. Rad F, Savabi H. Investigation on tendency to fertility and its related social factors (a case study of married women aged 15 to 50 in Tabriz). Journal of Woman and Family Studies. 2015; 3(1): 127-55 (Persian). ##42. Soroush M, Bohrani SH. A study of relationship between religiosity, sex role attitude, attitude toward children and ideal and actual number of children .Women in Development & Politics 1392; 11(2): 189-208 (Persian). ##43. Rijkin AJ, Liefbroer AC. The Influence of Partner Relationship Quality on Fertility. 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ارزشیابی درونی گروه های آموزشی بالینی دانشگاه علوم پزشکی مازندران   Internal Evaluation of Clinical Departments of Mazandaran University of Medical Sciences 1 1 سابقه و هدف: ارزشیابی درونی، فرآیندی سیستماتیک جهت جمع‌آوری و تحلیل اطلاعات به منظور تعیین فواید و مضرات یک برنامه و میزان حصول اهداف آن می‌باشد. مطالعه حاضر با هدف بررسی وضعیت موجود ارزشیابی درونی در گروه های آموزشی بالینی دانشگاه علوم پزشکی مازندران در دو سال تحصیلی متوالی انجام شد. مواد و روش‌ها: این پژوهش توصیفی- مقطعی در کلیه گروه های آموزشی بالینی دانشگاه علوم پزشکی مازندران در سال تحصیلی 95-94 و 96-95 به انجام رسید. ابتدا داده‌های مربوط به هشت حوزه ارزشیابی درونی از طریق چـک لیسـت ها و پرسشنامه‌ها جمع‌آوری و سپس وضعیت گروه ها در هشت حوزه ارزشیابی درونی در رابطه با استانداردها و نیز وضعیت کل گروه ها در دو سال متوالی تحصیلی تعیین شد. نتایج با استفاده از نرم افزار SPSS با تاکید بر آمارهای توصیفی (میانگین و محاسبه درصد امتیازات) مورد تحلیل آماری قرار گرفت. هم‌چنین نتایج ارزیابی در دو سال متوالی مقایسه و روند پویایی مورد بررسی قرار گرفت. یافته‌ها: نتایج نشان داد که وضعیت اکثر حوزه‌ها در گروه های آموزشی بالینی نسبتاً مطلوب بوده است. بالاترین مطلوبیت در سال های 95-94 و 96-95 در حوزه دوره ها و برنامه های درسی 53/74 درصد و 66/78 درصد و دانش آموختگان 61/88 درصد بوده است. درصد امتیاز کل گروه های آموزشی بالینی در سال های 95-94 و 96-95 به ترتیب 22/64 درصد و 69/70 درصد بود. استنتاج: ارزشیابی درونی مستمر، منجر به استخراج نقاط قوت و ضعف گروه ها می‌شود که بر اساس نتایج آن، برنامه‌ریزی برای رسیدن به شرایط مطلوب‌تر توسط گروه ها صورت می‌گیرد و می‌تواند در دریافت تاییدیه پذیرش دستیار در گروه ها نقش داشته باشد.   2 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.       145 154 2017/03/72018/06/302018/04/72018/07/302017/11/12018/07/282018/05/182018/02/72017/11/262018/06/112018/03/12017/08/262018/06/18 1397/3/28 2018/10/202018/11/62018/10/12018/06/92018/11/62018/11/42018/06/92018/05/212018/10/312018/06/92018/06/92018/10/22 1397/7/30 فروزان صادقی محلی Forouzan Sadeghimahalli استادیار، مرکز مطالعات و توسعه آموزش پزشکی، دانشگاه علوم پزشکی مازندران، ساری، ایران ایران sadeghi.f.ph@gamil.com فتانه عمویی Fattane Amuei دکتری مدیریت آموزشی، مرکز مدیریت مرکز مطالعات و آموزش، دانشگاه علوم پزشکی مازندران، ساری، ایران ایران منصور رنجبر Mansour Ranjbar استادیار، مرکز مطالعات و توسعه آموزش پزشکی، دانشگاه علوم پزشکی مازندران، ساری، ایران. ایران سیاوش مرادی Siavash Moradi استادیار، مرکز تحقیقات سرطان دستگاه گوارش، دانشگاه علوم پزشکی مازندران، ساری، ایران ایران حسین خالق زاده آهنگر Hossein Khaleghzadeh-Ahangar استادیار، گروه فیریولوژی، دانشکده پزشکی، دانشگاه علوم پزشکی بابل، بابل، ایران. ایران internal evaluation clinical departments Mazandaran University of Medical Sciences ارزشیابی درونی گروه های آموزشی بالینی دانشگاه علوم پزشکی مازندران 1. Arefi M, Khorsandi Yamchi A. Internal evaluation, the necessity for accountability (case study: department of engineering, Shahid Beheshti University). Some of the Main Topics in Engineering Education 2012; 14(53): 131-153 (Persian).##2. Alipour M, Gangkhani M, Eskandari M, Rostami A, Tajkey J, Jafari MR. Internal evaluation of Department of Physiology and Pharmacology of Zanjan University of Medical Sciences in 2009. J Med Educ Dev 2012; 4(7): 44-53 (Persian).##3. Kavoussi H, Ebrahimi A, Amini K, Rezaei M, Omidi N. Internal evaluation: A tool for improving educational quality in the Department of Dermatology of Kermanshah University of Medical Sciences. Journal of Dermatology and Cosmetic (jdc) 2016; 7(1): 38-45 (Persian).##4. Rezaeian M, Vazirinajad R, Esmaeili A, Salem Z, Asadpour M, Heidari L. Internal Evaluation of Social Medicine Department of Rafsanjan Medical School. J Rafsanjan Univ Med Sci. 2011; 10(1): 55-66 (Persian).##5. Seif Hashemi M, Amin Bidokhty ME, Yazdi MS, Nabavi M, Francesh M. Internal evaluation: a process for improving the quality of education in Pediatric Department of Semnan University of Medical Sciences. Koomeshl 2000; 2(3-4): 167-176 (Persian).##6. Mahmodifar Y, Esmaili H, Habibzadeh S, Salehi K. Internal evaluation of nursing department in Islamic Azad University of Mahabad. Educ Strategies Med Sci 2009; 2(2): 3-4 (Persian).##7. Yedgari F, Ashtari A, Mehdi Pourne, Jafari N, Shirazi Tass, Rafiee Alaviyeh Shem, et al. Internal evaluation of speech therapy. Speech and Language Pathology 2012; 1(1): 29-35 (Persian).##8. Mohamadi N, Hasanian M, Borzou S, Amini R. The Comparison of Internal Evaluation of 4 Nursing Departments in Nursing and Midwifery Faculty of Hamedan University of Medical Sciences. Sci J Hamadan Nurs Midwif Fac 2013; 21(1): 66-76 (Persian).##9. Dehghani Poudeh M, Shams B, Esmaeilee A, Asilian A, Nasri P, Hosseini M. 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اثر تزریق داروی سینوپار بر تراکم استخوانی زنان یائسه مبتلا به استئوپروزیس Effect of Teriparatide in Postmenopausal Women with Osteoporosis 1 1 سابقه و هدف: پوکی استخوان شایع‌ترین بیماری متابولیک استخوان است. هدف از انجام این مطالعه، بررسی اثر داروی سینوپار بر میزان بروز شکستگی‌ها و تراکم استخوانی در زنان یائسه مبتلا به استئوپروزیس است. مواد و روش‌ها: این مطالعه یک کارآزمایی بالینی بود که در زنان یائسه 45 تا 75 ساله مبتلا به استئوپروزیس، مراجعه‌کننده به یک بیمارستان آموزشی وابسته به دانشگاه علوم پزشکی مازندران، انجام شد. بیماران در دو گروه کنترل (الندرونات) و آزمون (سینوپار) قرار گرفتند (هر گروه متشکل از 30 بیمار). بیمارانی که در گروه آزمون قرار داشتند، برای مدت 6 ماه روزانه 8 واحد پن‌سینوپار را به صورت تزریق زیر جلدی دریافت نمودند. به بیماران گروه کنترل، آلندرونات 70 میلی‌گرم هفتگی تا شش ماه تجویز شد. میزان شکستگی‌ها و دانسیتومتری در خط پایه و پس از 6 ماه در دوگروه مورد سنجش قرارگرفت. یافته‌ها: دانسیتومتری مهره و گردن فمور بیماران تحت درمان با آلندرونات و سینوپار نسبت به خط پایه تفاوت آماری معنی‌داری داشت و باعث افزایش چشمگیر دانسیتومتری مهره‌ها گردید. هم‌چنین آلندرونات باعث بهبود چشمگیر دانسیتومتری گردن فمور نسبت به خط پایه گردید(002/0<p). علاوه بر این، سینوپار موجب بهبود چشمگیر دانسیتومتری مهره‌ها نسبت به خط گردید(001/0<p)، اما بر دانسیتومتری گردن فمور نسبت به خط پایه تأثیر  معنی داری نداشت(085/0<p). استنتاج: انتخاب اول درمانی در استئوپروزیس زنان یائسه، آلندرونات ومکمل کلسیم و ویتامین D است. تری‌پاراتید به عنوان خط درمانی دوم به تنهایی می‌تواند مورد استفاده قرار گیرد که باعث بهبود درد و دانسیته استخوان خصوصاً مهره‌ها در درمان استئوپروزیس زنان یائسه می‌گردد. 2 Background and purpose: Osteoporosis is the most common metabolic bone disease. The aim of this study was to evaluate the effects of teriparatide on the incidence of fractures and bone density in postmenopausal women with osteoporosis. Materials and methods: A clinical trial was performed in all postmenopausal women aged 45-75 years old with osteoporosis attending a teaching hospital affiliated to Mazandaran University of Medical Sciences, Sari, Iran. The participants were divided into control and experimental groups (30 patients per group). The experimental group received daily subcutaneous injection of teriparatide (CinnoPar® pen 250 mg, eight units) for six months. Patients in the control group received alendronate 70 mg weekly for six months. Fractures and densitometry were measured at baseline and after six months in both groups. Results: Bone densitometry values in spine and femoral neck at baseline and after six months were significantly different between the experimental and control groups. Bone densitometry values increased dramatically in both groups. Alendronate significantly improved bone densitometry values of femoral neck after six months compared to baseline (p>0.002). Teriparatide significantly improved bone densitometry values of the spine after six months compared to the baseline (p>0.001), but did not have a significant effect on bone densitometry of femoral neck compared to baseline (p>0.085). Conclusion: Alendronate, calcium and vitamin D supplements are the first choices in treatment of osteoporosis in menopausal women. As the second-line treatment for osteoporosis, teriparatide could be used alone to relieve pain and improve bone density (especially in the spine) in postmenopausal women.   155 164 2017/03/72018/06/302018/04/72018/07/302017/11/12018/07/282018/05/182018/02/72017/11/262018/06/112018/03/12017/08/262018/06/182018/02/4 1396/11/15 2018/10/202018/11/62018/10/12018/06/92018/11/62018/11/42018/06/92018/05/212018/10/312018/06/92018/06/92018/10/222018/10/9 1397/7/17 مسعود شایسته آذر Masoud Shayestehazar دانشیار، مرکز تحقیقات ارتوپدی، دانشگاه علوم پزشکی مازندران، ساری، ایران ایران mshayestehazar@yahoo.com محمد حسین کریمی نسب Mohammadhossein Kariminasab دانشیار، مرکز تحقیقات ارتوپدی، دانشگاه علوم پزشکی مازندران، ساری، ایران ایران dr.kariminasab@yahoo.com سلمان غفاری Salman Ghafari استادیار، مرکز تحقیقات ارتوپدی، دانشگاه علوم پزشکی مازندران، ساری، ایران ایران orthosalman@yahoo.com افشین شروفی Seyed Afshin Shorofi . استادیار، مرکز تحقیقات طب سنتی و مکمل، پژوهشکده اعتیاد، دانشگاه علوم پزشکی مازندران، ساری، ایران 4. فلوی پژوهشی الحاقی، دانشگاه فلیندرز، آدلاید، استرالیا ایران ashorofi@yahoo.com فاطمه نیک صولت Fatemeh Niksolat استادیار، مرکز تحقیقات ارتوپدی، دانشگاه علوم پزشکی مازندران، ساری، ایران ایران Fniksolat@yahoo.com زینب اندرخورا Zeynab Andarkhora پزشک عمومی، کمیته تحقیقات دانشجویی، دانشکده پزشکی، دانشگاه علوم پزشکی مازندران، ساری، ایران ایران Zeinab_andarkhora@yahoo.com CinnoPar® densitometry osteoporosis postmenopausal teriparatide women سینوپار دانسیتومتری استئوپروزیس پس از یائسگی تری پاراتید زنان 1. 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Hip fracture protection by alendronate treatment in postmenopausal women with osteoporosis: a review of the literature. Clin Interv Aging 2008; 3(3):483-489.##7. Hochberg MC, Ross PD, Black D, Cummings SR, Genant HK, Nevitt MC, et al. Larger increases in bone mineral density during alendronate therapy are associated with a lower risk of new vertebral fractures in women with postmenopausal osteoporosis. Arthritis Rheum 1999; 42(6): 1246-1254.##8. Hesp R, Hulme P, Williams D, Reeve J. The relationship between changes in femoral bone density and calcium balance in patients with involutional osteoporosis treated with human parathyroid hormone fragment (hPTH 1–34). Metab Bone Dis Relat Res 1981; 2(5): 331-334.##9. Lin T, Wang C, Cai XZ, Zhao X, Shi MM, Ying ZM, et al. Comparison of clinical efficacy and safety between denosumab and alendronate in postmenopausal women with osteoporosis: a meta‐analysis. Int J Clin Pract 2012; 66(4): 399-408.##10. 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بررسی فراوانی میگرن در دانشجویان پزشکی دانشگاه علوم پزشکی شهید صدوقی یزد سال 1395 Frequency of Migraine among Medical Students in Shahid Sadoughi University of Medical Sciences, Yazd, Iran 2016 1 1 سابقه و هدف: سردرد جزء شایع‌ترین شکایت های پزشکی می باشد. یکی از علل مهم و شایع آن میگرن است. هدف از این مطالعه بررسی میزان شیوع میگرن در دانشجویان پزشکی دانشگاه علوم پزشکی یزد بوده است. مواد و روش‌ها: این مطالعه توصیفی به روش مقطعی در سال 1395 انجام شد. تعداد 400 دانشجوی پزشکی دانشگاه علوم پزشکی یزد به روش تصادفی انتخاب و وارد مطالعه شدند. ابزار گردآوری داده‌ها، پرسشنامه استاندارد خودایفا، مطابق معیارهای بین‌المللی سردرد (IHS) بود. داده‌ها با نرم افزار SPSS16 تجزیه و تحلیل شد. یافته‌ها: از400 دانشجوی مورد مطالعه 58 درصد مونث و 5/72 درصد مجرد بودند . 5/75 درصد درمقطع بالینی تحصیل کرده و 7/51 درصدساکن خوابگاه بودند. شیوع میگرن، 3/10 درصد بدست آمد که در زنان 34/12 درصد و در مردان 27/7 درصد بود. 39 درصد بیماران میگرن اورا داشتند. سردرد یک طرفه ضربان دار (000/0= p) و همراهی سردرد با تهوع، استفراغ (000/0= p)، ترس از صدا (035/0= p) و نور (000/0= p) در بیماران مبتلا به میگرن بیش‌تر و سردرد مبهم (001/0= p) در غیرمیگرنی‌ها شایع‌تر بود. اکثر سردردهای میگرنی (5/80 درصد) متوسط/شدید و بیش‌تر سردردهای غیرمیگرنی (3/56 درصد) خفیف بودند (000/0= p). سابقه خانوادگی مثبت (028/0= p)، مراجعه به پزشک (000/0= p) و تسکین سردرد با دارو (035/0= p) در میگرنی‌ها شایع‌تر بود. استنتاج: شیوع میگرن در این مطالعه مشابه سایر مطالعات بود.چون اکثرسردردهای میگرنی متوسط وشدید بوده و به مداخلات درمانی نیاز دارد،توجه به این بیماری وکنترل عوامل تشدیدکننده به ویژه دردانشجویان پزشکی اهمیت زیادی دارد.   2 Background and purpose: Headache is one of the most common medical complaints and migraine is one of its major causes. The aim of this study was to investigate the prevalence of migraine in medical students in Shahid Sadoughi University of Medical Sciences. Materials and methods: This cross-sectional descriptive research was carried out in 400 medical students in Shahid Sadoughi University of Medical Sciences, Yazd, Iran 2016, who were selected by random sampling. Data were collected using a self-administered standard questionnaire according to International Headache Society (IHS). SPSS V16 was used to analyze the data. Results: The subjects included 58% females and 72.5% of the participants were single, 75.5% were in clinical education program and 51.7% lived in university accommodation. The prevalence of migraine was 10.3% (12.34% in females and 7.27% in males. Among the subjects 39% had migraine aura. Unilateral and pulsatile headache (P=0.000), headache accompanied by nausea and vomiting (P=0.000), photophobia (P=0.000) and phonophobia (P=0.035) were more prevalent in those with migraines; whereas vague headache was more common in students suffering from non-migraine headaches. Most of the migraine headaches were both moderate and severe (80.5%) but non-migraine headaches were mostly mild (56.3%) (P=0.000). Positive family history (P=0.028), referral to physicians (P=0.000), and taking analgesics (P=0.035) were more common in migraines. Conclusion: The incidence of migraine in this study was similar to that reported by other studies. Most of the migraine attacks were moderate and severe and required medical intervention. So, it is important to focus more on this condition and control the exacerbating factors, especially in medical students. 165 170 2017/03/72018/06/302018/04/72018/07/302017/11/12018/07/282018/05/182018/02/72017/11/262018/06/112018/03/12017/08/262018/06/182018/02/42017/07/29 1396/5/7 2018/10/202018/11/62018/10/12018/06/92018/11/62018/11/42018/06/92018/05/212018/10/312018/06/92018/06/92018/10/222018/10/92018/05/28 1397/3/7 محمود وکیلی Mahmoud Vakili دانشیار، گروه پزشکی اجتماعی، مرکز تحقیقات پایش سلامت، دانشکده پزشکی، دانشگاه علوم پزشکی شهید صدوقی یزد، یزد، ایران ایران Vakilim52@yahoo.com محسن میرزایی Mohsen Mirzaei پزشک عمومی، مرکز تحقیقات قلب و عروق یزد، دانشگاه علوم پزشکی شهید صدوقی یزد، یزد، ایران ایران sazk69@gmail.com سید علی ضیاء کاشانی Seyed Ali Zia Kashani دانشجوی دکتری حرفه ای، دانشگاه علوم پزشکی شهید صدوقی یزد، یزد، ایران ایران drmmirzaei@yahoo.com زهرا محمدی Zahra Mohammadi دانشجوی دکتری حرفه ای، دانشگاه علوم پزشکی شهید صدوقی یزد، یزد، ایران ایران fbehnaz@gmail.com مهرداد منصوری Mehrdad Mansouri دانشجوی دکتری حرفه ای، دانشگاه علوم پزشکی شهید صدوقی یزد، یزد، ایران ایران mansory.mehrdad@yahoo.com migraine medical students prevalence Iran میگرن سردرد دانشجویان پزشکی شیوع 1. Abu-Arafeh I, Razak S, Sivaraman B, Graham C. Prevalence of headache and migraine in children and adolescents: a systematic review of population based studies. Dev Med Child Nneurol 2010; 52(12): 1088-1097.##2. World Health Organization (WHO). Atlas of headache disorders and resources in the world 2011. WHO, 2011.##3. Mirzaei MGR. A review of cammon migraine in girls high school and related fall in education in Shahrekord region. J Shahrekord Univ Med Sci 2004; 5(4): 55-62 (Persian).##4. Woldeamanuel YW, Cowan RP. Migraine affects 1 in 10 people worldwide featuring recent rise: A systematic review and meta-analysis of community-based studies involving 6 million participants. J Neurol Sci 2017; 372: 307-315.##5. Vos T, Barber RM, Bell B, Bertozzi-Villa A, Biryukov S, Bolliger I, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2015; 386(9995): 743-800.##6. Miller S, Matharu MS. Migraine is underdiagnosed and undertreated. Practitioner 2014; 258(1774): 19-24.##7. Farhadi Z, Alidoost S, Behzadifar M, Mohammadibakhsh R, Khodadadi N, Sepehrian R, et al. The prevalence of migraine in Iran: a systematic review and meta-analysis. Iran Red Crescent Med J 2016; 18(10): e40061 (Persian).##8. Yazdanparast M, Abrishamizadeh AA, Mahboobi H, Omrani A, Ghasemi M, Ghorashi M, et al. Electron Physician 2013; 5(3): 679-684.##9. Wang X, Zhou H, Sun J, Xing Y, Zhu Y, Zhao Y. The prevalence of migraine in university students: A systematic review and meta analysis. Eur J Neurol 2016; 23(3): 464-475.##10. Al-Hashel JY, Ahmed SF, Alroughani R, Goadsby PJ. Migraine among medical students in Kuwait University. J Headache Pain 2014; 15(1): 26. ##11. Headache Classification Committee of the International Headache Society (IHS). The international classification of headache disorders. Cephalalgia 2004; 24(1):1-160.##12. Ghorbani A, Chitsaz A. Comparison of validity and reliability of the Migraine disability assessment (MIDAS) versus headache impact test (HIT) in an Iranian population. Iran J Neurol 2011; 10(3-4): 39-42 (Persian).##13. Zandifar A, Asgari F, Haghdoost F, Masjedi SS, Manouchehri N, Banihashemi M, et al. Reliability and validity of the migraine disability assessment scale among migraine and tension type headache in Iranian patients. Biomed Res Int 2014; 2014: 978064.##14. Balaban H, Semiz M, Şentürk İA, Kavakçı Ö, Cınar Z, Dikici A, et al. Migraine prevalence, alexithymia, and post-traumatic stress disorder among medical students in Turkey. J Headache Pain 2012; 13(6): 459-467.##15. Deleu D, Khan M, Humaidan H, Al Mantheri Z, Al Hashami S. Prevalence and clinical characteristics of headache in medical students in Oman. Headache 2001; 41(8): 798-804.##16. Ghorbani A, Abtahi SM, Fereidan-Esfahani M, Abtahi S-H, Shemshaki H, Akbari M, et al. Prevalence and clinical characteristics of headache among medical students, Isfahan, Iran. J Res Med Sci 2013; 18(Suppl 1): S24-S27.##17. Shahrakai MR, Mirshekari H, Ghanbari AT, Shahraki AR, Shahraki E. Prevalence of migraine among medical students in Zahedan Faculty of Medicine (Southeast of Iran). Basic and Clinical Neuroscience 2011; 2(2): 20-25.##18. Mitsikostas DD, Gatzonis S, Thomas A, Kalfakis N, Llias A, Papageoergiou C. An epidemiological study of headaches among medical students in Athens. Headache 1996; 36(9): 561-564.##19. Khazaie T, Dehghani Firoozabadi M, Sharifzadeh GR. Prevalence of migraine and its relationship to educational performance in adolescents of Brijand city (2010). J Birjand Univ Med Sci 2011; 18(2): 94-101 (Persian).## ##

تاثیر دیابت در دوران بارداری بر سطح پلاسمایی هورمون گرلین در نوزادن موش صحرایی Effects of Maternal Diabetes on rat’s Offspring Plasma Ghrelin 1 1 سابقه و هدف: گرلین به ‌عنوان یک لیگاند طبیعی برای گیرنده سلول‌های ترشح کننده هورمون رشد نقش مهمی را در تنظیم اشتها، توده چربی بدن و تعادل انرژی ایفا می‌کند. هدف از این مطالعه، بررسی تاثیر دیابت دوران بارداری بر سطح پلاسمایی گرلین پس از تولد در نوزادان رت می باشد. مواد و روش‌ها: دراین مطالعه تجربی، رت های ماده نژاد ویستار به دو گروه دیابتی (20=n) و کنترل (10=n) تقسیم شدند و مورد جفت اندازی قرار گرفتند. از هرگروه، 16 نوزاد (8 نر) در هر یک از روزهای 7 و 14 انتخاب شدند. پارامترهای وزن بدن، قند خون و غلظت گرلین فعال اندازه‌گیری شد. مقایسه داده‌ها با آزمون آنالیز واریانس دو طرفه (جنس*گروه) در محیط نرم‌افزار SPSS ویرایش 22 انجام شد. یافته‌ها: در 7 و 14 روزگی، میانگین وزنی نوزادان گروه دیابتی (به ترتیب 42/0±49/18 و 43/0± 27/22 گرم) به طور معنی‌داری (0001/0>p هر دو)، کم‌تر از گروه کنترل (به ترتیب 402/0± 34/22 و 45/1± 32/30 گرم) بود، در حالی که تفاوت معنی‌داری در قند خون بین گروه‌ها وجود نداشت. در 7 روزگی، اختلاف معنی‌داری بین گروه‌ها در سطح گرلین وجود نداشت، اما در14 روزگی، گروه دیابتی سطح گرلین بالاتری در قیاس با گروه کنترل داشت ( pg/ml59/3± 25/29 در مقابل pg/ml 75/2±81/14؛0001/0>p). در همین زمان در گروه دیابتی سطح گرلین نوزادان نر به طور معنی‌داری بیش تر از جنس ماده بود (58/2± 87/29 در مقابل 68/1± 62/22؛ 0001/0>p). استنتاج: نتایج این مطالعه به وضوح نشان می دهد که دیابت دوران بارداری می‌تواند در اثری وابسته به جنس، سطح گرلین پس از تولد را در نوزادان تحت تاثیر قرار دهد.     2 Background and purpose: Ghrelin, a natural ligand of the growth hormone secretagogue receptor plays a major role in regulation of appetite, body fat mass, and energy balance in the body. The aim of this study was to evaluate the effects of maternal diabetes on circulatory ghrelin levels in rat newborns. Materials and methods: In this experimental study, female Wistar rats were allocated into diabetic (n=20) and control (n=10) groups and mated with males. After parturition, 16 offspring (8 males) were collected at both postnatal days (P), P7 and P14. The body weight, blood glucose and plasma ghrelin levels were measured. Data were analyzed applying two-way ANOVA using sex and group as the factors in SPSS V22. Results: At both P7 and P14, the body weight of newborns of diabetic mothers (18.49± 0.42g, 22.27± 0.43g respectively) were significantly lower (P<0.0001 each) than those of the control group (22.34± 0.402g, 30.32± 1.45g) while there were no significant differences in blood glucose levels between the two groups. At P7, plasma ghrelin levels showed no significant difference between experimental and control groups, but at P14, experimental group had markedly higher ghrelin levels than that of the control group (29.25± 3.59 pg/ml vs. 14.81± 2.75 pg/ml; P<0.0001). Moreover, at P14, male offspring had significantly higher level of ghrelin than female (29.87± 2.58 pg/ml vs. 22.62±1.68 pg/ml; P<0.0001). Conclusion: Current results clearly demonstrate that diabetes during pregnancy can influence plasma ghrelin levels with male and female offspring responding differently.   171 176 2017/03/72018/06/302018/04/72018/07/302017/11/12018/07/282018/05/182018/02/72017/11/262018/06/112018/03/12017/08/262018/06/182018/02/42017/07/292017/12/9 1396/9/18 2018/10/202018/11/62018/10/12018/06/92018/11/62018/11/42018/06/92018/05/212018/10/312018/06/92018/06/92018/10/222018/10/92018/05/282018/06/9 1397/3/19 قاسم ایوار Ghasem Ivar کارشناس ارشد علوم تشریحی، دانشکده پزشکی، دانشگاه علوم پزشکی بیرجند، بیرجند، ایران ایران زهرا قیروانی Zahra Ghiravani مربی، گروه فیزیولوژی، دانشکده پزشکی، دانشگاه علوم پزشکی بیرجند، بیرجند، ایران ایران فائزه رضایی Faezeh Rezaei کارشناس ارشد علوم تشریحی، دانشکده پزشکی، دانشگاه علوم پزشکی بیرجند، بیرجند، ایران ایران سمیه یوسفی Somayeh Yousefi مربی، گروه مامایی، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی بیرجند، بیرجند، ایران ایران عرفان لطفی Erfan Lotfi دانشجوی پزشکی، دانشکده پزشکی، دانشگاه علوم پزشکی بیرجند، بیرجند، ایران ایران مهران حسینی Mehran Hosseini کارشناس ارشد علوم تشریحی، مرکز تحقیقات سلولی و مولکولی، دانشگاه علوم پزشکی بیرجند، بیرجند، ایران ایران mehranhosseiny@yahoo.co.in maternal diabetes offspring sexual dimorphism ghrelin rat دیابت بارداری نوزادان دیمورفیسم جنسیتی گرلین رت 1. Herman WH. The global agenda for the prevention of type 2 diabetes. Nutr Rev 2017; 75(suppl_1): 13-18.##2. Tutino GE, Tam WH, Yang X, Chan JC, Lao TT, Ma RC. Diabetes and pregnancy: perspectives from Asia. Diabet Med 2014; 31(3): 302-318.##3. Bao W, Baecker A, Song Y, Kiely M, Liu S, Zhang C. Adipokine levels during the first or early second trimester of pregnancy and subsequent risk of gestational diabetes mellitus: a systematic review. Metabolism. 2015; 64(6): 756-764.##4. Ukkola O. Ghrelin in Type 2 diabetes mellitus and metabolic syndrome. Mol Cell Endocrinol 2011; 340(1): 26-28.##5. Nass R, Gaylinn BD, Thorner MO. The ghrelin axis in disease: Potential therapeutic indications. Mol Cell Endocrinol 2011; 340(1): 106-110.##6. Ariyasu H, Takaya K, Tagami T, Ogawa Y, Hosoda K, Akamizu T, et al. Stomach is a major source of circulating ghrelin, and feeding state determines plasma ghrelin-like immunoreactivity levels in humans. J Clin Endocrinol Metab 2001; 86(10): 4753-4758.##7. Gómez-Díaz RA, Gómez-Medina MP, Ramírez- Soriano E, López-Robles L, Aguilar-Salinas CA, Saucedo R, et al. Lower Plasma Ghrelin Levels are Found in Women with Diabetes-Complicated Pregnancies. J Clin Res Pediatr Endocrinol 2016; 8(4): 425-431.##8. Hami J, Vafaei-nezhad S, Ghaemi K, Sadeghi A, Ivar G, Shojae F, et al. Stereological study of the effects of maternal diabetes on cerebellar cortex development in rat. Metab Brain Dis 2016; 31(3):643-652.##9. Serki E, Vazifeshenas Darmiyan K, Ezi S, Bayat J, Shahamat F, Ghiravani Z, et al. Effects of Colostrum on Sperm Parameters, Sex Hormones and Testes Histopathological Changes in Diabetic Rats. J Mazandaran Univ Med Sci 2016; 26(141): 83-94 (Persian)##10. Lotfi N, Hami J, Hosseini M, Haghir D, Haghir H. Diabetes during pregnancy enhanced neuronal death in the hippocampus of rat offspring. Int J Dev Neurosci 2016; 51: 28-35. ##11. Berggren EK, Stuebe AM, Boggess KA. Excess maternal weight gain and large for gestational age risk among women with gestational diabetes. Am J Perinatol 2015; 32(03): 251-256.##12. Kiss AC, Lima PH, Sinzato YK, Takaku M, Takeno MA, Rudge MV, et al. Animal models for clinical and gestational diabetes: maternal and fetal outcomes. Diabetol Metab Syndr 2009; 1(1): 21.##13. Kervran A, Guillaume M, Jost A. The endocrine pancreas of the fetus from diabetic pregnant rat. Diabetologia 1978; 15(5): 387-393.##14. Ng P, Lee C, Lam C, Wong E, Chan I, Fok T. Plasma ghrelin and resistin concentrations are suppressed in infants of insulin-dependent diabetic mothers. J Clin Endocrinol Metab 2004; 89(11): 5563-5568.##15. Farquhar J, Heiman M, Wong AC, Wach R, Chessex P, Chanoine JP. Elevated umbilical cord ghrelin concentrations in small for gestational age neonates. J Clin Endocrinol Metab 2003; 88(9): 4324-4327.##16. Karakulak M, Saygili U, Temur M, Yilmaz Ö, Özün Özbay P, Calan M, et al. Comparison of umbilical cord ghrelin concentrations in full-term pregnant women with or without gestational diabetes. Endocr Res 2017; 42(2): 79-85.#### ##

توده بزرگ مغزی در پسر 16 ساله همراه با تشنج: گزارش مورد توبرکلوما مغزی A Large Brain Mass in a 16-year-old Boy with Seizure: A Case Report of Brain Tuberculoma 1 1 توبرکلوما در کشورهای در حال توسعه رایج بوده و گاهاً با عفونت سیستم عصبی مرکزی (CNS) تظاهر می‌یابد، اما تظاهر آن به شکل توده مغزی بزرگ، غیرمعمول و نادر است. در این مقاله پسر 16 ساله را با تظاهرات تشنج و توده مغزی معرفی می‌کنیم که پس از ارزیابی بر اساس پاتولوژی، توبرکلومای مغزی تشخیص داده شد. 2 Tuberculoma is a common condition in developing countries that sometimes presents with CNS infection, but it is rare to be found as a big brain mass. This article reports a case of a 16- year- old boy with seizure and a large brain mass lesion. According to pathology evaluations, the diagnosis of brain tuberculoma was made. 177 181 2017/03/72018/06/302018/04/72018/07/302017/11/12018/07/282018/05/182018/02/72017/11/262018/06/112018/03/12017/08/262018/06/182018/02/42017/07/292017/12/92018/05/18 1397/2/28 2018/10/202018/11/62018/10/12018/06/92018/11/62018/11/42018/06/92018/05/212018/10/312018/06/92018/06/92018/10/222018/10/92018/05/282018/06/92018/11/19 1397/8/28 احمد علیخانی Ahmad Alikhani دانشیار، گروه عفونی، مرکز تحقیقات مقاومتهای ضد میکربی، دانشگاه علوم پزشکی مازندران، ساری، ایران ایران ahalikhani@yahoo.com سجاد شفیعی Sajad Shafiee استادیار، گروه جراحی، دانشکده پزشکی، دانشگاه علوم پزشکی مازندران، ساری، ایران ایران sajad.shafiee@gmail.com فاطمه منتظر Fatemeh Montazer استادیار، گروه پاتولوژی، دانشکده پزشکی، دانشگاه علوم پزشکی مازندران، ساری، ایران ایران saa_montazer@yahoo.com سعید اصغری خنکدار Saeid Asghari Khonakdar متخصص رادیولوژی، بیمارستان رازی، دانشگاه علوم پزشکی مازندران، ساری، ایران ایران saeidasgharikhonakdari@gmail.com شمیلا عباسپور Shamila Abbaspour دانشجوی پزشکی،کمیته تحقیقات دانشجویی، دانشکده پزشکی، دانشگاه علوم پزشکی مازندران، ساری، ایران ایران shamila.abbaspour@yahoo.com brain tuberculoma mass مغز توبرکلوما توده 1. Park HS, Song YJ. Multiple tuberculoma involving the brain and spinal cord in a patient with miliary pulmonary tuberculosis. J Korean Neurosurg Soc 2008; 44(1): 36-39.##2. Lober RM, Veeravagu A, Singh H. Brain tuberculoma in a non-endemic area. Infect Dis Rep 2013; 5(1): e1.##3. Babamahmoodi F, Alikhani A, Yazdani Charati J, Ghovvati A, Ahangarkani F, Delavarian L, et al. Clinical epidemiology and paraclinical findings in tuberculosis patients in north of Iran. Bio Med Res Intern 2015; 2015.##4. Najafi N, Tayebi A, Alikhani A, Davoudi A. An unusual presentation of brain tuberculoma: A review of clinical features, radiographic and laboratory findings of CNS tuberculosis in adults. J Mazandaran Univ Med Sci 2013; 23(102): 14-21 (Persian).##5. Kheir AEM, Ibrahim SA, Hamed AA, Yousif BM, Hamid FA. Brain tuberculoma, an unusual cause of stroke in a child with trisomy 21: a case report. J Med Case Rep 2017; 11(1): 114.##6. Akhaddar A, Boucetta M. Giant brain tuberculoma mimicking a malignant tumor in a child. Pan Afr Med J. 2014; 17: 112.##7. Aloreidi K, Dodin J, Berg J, Hoffman W. Brain Tuberculoma: A Case Report and Literature Review. S D Med 2017; 70(7): 298-301.##8. Sumer S, Koktekir E, Demir NA, Akdemir G. Intracranial giant tuberculoma mimicking brain tumor: a case report. Turk Neurosurg 2015; 25(2): 337-339.##9. Payam S, Amir MA, Sasan S, Ahmad PB, Zahra T, Athena SR. Treatment of patients with suspected brain tuberculoma before or without bacteriologic confirmation in endemic places: report of two cases. Acta Neurol Belg 2015; 115(2): 181-185.##10. Nahid P, Dorman SE, Alipanah N, Barry PM, Brozek JL, Cattamanchi A, et al. Official American thoracic society/centers for disease control and prevention/infectious diseases society of America clinical practice guidelines: treatment of drug-susceptible tuberculosis. Clin Infect Dis 2016; 63(7): e147-e195.##11. Kim JK, Jung TY, Lee KH, Kim SK. Radiological Follow-up of a Cerebral Tuberculoma with a Paradoxical Response Mimicking a Brain Tumor. J Korean Neurosurg Soc 2015; 57(4): 307-310## ##

سندرم آپکس اوربیتال ناشی از هرپس زوستر در بیمار با سیستم ایمنی کامل: گزارش مورد Orbital Apex Syndrome Caused by Herpes Zoster in an Immunocompetent Patient: A Case Report 1 1 سندرم آپکس اوربیتال با افتالموپلژی و کاهش بینایی و درگیریی اعصاب کرانیال 3 و 4 و 6 و اولین شاخه عصب 5 مشخص می‌شود. علت شایع آن عفونت‌های قارچی مهاجم مانند موکورمایکوز و آسپرژیلوس در میزبان سالم یا میزبان با نقص سیستم ایمنی می‌باشد. در موارد نادری ممکن است هرپس زوستر باعث سندرم آپکس اوربیتال شود. در این گزارش مورد، آقای میان سالی معرفی می گردد که با سردرد نیمه راست و درد چشم و اشکریزش و پرخونی ملتحمه مراجعه کرده و به تدریج طی 3-2 روز دچار کاهش بینایی، پروپتوز، پتوز و اختلال در حرکات چشم راست گردید. در این زمان هیچ ضایعه پوستی مشاهده نشد. در معاینه حدت بینایی بیمار در حد Light perception بوده و حرکات چشم کاملاً مختل بود. در معاینه با اسلیت لامپ کدورت منتشر قرنیه داشت. فشار چشم مختصری افزایش و میدان بینایی کاهش یافته داشت. بعد از 4 روز، اریتم پیشانی و اطراف چشم و ضایعه وزیکولر در همان ناحیه ظاهر شد. در CT اسکن حفره اربیت، التهاب شدید ساختمان های داخلی چشم و غدد اشکی و عضلات اکسترا اوربیکولار رویت شد. با تشخیص سندرم آپکس اوربیتال در زمینه هرپس زوستر جهت بیمار آسیکویر وریدی، کورتون وریدی و آنتی‌بیوتیک وسیع الطیف شروع شد. حدت بینایی و یوئیت در عرض 20 روز بهبود یافت و درمان با آسیکلویر خوراکی و کورتیکواستروئید خوراکی ادامه یافت. در انتهای ماه چهارم، حرکات چشم طبیعی و پتوز اصلاح شد. درمان ترکیبی و طولانی مدت با آسیکلویر و کورتون سیتمیک در بیمار مورد مطالعه، پروگنوز خوبی داشت. 2 Orbital apex syndrome (OPS) is determined by ophthalmoplegia, vision loss, and involvement of cranial nerves III, IV, VI, and the first branch of the trigeminal nerve. The disease is commonly caused by invasive fungal infections such as mucormycosis and aspergillosis in immunocompromised or immunocompetent patients. Rarely, herpes zoster virus may cause OPS. This report presents the case of a 48 year-old man with right-sided headache, tearing, and conjunctival hyperemia. The patient also gradually developed vision loss, proptosis, ptosis, and right ocular motility disorder within 2-3 days. At this time, there were no skin lesions. Physical examination showed that the visual acuity of the patient was limited to light perception. Also, it revealed decreased visual field of the right eye and fixed eye. In slit lamp examination diffused corneal opacity was seen and brief ocular hypertension was detected in tonometry. After four days, erythema and periorbital vesicular rash occurred around the right eyelid and forehead. Computed tomography scan (CT scan) of the orbits showed severe inflammation in the right intra orbital structures, including the lacrimal glands and extraocular muscles. Early diagnosis of the orbital apex syndrome due to the herpes zoster virus was made and treatment with intravenous acyclovir and corticosteroid and parenteral antibiotics was initiated. The visual acuity improved and uveitis recovered in 20 days. Treatment with oral acyclovir and prednisolone was continued. After four months, ocular movement was normal in all directions and ptosis recovered. Combination therapy with systemic corticosteroid and acyclovir in our immunocompetent patient had a good prognosis.   182 188 2017/03/72018/06/302018/04/72018/07/302017/11/12018/07/282018/05/182018/02/72017/11/262018/06/112018/03/12017/08/262018/06/182018/02/42017/07/292017/12/92018/05/182018/07/17 1397/4/26 2018/10/202018/11/62018/10/12018/06/92018/11/62018/11/42018/06/92018/05/212018/10/312018/06/92018/06/92018/10/222018/10/92018/05/282018/06/92018/11/192018/10/31 1397/8/9 علیرضا داودی Alireza Davoudi دانشیار، مرکز تحقیقات مقاومت های میکروبی، دانشگاه علوم پزشکی مازندران، ساری، ایران ایران eiy_iran@yahoo.com فاطمه آهنگرکانی Fatemeh Ahangarkani دانشجوی دکترای قارچ شناسی پزشکی، مرکز تحقیقات مقاومت های میکروبی، کمیته تحقیقات دانشجویی، دانشگاه علوم پزشکی مازندران، ساری، ایران ایران نرگس نجفی Narges Najafi دانشیار، مرکز تحقیقات مقاومت های میکروبی، دانشگاه علوم پزشکی مازندران، ساری، ایران ایران nr93najafi@gmaiil.com محمد رحمانی Mohammad Rahmani پزشک عمومی، مرکز تحقیقات مقاومت های میکروبی، دانشگاه علوم پزشکی مازندران، ساری، ایران ایران wergtgre@gmail.com فاطمه کوهکن Fatemeh Koohkan متخصص عفونی، مرکز تحقیقات مقاومت های میکروبی، دانشگاه علوم پزشکی مازندران، ساری، ایران ایران koohkan.fa@gmail.com شهریار عالیان Shahriar Alian دانشیار، مرکز تحقیقات مقاومت های میکروبی، دانشگاه علوم پزشکی مازندران، ساری، ایران ایران shahriaar.alian@yahoo.com سیده روشینا حسن تبار Seyedeh Roshina Hasantabar پزشک عمومی، مرکز تحقیقات مقاومت های میکروبی، دانشگاه علوم پزشکی مازندران، ساری، ایران ایران qr6543fghgfdsa34t@yahoo.com ophthalmoplegia herpes zoster acyclovir corticosteroid افتالموپلژی هرپس زوستر آسیکلویر کورتون 1. Arda H, Mirza E, Gumus K, Oner A, Karakucuk S, Sirakaya E. Orbital apex syndrome in herpes zoster ophthalmicus. Case Rep Ophthalmol Med 2012; 2012: 854503.##2. Kahloun R, Attia S, Jelliti B, Attia AZ, Khochtali S, Yahia SB, et al. Ocular involvement and visual outcome of herpes zoster ophthalmicus: review of 45 patients from Tunisia, North Africa. J Ophthalmic Inflamm Infect 2014; 4(1): 25.##3. Lee CY, Tsai HC, Lee SS, Chen YS. Orbital apex syndrome: an unusual complication of herpes zoster ophthalmicus. BMC Infect Dis 2015; 15: 33.##4. Babamahmoodi F, Alikhani A, Ahangarkani F, Delavarian L, Barani H, Babamahmoodi A. Clinical Manifestations of Herpes Zoster, Its Comorbidities, and Its Complications in North of Iran from 2007 to 2013. Neurol Res Int 2015; 2015: 896098.##5. Kattah JC, Kennerdell JS. Orbital apex syndrome secondary to herpes zoster ophthalmicus. Am J Ophthalmol 1978; 85(3): 378-382.##6. Chang-Godinich A, Lee AG, Brazis PW, Liesegang TJ, Jones DB. Complete ophthalmoplegia after zoster ophthalmicus. J Neuroophthalmol 1997; 17(4): 262-265.##7. Saxena R, Phuljhele S, Aalok L, Sinha A, Menon V, Sharma P, et al. A rare case of orbital apex syndrome with herpes zoster ophthalmicus in a human immunodeficiency virus-positive patient. Indian J Ophthalmol 2010; 58(6): 527-530##8. Bennett JE, Dolin R, Blaser MJ. Mandell, Douglas, and Bennett's principles and practice of infectious diseases. 8th ed. New York: Elsevier Health Sciences; 2014.##9. Xiao Z, Lu Z, Pan S, Liang J, Liu Z. Orbital apex syndrome and meningoencephalitis: a rare complication of herpes zoster. Int J Clin Exp Med 2015; 8(8): 14260.##10. Kestelyn P, Stevens A, Bakkers E, Rouvroy D, Van de Perre P. Severe herpes zoster ophthalmicus in young African adults: a marker for HTLV-III seropositivity. Br J Ophthalmol 1987; 71(11): 806-809.##11. Kocaoğlu G, Utine CA, Yaman A, Men S. Orbital Apex Syndrome Secondary to Herpes Zoster Ophthalmicus. Turk J Ophthalmol 2018; 48(1): 42-46.##12. DeLengocky T, Bui CM. Complete ophthalmoplegia with pupillary involvement as an initial clinical presentation of herpes zoster ophthalmicus. J Am Osteopath Assoc 2008; 108(10): 615-621.##13. Chhabra MS, Golnik KC. Recovery of ocular motor cranial nerve palsy after herpes zoster ophthalmicus. J Neuroophthalmol 2014; 34(1): 20-22.##14. Garg R, Kar A, Jain A. Herpes zoster opthalmicus with complete external ophthalmoplegia. J Assoc Physicians India 1992; 40(7): 496-497.##15. Naumann G, Donald J, Gass M, Font RL. Histopathology of herpes zoster ophthalmicus. Am J Ophthalmol 1968; 65(4): 533-541.##16. Sanjay S, Chan EWe, Gopal L, Hegde SR, Chang BC-M. Complete unilateral ophthalmoplegia in herpes zoster ophthalmicus. J Neuroophthalmol 2009; 29(4): 325-337.## ##

مروری بر کارآزمایی بالینی درمان مبتنی بر پذیرش و تعهد بر سلامت روانی و کیفیت زندگی زنان مبتلا به سرطان پستان A Systematic Review and Meta-analysis of Acceptance and Commitment Therapy on Mental Health and Quality of Life of Women with Breast Cancer 1 1 سابقه و هدف: سرطان پستان شایع‌ترین سرطان در زنان ایرانی می‌باشد. دو شکایت روانی اصلی در بیماران سرطانی، افسردگی و اضطراب است که منجر به تاثیر منفی بر کیفیت زندگی می گردد. درمان مبتنی بر پذیرش و تعهد، مهارت‌هایی برای پاسخ به این تجارب غیر قابل کنترل و تعهد به ارزش های شخصی را آموزش می‌دهد. این مطالعه با هدف بررسی کارآزمایی‌های انجام شده درباره اثر گذاری این روش بر افسردگی و اضطراب و کیفیت زندگی این بیماران در ایران انجام پذیرفت. مواد و روش‌ها: در این مطالعه مروری سیستماتیک و متاآنالیز، کلیه مقالات کارآزمایی بالینی از سال 2005 تا 2017 (1396-1384 شمسی) که در ایران انجام و در پایگاه‌های اطلاعاتی بین‌المللی، Since Direct، Scopus،Pub ، med Googelscholrar، و پایگاه های اطلاعاتی ملی medex، Iran doc، Mag iran، SID، Cochrane وجود دارد، مورد بررسی قرار گرفت. یافته‌ها: پس از جستجو داده ها و با استفاده از چک لیست، 8 مقاله بررسی گردید )3 مقاله به کیفیت زندگی و 5 مقاله به افسردگی( پرداخته بودند. افراد شرکت کننده در محدوده سنی 20تا 60 سال، و تمامی مطالعات پیش آزمون و پس آزمون داشتند و در دو مداخله پیگیری انجام شده بود. استنتاج: این رویکرد، نوعی توانمند سازی است و می‌تواند مداخله ای مناسب و بهنگام برای ارتقاء توانمندی بیماران سرطانی در پذیرش بیماری، کاهش اضطراب و افسردگی و حل این بحران و افزایش کیفیت زندگی باشد. اما برای اطمینان نیازمند گروه های بیش‌تر، و انجام مداخله در مراحل مختلف بیماری هستیم. استفاده از ابزارهای مناسب تر می تواند نتایج قابل اطمینان تری ارائه دهد. همچنین لازم است این روش در مردان مبتلا نیز بررسی گردد. 2 Background and purpose: Breast cancer is the most common cancer in Iranian women. Two main psychological complaints in cancer patients are depression and anxiety which have negative impacts on their quality of life. Acceptance and commitment therapy provides the involved patients with the skills to respond to these uncontrollable experiences and commitment to personal values. The purpose of this study was to review the clinical trials conducted on the effect of this method on depression, anxiety, and quality of life of these patients in Iran. Materials and methods: This systematic review and meta-analysis investigated all clinical trials conducted between 2005 and 2017 in Iran. Electronic databases were searched, including Since Direct, Scopus, Pubmed, Google Scholrar, SID, Mag iran, Iran doc, Medex, and Cochrane. Results: In final investigation, 8 articles were reviewed (three on quality of life and five on depression and anxiety). The studies included people aged 20- 60 years old, all followed pre-test and post-test designs and two studies had performed follow-up interventions.  Conclusion: Acceptance and commitment therapy could empower breast cancer patients and enhance their ability in accepting the disease, reduce anxiety, and depression and improve their quality of life. Nevertheless, further research consisting of more population and interventions in different stages of the disease are needed. Studies on male cancer patients could be beneficial too. Using more appropriate tools can also provide more reliable results. 192 207 2017/03/72018/06/302018/04/72018/07/302017/11/12018/07/282018/05/182018/02/72017/11/262018/06/112018/03/12017/08/262018/06/182018/02/42017/07/292017/12/92018/05/182018/07/172018/05/12 1397/2/22 2018/10/202018/11/62018/10/12018/06/92018/11/62018/11/42018/06/92018/05/212018/10/312018/06/92018/06/92018/10/222018/10/92018/05/282018/06/92018/11/192018/10/312018/09/9 1397/6/18 مریم حسن نژاد رسکتی Maryam Hasannezhad Reskati دانشجوی دکتری روانشناسی تربیتی، واحد ساری، دانشگاه آزاد اسلامی، ساری، ایران ایران بهرام میرزائیان Bahram Mirzaian استادیار، گروه روانشناسی، دانشکده علوم انسانی، واحد ساری، دانشگاه آزاد اسلامی، ساری، ایران ایران سید حمزه حسینی Seyed Hamzeh Hosseini استاد، گروه روانپزشکی، مرکز تحقیقات روانپزشکی و علوم رفتاری، دانشگاه علوم پزشکی مازندران، ساری، ایران ایران acceptance and commitment therapy breast cancer quality of life anxiety depression درمان مبتنی بر پذیرش و تعهد سرطان پستان کیفیت زندگی اضطراب افسردگی 1. Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics 2012. CA Cancer J Clin 2015; 65(2): 87–108.##2. Akbari ME, Khayamzade M, Khoshnevis SJ, Nafisi N, Akbari A. Five and ten yearssurvival in breast cancer patients mastectomies vs, breast conserving surgeries personal experience. Iranian Journal of Cancer Prevention 2008; 1(2): 53-56 (Persian).##3. Gülben K, Berberoğlu U, Aydoğan O, Kınaş V. Subtype Is a Predictive Factor of Nonsentinel Lymph Node Involvement in Sentinel Node-Positive Breast Cancer Patients. J Breast Cancer 2014; 17(4): 370-375.##4. Spiegel D, Riba M B. Managing anxiety and depression during treatmet. Breast J 2015; 21(1: (97-103.##5. Howard -Anderson J, Ganz PA, Bower JE, Stanton AL. Quality of life, fertility concerns, and behavioral health outcomes in younger breast cancer survivors: a systematic review. J Natl Cancer Inst 2012; 104(5): 386-405.##6. Knobf MT. Psychosocial responses in breast cancer survivors. Semin Oncol Nurs 2007; 23(1): 71-83.##7. Stafford L, Komiti A, Bousman C, Judd F, Gibson P, Mann GB, et al. Predictors of depression andanxiety symptom trajectories in the 24months following diagnosis of breast or gynaecologic cancer. Breast 2016; 26: 100-105.##8. Levkovich I, Cohen M, Pollack S, Drumea K, Fried G. Cancer related fatigue and depression in breast cancer patients post chemotherapy: different associations with optimism and stress appraisals. Palliat Support Care 2015; 13(05): 1141-1151.##9. Sajadian A, Dokanei Fard F, Behboodi M. HER3 Gene Expression Study by RT-PCR in Patient with Breast Cancer. IJBD 2016; 9(2): 43-51 (Persian).##10. Musarezaie A, Khaledi F, Kabbazi-fard M, Momeni-GhaleGhasemi T, Keshavarz M, Khodaee M. Investigation the dysfunctional attitudes and its´ relationship with stress, anxiety and depression in breast cancer patients. Health Syst Res 2015; 11(1) :68-76 (Persian).##11. Bennett H, Wells A. Meta cognition, memory disorganization and rumination in post traumatic stress symptoms. J Anxiety Disord 2010; 24(3): 318-325.##12. Ranjbar Kochaksarayi F, Mostafavi G. Anxiety disorders and depression in women with breast cancer and genital. Nursing & Midwifery Journal 2006; 1(1): 28-34 (Persian).##13. Snoj Z, Licina M, Pregelj P. Depression and anxiety in Slovenian female cancer patients. Psychiatr Danub 2008; 20(2): 157-161.##14. Lopez AD, Mathers CD, Ezzati M. Global andregional burden of disease and risk factors, 2001: systematic analysis of population health data. Lancet 2006; 367(9524): 1747-1757.##15. Montazeri A, Mousavi SJ, Omidvari S, Tavousi M, Hashemi A, Rostami T. Depression in Iran: a systematic review of the literature (2000-2010). Payesh 2013; 12(6): 567-594 (Persian).##16. Kutlu R, Çivi S, Börüban MC, Demir A. Depression and the factors affecting the quality of Life in cancer patients. Selçuk Üniv Tıp Derg 2011; 27(3): 149-153.##17. Osborn RL, Demoncada AC, Feuerstein M. Psychosocial inter- ventions for depression, anxiety, and quality of life in cancer survivors: meta-analyses. Int J Psychiatry Med 2006; 36(1): 13-34.##18. Brother BM, Andersen BL. Hopelessness as a predictor of depressive symptoms for breast cancer patients coping with recurrence. Psychooncology 2009; 18(3): 267-275.##19. Twohig MP. Acceptance and commitment therapy: introduction. Cognitive & Behavioral Practice 2012; 19(4): 499-507.##20. Aminzadeh A. Act in made: An easy-to-Read primer on Acceptance and commitment theraoy, 1rd ed. Tehran: Arjomand; 2016. (Persian).##21. Hamidpour H. The inter personal problems work book, 1rd ed. Tehran: Arjomand; 2015. (Persian).##22. Mirzai M, Nounahal S, Blackledge JT, Avigal L, Skeen M. Acceptance and commitment therapy: distinctive features, 2rd ed. Tehran: Arjomand; 2014. (Persian).##23. Bach PA, Moran DJ. ACT in Practice: Case Conceptualization in Acceptance and Commitment Therapy. 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