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Background and purpose: Ïnflammation is a common feature in hemodialysis patients which is characterized by increase in inflammatory biomarkers such as Ç - reactive protein (ÇRP). Ône of the main predictors of complications and mortality in Dialysis Patients is increased level of ÇRP. The aim of this study was to determine the effect of intravenous vitamin Ç on the level of ÇRP in hemodialysis patients.
Materials and methods: Ïn a double blind randomized clinical trial, 60 patients were allocated into two groups, an experimental and a control group. Ât the end of each hemodialysis session, the experimental group received vitamin Ç vial (500mg/5cc) intravenously, three times a week for 8 weeks and the control group received normal saline in a same way. The level of ÇRP was compared in each group before and after the intervention. Data were analyzed by Ïndependent T test, Paired T test and Çhi-square tests.
Results: Âccording to the results, plasma level of ÇRP was significantly decreased in the experimental group (p<0.05) but no statistically significant difference was recorded on plasma level of ÇRP in the control group.
Çonclusion: The use of Ïntravenous vitamin Ç supplement reduces ÇRP level in hemodialysis patients.

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Primary heart tumors are not common. Âlthough myxoma is the most common tumor of the heart, mitral valve myxoma is extremely rare. The patient is a 55 years old woman who had atypical retrosternal pain, retinal artery emboli and visual deficit. Ïn transesophageal echocardiography a (4x3x3) cm mass was detected in posterior leaflet of mitral valve. The posterior leaflet of mitral valve was totally resected and the mitral valve was successfully replaced with prosthetic mechanical valve. Histopathology result confirmed myxoma.

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Background and purpose: The monitoring of the patients’ hemodynamic status and vital signs is a routine practice in ÏÇÜ and the use of a low-cost and soothing method to maintain stable physiological parameters is necessary. This study aimed at investigating the effect of music on the vital signs and SpÔ2 of patients after open heart surgery.
Materials and methods: This study was a randomized clinical trial (RÇT) conducted on 60 patients hospitalized in the open heart surgery ÏÇÜ of Mazandaran Heart Çenter. Patients were randomly assigned into case and control groups. Ïn the case group, the patients listened to the music, which they selected before, through headphones for 30 minutes, while headphones without playing any music were used for patients in the control group. Vital signs and SpÔ2 of the patients were assessed before the intervention, immediately, 30 and 60 minutes after the intervention. The data were analyzed using Çhi-square T-test and repeated measure statistical tests.
Results: Findings showed that music led to a significant decrease in the rate of heartbeat, systolic blood pressure, and mean arterial pressure and a significant increase in SpÔ2 rate (P<0.05) was also observed. But music had no significant effect on the respiratory rate and diastolic blood pressure (P>0.05).
Çonclusion: Âs a non-pharmacologic, inexpensive, non-invasive method and without any side effects, music can improve the vital signs of the patients after open heart surgery.

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Background and purpose: Surgical site infection (SSI) is the third leading cause of hospital infections which results in increased morbidity, mortality and costs after cardiac surgery. The importance of prophylactic antibiotics in cardiac surgery has been proved. The aim of this randomized clinical trial was to compare two prophylactic antibiotic regimens (cefazolin and cefazolin plus gentamicin) on surgical site infection in CABG patients in Mazandaran Heart Center. Materials and methods: A total of 400 patients, meeting eligibility criteria, were randomly allocated into two groups. In the control group the prophylactic regimen consisted of cefazolin 2 g IV prior to sternal incision followed by 1 g IV every 6 hours for 72 hours. The intervention group recieved cefazolin 2 g IV plus gentamicin 1.5mg/kg IV before sternal incision followed by cefazolin 1 g IV every 6 hours plus gentamicin 1.5mg/kg IV every 8 hours for 72hrs after the sternal incision. Three, seven, 21 and 30 days after cardiac surgery the patients were observed by a cardiac surgeon for symptoms of surgical wound infection. Moreover, the serum level of creatinine and BUN were measured before the surgery and also in second and forth days after the surgery. Results: From the total of 400 patients 392 were assessed of whom 198 were in control group and 194 were in the intervention group. There was no significant difference between the two groups regarding demographic and clinical variables and also the rate of infection (P>0.05). However, the serum level of creatinine and BUN were significantly higher in intervention group (P<0.05). Conclusion: Since there was no significant difference in infection rates between the two groups and significant increase in serum level of creatinine and BUN in intervention group, using cefazolin as the sole prophylactic antibiotic is suggested to prevent surgical site infection in CABG patients. (Clinical Trials Registry Number: IRCT201201114365N10)

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Background and purpose: Pain and fatigue are among the complications after coronary artery bypass graft surgery (CABG). Non- pharmacological methods are more favorable than pharmacological agents. This study assessed the effects of foot reflexology massage on pain and fatigue in patients after CABG. Materials and methods: A randomized controlled clinical trial was conducted in 80 patients hospitalized in Mazandaran Heart Center, 2011. The samples were allocated based on their accessibility. They were age and gender matched and then divided randomly into two groups of case and control. The case group received reflexology massage on left foot for 20 minutes from the second day after surgery for four consecutive days. In control group, the left foot of the patients was moisturized for one minute without applying any pressure. The intensity of pain and fatigue were recorded before and after the intervention using visual analogue scale. Descriptive and inferential statistics were used to analyze the data. Results: Results showed significant differences in pain and fatigue levels after the intervention among both groups (P= 0.0001). Conclusion: According to this study, foot reflexology massage, is a useful nursing intervention to relieve fatigue and pain in CABG patients. Since this low-cost method is easy to apply we recommend it to ease the pain and fatigue in patients after CABG.

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Background and purpose: Giardia cyst and trophozoite have invariant morphologies, therefore, investigating aspects such as host specificity, transmission patterns and clinical behavior of the parasite in hosts requires molecular characterization of the parasites isolated from clinical samples. The aim of this study was to characterize giardiasis isolated from human fecal samples with symptomatic (with a history of chronic diarrhea) and asymptomatic giardiasis and investigating the correlation of parasite's assemblage with diarrhea. Materials and methods: Thirty one fecal samples containing Giardia cysts from individuals with symptomatic and asymptomatic giardiasis were used to characterize the parasites' genotype. Triose Phosphate Isomerase (TPI) gene was amplified by polymerase chain Reaction (PCR). Demographic information was recorded using a questionnaire and SPSS ver.16 and Fisher’s exact test were applied to analyse the data. Results: PCR showed a higher frequency of Giardia duodenalis assemblage B compared with assemblage A (51.6% vs. 35.5%). However, the frequency of Giardia duodenalis assemblage A in symptomatic giardiasis was significantly higher than that of the asymptomatic giardiasis (62.5% vs. 18.75%). The Fisher's exact test revealed a significant correlation between Giardia doudenalis assemblage A and diarrhea (p<0.005). Conclusion: Usually, duodenalis assemblage A is accompanied by clinical symptoms such as diarrhea. However, duodenalis assemblage B is more prevalent among those with diarrhea.

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Background and purpose: Coma results from brain damage and patients in intensive care units (ICU) are often more at risk for sensory deprivation. This study compares the effects of familiar and unfamiliar voices on recovering the consciousness level in comatose patients. Materials and methods: This double blind clinical trial (patient and assessor) was performed in 45 traumatic comatose patients with Glasgow Coma Scale (GCS) ≤8 within the age range of 15-75 years, admitted to ICU training centers affiliated to Mazandaran University of Medical Sciences. The subjects were randomly allocated into three groups. Group A was stimulated with a familiar voice, group B’s auditory stimulation was done by the researcher introduced as a nurse) and no intervention was done for group C (control group). The interventions were conducted twice a day for 1-5 minutes. The level of consciousness was measured using the GCS scale. To analyze the data descriptive and inferential statistics (Logrank Test) were used. Results: In the day before the intervention the mean levels of GCS in groups A, B, and C were 6.40, 5.66, and 5.53, respectively. Logrank test revealed significant differences between the groups in the time to reach CGS= 15 which happened sooner in group A (P<0.0001). Conclusion: Familiar voice could highly influence the auditory level of patients in ICU. Therefore, auditory stimulation programs are recommended for comatose patients.

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Background and purpose: Nursing is a stressful job and nurses are always susceptible to health threats in various aspects due to long shifts. Zinc is a trace element that is essential for human health. This study was performed to assess the effect of zinc supplement on general health of nurses working in intensive care units (ICU). Materials and methods: This double blind randomized clinical trial was performed in 46 ICU accessible nurses from Imam Khomeini and Fatima Zahra hospitals (Sari-2011) with general health disorder (n = 23 intervention and 23 control). In intervention group zinc sulfate 220 mg capsules were administered twice daily every 78 hours for a month while for the control group placebo were administered in the same way. General health and serum zinc level were measured pre and post-intervention. Data was obtained using demographic and standard general health questionnaires. For data analysis we applied SPSS ver. 18, chi square, t-independent, paired t-test and kolmogorov-smirnov tests. Results: In the intervention group the mean of general health score was 23.04±9.54 after a month and in the control group it was 27.96±13.82, (P=0.298). Among the four aspects of public health, significant improvement was observed only in physical symptoms in the intervention group (P=0.044). After a month the mean levels of zinc were 73.57±13.4 and 59.67±14.3 in the intervention group and in control group, respectively. The study showed significant increase in level of zinc in the intervention group (P=0.034). Conclusion: This study indicated a low level of zinc serum in nurses working in ICU. The zinc supplements showed positive effects on some aspects of general health, hence, administrating zinc supplements could be of great benefit in enhancing the general health among nurses. (Clinical Trials Registry Number: IRCT20120625436513)

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Background and purpose: The main source of trace elements in plants is soil and nutrients of their growth medium. On the other hand, growth of tea is affected by some variables such as relative humidity of weather, temperature difference between day and night and and length of the day which are different in each season. This study aimed to investigate the effects of harvest time on tea leaf heavy metals in Mazandaran province. Materials and methods: The study was carried out in Mazandaran food control laboratory on 32 samples of black tea leaves, obtained from Mazandaran factories. The elements were analyzed using graphite furnace and flame atomic absorption spectrophotometer. To compare the mean with standard threshold and independence of variables one-sample t-test and chi square were used respectively. Results: Cu, cd and pb mean contents, as mg/kg in spring and summer, was (23.14±10.3, 30.19 ±12.8,), (0.16±0.07, 0.4±0.68) and (2.25±1.21, 2.33± 1.34), respectively. Pb content in spring and summer and then cd content in summer was significantly higher and cu content in summer and spring was significantly lower than Iran’s standard threshold (p≤0.05). There were no significant differences between harvest season and metal content. Conclusion: Control of trace elements content in tea is necessary due to the high per capita consumption of tea in Iran which makes it one of the most important ways to trace element intake.

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Background and purpose: Today, most organizations have recognized the value of their invisible assets and seek multiple methods to use them efficiently. One of these invisible assets is knowledge and knowledge management is a process of creating value from knowledge implementation. Execution of knowledge management requires paying attention to important factors such as organizational culture and information technology. The importance of these factors varies in different organizations according to organizational goals, organizational activities, the environment in which the organization is located, the amount of information and knowledge of the staff and facilities. This study was conducted to investigate the key factors in the establishment of knowledge management in administrative offices of Mazandaran University of Medical Sciences Materials and methods: This descriptive survey was conducted among the managers and the staff working in administrative offices of Mazandaran University of Medical Sciences. Morgan table was used and 200 people were selected of whom 189 (97 female and 88 male) completed a questionnaire. The questionnaire included 55 questions regarding information technology, organizational culture and knowledge management, and some questions on demographic features. Data analysis was done using IBM SPSS 20. Results: The result of this study showed significant differences between the knowledge of female and male subjects and the female case’s knowledge was lower than male cases (P <0.039). On the other hand there were significant association between support executives, sense of organization, collaboration, and management of information technology and knowledge management, but no significant correlation was found between trust and process information Conclusion: Due to the importance of knowledge management for organizations and interconnected nature of organizational culture and IT, staff should receive supports to maximally benefit from their experience and knowledge, thereby the most advanced information systems are created.

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Background and purpose: According to the confirmed dangerous side effects of chemical preservatives such potassium sorbate in public health and food safety, accurate monitoring of the presence of preservatives in food is necessary. Since, according to Iran national standard, using potassium sorbate in dough as preservative is prohibited, so, this study aimed to investigate the presence of potassium sorbate in dough and validation method of potassium sorbate detection. Material and methods: In this study, 100 dough samples were collected from Mazandaran province factories. The samples were analyzed by high performance liquid chromatography (HPLC), UV detectors. Validation was performed according to USP and ICH guidelines. Results: The correlation coefficient of curve equation was 99.9%. The linearity rang was from 19 to 100 µg/ml and the limit of detection LOD and limit of quantification (LOQ) were 6.37 and 19.11 µg/ml, respectively. The accuracy of repeatability and intermediate precision of the range were acceptable. Potassium sorbate was detected in 32% samples. Content of Potassium sorbate in 22% of samples was greater than 100 mg/kg and in 10% of samples were lower than 100 mg/kg. Conclusion: With regard to the presence of potassium sorbate in dough samples despite of Iran national standard ban on the use of it in dough, continues monitoring of several preservatives such as potassium sorbate seems to be necessary.

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Background and purpose: Coronary artery bypass surgery (CABG) is an effective and important treatment for patients with coronary artery disease. In recent years there has been increasing interest in prediction of mortality and patient's outcome after cardiac surgery. Several models have been designed to identify related risk factors. This study aimed at evaluating EuroSCORE model in CABG patients in Sari Fatemeh Zahra Center for Cardiac Surgery. Materials and methods: A cross-sectional study was performed and EuroSCORE was calculated for 1000 patients who had CABG. To determine the rate of mortality, the patients were followed for 30 days after the surgery. The main risk factors affecting mortality and validity and reliability of EuroSCORE were also evaluated. Results: Thirty-day mortality rate was 1.5%. The main risk factors affecting mortality rate were age, poor left ventricular dysfunction, chronic pulmonary disease, high serum Cr, critical preoperative state, pulmonary hypertension, other than CABG and post infarct septal rupture. Conclusion: EuroSCORE model could predict the rate of mortality in 78% of the samples. In other studies this rate was predicted at 75%, therefore, EuroSCORE model was found more efficient in this study.

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Background and purpose: Gastrointestinal complications frequently occur in patients admitted to intensive care units (ICUs). Of these, ulceration and bleeding due to stress-related mucosal disease (SRMD) can lengthen hospitalization and increase mortality. The purpose of this study was to evaluate the risk factors of SRMD in patients and review the rational use of SUP drugs in ICU.

Materials and methods: The study was conducted in Sari Imam Khomeini Hospital, 2013-2014. We investigated 100 patients in ICU. Demographic and clinical data was recorded and the appropriateness of SUP administration was determined according to American Society of Health-System Pharmacists (ASHP) protocol.

Results: The patients were 51% male and 43% female. Overall 92% of the patients received prophylaxis. 34% of the patients who were administered parenteral drugs tolerated oral medications too. Among the patients, 31% who received prophylaxis did not have any indication for SUP. We found that 64% of the patients received SUP according to ASHP guidelines.

Conclusion: Unnecessary prophylaxis could cause adverse drug reactions, increase the risk of hospital-acquired pneumonia, and increase the burden of treatment. The prophylactic regimen to prevent stress ulcer bleeding should be chosen based on risk factors and underlying diseases of patients in order to provide the best therapy.  Health care professionals should evaluate the risks and assess the need for stress ulcer prophylaxis.

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Background and purpose: Some patients need to repeat certain tests. However, despite a peripheral vein catheter in the patients usually phlebotomy is done. This study examined the biochemical and hematological test results of the two methods of usual blood sampling and blood sampling through peripheral vein catheter.

Materials and methods: A case-control study was carried out in 96 patients admitted to the intensive care unit in Sari Imam Khomeini Hospital, 2014. Each patient was considered as a control group. Blood samples were taken in the usual way (control) and peripheral venous catheter (case). To obtain a blood sample, peripheral venous catheters were washed by 2cc of normal saline. After 5 minutes, 0.5 CC blood was discarded and sampling was performed again. In all samples the levels of hemoglobin, hematocrit, sodium, potassium, BUN, Cr and FBS were investigated. Results were analyzed using Chi-square test, t-test, Wilcoxon, and Fisher’s exact test in SPSS V.18.

Results: The patients were 56.2% male (n= 54). Mean age of the participants was 47.58±17.83 years. The results showed no significant difference in the values of hemoglobin (P=0.452), hematocrit (P=0.718), potassium (P=0.282), BUN (P=0.239), Cr (P=0.247) and FBS (P=0.074) between the two methods. But a significant difference was found between the values determined for sodium levels (P= 0.034).

Conclusion: Blood sampling through peripheral venous catheter while the patient is receiving liquid, is a reliable method for the analysis of hematocrit, hemoglobin, BUN and Cr.

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Background and purpose: Despite the proven effectiveness of propofol on reducing smooth muscle tone, the effect of this drug on ureteral spasm has not been investigated yet. This study was designed to investigate the effect of propofol on transurethral lithotripsy (TUL) and its influence on reducing acute ureteral spasm.

Materials and methods: A double-blind clinical trial was conducted in 122 patients. Initially, all patients were given 0.02mg/kg midazolam and 2μg/kg fentanyl. The subjects were then randomly divided into two groups. The first group (n=65) received 2.5mg/kg propofol and for the second group
(n= 57) 5mg/kg thiopental was injected. TUL was performed using pneumatic method. Duration of TUL, hemodynamic condition, and success rate of lithotripsy, using ESWL, ureteral stent, Double J and any complications were recorded.

Results: There were no significant differences in terms of gender, age, weight and stone size between the two groups (P> 0.05). Duration of TUL (P=0.004) and the mean of SBP, DBP and HR in one and five minutes were significantly lower in the propofol group (P< 0.01). The success rate of TUL was 96.9% and 89.5% in propofol and thiopental groups, respectively (P= 0.097). Stent and double J replacement were observed in 17.5% and 22.8% of thiopental group and 20% and 16.9% of the propofol group, respectively (P= 0.415).

Conclusion: Propofol was associated with higher reduction in systolic and diastolic blood pressure, less changes in heart rate, reducing the duration of TUL, increasing the success rate of TUL, and less need to Double J and ESWL.

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Background and purpose: Intensive care unit (ICU) nurses play an important role in non-pharmacological prevention of ventilator-associated pneumonia (VAP). The aim of this study was to assess the knowledge of nurses in ICU about non-pharmacological prevention of ventilator-associated pneumonia.

Materials and methods: In a descriptive cross-sectional study, 120 ICU nurses were studied in teaching hospitals of Mazandaran University of Medical Sciences, 2015. Demographic information of nurses were recorded including age, sex, duration of being in ICU and their educational level. An authentic multiple-choice questionnaire was administered to assess the nurses' knowledge about the prevention of VAP.

Results: 120 nurses including 96 females and 24 males (mean age: 32.39±5.57, mean work experience: 5.94±4.5 years) were studied. The average number of beds in the studied ICUs was 9.53±1.97 beds (Median=9). Percentage of correct answers of nurses on the oral route for intubation, frequency of ventilator circuit changes, type of airway humidifier, frequency of humidifier changes, type of suction system, frequency of change in suction systems, drainage of subglottic secretions, kinetic vs. standard beds, and patients positioning were 81.7%, 53.3%, 42.5%, 6.7%, 62.5%, 38.3%, 30%, 46.7%, and 85.8%, respectively. The average score of the participants was 4.48±1.69 out of 9.

Conclusion: ICU nurses' knowledge about the type of humidifier, switching frequency of humidifier, switching frequency of suction system, subglottic secretion drainage, and the type of bed was found to be very low. These findings call for continuous training and assessment to promote the knowledge of nurses in ICUs for non-pharmaceutical prevention of VAP

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Background and purpose: Critical care nurses could actively participate in the decision made by the healthcare team especially if they have the knowledge on the factors that affect extubation time following coronary artery bypass surgery. This study aimed to evaluate the duration of intubation after coronary artery bypass surgery and related factors in Mazandaran Heart Center, Sari, Iran.

Materials and methods: A descriptive analytical study was carried out in 200 patients with a diagnosis of coronary artery disease undergoing coronary artery bypass surgery. Relevant information was obtained via observation, patients medical records, and nursing notes. Data analysis was performed using frequency and central tendency, dispersion indices, Spearman correlation, Mann-Whitney, Kruskal-Wallis, chi-square, and regression tests.

Results: The duration of intubation was 9.39±2.27 hours. Meanwhile, the relationship between demographic variables and preoperative clinical factors was examined using regression models. In this study, respiratory disease, history of MI, age, and weight were found to be significantly associated with duration of intubation.

Conclusion: Considering demographic and clinical factors on admission and preparation of patients undergoing coronary artery bypass surgery results in earlier detection of patients at risk of prolonged intubation, and makes it possible to schedule and perform care plans accurately to prevent physical and psychological complications of prolonged mechanical ventilation and increased healthcare costs.

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Background and purpose: Adenoviruses and enteroviruses as intestinal viruses are detected in wastewater. Fecal shedding of 2019 novel coronavirus (SARS-CoV-2) has been reported in some studies. Therefore, determining the presence of these viruses in wastewater is important to maintain public health and helps in predicting and preventing viral infections in a community.
Materials and methods: In this analytical study, 24 raw wastewater samples were taken from two municipal wastewater treatment plants and viral nucleic acids were extracted. Finally, the presence of adenovirus was detected by real-time PCR, and SARS-CoV-2 and enterovirus were detected using RT Real-time PCR.
Results: Nine (37.5%) samples were found to be positive for SARS-CoV-2. Also, 19 (79%) and 6 (6%) samples showed the presence of adenovirus and enterovirus, respectively.
Conclusion: Detection of SARS-CoV-2, enterovirus, and adenovirus in wastewater samples indicated the prevalence of viral infections in the community served by two wastewater treatment plants studied. The presence of viruses in wastewater shows that monitoring of wastewater could be used as an important tool for the survey of viral infections in the community.