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Author(s): Seyed Mostafa Mirakbari (corresponding author) [1]; Amir Mohammad Kazemifar [1]; Peyman Namdar [2]; Mahyar Seddighi [3]; Abbas Allami [4]; Ameneh Barikani [5] INTRODUCTION Acute poisonings are increasingly exerting a [...], Background and Aims: To date, different methods have been invented to risk-stratify critically ill patients, however, there is a paucity of information regarding assessing the severity of poisonings. This study was designed to determine the comparative efficacy of Simplified Acute Physiology Score-II (SAPS-II) and Acute Physiology and Chronic Health Evaluation-II (APACHE-II)score with cardiac troponin I (cTnI) in predicting severe intoxication outcomes. Methods: This was a prospective study conducted on patients who fulfilled defined severe intoxication criteria necessitating intensive care unit (ICU) admission over a period of 6 months. SAPS-II and APACHE-II scores were calculated and cTnI concentrations were measured. These indicators were compared to determine which has the better ability to prognosticate mortality and complications. Results: A total of 55 cases (median age, 35 [24-49] years) were enroled. Eight patients (14.5) died. Mean SAPS-II, median APACHE-II score and median cTnI concentrations were 32.05 ± 11.24, 13 [10-17] and 0.008 [0.002-0.300] ng/ml, respectively, which were significantly different between the survivors and non-survivors. Receiver operating characteristics curve results of SAPS-II, APACHE-II score and cTnI concentrations in predicting mortality were 0.945, 0.932 and 0.763 and in predicting complications were 0.779, 0.739 and 0.727, respectively. High cTnI concentration (>0.37 ng/ml) correlated with soft clinical outcomes, including length of ventilatory support, length of ICU stay and length of hospital stay (LOS) (r: 0.928, 0.881 and 0.735 respectively; all P < 0.001). Conclusion: SAPS-II scores were superior in predicting death and complications, while cTnI correlated more closely with soft clinical outcomes, such as the length of ventilator support, length of ICU stay or LOS. Keywords: APACHE, mortality, poisoning, simplified acute physiology score, troponin

Background: Coronavirus disease 2019 (COVID-19) is a global pandemic that has spread worldwide. The high rates of morbidity and mortality associated with the disease are notable, causing significant socioeconomic damage in many parts of the world. Objectives: This study investigates the epidemiological status of COVID-19 in patients admitted to 15 hospitals between 2020 and 2021. Methods: In this multicenter cross-sectional study, we analyzed 18,653 patients with COVID-19 who were treated in hospitals. Demographic characteristics, symptoms, and comorbidities were also assessed. Additionally, the duration of hospitalization and the outcomes of the disease (recovery or death) were recorded. Data were extracted from the National Registry System of the Medical Care Monitoring Center (MCMC) and analyzed using SPSS software version 18. Chi-square and Fisher's exact tests were used to analyze categorical data. A P-value of less than 0.05 was considered statistically significant. Results: From February 4, 2020, to February 3, 2021, 18,653 patients were hospitalized in hospitals in Qazvin province with COVID-19 symptoms. A total of 2,678 patients died. Approximately 14.7% (2,614) of the patients required intubation, and 9.2% (1,635) required oxygen therapy. Cardiovascular diseases, hypertension, and diabetes mellitus were the most common comorbidities. Conclusions: The present study indicates that advanced age, underlying diseases, and intubation are associated with an increased risk of death in patients with COVID-19. Given the various strains of coronavirus, epidemiological studies are essential for the prevention, control, and understanding of this disease. [ABSTRACT FROM AUTHOR]

Background and objectives: High blood pressure increases the probability of insulin resistance and hyperinsulinemia. Also, insulin resistance can be defined as a risk factor for hypertension. The present study investigated the relationship between hypertension and insulin resistance in non-diabetic participants who were referred to Qazvin Metabolic Diseases Center. Material and methods: In this cross sectional study, 1103 participants (111 non-diabetic with newly diagnosed hypertension and 992 normotensive subjects aged = 20 years) were enrolled from September 2014 to April 2016 in Qazvin (Iran). Systolic and diastolic blood pressure, insulin resistance, waist circumference, body mass index, triglycerides, cholesterol, LDL-cholesterol, fasting blood glucose (FBG) were measured. Fasting triglyceride to highdensity lipoprotein cholesterol ratio (TG/HDL-C) was used as a surrogate of insulin resistance. Data were analyzed using SPSS software and p < 0.05 was assumed as significant level. Results: Ten percent of all participants had hypertension. TG/HDL-C was 3.78 ± 3.28 in non-HTN and 5.76 ± 5.35 in HTN participants (p < 0.001). The frequency of all cardio-metabolic risk factors (except HDL cholesterol level) was higher in hypertensive group, after adjusting for age and gender (p < 0.001). Conclusion: Based on these results, essential hypertension is associated with a higher prevalence of hyperinsulinemia and insulin resistance in the non-diabetic community in Iran. [ABSTRACT FROM AUTHOR]

Background: Intestinal parasitic infections (IPIs) are among the most important etiologies of gastrointestinal disorders in developing countries. The present study was performed to determine the prevalence of IPIs in rural inhabitants of Fouman, northern Iran. Methods: Overall, 31 villages were randomly selected during 2015-2016. Stool samples were collected from 1500 inhabitants aged 2-87. The samples were examined by direct wet smear, formalin ethyl-acetate concentration and agar plate culture. Trichrome staining and modified acid-fast staining were used as confirmatory tests for intestinal amoeba and flagellates and cryptosporidium spp., respectively. Data were analyzed with Chi-Square and Fisher exact tests using SPSS. Results: 8.06% of participants were positive for at least one intestinal parasite. The prevalence of mixed parasitic infections was 0.87%. The most prevalent IPIs were caused by Trichostrongylus spp. (3.13%), followed by Strongyloides stercoralis (1.5%), Giardia lamblia (1.3%), and Entamoeba coli (1.0%), Blastocystis hominis (0.86%), E. histolytica/dispar (0.53%), Endolimax nana (0.26%), Iodamoeba butschlii (0.13%), Trichuris trichiura (0.07%), Enterobius vermicularis (0.07%), Hook worm (0.07%) and E. hartmani (0.07%). Statistically, the prevalence of IPIs showed significant differences regarding the age groups, education status, occupation (P<0.001), and the habit of eating raw vegetables (P<0.007), whereas, the differences were insignificant with regard to sex (P=0.924) and water supply (P=0.088). Conclusion: The prevalence of IPIs, especially soil-transmitted helminthes (STHs) has sharply decreased in northern Iran. Excluding Trichostrongylus spp. and S. stercoralis, other intestinal parasites only produce a marginal and unnoticeable health problem in this area, today. [ABSTRACT FROM AUTHOR]

Background: Intestinal parasites are one of the health challenges in developing countries. Decreasing the prevalence of intestinal parasitic infections (IPIs) is one of the main aims of health services in these countries. This study was designed to determine the current status of IPIs in rural residents of Takestan a town located in North West of Iran. Methods: A total of 2280 rural residents of Takestan were randomly selected. Data were collected through questionnaire by interviews and laboratory findings obtained by microscopic examination of stool sample including wet smear and formalin ethyl-acetate concentration. A P <0.05 was considered significant, statistically. Results: In total, 8.7% (199/2280) of participants were positive for at least one intestinal parasite. The prevalence of polyparasitism was 0.7% in study population. Hymenolepis nana was the only helminthic infection which was detected (1/2280). Blastocystis, Entamoeba coli, and Giardia lamblia were the most common IPIs with prevalence of 3.6%, 2.9%, and 1.6%, respectively. Statistically, the prevalence of IPIs showed significant differences among villages (P<0.01) and age groups (P<0.001), and also habit of eating raw vegetables (P<0.005), whereas, the difference was insignificant in terms of sex, education level, and occupation. Conclusion: The prevalence of IPIs in rural residents of the study area is considerably low and this reduction was very impressive about helminthic infections. [ABSTRACT FROM AUTHOR]

The use of corticosteroids is one of the methods put forward for the strengthening and speeding up the process of labor. After identification of glucocorticoid receptors in human amnion, the role of corticosteroids in starting the process of labor has been studied in numerous studies. The purpose of this study was to determine the effect of intravenous Dexamethasone on preparing the cervix and on labor induction. A randomized, clinical, and double - blind trial was conducted on 172 women divided into a control and an experimental group. The inclusion criteria were that they had to be primparous, in or before the 40th week of pregnancy, and with Bishop scores (B.S.s) of 4 or lower. The exclusion criteria were diabetes, preeclampsia, macrosomia, twin pregnancy, rupture of the membrane (ROM), breech, and women suffering from background diseases. The B.S.s of the women was measured in charge of the study, and each woman was intravenously injected with eight milligrams of Dexamethasone or eight milligrams of distilled water. Four hours after the injections, the B.S.s of the participants was measured, and they were put under the conditions of labor induction using oxytocin. Information was collected in checklists A and B. The patients were compared with respect to B.S., the time the induction started, the average interval between the start of induction and the beginning of the active phase of childbirth, and the average length of time between the start of the active phase and the second stage of childbirth. The first and five minutes Apgar scores of the two groups of women were compared. The frequencies, the means, and the standard deviations were calculated using the SPSS - 16 software, and analysis of the results was performed with the Student's t- test and the chi-square test with P<0.05. There were no statistically significant differences between the two groups in terms of their age, period of pregnancy, and B.S. at the start of the study. The average B.S. of women four hours after the injections with Dexamethasone was 5.9 ± 1.57, and the corresponding figure for women in the control group was 4.6 ± 1.72. These figures were significantly different at P<0.001. The average interval between labor induction and the start of the active phase in the group injected with Dexamethasone was significantly less than that of the control group (2.87±0.93 versus 3.80± 0.93 at P<0.001). The average duration of the active phase of the second stage of childbirth was 3.47±1.10 hours in the experimental group and 3.6 ± 0.99 hours in the control group at P<0.49. These two figures were not significantly different. The Apgar scores of the first and fifth minutes after the birth of the children of the two groups of women were not significantly different. It was found that intravenous Dexamethasone improves the Bishop score of the cervix and thus causes softening of the cervix and reduces the length of time between labor induction and the start of the active phase of childbirth. [ABSTRACT FROM AUTHOR]

Orientation of public and physicians to the complementary and alternative medicine (CAM) is one of the most prominent symbols of structural changes in the health service system. The aim of his study was a determination of knowledge, attitude, and practice of general practitioners in complementary and alternative medicine. This cross- sectional study was conducted in Qazvin, Iran in 2013. A self-administered questionnaire was used for collecting data including four information parts: population information, physicians' attitude and knowledge, methods of getting information and their function. A total of 228 physicians in Qazvin comprised the population of study according to the deputy of treatment's report of Qazvin University of Medical Sciences. A total of 150 physicians were selected randomly, and SPSS Statistical program was used to enter questionnaires' data. Results were analyzed as descriptive statistics and statistical analysis. Sixty percent of all responders were male. About sixty (59.4) percent of participating practitioners had worked less than 10 years. 96.4 percent had a positive attitude towards complementary and alternative medicine. Knowledge of practitioners about traditional medicine in 11 percent was good, 36.3% and 52.7% had average and little information, respectively. 17.9% of practitioners offered their patients complementary and alternative medicine for treatment. Although there was little knowledge among practitioners about traditional medicine and complementary approaches, a significant percentage of them had attitude higher than the lower limit. [ABSTRACT FROM AUTHOR]

The ophthalmologic outcomes of diabetes were important. This research is conducted to assess the relation between diabetes and intraocular pressure changes in the patients of Avicenna Hospital, compared with healthy persons referring to the facility. With cross-sectional research, 400 persons including 200 diabetics and non-diabetics were selected on a random basis over one year in 2012. Research data were collected by examination and checklists, and then analyzed by SPSS 16 statistical software. Descriptive results were extracted, and the relation between the variables were analyzed by Chi2 test, t-test, Fisher's exact test, Pearson's correlation coefficient, with P. value less than 0.05 (P<0.05). In the group of diabetics, 37% and 63%were male and female respectively, while in non-diabetics group 47% and 53% were male and female. The mean age of diabetics patients were 54.17 ± 8.25 and non-diabetics 49.06 ± 7.26 years. Mean vision acuity of the right eye was 9.035 in the diabetics and 9.56 in the witness group. Mean intraocular pressure was 16.71 ± 1.96 mm/Hg in diabetics, and 12.86 ± 1.45 mm/Hg in non-diabetics, which showed a significant difference (t = 22.337, P=0.001). It is advisable that the intraocular pressure of diabetics be measured and recorded on a regular basis. [ABSTRACT FROM AUTHOR]

Vitiligo Vulgaris is a pigment disorder as the lack of skin pigmentation which its most prevalent cause is autoimmune. Vitamin D has various effects on the natural and acquired immune of the body because of its effectiveness on the T cells and B cells, macrophages and dendritic cells.The object of this study was assessment of the Vitamin D in patients with vitiligo vulgaris in dermatologic clinics in Qazvin in 2012. The 100 patients with Vitiligo were studied through a cross-sectional study. The required data were collectedby the questionnaire (age, gender, job, family background, consumption of the dairies and vitamin D supplements), examination (type of skin) and para clinical test (measurement of the serum 25-hydroxyvitamin D level). The 42 (42%) and 58 (58%) people of the population under study were respectively male and female. The mean age of the population under study was 28.7±1.17. The mean serum of 25-hydroxyvitamin D level was 42±24.14 which had a significance difference with a normal level (p<0.04). The mean serum 25-hydroxyvitamin D level among patients with Vitiligo had a significance difference with a normal level. [ABSTRACT FROM AUTHOR]

Background: 5TCoronary Artery Bypass Graft surgery (CABG) is one of the most common surgery procedures performed annually in worldwide. The objective of this study is to determine the prevalence and risk factors of the early neurologic complications emerged after CABG surgery. Materials and Methods: In a cross-sectional study we have investigated 160 consecutive patients undergoing CABG between July 2008 and April 2011 in cardiac surgery ward. Risk factors that evaluated in our analysis consist of hypertension (HTN), diabetes, age, sex, perioperative Myocardial Infarction (MI), postoperative atrial fibrillation, duration of aortic clamp, severity of carotid artery stenosis and addiction. Our dependent variables were delirium, CVA and seizure. The data were analyzed by SPSS-16 with Chi-square test and p<0.05. Results: In our analysis, of total 160 patients, 58 (36.2%) were female. Mean age of patients was 62.7±9.6 years. Of total patients, 71 (44.4%) were found to have HTN, 35.6% had diabetes, 18.8% had atrial fibrillation, 30.6% had a history of preoperative MI and 10.6% had addiction. Mean time of aorta clamp time was 78.5±8.9 min. The incidence rate of delirium after CABG was 12 out of 160 patients (7.5%) and for CVA were 2 (1.2%). There was not any seizure among our population. Of total patients, 7% of diabetic patients, 8.5% of patients with HTN, 16.7% with atrial fibrillation and 8.2% of patients with a history of preoperative MI affected with delirium after the CABG surgery. In our analysis, no significant correlation observed between delirium and these risk factors. In present study, duration of aortic clamp had a significant relation with CVA after CABG (p=0.0001). Conclusion: According to this analysis, duration of aorta clamp time is one of the most important risk factors of CVA after CABG. [ABSTRACT FROM AUTHOR]

This study was conducted to investigate whether the length of the interval between a urinary tract infection and the performance of the voiding cystourethrogram influences the presence or severity of vesicoureteral reflux (VUR). In this study 161 children with first episode of urinary tract infection were evaluated. Depending on time of performance of voiding cystourethrogram (VCUG), patients divided into two groups: early (within the first 7 days following treatment) and late (during second week or thereafter of the start of treatment). The prevalence and severity of vesicoureteral reflux in both groups were compared. Out of 161patients, the early and late groups consisted of 75 and 86 patients, respectively. The prevalence of vesicouretral reflux in the early and late groups was 25.3% and 30.2%, respectively. No significant difference was observed between two groups regarding prevalence (P=0.598) and severity (P=0.379) of vesicoureteral reflux. This study showed that the prevalence and severity of VUR is not affected by timing of VCUG. Therefore, it is recommended that in children with urinary tract infection, VCUG should be done following negative urine culture as soon as possible. [ABSTRACT FROM AUTHOR]

Objective: This study was performed to determine the relationship between urinary nitrite results and bacterial resistance to antimicrobial drugs in urinary tract infection of children. Methods: In a cross-section study 119 children younger than 12 years with urinary tract infection were evaluated in Qazvin children's hospital. Patients were divided into negative and positive nitrite groups depending on urinary nitrite test result Rates of antibiotic resistance in the two groups were compared. Findings: Sixty seven patients were in the negative nitrite group and 52 in the positive nitrite group. Resistance rates to ceftriaxone, trimethoprim sulfamethoxazole, ampicillin, gentamicin, amikacin, nalidixic acid, cephalothin and nitrofurantoin in the nitrite negative group were 7.5%, 31.3%, 50.7%, 11.9%, 9%, 3%, 14.9% and 11.9%, respectively. These values in the nitrite positive group were 21.2%, 28.8%, 63.5%, 7.7%, 5.8%, 1.9%, 9.6%, and 3.8%, respectively (P>0.05). Conclusion: This study showed that there is no correlation between urinary nitrite results and bacterial resistance to antimicrobial drugs. Therefore, it seems that physicians should not adjust antibiotic therapy for UTI based on nitrite results. [ABSTRACT FROM AUTHOR]

Background: Color vision deficiency (CVD) is an X chromosome-linked recessive autosomal dominant. Determine the prevalence of color blindness in Qazvin population. Materials and Methods: In a cross sectional study color vision deficiency examined in 1853 individuals with age 10-25 years old who participated in private clinics and eye clinic of Bu-Ali hospital in Qazvin in 2010. The screening of color vision deficiency was performed using Ishihara test. Data were analyzed by SPSS-16 with ² test with p<0.05. Results: Mean age of participant was 17.86±4.48 years. 59.5% of them were female. 3.49% of the total population had color vision deficiency that 0.93% and 2.56% were female and male respectively. Conclusion: color vision deficiency must be noticed by decision makers in health field for screen planning. [ABSTRACT FROM AUTHOR]

Background: Hypertensive disorders are an important cause of maternal mortality and morbidity, and severe preeclampsia is the most common cause [Baha M. Sibia, AJOG (2012)]. The blood pressure rises progressively during the first 5 days after delivery, and it is due to mobilization of 6-8 liters of liquid, and 950 meq of accumulated sodium,from interstitial and extravascular space to intravascular space[Davison JM and Dunlop W, Seminars in Nephrology,4:198-207 (1984)].Severe rising of blood pressure may lead to complications, such as renal failure, pulmonary edema, eclampsia, intracranial hemorrhage, stroke, coma and death [Baha M. Sibia, AJOG (2012)].Therefore, postpartum anti-hypertensive therapy can prevent these complications and diminishes maternal mortality and morbidity rate. Objective: This investigation was done to evaluate whether a short course of postpartum furosemide therapy in patients with severe preeclampsia accelerates blood pressure recovery, reduces antihypertensive drugs usage, prevents complications such as eclampsia and finally diminishes hospitalization. Study design: In a randomized clinical trial, 90 patients with severe preeclampsia participated. After spontaneous onset of diuresis and discontinuation of sulfate magnesium, patients were randomly allocated to receive either no therapy or 20 mg oral furosemide daily for five days with oral potassium supplementation. Postpartum blood pressure, the need for antihypertensive therapy, rate of complications and duration of hospitalization between treatment and control groups were compared. Results: Mean systolic blood pressure on the third day after delivery was not different significantly between treatment and control groups(127.9±10.2 compared with 130 ± 11.5 mm-Hg, P=0.36). Mean diastolic blood pressure on the third day after delivery was not different between two groups. Patients in treatment group required less antihypertensive therapy during hospitalization (26.7% compared with 33.3%, P=0.64) but the difference was not significant. Eclampsia occurred in two patients in control group and not occurred in treatment group. Duration of hospitalization was not affected by the intervention. Conclusion: Brief postpartum furosemide therapy in patients with severe preeclampsia may not be effective in postpartum blood pressure recovery and reducing the need for antihypertensive therapy. It may be useful to prevent complications such as eclampsia. Duration of hospitalization was not affected by the intervention. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to evaluate some virulence factors in Candida albicans isolates from patients with onychomycosis and determine the correlation between these factors and the antifungal resistance profile., Methods: Seventy species of C. albicans were confirmed using polymerase chain reaction amplification of the HWP1 gene. According to the Clinical & Laboratory Standards Institute guidelines, the susceptibility profile of four antifungal agents was investigated, and the production of aspartyl protease, phospholipase, haemolysin, and biofilm was determined. The correlation between these profiles was also investigated., Results: The isolates indicated different levels of resistance and production of virulence factors. Significant correlations were observed between the minimum inhibitory concentration (MIC) of fluconazole/itraconazole and biofilm production, between phospholipase production and fluconazole/itraconazole MIC, and between fluconazole MIC and hemolytic activity in C. albicans isolates. The results also showed significant correlations between phospholipase activity and biofilm production., Conclusions: Our findings will contribute to a better understanding of the pathogenesis of C. albicans and characterize the relationship between virulence factors and antifungal resistance, which may suggest new therapeutic strategies considering the possible involvement of the virulence mechanism in the effectiveness of treatment.

Background: Recent literature has mentioned that people with sleep disorder, experience insulin sensitivity reduction and accordingly higher levels of blood glucose., Objectives: This study aimed to investigate the relationship between sleep quality and blood lipid composition in patients with diabetes referring to Minoodar health center in Qazvin, Iran in 2017., Methods: Sleep duration and quality were assessed in 347 patients with diabetes using the Pittsburgh sleep quality index (PSQI). The glycosylated hemoglobin A1c (HbA1c) test was used to measure the glycemic control and total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), and high-density lipoprotein cholesterol (HDL-C) were used to determine blood lipid composition of the patients. Multiple regression analyses were applied to examine the associations between sleep measures and HbA1c and lipid parameters using SPSS version 20., Results: The patients in the poor sleep quality group had higher levels of fasting blood sugar (FBS) (146.07 ± 57.06 versus 132.8 ± 53.3 mg/dL, P = 0.02), body mass index (BMI) (29.1 ± 3.9 versus 27.6 ± 4.2 kg/m 2 , P = 0.005) and total cholesterol (209.9 ± 53.4 versus 193.4 ± 45.8, P = 0.02). Furthermore, the patients with short sleep duration had higher total cholesterol level compared with long sleep and medium sleep duration group (202.3 ± 50.2 versus 196.6 ± 47.7 and 195.7 ± 47.4, respectively, P = 0.05). Among different PSQI measures, subjective sleep quality was associated with lower TC and TG in unadjusted models (β = -0.0.1, P = 0.05). Furthermore, greater sleep disturbance was positively linked with higher levels of TC and TG (β = 0.1, P = 0.01 and β = 0.02, P = 0.05)., Conclusions: In an Iranian population with diabetes living in Qazvin city, sleep disorder is common and as study findings revealed sleep quality was recognized as an influencing factor on some of the lipid profiles, including TC and TG. Thus sleep assessment of patients with type 2 diabetes to find the early recognition of their sleep disorder should be considered an important part of the patients' treatment., Competing Interests: Conflict of Interests: The authors declare no conflict of interest.

Accurate and early diagnosis and appropriate treatment of patient with urinary tract infection (UTI) are essential for the prevention or restriction of permanent damage to the kidneys in children. The aim of this study was to compare renal ultrasonography (US) and dimercaptosuccinic acid (DMSA) renal scan in the diagnosis of patients with febrile urinary tract infection. This study involved the medical records of children with febrile urinary tract infection who were admitted to the children's hospital in Qazvin, Iran. Pyelonephritis was diagnosed on the basis of clinical symptoms, laboratory tests and abnormal DMSA renal scans. The criteria for abnormality of renal US were an increase or a decrease in diffuse or focal parenchymal echogenicity, loss of corticomedullary differentiation, kidney position irregularities, parenchymal reduction and increased kidney size. Of the 100 study patients, 23% had an abnormal US and 46% had an abnormal DMSA renal scan. Of the latter patients, 15 had concurrent abnormal US (P value ≤ 0.03, concordance rate: 18%). Renal US had a sensitivity of 32%, specificity of 85%, positive predictive value of 65% and negative predictive value of 60%. Of the 77 patients with normal US, 31 (40.2%) had an abnormal DMSA renal scan. Despite the benefits and accessibility of renal US, its value in the diagnosis of pyelonephritis is limited.

Background: Disk herniation (DH) is one of the most common disk lesions, inducing low back pain (LBP). Various therapeutic options have been proposed for treatment of disk herniation (DH). Intradiscal injection of ozone has been suggested for treatment of DH., Objectives: To determine the effect of intradiscal ozone injection on pain score and disability in patients with LBP from disk prolapsed., Patients and Methods: Patients with LBP diagnosed with DH were enrolled in this clinical trial study. After prep and drape the area and under the fluoroscopy guide (c-arm), intradiscal injection of ozone/oxygen mixture (4 mL, 40 µg/mL) was performed. Pain score and functional ability of the patients according to Oswestry Disability Index (ODI) were measured prior to the injection (baseline) and then at 2 and 4 weeks and then at 3 and 6 months after the injection., Results: Thirty patients (17 females, 13 males) with the mean age of 58.6 y (range, 42-73 y) enrolled in the study. The mean ± standard deviation (SD) of pain score before intervention was 8.1 ± 0.8. After two weeks, it was reduced to 3.2 ± 0.6 (P < 0.001) and finally dropped to 2.0 ± 0.6 sixth months after intervention (P = 0.0001). Functional status of ODI was 28.5 ± 2.1 before intervention and showed significant reduction after two weeks (with the mean of 12.3), and it was almost sustained till sixth months after intervention, with the mean of 11.4 (P = 0.001)., Conclusions: Altogether, ozone had significant positive effects on patients with disk herniation unresponsive to other conservative and minimally invasive treatments.

Objective: postoperative pain increases the activity of the sympathetic system, causes hypermetabolic conditions, retains salt and water, increases glucose, fatty acid lactate and oxygen consumption, weakens the immunity system which delays wound healing. Our object was comparison of the analgesic effect of morphine and paracetamol in the patients undergoing laparotomy, using PCA method., Method: Seventy patients who had undergone laparotomy were studied using double blind randomized clinical trial (35 patients received morphine and 35 paracetamol) in the Shahid Rajaee Center and Velayat Hospital (Qazvin, Iran). People using opioids, painkillers and sedatives regularly and in large doses and patients with a history of lung or liver problems did not participate in this project. The parameters of the severity of pain and nausea (VAS), hemodynamic changes (BP and HR), pruritus, arterial oxygen desaturation and patient satisfaction (VAS) of both groups were measured by a third party (trained colleague). The data was analyzed using SPSS 16 statistical software then descriptive results were extracted and ultimately the groups were compared using the following statistical tests: student's T-test, chi 2 and Fisher's exact test (P<0.05)., Findings: The mean age of the participants was 45±12.5 years. Women constituted 24.3% of the patients and men 75.7%. The average pain severity for morphine and paracetamol groups (VAS) was 5.3±2.2and 6.37±1.7 after2 hours and reached 1.91±1.3 and 2.49±1.3 after 8 hours (after the operation) respectively. There was a significant difference between the groups after 2 and 4 hours in terms of pain severity (after 2 hours P=0.007 and after 4 hours P=0.047). However there was no significant difference between the average pain severity of the studied groups (after 6 hours P=0.4 and 8 hours P=0.08). After 8 hours, the average nausea severity was the minimum in both groups being 1.71±1.6 and 1.43±1.1 in morphine and paracetamol groups respectively. Nausea severity was higher after 2 hours in paracetamol group. In morphine group, it was higher after 4, 6 and 8 hours. Difference between the groups was not significant. The average satisfaction level (VAS) for morphine and paracetamol groups reached from 5.29±2.3 and 4.2±2.4 after 2 hours, to 7.94±1.8 and 7.69±2.1 after 8 hours (after the operation), respectively. The average satisfaction level of patients was higher in morphine group in 2,4,6 and 8 hours and except for, after 4 hours (P=0.01), the satisfaction difference between both groups was not significant in other hours (P=0.06 after 2 hours, P=0.6 after 6 hours and P=0.5 after 8 hours), Conclusion: Morphine seems to be more effective at 2 and 4 hours, but after 4 hours they have similar effects, the satisfaction difference between both groups was not significant in the patients.

Background: Human resource in health system especially in developing countries has main role in health promotion. Therefore their satisfaction and motivation are the key points in developing health system., Objective: To determine the motivation and satisfaction of general physicians (GP) towards their career., Methods: Using random sampling, 150 physicians were selected from comprehension commercial database list. Data were collected using a self-administered questionnaire that consisted of three sections; first demographic data, second work satisfaction and third questions toward biologic, dependent and growth motivation. Data were analyzed by SPSS version 16 with P&lt;0.05., Results: From participants 64.7% of physicians were in age between 30-40 years and 27.3% were men. Only 5.3% of physicians who were employed for over 10 years were satisfied from their career. Satisfaction of career among female and male physicians was 8% and 24% respectively. The item of job safety sensation in biologic motivation had maximum scale (4.1±0.89). In dependent and growth motivations, value success sensation in job (4+-0.88) and make new skills and knowledge (4+-0.67) had maximum scale of mean. Relation of growth motivators with age (P&lt;0.01), postgraduate duration (P&lt;0.005) was significant. Dependent motivators had significant relation with age (P&lt;0.04), postgraduate duration (P&lt;0.01) and employment duration (P&lt;0.002). Biological motivators had significant relation with sex (P&lt;0.4) and satisfaction of work hours (P&lt;0.007). Correlation of biological (r=0.44, P&lt;0.001) and growth (r=0.7, P&lt;0.001) motivators was significant., Conclusion: Growth motivators score had higher ranking than other motivators. However, biological motivators especially job security and finance were also important and must be noticed from decision makers.

Background: Visual impairment is one of a major public health problem among elderly people., Object: Aim of this study was determining the prevalence of visual impairment in median and old peoples in Qazvin (Iran)., Method: In this cross sectional study, with a simple random sampling, 446 patients older than 5o years who were referred to outpatient ophthalmology clinics at Avecina hospital of Qazvin (a province of Iran) in 2010 were enrolled. Participants first complete a questionnaire with 25 questions toward demographic and past medical history and then were examined by ophthalmologist. These examinations includes direct and indirect ophthalmoscopy, slit lamp examination, measurement of uncorrected visual acuity and visual acuity with current glasses, lensometery of the previous glasses, refraction with and without the use of cycloplegic and determining the best corrected visual acuity. All slit lamp examinations were performed by the same ophthalmologist. Data were analyzed with SPSS16 with use of Chi - Square test with Pvalue &lt;0.05., Results: In this study 446 patients were examined that 54.7% were male. Mean age of study population was 62+-9.3 years old. 96.4% of participants had refractory disorder. Prevalence of myopia, hyperopia and astigmatism were 33.6%, 45.9% and 16.8% respectively. Of patients 17.4% had diabetes. Of participants 28.9% had temporal headache, 37% red eye, 41.2% flashing, 27.3% and 28% had dryness and discharge of eye respectively. 31.1% of participants had eyelide problem, 4.7% Color Vision Deficiency (CVD) and 3.8% had family history of CVD. Of total 4.5% had glaucoma, 3.3% macular degeneration and 21.7% had hypertension. 0.6% of population had macular degeneration, 0.4% of population had glaucoma Of 892 eyes (446 individuals), 36.2% had visual acuity less than 7/10, 1.7% light perception (LP) and 0.22% no light perception (NLP) and 2.7% finger count., Conclusion: Refractory errors, cataract and amblyopia were most important eye disorders in older people in Qazvin.

Background: Marital separation and divorce can be the most unpleasant event in the adult's life, and families will be hurt by divorce event. The prevalence of divorce has been increased in last decades. Therefore, this study was conducted to identify the divorce cause among the divorce seeking men and women in Qazvin, Iran., Method: This cross-sectional study was conducted among 572 (400 women and 172 men) subjects who requested for divorce and were referred to divorce and marriage office of Qazvin province during 3 month in 2009. Data were collected by self - administered questionnaire, interviewing subjects and using Likert scale. Data were analyzed by Chi- Square test and Mann-Whitney (SPSS version 16)., Results: The participants of the study included 400 women (26.5 ± 7.4 years) and 172 men. In view points of women the primary wrong mate selection was main cause of divorce (59.8%), but the men believed that the families and relatives interference was the main reason for separation (43.7%). Among the respondents, mean score of "dependency to their families" and "unmet emotional needs" were 3.44 ± 1.6 and 3.86 ± 1.4 respectively. In addition mean score of infertility among men and women were 1.37 ± 1.0 and 1.29 ± 0.9 respectively., Conclusion: Wrong mate selection, unmet emotional needs, families' interference, and "dependency to families" are more important factors than traditional factors which are sexual or physical factors.

Introduction: Young physicians have many recruitment barriers in Iran. Therefore, for planning purpose, assessment of the attitudes of medical intern students towards their future career is important., Methods: This cross-sectional study assessed the view points of 300 medical students through a self administered questionnaire. Data were analyzed using SPSS software with P value &lt; 0.05., Results: Two hundred and forty students (80%) of the students had responded to the questionnaire. Among them, 67.5% were female with mean age of 21.7±2.4. The main factors for deciding to study in medicine were their interest (64.1%), family pressure (13.5%) and social prestige of medical career (9.8%). The mean score of attitudes was 2.3±0.6. In total, 24.5% of students demonstrated not having interest in studying medicine. The most important cause of their interest change was long duration of education (24.4%) and cost of studying in medicine (13.8%). In total, 88.6% of students had negative viewpoint towards their medical career in future., Conclusion: In general, the attitude of medical students toward their future career was negative.

Objective: This study was performed to determine the relationship between urinary nitrite results and bacterial resistance to antimicrobial drugs in urinary tract infection of children., Methods: In a cross-section study 119 children younger than 12 years with urinary tract infection were evaluated in Qazvin children's hospital. Patients were divided into negative and positive nitrite groups depending on urinary nitrite test result. Rates of antibiotic resistance in the two groups were compared., Findings: Sixty seven patients were in the negative nitrite group and 52 in the positive nitrite group. Resistance rates to ceftriaxone, trimethoprim sulfamethoxazole, ampicillin, gentamicin, amikacin, nalidixic acid, cephalothin and nitrofurantoin in the nitrite negative group were 7.5%, 31.3%, 50.7%, 11.9%, 9%, 3%, 14.9% and 11.9%, respectively. These values in the nitrite positive group were 21.2%, 28.8%, 63.5%, 7.7%, 5.8%, 1.9%, 9.6%, and 3.8%, respectively (P>0.05)., Conclusion: This study showed that there is no correlation between urinary nitrite results and bacterial resistance to antimicrobial drugs. Therefore, it seems that physicians should not adjust antibiotic therapy for UTI based on nitrite results.

Objective: Health care workers especially medical students are at risk of being exposed to blood-borne pathogens. Therefore, the aim of this study was to determine the knowledge, attitude and practice of medical students towards standard isolation precautions (SIP)., Methods: A standardized questionnaire was completed by 148 medical students from April to July of year 2009 to seek their knowledge, attitude and practice towards standard isolation precautions in a clinical setting at Qazvin University of Medical Sciences, Iran., Results: The mean score of knowledge, attitude and practice towards standard isolation precautions were 6.8±2.1 (maximum 10), 16.6±4.2 (maximum 20), and 18.05 ± 4.5 (maximum 30) respectively. Significant differences were observed between practice of female and male (P &lt; 0.008) and also knowledge of year 6 and year 7 students (P &lt;0.021)., Discussion: Education on infection control based on standard isolation precaution must be stressed and barriers of appropriate practice must be removed.