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Key Clinical Message Innovative mixed treatment offers hope for persistent mixed urinary incontinence (MUI): PRP‐Fibrin Glue‐Stem Cell injection, Botox, and TVT in a single session. Successful case study reveals promising outcomes, emphasizing the need for further research. Abstract Mixed urinary incontinence is a complaint of stress and urge incontinence which affects patients' quality of life and dramatic changes in patients' physical, mental, and socioeconomic status. The treatment is challenging and depends on the dominance of one of the complaints to the other. The progress in the method of treatment is still under discussion. This study reports treatment of a MUI case in a 56‐year‐old, with a history of MUI of 7‐year duration, which was persistent to pharmacological treatment, pelvic muscle training, biofeedback, and anti‐incontinence surgery (Burch Colposuspension). PRP‐Fibrin Glue‐Stem Cell injection, Botox injection, and TVT were performed in a one surgery session. Patient was discharged with ability to urinate with acceptable amount of post void residue. After 3‐month follow‐up, patient was completely satisfied and happy. Further research is needed to substantiate the efficacy of these mixed treatments for MUI.

Abstract Background and Aims Perianal fistula is a prevalent anorectal condition originating from an infectious crypt extending to the external opening. Multiple surgical methods exist for treating perianal fistulas; however, selecting the appropriate options is still controversial. Our study aims to evaluate seton replacement versus other surgical methods in treating perianal fistula. Methods This study recruited 72 patients presenting with perianal discharge and diagnosed with perianal fistula through intra‐sphincteric, trans‐sphincteric, and supra‐sphincteric examinations at Imam Reza and Besat Hospitals from July 2022 up to March 2023. Regarding case‐control design, patients were divided into two groups: the first group (n = 36) underwent seton insertion, while the control group (n = 36) received alternative surgical methods. Follow‐up was conducted for 1 month post‐discharge, with monthly visits for 6 months. Patients were evaluated for fistula tract healing, seton loosening, and daily secretion rate (based on infected pads) during each visit. Finally, the two groups were compared in terms of improvement rates. Results In the seton group, approximately 94.4% of patients showed improvement. However, the difference between the groups was insignificant (p = 0.494). Seton replacement was performed in 52% of patients, with the majority requiring replacement twice (61%). Improvement rates were highest among cases with two seton replacements, although the difference was not statistically significant (p = 0.073). Following seton replacement, the most common treatment methods were endoanal flap and fistulotomy, with observed improvement in 10 cases for each procedure. Conclusion This study highlights that draining seton remains a primary choice for intermediate treatment due to its satisfactory improvement rate and lower requirement for replacement, especially up to two times.

Abstract Background and Aims The Hemorrhoidal Disease Symptom Score (HDSS) is a tool that is scored based on five main symptoms: pain, bleeding, itching, soiling, and prolapse. Furthermore, the Short Health Scale (SHS) is a measurement tool of subjective health and health‐related quality of life. This study was performed to validate the Farsi‐translated Hemorrhoidal Disease Symptom Score (HDSS), and Scale Short Health Scale adapted for hemorrhoidal disease (SHS‐HD) as a measure of symptom severity in patients with hemorrhoid disease. Methods In this study, HDSS and SHS‐HD were translated into Farsi. Participants with confirmed hemorrhoid disease completed the questionnaire. Subsequently, the questionnaire's discriminative validity, convergent validity, reliability, sensitivity, and specificity were evaluated. Results Data from 31 patients were analyzed (mean age 39.68; 71% male). The results of the analysis showed good internal consistency as Cronbach's α for HDSS and SHS were 0.994 and 0.995 respectively. Spearman's correlation coefficient for the test–retest comparison was 0.986 (p

Abstract Background and Aims Anal fistula (AF) with cryptoglandular origin tends to recur, and multiple risk factors are implicated. Recently, some magnetic resonance imaging (MRI) findings with predictive value for disease outcomes have been proposed. These intrinsic anatomic features include those of the AF and its surrounding structures. This study aims to clarify the prognostic role of MRI in AF. Methods We performed a systematic search of PubMed, Embase, and EBSCO databases. Two independent reviewers conducted the search and screened the articles. We selected studies that used MRI to assess AF and reported its relationship to disease outcome. We extracted data regarding the study design, type of intervention, outcome, MRI‐measured items, and their significance. Results Out of 1230 retrieved articles, 18 were eligible for final inclusion, and a total of 4026 patients were enrolled in the selected studies. For preoperative MRI, the significant items affecting the outcome were the length of the fistula, horseshoe type, presence of multiple tracts, supralevator extension, and apparent diffusion coefficient (ADC) value. Other studies investigated the healing process using postoperative MRI. Conclusion This review found that MRI can be useful in the management of AF, both preoperatively and postoperatively. Factors, such as fistula length, horseshoe type, presence of multiple tracts, supralevator extension, and ADC value were found to be significantly associated with treatment outcomes. The presence of the fistula tract and the development of new abscesses on postoperative MRI was found to hinder the healing process. Further studies are needed to confirm these findings.

AbstractBackground: Surgery is the mainstay of treatment for colorectal cancers. However, the effect of resection extent on patient’s function and quality of life (QoL) should be clearly assessed before surgery.Methods: A retrospective study conducted on all consecutive patient with stage I-III colon cancer who underwent surgery at Department of Colorectal Surgery from January 2014 to January 2018. The EORTC QLQ-C30 was completed to assess functional capacity and quality of life in all patients free of recurrence.Results: The study population consisted of 57 male (45%) and the mean ± SD of age was 57.7 ± 13.2 years. Most patients (54%) underwent total colectomy. The mean ± SD of interval between operation date and filling questionnaire date was 41.8 ± 6.9. There was no statistically significant difference between this interval period and type of surgery (p value: 0.76). However, it was revealed that as this period gets longer the score is higher (α: 2.3, CI: 2.1-3.9, p value=0.001). Multivariate analysis showed that after adjusting for T and N stage, age and gender, the type of surgical resection is an independent risk factor of having lower global health status(OR:3.2, CI:2.9-7.6, p-value=0.03), financial difficulties(OR:1.4, CI:1.1-3.6, p value=0.022) and higher rates of fatigue (OR:2.4, CI:1.8-4.6, p value=0.006). Conclusion: It was found that as the larger segment of the colon is resected the worsening of global health status happens. So, the post-operative challenges toward coping with new functional capacity of resected bowel and QoL should be discussed with patient prior to surgery.

Introduction: Surgical site infection (SSI) has been associated with increased hospital stay and subsequent increased burden on health care. Recognition of risk factors might be helpful to prevent it.Materials & Methods: Patients referring to colorectal department of Imam Khomeini Hospital Complex for elective or emergent surgery have been evaluated during January 2018 and 2019. All the variables known to be associated with SSI have been investigated.Results: Total number of 473 patients with mean ± SD of age, 55.6 ± 13.9 years (range 18-88 years) and male to female ratio of 1.4 were evaluated. 103 patients developed SSI within 30 days after surgery with the incidence rate of 21.7%. Seventy seven percent of patients with SSI were in the age group under 65 years, 42% were female, and 58% were male. There were 89 cases of superficial (86%), 11 cases of deep (10%), and 3 cases of organ/space surgical site infection (3%).The risk factors significantly associated with SSI development were diabetes mellitus, operation on rectum, emergency surgery, history of neoadjuvant chemotherapy, laparoscopy approach changed to laparotomy approach, colostomy /ileostomy implantation or closure, blood transfusion after surgery, anastomotic leakage, and surgery lasting more than 200 minutes. After multivariate analysis, neo-adjuvant chemo-radiotherapy, emergent surgery, operation on rectum, postoperative blood transfusion, and prolonged operation to discharge periods remained significantly associated with a remarkably higher SSI risk. Conclusion: SSI is devastating condition, compromising surgical outcomes. Preventive measures should be applied in every surgical facilities to prevent incidence and lessen complications related to SSI.

IntroductionThe effective treatment of anal fistulas almost always requires surgical intervention, which could be accompanied by post-operative complications, and affect the quality of life of patients. This study aimed to cross-culturally adapt the Persian version of the Quality of Life in patients with Anal Fistula questionnaire and evaluate its validity and reliability.Materials and methodsSixty patients with a mean age of 44 years ranging from 21 to 72 years entered the study. Forty-seven participants were men, and thirteen were women. After performing a scientific translation of the questionnaire based on Beaton's guidelines for cross-cultural adaptation and after extensive reviews by experts and specialists, the final version of the questionnaire was obtained. Then, 60 questionnaires (100%) were filled out by the participants (n = 60) and retrieved during a 7 to 21-day period. Data were collected and analyzed. Finally, according to the obtained data, the validity and reliability of the questionnaire were calculated.ResultsCross-cultural adaptation of the translated questionnaire was verified by the expert committee. The results showed perfect internal consistency (Cronbach alpha = 0.842), and external consistency (intraclass correlation coefficient = 0.800; PConclusionThe Persian translation of the Quality of Life in patients with the Anal Fistula questionnaire was proven to be valid and reliable for the evaluation of the QoL of patients with anal fistula.

Background and purpose: Tympanostomy surgery and ventilation tube (VT) placement are reliable methods to reduce the complications of eustachian tube dysfunction and inadequate middle ear ventilation. However, tympanostomy is associated with some complications. This study aimed to investigate the frequency distribution of tympanostomy surgery, success rate, its complications and the demographic characteristics of patients during 2011-2017 in Sari, Iran. Materials and methods: This retrospective descriptive study was performed using data from the records of 512 patients who underwent VT surgery in Sari during 2011-2017. A checklist was used to collect the data and SPSS V24 was used for data analysis. Results: The most common complaint at the time of referral was hearing loss (38.3%). In 79%, bilateral VT was performed and 6.5% had complications after the operation. The most common complication was purulent otorrhea (4.1%). Postoperative success rate of VT was found to be 93%. Conclusion: Given the high success rate of VT surgery, this procedure could be a good method in treatment of hearing loss, acute recurrent middle ear infections, and the adverse effects of tonsillitis and allergy on middle ear.

Tissue engineering is a promising field for treating various diseases using tissue-like structures generated through biomaterials, scaffolds, nanoparticles, biomolecules, and stem cells. This advanced method is considered one of the next-generation therapeutic techniques that may solve the therapeutic challenges in treating perianal fistula based on seton therapy. Remarkable advances in stem cell biology, genetics, biomaterials, fabrication technologies, and nanotechnology have provided the opportunity to implement this multidisciplinary approach to repair damaged tissue in the seton-based fistula treatment. In addition, tissue engineering provides us with nanostructured biomaterials to fabricate setons that can act as scaffolds, with modified mechanical and biological properties such as antibacterial and anti-inflammatory. This review focuses on the applications, advantages, and future perspectives of tissue engineering to enhance the seton placement techniques and present a novel therapeutic solution to treat perianal fistula. In addition, in vivo and in vitro studies about implementing tissue engineering in the treatment of perianal fistula are reported in this study. Also, it summarizes the surgical procedures for the treatment of fistula, including Ligation of the Intersphincteric Fistula Tract (LIFT), Fistula Laser Closure (FiLaC™), Over-The-Scope Clip System (OTSC), Video-assisted anal fistula treatment (VAAFT), Anal fistula plug (AFP), and Rectal advancement flap (RAF). Furthermore, the applications and properties of different setons including, cutting setons (Penrose drains, rubber band, polypropylene, and silk), non-cutting setons (loose, knot-free, Comfort, and Super Seton®), and chemical setons (Ksharasutra) are described. In the end, we present the challenges and future trends of implementing tissue engineering technology in the seton-based therapy for the treatment of perianal fistula.

Introduction Nosocomial infections are a major global problem. Using metallic oxide nanoparticles to counter bacterial infections as an alternative to antibiotics can be effective. The aim of this study was to evaluate the effect of iron and silver nanoparticles on biofilm formation in bacteria isolated from clinical specimens and the possibility of using these nanoparticles on laboratory surfaces. Materials and Methods This study was performed on three bacterial strains isolated from different wards of Imam Reza, Imam Hossein, and Taleghani hospitals in Kermanshah. The biochemical tests of the bacteria were identified and their antibiotic resistance was determined by the disk method. The microtiter plate method was used to investigate the disinfecting effect of silver and iron nanoparticles on biofilm formation. Data were analyzed by SPSS software. Results Results showed 9 blood samples (30%), 5 skin samples (16.67%), and 16 urine samples (53.33%). The highest rate of inhibition of Escherichia coli biofilm formation by silver and iron nanoparticles was 93% and 64%, respectively. The inhibition of biofilm formation in S. epidermidis by silver and iron nanoparticles was 86 and 64%, respectively, and the highest inhibition of biofilm formation by Pseudomonas aeruginosa by silver and iron nanoparticles was 96 and 88%, respectively. Conclusion The use of silver and iron nanoparticles has a high potential to kill the bacteria in the biofilm of P.aeruginosa.

Background: Promoting self-management behaviors is one of the most important supportive measures for people with diabetes. The purpose of this study was to determine the effect of home visit program on self-management behaviors and glycemic control indices in patients with type 2 diabetes mellitus treated with insulin. Methods: This clinical trial study was performed on 64 patients with type 2 diabetes mellitus (32 patients in each case and control groups) in Shahid Asghar Shabani Center, Isfahan, Iran, in 2018. For the two groups of case and control, the demographic and self-management questionnaires were completed immediately, and three months after the intervention. The intervention was performed as a 4-6 session of the home visit program for the intervention group. Data were analyzed using descriptive statistics and chi-square, independent t, and paired t tests via SPSS software. Findings: Before the intervention, the mean score of self-management behaviors and blood glucose control indices did not differ significantly between the two groups. However, the mean score of self-management behaviors became significant immediately and three months later, and the mean blood glucose control indices became significant three months after the implementation of the program in the intervention group. (P < 0.001). Conclusion: The home visit improve the patients' self-management behaviors scales, and fasting blood sugar and glycated hemoglobin (HbA1C) tests.

Resident and recruited macrophages control the development and proliferation of the liver. We have previously shown in multiple species that treatment with a macrophage colony stimulating factor (CSF1)-Fc fusion protein initiated hepatocyte proliferation and promoted repair in models of acute hepatic injury in mice. Here, we investigated the impact of CSF1-Fc on resolution of advanced fibrosis and liver regeneration, using a non-resolving toxin-induced model of chronic liver injury and fibrosis in C57BL/6J mice. Co-administration of CSF1-Fc with exposure to thioacetamide (TAA) exacerbated inflammation consistent with monocyte contributions to initiation of pathology. After removal of TAA, either acute or chronic CSF1-Fc treatment promoted liver growth, prevented progression and promoted resolution of fibrosis. Acute CSF1-Fc treatment was also anti-fibrotic and pro-regenerative in a model of partial hepatectomy in mice with established fibrosis. The beneficial impacts of CSF1-Fc treatment were associated with monocyte-macrophage recruitment and increased expression of remodelling enzymes and growth factors. These studies indicate that CSF1-dependent macrophages contribute to both initiation and resolution of fibrotic injury and that CSF1-Fc has therapeutic potential in human liver disease.

Background: Patients with hereditary bleeding disorders (HBDs) have always been vulnerable to transfusion-transmitted infections (TTIs) such as hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) infections due to being regular recipients of blood and blood products. This study aimed to detect the trends in the prevalence of HBV, HCV, and HIV infections by birthyear in Iranian patients with HBDs to show the efficacy of national interventions implemented to administrate control and to prevent these infections, i.e., blood safety, newborn HBV vaccination, and safe replacement treatments. Methods: In this retrospective study, the trends in the prevalence of hepatitis B core antibody (HBcAb), HCV antibody (HCV-Ab), and HIV antibody (HIV-Ab) in Iranian patients with HBDs born before 2012 were assessed using patients’ clinical archives. The determinants of HBV, HCV, and HIV infections were investigated in bivariable and multivariable logistic regression analyses. Results: Out of 1475 patients with HBDs, most were male (87.7%) and diagnosed with hemophilia A (52.1%) and severe bleeding disorder (63.7%). The prevalence of HBcAb, HCV-Ab, and confirmed HIV-Ab was 22.9%, 59.8%, and 1.2%, respectively. The trends in HBcAb, HCV-Ab, and HIV-Ab were all decreasing by birthyear and reached a stable level of 0% for patients with birthyears in 1999, 2000, and 1984, respectively. In multivariable analysis, birthyear was significantly associated with HBcAb prevalence. In the multivariable analysis, type of HBD; birthyear; bleeding severity; histories of receiving packed cells, fresh frozen plasma, and cryoprecipitate before 1996; and history of receiving factor concentrate before 1997 were highly associated with the prevalence of HCV-Ab. Moreover, in the bivariable analysis, birthyear and type of HBD were associated with HIV-Ab prevalence. Conclusion: This study demonstrated the decreasing trends in HBV, HCV, and HIV seroprevalence in Iranian patients with HBDs following preventive interventions such as HBV vaccination, blood safety measures, and the provision of safe replacement treatments.

Multiple primary tumors may develop in patients with head and neck squamous cell carcinoma. The coincidence of head and neck squamous cell carcinoma with papillary thyroid carcinoma is a rare finding. This study reports a case of papillary thyroid carcinoma, which was incidentally detected during the microscopic examination of lymph nodes of a patient diagnosed as gingival squamous cell carcinoma. A review of literature is also presented.

Background: Hospitals are the most important element of the health system. Hospitals play a key role in providing health services and have a major impact on the health system's performance. The success of organizations depends on their managers’ performance. Organizations with qualified and experienced managers will be more successful in achieving their goals and can reach optimal efficiency. Methods: This is a phenomenological qualitative study in which content analysis was used to achieve study objectives. The study population included the hospitals managers and senior experts of the vice chancellor for treatment of a provincial department of the Ministry of Health and Medical Education in Iran. Participants were selected by purposive and heterogeneous methods and data collection continued until data saturation was achieved. Data were collected by semi-structured face-to-face interviews. Results: From our data, seven main themes were drawn, consisting of monitoring and control, planning, organizing, leadership and motivational factors, management of resources and information, communication and interdepartmental coordination and patient orientation Conclusion: Hospital managers play a key role in improving hospital function. Assessing hospital managers' performance, determining their strengths and weaknesses and taking corrective actions are beneficial to the improvement of hospitals’ performance.

IntroductionLow anterior resection (LAR) for rectal cancer affects bowel function after the operation, causing a group of symptoms known as LAR Syndrome (LARS). LARS score is a patient-reported questionnaire to assess bowel dysfunction after the LAR operation. This study performed to validate the Persian (Farsi) translation of the LARS score and to investigate the psychometric properties of the score. The impact of LARS on the Quality of Life (QoL) of patients was also assessed.Materials and methodsThe LARS score was translated into Persian. Participants with a history of rectal cancer and low anterior resection were asked to complete the LARS score questionnaire. They were also asked a single question evaluating the impact of bowel function on QoL. Discriminative validity, convergent validity, sensitivity, and specificity of the questionnaire were calculated. A group of patients completed the score twice to assess the reliability of the questionnaire.ResultsFrom 358 patients with rectal cancer, 101 participants completed the Persian questionnaire. Answers of a high fraction of participants showed a moderate/perfect fit between their LARS score and their QoL. The Persian score demonstrated good convergent validity. It was able to differentiate between participants in terms of gender and T staging of the primary tumor. The score had high reliability.ConclusionThe Persian translation of the LARS score has excellent psychometric properties compared to previous translations in other languages. Therefore, it is a valid and reliable questionnaire to assess LARS.

Background: Coronary artery disease is the most important cause of death due to cardiovascular diseases and the main treatment is angioplasty. The purpose of this study was to evaluate the results of angioplasty in patients based on angiographic results, SYNTAX score, clinical conditions, cardiovascular risk factors and non-invasive tests. Additionally, the matching of angioplasty procedure with clinical guidelines was investigated. Methods: This was a cross-sectional study on 2297 patients referred to cardiac centers in Isfahan City (Chamran, Sina, Sepahan, Sa'adi, and Shahid Sadughi), Iran, for angioplasty during the second half of the year 2015. Demographic data, history of diabetes, hypertension, or hyperlipidemia, family history of heart disease, and current use of cigarettes were recorded. The extension of coronary artery disease was assessed using SYNTAX score. Findings: Among 2297 patients, 1577 (69.1%) were men and 706 (30.9%) were women. In 87% of patients, angioplasty was performed according to the guideline; and in 13% of them, open heart surgery or medical treatment was appropriate treatment instead of angioplasty. Significant correlation between the extent of coronary artery disease and the risk factors as age, diabetes, and hyperlipidemia was observed based on SYNTAX score system. Conclusion: In patients undergoing coronary angiography, SYNTAX score has an acceptable value in association with heart risk factors to demonstrate the generalizability of this association. A prospective cohort study can be used as a way to risk assessment for the patients and selection of appropriate diagnostic or medical strategy.

Objective (s): Obesity is a major public health problem worldwide. This review was carried out to assess obesity among Iranian primary school students. Methods: All cross-sectional studies that conducted on prevalence of obesity in adolescents in Iran without any restrictions was examined. The search engines included national and international databases including: Magiran, SID, Iranmedex, Scopus and PubMed in August 2015. Stata software version 12 was used for analysis of data and to obtain a summary measure. Results: In all 25 papers had the inclusion criteria for the study. Studies showed that the prevalence of obesity in Iranian primary school students was 7.18 percent (95% CI: 5.63-8.73). The prevalence of obesity was higher in boys than girls (8.02% vs. 6.07 %). Conclusion: This information might help to implement interventions to prevent obesity among Iranian primary school students. It seems that implementing interventions that aim to improve lifestyle and dietary patterns of this age group range are essential.

Obsession with the physique and appearance is a by-product of consumer societies. As such, fitness and slimming have now become major concerns of Iranian females. This study endeavors to elaborate on information-seeking behaviors among female students of Isfahan University of Medical Sciences concerning fitness. This study conducted in 2018, employs a qualitative approach using conventional content analysis. The research population includes female students of Isfahan University of Medical Sciences, 16 of whom were selected with use of purposive sampling. Data were collected through face-to-face semi-structured interviews and their trustworthiness was confirmed by the criteria of 'credibility', 'confirmability', 'dependability', and 'transferability' proposed by Guba and Lincoln. Results reveal four sub-categories and nineteen codes on information-seeking behavior. Sub-categories and codes including information-seeking motivations (achieving physical health, physical appearance, social acceptability, self-confidence, family and friends' pressure) information resources (electronic information resources, social media, printed information resources, doctors and nutritionists, family and friends, traditional & Islamic medicine, radio and TV), information validation (asking the doctors and specialists, matching the information with scientific references, consulting with friends and relatives) and obstacles to seeking information (lack of time, high costs, distrust, access limitation). by increasing the students' informational and media literacy, providing authentic and low-cost online resources of information and specialized TV programs, the damages rooted in using invalid information resources concerning fitness can be substantially diminished.

Abstract Background: Client satisfaction as an important indicator to assess the quality of provided services has found a special place over the past few decades. The main purpose of this study is to compare the client satisfaction in the public health posts and outsourced health posts affiliated to Qom university of medical Sciences in 2014. Materials and Methods: This was a descriptive analytic (cross- sectional) study.The participants were 216 clients, who had referred to 10 public health posts and outsourced health posts of Qom province. Health posts were selected by cluster sampling from different urban areas and participants were selected by simple sampling methods. A researcher made questionnaire was used to measure the data on a 5-point Likert scale, which it's validity and reliability were confirmed by experts panel and Cronbach's alpha coefficient, respectively. After collection, the data were analyzed by SPSS 20, and descriptive statistical methods, Mann-Whitney test, chi-square, with 0.05 significant level. Results: Among 60 health posts, 20 health posts (33.33%) were outsourced and 40 (66.66%) were managed by the public sector. Results showed that in health centers outsourced , overall satisfaction of the child care and vaccinations and maternity care were respectively, 64.5 and 55.42 and 67.43 percent and in public health posts were respectively, 35.5 and 44.58 and 37.66 percent and this difference was significant. Client satisfaction in the public health posts of the vaccination (57.1%) compared with client satisfaction in the outsourced health posts (47.2%) was higher, also at public health posts, satisfaction of the scientific skill employees (55.1 percent) assigned to the outsourced health posts (44.9%) was even greater, that this difference was significant. Conclusion: Results of the present study showed that, there is a significant difference in satisfaction of clients in public health posts and outsourced health posts It seems necessary to pay special attention to employee training programs by managers and also considering the results of client satisfaction in performance appraisal of personnel in health care posts.

Regeneration and engineering of functional new tissues containing the neural network have great importance. Progression of neural network into the dental tissue has a crucial role in dental tissue regeneration. In the present study polymer-ceramic blended scaffolds containing different weight percentages of carbon nanotube in poly caprolactone nanofiber matrix were fabricated. Morphological, mechanical and electrical properties of the prepared scaffolds have been characterized. Results showed that the sample containing 5 weight % of carbon nanotube had the smallest mean fiber diameter (50 - 300 nm) and the highest mechanical behavior. Also, its electrical conductivity was suitable to be used in nerve tissue scaffolds. mical properties as scaffold for neural tissue engineering. The static culture of the Schwann cells on the prepared scaffolds indicated that increasing weight percentage of carbon nanotube into the polycaprolactone matrix up to the 5 wt. % enhanced cell viability.

Introduction: Clinical governance is a framework in which service provider organizations are accountable for continuous improvement of responsive quality and protect high service standards by creating an environment where clinical service excellence is flourished. The purpose of this study was to explore challenges of establishing clinical governance in the field of patient education. Methods: This qualitative study was conducted in four teaching hospitals of Tehran University of Medical Sciences and the population consisted of experts involved in the clinical governance program. Sixteen participants were selected using non probability purposive sampling and known cases. Data were collected through semi-structured interviews which were recorded, transcribed and analyzed after informed consent was obtained. Qualitative content analysis was used to analyze the data. Results: Two major themes were emerged: “organization-related and patient-related factors”. Cultural factors included “poor teamwork culture, nurses’ lack of motivation to train patients, unvalued education, lack of time and high workload, shortage of personnel, lack of clear guidelines for education, overtime processes, managers’ neglect of education”. Patient-related factors, included “patients’ unawareness of their legal rights, public predicament and lack of cooperation from patients, patients’ illiteracy and low literacy, low motivation, cultural diversity of patients and difficulty to communicate with them”. Conclusion: Informing patients of their rights to receive comprehensive education and informing caregivers of such rights are the manifestation of patient-orientation concept and could pave the way to remove the challenges of clinical governance program.

Background: Methadone maintenance has received little scientific attention regarding neurocognitive effects. This study is aimed to assess the neuropsychological performance of methadone maintenance patients (MMP) compared to those healthy controls. Methods: Thirty-five MMP and 35 healthy controls, matched for age, gender, education and employment status, examined on a battery of tests aimed at assessing verbal fluency, executive functions, verbal memory, and working memory, using controlled oral word association test (COWAT), trial making test (TMT) Part A and B, Rey auditory verbal learning test (RAVLT), and backward digit span. Findings: MMP performed significantly poorly than controls in cognitive domains of verbal fluency, executive function, and verbal memory. MMP did not exhibit impairment in working memory, and TMT Part A compared to controls. Conclusion: These results suggest that methadone consumption induces significant cognitive impairment that could compromise drug-treatment outcomes in MMP.

Objectives: Health care providers in the rural centers offer the primary health services in the form of proficiencies and professions to the most required target population in the health system. These services are provided in certain condition and population with a verity of limitations. This study aimed to describe and interpret the experiences of the employees from their own working condition in the rural health centers. Methods: The present study conducted in a qualitative research approach and content analysis method through individual and group interviews with 26 employed primary health care providers (including 7 family physicians, 7 midwives, and 12 health workers) in the rural health centers in Isfahan in 2009. Sampling was done using purposive sampling method. The data were analyzed using qualitative content analysis as constant comparative basis. Results: During the content analysis process, six themes were obtained; "instability and frequent changes", "involved in laws and regulations", "pressure and stress due to unbalanced workload and manpower", "helplessness in performing the tasks and duties", "sense of identity threat and low self-concept", and "deprivation of professional development". The mentioned themes indicate a main and more important theme called "burnout". Conclusions: Health services providers in the rural health centers are working in stressful and challenging work conditions and are suffered from deprivation of something for which are responsible to the community.

Background: Resistin is peptides that signal the functional status of adipose tissue to the brain and other target organs. It causes insulin resistance and affects the vascular endothelial dysfunction. However, the function and relation between resistin in endothelin-1 (ET-1), which leads to the endothelial dysfunction in humans are enigmatic. Materials and Methods: In a cross-sectional study of 76 participants (38 metabolic syndrome patients and 38 healthy participants), biochemical and clinical parameters, including lipid profile, fasting glucose, resistin, ET-1, C-reactive protein (CRP), flow-mediated dilation (FMD), and hypertension were determined and compared between the two groups. Results: Multiple linear regression analysis was performed with age- and sex-adjusted plasma resistin levels, FMD, and ET-1 as the dependent variables. Analysis showed that weight, body mass index, triglycerides (TGs), and ET-1 were statistically significant correlated with serum resistin. FMD has negative significantly correlated with weight (r = −0.491, P = 0.001), waist circumference (r = −0.491, P = 0.001), waist-to-hip ratio (r = −0.0444, P = 0.001), and ET-1 (r = −0.075, P = 0.050), but it has significantly correlated with systolic blood pressure (SBP) (r = 0.290, P = 0.016), diastolic blood pressure (DBP) (r = 0.275, P = 0.023), and high-density lipoprotein cholesterol (HDL-C) (r = −0.266, P = 0.050), and ET-1, but it has significantly correlated with SBP, DBP, and HDL-C. ET-1 is significantly correlated with TGs (r = −0.436, P = 0.006), total cholesterol (r = 0.452, P = 0.004), low-density lipoprotein cholesterol (r = 0.454, r = 0.004), and resistin (r = 0.282, P = 0.050), whereas it has negative significantly correlated with HDL-C (r = 0.346, P = 0.034), FMD (r = −0.075, P = 0.050. Conclusion: In this study, results shown plasma ET-1 and resistin are suggested as risk factors for the development of endothelial dysfunction and with further study, it is possible that can diagnose the risk of diabetes and cardiovascular disease in the early stages.

Background and Objective: Lower ureter is the most common site of stone traped causing renal colic and hydroureteronephrosis. If medical therapy is not effective , the treatment consist of extracorporeal shock wave lithotripsy (ESWL), transurethral lithotripsy (TUL) or on rare cases, open surgery. This study was done to compare the ESWL with TUL in sixty patients with lower ureteral stones which did not responed to thraputic regiment. Materials and Methods: This prospective cohort study was done on sixty patients with obstructive lower ureteral stones for more than 3 weeks, that have not been responded to the thraputic regiment in Imam Reza hospital, Mashhad, Iran during 2004-06. According to treatment indications sixty patients divided in two equal ESWL and TUL groups. Success of procedure were evaluated by ultrasonography and KUB radiography. The success rate of two different technique and the side effects in each patients was recorded. Results: In ESWL group in 14 patients (46.66%) the stone was broken and its particles were removed but in 13 patients (43.33%) the stone was not broken and they became candidates for TUL. In 3 patients (10%) the stone was broken but the particles did not pass. The only complication of ESWL was renal colic which was in 15 patients (50%) and cured by medical treatment. In TUL group, in 93.5% of patients, the stone was broken and particles were removed, but in 6.5% the procedure was not successful and the patients underwented ESWL or open surgery. 10% of patients experienced fever and colic pain, who underwented medical treatment. Conclusion: This study showed that TUL technique has higher successful rate than ESWL technique in lower uretaral stones.

The high rate of hepatitis C virus (HCV) infection among transfusion related risk groups such as patients with inherited bleeding disorders highlighting the investigation on prevalent subtypes and their epidemic history among this group. In this study, 166 new HCV NS5B sequences isolated from patients with inherited bleeding disorders together with 29 sequences related to hemophiliacs obtained from a previous study on diversity of HCV in Iran were analyzed. The most prevalent subtype was 1a (65%), followed by 3a (18.7%),1b (14.5%),4(1.2%) and 2k (0.6%). Subtypes 1a and 3a showed exponential expansion during the 20th century. Whereas expansion of 3a started around 20 years earlier than 1a among the study patients, the epidemic growth of 1a revealed a delay of about 10 years compared with that found for this subtype in developed countries. Our results supported the view that the spread of 3a reached the plateau 10 years prior to the screening of blood donors for HCV. Rather, 1a reached the plateau when screening program was implemented. The differences observed in the epidemic behavior of HCV-1a and 3a may be associated with different transmission routes of two subtypes. Indeed, expansion of 1a was more commonly linked to blood transfusion, while 3a was more strongly associated to drug use and specially IDU after 1960. Our findings also showed HCV transmission through blood products has effectively been controlled from late 1990s. In conclusion, the implementation of strategies such as standard surveillance programs and subsiding antiviral treatments seems to be essential to both prevent new HCV infections and to decline the current and future HCV disease among Iranian patients with inherited bleeding disorders.

Introduction: Zinc deficiency has been reported in patients with both hepatitis C and beta thalassemia major. Zinc supplementation in addition to antiviral therapy of chronic hepatitis C has been accompanied by some success in patients with chronic hepatitis C. Objective: The aim of the present pilot study is to determine the effect of 30 mg elemental zinc on biochemical and virological response in a population of patients with chronic hepatitis C with beta thalassemia major. Materials and Methods: A prospective, double blind,placebo controlled trial included 40 patients being treated with Pegylated interferon Alfa (Peg IFN-α) and ribavirin. Biochemical and virological parameters and plasma zinc levels were determined before starting treatment. Patients were randomly selected to receive either zinc or a placebo in addition to Peg IFN-α and ribavirin for a period of one year. AST, ALT, sustained viral response (SVR), and zinc levels were measured after treatment. Of the original 40 eligible patients, eight withdrawn from the study and 32 patients completed the study; 16 in the zinc group and 16 in the placebo group. Analysis of the data shows that there is no difference between the two groups in AST, ALT, SVR or zinc level following one year of treatment (p=0.224, p=0.616, p=0.670, p=0.999, respectively). Conclusion:The results of this study indicate that using 30 mg/ day elemental zinc did not significantly improve the outcome of treatment in thalassemia patients with chronic hepatitis C. In future studies, we recommend trying higher doses zinc in patients with hepatitis C who had beta thalassemia major.

Asthma and allergic diseases present a major health burden. Information on the prevalence of these diseases indicates that these diseases are increasing in various parts of the world. It was hoped that this study would be helpful to health system policy-makers in planning allergy prevention programs in the region.The prevalence of asthma and allergic diseases and relation between the various risk factors involved were assessed among schoolchildren in the city of Bushehr, Iran. The ISAAC Phase I and III questionnaires were completed by parents of 1280 children aged 6-7 years and self-completed by 1115 students aged 13-14 years.The prevalence of atopic eczema, allergic rhinitis and asthma among 6-7 year-old students were 12.1%, 11.8% and 6.7%, respectively. While, the prevalence of these diseases among 13-14 year-old students were found to be 19%, 30% and 7.6%, respectively. There was an association between asthma and allergic rhinitis as well as eczema (p