مجله دانشگاه علوم پزشکی مازندران
پیاپی 174 (تیر1398)

Surgical site infection (SSI) is one of the most commonly reported post-operative condition. The purpose of this study was to evaluate the effect of topical vancomycin powder on prevention of SSI in spinal surgery. A single blind clinical trial was performed in 200 patients who were randomly divided into two groups. In both groups IV injection of cefazolin was done before the surgery and 24 hours later, but in case group, vancomycin powder was used before wound closure. The condition was examined for two weeks, one month and two months after the operation. In suspected cases of SSI, wound culture was done and ESR and CRP levels were also measured. In current study, no significant relationship was found between the incidence of infection and age (P=0.038). Increased BMI in weeks two and four increased the incidence of SSI in both groups. The diagnosis and type of surgery did not correlate with post-operative infection. (P=0.635) There was no significant correlation between the two groups in CRP and ESR levels within the time studied (P=0.311). However, post-operative wound healing was significantly slower in case group (P=0.041). Vancomycin powder as a prophylactic treatment at incision was not found to change the risk of infection. Therefore, further studies are suggested to focus on one type of surgery merely.
(Clinical Trials Registry Number: IRCT20180826040869N1)

Ovarian cancer is the fourth leading cause of death from gynecological cancers in women. Using specific tumor markers that help in making diagnosis at early stages improve therapeutic outcomes. The purpose of this study was to evaluate the diagnostic value of the Risk of Ovarian Malignancy Algorithm (ROMA) index in patients with ovarian mass. A cross-sectional study was conducted in 84 patients with diagnosis of ovarian mass admitted in Mashhad Ghaem Hospital. After obtaining informed consent and recording demographic data, serum levels of CA125 (Cancer antigen -125), HE4 (Human Epididymis Secretory Protein 4) and ROMA were recorded before the surgery. The results were then compared with pathological outcomes. Data analysis was done in SPSS V20 applying Chi-square and Mann-Whitney tests. The mean age of the patients was 44.54 ± 13.53 years. Sensitivity, specificity, positive and negative predictive values and total accuracy of CA125 in diagnosis of malignant ovarian tumors were 57.89%, 84.61%, 52.38%, 87.3% and 78.75%, respectively (P<0.001). Also, the values for ROMA were 94.78%, 93.75%, 75%, 92.3%, and 89.29% (P<0.001). ROMA was found with a high diagnostic accuracy in women before and after menopause. Current study showed that the diagnostic accuracy of ROMA index in detection of malignant ovarian tumors is very high compared to CA125, therefore, it could be used in investigating malignant ovarian mass before surgery.

High cancer related mortality can be due to the presence of cancer stem cells (CSCs). Studies suggest aldehyde dehydrogenase (ALDH1) as a marker of CSCs. The aim of this study was to investigate its expression in colorectal cancer and also its association with clinicopathologic characteristics. In a retrospective study, patients with colorectal cancer attending Sari Imam Khomeini Hospital were enrolled. The intensity and distribution of ALDH1 expression in tumor and non-tumoral adjacent tissue samples were measured by immunohistochemistry. Data were analyzed using SPSS V18. Forty patients including 20 males and 20 females were studied. The frequency and intensity of ALDH1 expression in tumoral and non-tumoral tissues were not significantly different. The expression intensity was not related to age, type of adenocarcinoma, and tumor location, but it was found to be higher in women (P=0.08). Mild ALDH1 expression was higher in well-differentiated grade (P= 0.07). Discontinuous distribution was higher in non-mucinous adenocarcinoma (P= 0.06) and well-differentiated grade (P= 0.028). In this study, ALDH1 expression was not significantly different in the samples of colorectal cancer and normal adjacent. But, higher intensity of expression in women and discontinuous distribution were observed in well-differentiated and non-mucinous samples. The role of ALDH1 as a CSC marker in colorectal cancer requires further investigations.

Acinetobacter Baumannii is an opportunistic bacterium, which is considered as a concern in hospitals throughout the world due to high antibiotic resistance rate. The aim of this study was to investigate the prevalence of carbapenem resistance genes in clinical isolates of this bacterium. In this study, 100 clinical isolates of Acinetobacter Baumannii were collected from hospitals affiliated to Mazandaran University of Medical Sciences. Antibiotic susceptibility patterns of the bacteria were evaluated using disk agar diffusion method and agar dilution method was used to determine the minimum inhibitory concentration of colistin. Carbapenemase-producing isolates were detected by phenotypic Combined Disk Test (CDT) and PCR method was performed to investigate the presence of IMP and SPM genes in the isolates. The highest and the lowest antibiotic resistance rates were to piperacillin (99%) and colistin (7%), respectively. Among the isolates studied, 97 were found to be resistant to carbapenems, while phenotypic evaluation (CDT) showed metallo-beta-lactamase production in 95 isolates. Of the strains resistant to carbapenems, only two (2.06%) contained the IMP gene, while none of these isolates carried the SPM metallo-beta-lactamase. According to the findings, other mechanisms of resistance such as increasing the activity of the efflux pumps, decreasing the expression of outer membrane proteins, excessive expression of the AmpC enzyme or production of other carbapenemases can be effective in resistance to carbapenem in Acinetobacter Baumannii species isolated in this area.

Stroke is the third leading cause of death and the most common debilitating neurological disease. Intracranial Hemorrhage (ICH) is the second most prevalent form
of stroke after ischemia. The aim of this study was to investigate the consequences of ICH and its effective factors. In this prospective cross-sectional study, 288 patients with non-traumatic ICH attending Hamedan Sina Hospital were investigated in 2015-2016. Hospital mortality rate and length of stay were used to determine the outcomes. Data were collected through interviews, patient records and CT scan, and then analyzed in SPSS. The patients were 58.7% females and 41.3% males. Among the patients, 54.4% aged 61-80 years old. Death occurred in 35.1% of the patients. Mortality rates in men and women were 38.7% and 32.5%, respectively. The mean age at death was 69.36±13.25 years old and the mean of hospital stay was 9.8 days. Mortality rate was higher in patients with higher blood glucose level, creatinine and high systolic blood pressure, early thrombocytopenia, and lower initial alertness. The mortality rate was also found to be high in patients with bilateral hemorrhage in putamen and caudate, intraventricular haemorrhage, hydrocephalus, subarachnoid hemorrhage, and midline shift. Mortality due to non-traumatic intracerebral bleeding was found to be highly associated with bleeding site, level of consciousness, blood pressure, blood glucose level, platelet count, and initial creatinine. Thalamus and then putamen were the most common sites of bleeding. Mortality rate was not associated with age and gender.

One of the major risk factors for the health of mother and child is cesarean section (CS) without medical reasons. This study aimed at addressing the causes associated with selecting delivery method in nulliparous women. A descriptive comparative study was performed in which the research population included all nulliparous women attending a health center in Mazandaran province, Iran 2017. Census method was used and 272 women with normal vaginal delivery (NVD, n=132) and CS (n=140) were selected. Data was collected using a researcher-made questionnaire. The reliability and validity of the questionnaire were confirmed by gynecologists and Cronbach's alpha 0.76, respectively. Data analysis was done in SPSS V24. Out of 140 CS delivery, 66 (46.5%) had no medical recommendations. The main causes were fear of vaginal pain and health and safety of the fetus. The chance of NVD improved by 1% increase in knowledge about the benefits of NVD (15%) and disadvantages of CS (12%) (P<0.001). Also, 1% improvement in socioeconomic status rose the chance of choosing CS 2.45 times (P=0.023). According to current research, informing nulliparous women about the disadvantages of CS and the benefits of NVD is necessary. Therefore, educational interventions are recommended for women planning pregnancy.

The relationship between obesity and the risk of breast cancer has been highlighted in some studies. This research aimed at studying the association between anthropometric indices and breast cancer based on enrolment phase (cross-sectional phase) data in Tabari cohort study. In this cohort, 51 cases of breast cancer were recorded which were considered as the case group. Also, 153 individuals (without any type of cancer) from Tabari cohort population were randomly selected as control group. Data analysis was performed applying independent t-test, chi-square, and multivariate logistic regression. The frequency of waist circumference ≥88 cm in case group was slightly lower than that of the control group (74.5% vs. 75.2%, P= 0.926). In case group, the frequency of waist to hip ratio (less than 0.85) was lower than that of the control group (70.6% vs. 80.4%, P= 0.144). The risk of breast cancer was found to be higher in rural population (OR: 8.28, P<0.001) and in women with higher education (OR: 0.06, P<0.001). This study did not confirm the association between anthropometric indices and breast cancer.

Sensory processing is necessary to perform daily activities properly. The aim of this study was to investigate the frequency of sensory processing disorder in children aged 5-11 years old. This descriptive cross-sectional study included all children aged 5 to 11 years old in kindergartens and primary schools in Tehran, Iran. Children meeting the inclusion criteria were 2191, selected through multistage cluster sampling. Children parents completed the Dunn Sensory Profile. Participants’ demographic information was recorded and frequency of sensory processing disorder was analyzed in SPSS V22 based on the cut off point of the nine factors of the sensory profile. The study included 31.3% girls and 68.7% boys. Frequency of sensory processing disorder estimated based on the cut off points of the sensory profile was as follows: sensory seeking: 9.40٪, emotional reactivity: 10.81٪, low muscle tone and endurance: 18.16٪, oral sensory sensitivity: 18.34٪, inattention and distractibility: 7.85٪, poor sensory registration: 15.10٪, sensory sensitivity: 22.22٪, sedentary: 10.17%, and fine movement and perception: 3.60٪. In this study, children aged 5 to 11 years were found with different patterns in sensory processing. Frequency of sensory processing disorders in all nine factors of sensory profile was higher in boys. Further studies, using the Dunn Sensory Profile, are needed in other parts of Iran, especially in children with different sensory problems.

Memory dysfunction is one the most common challenges of patients with Multiple Sclerosis (MS). Memory has a major role in daily life and influences social communication of individuals. The aim of this research was to investigate the function of nonverbal episodic memory in Persian speaker patients with MS. In this cross-sectional study, 46 patients (13 males and 33 females) with definite relapsing-remitting multiple sclerosis and 46 age, gender, and educationally-matched healthy controls were selected using convenient sampling based on inclusion criteria. The patients were divided into two groups (n=23 per group) according to the Expanded Disability Status Scale (EDSS) scores; 0-4 and 4-6. The Montreal Cognitive Assessment (MoCA) test was used to screen cognitive function and the Benson Figure test was used to evaluate the non-verbal episodic memory function. Compared to healthy controls, both MS groups were found to be significantly impaired in accuracy and placement of structures of visuospatial abilities (copy trial), visual memory (immediate recall), and maintaining and retrieving visuospatial sources (delayed recall) (P< 0.05). Acquired brain injury in MS is associated with dysfunction of nonverbal episodic memory. In other words, MS would adversely influences patient’s performance in all stages of the visuospatial test (copy, immediate, and delayed recall). Moreover, EDSS could be regarded as a predictor for individual differences in MS patients in all stages of nonverbal episodic memory.

Protein binding (PB) is an important pharmacokinetic parameter in drug discovery and development. In past years Abraham parameters were used to predict some physicochemical and pharmacokinetic properties of drugs. But in these cases, the ionization of drugs in blood pH (7.4) was ignored. Recently, Abraham parameters of chemical compounds in ionized form are proposed. Also, Henderson Hasselbalch equation could be used to calculate the percent ionization of drugs. In this study, Abraham parameters were calculated according to the ionized fraction of drug and PB was predicted using these parameters. PB data points of 159 drugs were collected from the literature. Abraham parameters of drugs were calculated according to the percentage of ionization in blood pH=7.4. The models were built up based on the multiple linear regression (MLR) analysis and percentage error of each model was computed. Findings showed a linear relation between PB and Abraham parameters based on the ionized fraction in blood pH, so, the developed model could predict the PB better than the model established by Abraham parameters in :union:ized form. Ionization of drugs in blood pH is an essential parameter in predicting PB, and Abraham parameters for ionized form of drug can be used to predict it with a good accuracy.

Nowadays, rapid growth of car wash industries has led to a demand for wastewater reclamation. In this study, the hybrid process including electrocoagulation/flotation, sedimentation, and filtration were used in treatment of real carwash wastewater. In this research, the sample was first entered into the ECF reactor, then entered the retention tank after specific times and eventually passed through filtration. COD was measured by closed reflux colourimetric method and turbidity was measured by Nephelometric method. To optimize the COD and turbidity removal efficiency, a central composite design was used based on response surface methodology (RSM) using Design-Expert version 7. According to the the RSM model, optimum conditions for pH, electrolysis time, and applied current were 7.67, 1.69 amps and 90 min, respectively, in which COD removal and turbidity removal efficiency were 94.5% and 95%, respectively. The most predicted efficiency for the COD and turbidity removals were 100% and 96.69%, respectively. Electric energy consumption and operating costs were found to be 4.2 kWh / m3 and 8820 Rials, respectively. The hybrid treatment process used in this study, seems to be an efficient and cost effective method compared to existing conventional treatment methods used in removing pollutants from carwash wastewater. Therefore, this method can be used to remove pollutants with high concentrations from car wash industry wastewater and in wastewater reclamation.

Emission of bioaerosols from wastewater treatment plants is a potential hazard to human health. In this study aimed at investigating the effects of surface and deep aeration techniques on density and type of airborne bacteria and fungi in two municipal wastewater treatment plants. This descriptive cross-sectional study was done in two wastewater treatment plants in Tehran equipped with surface and deep aerations. Microbial samples were taken from air beside aeration tank, grit chamber, secondary sedimentation basin and two control points (upwind and downwind) every 6 days during summer and autumn 2017. Samples were analyzed for density of bioaerosols and types of bacteria and fungus applying standard methods. Wastewater treatment plant with surface aeration tank had the greatest effect on emission of bioaerosols than the plant with deep aeration. Mean values for density of bacterial bioaerosols and fungal emission were 6845 and 15784 CFU/m2/h in summer and 535 and 899 CFU/m2/h in autumn, respectively. Different gram-positive and gram-negative bacteria were identified in both wastewater treatment plants investigated. According to current study, emission of bioaerosol in wastewater treatment plants with surface aeration is more than that of those with deep aeration and has greater potential hazard.

Childbearing is of great importance in social issues. This study was conducted to determine the effect of transtheoretical model-based education on women attitudes and stages of childbearing behavior change. This clinical trial was performed using multi-stage random sampling in 75 women of reproductive age (38 in intervention group and 37 in control group) selected from nine health centers in Amol, Iran 2017. The intervention group attended five educational sessions, and then received online weekly trainings for six months while, the control group received routine education. Attitudes toward childbearing and stages of change in childbearing behavior were evaluated before, at 3 and 6 months after the education. Mean scores for women attitude before, at 3 and 6 months after education were 171.81±22.55, 179.12±22.55, and 177.39±20.54 in intervention group and 166.31±19.37, 165.85±21.49, and 165.07±18.37 in control group, respectively. Findings indicated significant improvements in women attitude toward childbearing (P <0.001). But, frequency of women at different stages of childbearing behavior in intervention group was not significantly different from that of the controls (P = 0.281). Transtheoretical model-based education improved women attitudes toward childbearing, but failed to change the stages of childbearing behavior. Given the multiplicity of factors in childbearing, such findings were predictable. Therefore, it is necessary to carry out studies with longer pre-pregnancy consultations and increase in number of samples.
(Clinical Trials Registry Number: IRCT2017083131117N4)

There is lack of concordance between researchers' interests and clinical problems. This study aimed at explaining researchable clinical problems from the perspective of healthcare providers to provide a better understanding of the issues that could be solved by the health system. This qualitative study was carried out in 27 healthcare providers in selected hospitals affiliated to Golestan University of Medical Sciences, 2017. The participants were selected by purposive sampling. Focused Group Discussion (FGD) was used to collect the data. The participants explained their experiences through three FGDs which began with a broad open-ended question and further probing questions were used. Interviews were recorded and transcribed verbatim. Data were analyzed using qualitative content analysis. The participants aged 25-53 years old with 2-26 years of clinical experience, among whom 59% were males. The analysis of data led to the development of four main themes. The researchable clinical problems included clinical problems associated with health system structure, the status of healthcare providers, the status of service delivery in the health system and needs assessment, and problems associated with clinical processes. Current study suggests that after determining the priority of researchable problems regional issues should be addressed in designing and performing clinical researches.

Kidney transplant is a major form of renal replacement therapy in many patients at advanced stages of the disease. Transplant rejection is a major complication following kidney transplant that could be reversible or irreversible. The present study was done to investigate the incidence of irreversible kidney transplant rejection. A retrospective cohort study was performed using the information on 1571 renal transplants in Kermanshah, Iran, 1989 to 2016. Kaplan-Meier, Cox regression, and log-rank test were used to estimate the incidence of kidney transplant rejection 24 hr after surgery, the graft survival rate, and investigating the differences between the subgroups, respectively. The rate of acute transplant rejection was 3.82% and the rejection rates within 6 months, one and three years after the transplantation were 10.06%, 12.41%, and 18.20%, respectively. The Cox regression model showed significant correlations between age (P=0.013), creatinine level (P=0.001), and diabetes (P=0.016) and survival rate of kidney transplants. High incidence of acute rejection and rejection within six months showed the influence of some underlying factors. Further studies on underlying variables that affect transplant rejection and kidney transplantation at younger ages could be of great benefit in increasing kidney transplantation survival.

Citrobacter freundii causes variety of infections, including respiratory tract infection, wound infection, meningitis, and urinary tract infection. The bacterium is considered as one of the main concerns in healthcare settings due to high antibiotic resistance patterns. The current research aimed at studying the prevalence of C. freundii strains in burned patients and investigating the antibiotic susceptibility patterns. In this cross-sectional study, C. freundii isolates (n=109) were collected from clinical specimens in Sari Zareh Hospital, 2016-2017. Conventional biochemical tests were used to confirm the presence of bacteria. Then, antibiotic resistance pattern was determined using standard disk diffusion (Kirby-Bauer) according to the Clinical Laboratory Standards Institute (CLSI) guidelines. Out of 3248 clinical samples, 109 (3.35%) C. freundii isolates were identified which were detected mainly in wounds (72.50%). Susceptibility patterns indicated that about 11.0% of isolates were susceptible against SXT, 95 of which were resistant to that. Susceptibility and resistance patterns against amikacin were 47.7%. Resistance to cephalexin and SXT, and amikacin were 87.15% and 48.62%, respectively. In this study, C. Freundii was detected as a major concern in burn ward. This bacterium is highly resistant to the majority of antibiotics, therefore, appropriate infection control processes and also using effective antibiotics such as amikacin would be of great value.

A timeliness warning of communicable diseases surveillance system (CDSS) in every country is vital for maintaining national, regional, and global health security. This study aimed at providing recommendations to improve the CDSS in Iran. This qualitative study was conducted in 64 people working in CDSS and other associated organizations using semi-structured interviews and focus group discussions between October 2016 and April 2017. The interviews were analyzed via conventional content analysis approach using MAXQDA 10. The solutions that could improve the CDSS were categorized into four main categories and 8 sub- categories as follows: stewardship of the CDSS, improving reporting comprehensiveness, development and improvement of infrastructures, and training and retraining. The timeliness and comprehensiveness of the CDSS information depend on intersectoral collaboration. Therefore, main recommendations for reinforcement of CDSS include strengthening intersectoral cooperation, using incentives to obtain the supports of private sector professionals, developing reporting systems, and community participation.

Non-syndromic bilateral humeroradial synostosis is a very rare congenital anomalies of the upper limbs. This condition often occurs in conjunction with various syndromes and is associated with a positive family history. Herein, we report a 6 year old boy with non-syndromic bilateral humeroradial synostosis, without aplasia, hypoplasia or family history. Both elbows were constant at 90 degrees flexion and the patient was not able to perform supination and pronation. Internal rotation, external rotation, and abduction movements of shoulder were normal. Except bilateral humero radial synostosis, findings of physical examinations, lab tests, and imaging were normal. Parents rejected surgical treatment.

Correction to: Investigation of Electrocoagulation Process Performance with DC Current in Treatment of Poultry Slaughterhouse Wastewater Using Aluminum Electrodes
Zabiholllah Yousefi1,
Hossein Sahebian2,
Abdoliman Amouei3,
Reza Ali Mohammadpour4,
Ebrahim Zarei5
1 Professor, Department of Environmental Health Engineering, Faculty of Health, Mazandaran University of Medical Sciences, Sari, Iran
2 MSc Student in Environmental Health Engineering, Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
3 Professor, Department of Environmental Health Engineering, Faculty of Health, Babol University of Medical Sciences, Babol, Iran
4 Associate Professor, Department of Biostatistics, Faculty of Health, Mazandaran University of Medical Sciences, Sari, Iran
5 Assistant Professor, Department of Basic Sciences, Farhangian University, Tehran, IranIn the article published in volume 29, issue 172, 2019, the title was published incorrectly, which is now corrected.