نشریه دانشگاه علوم پزشکی خراسان شمالی
سال ششم شماره 1 (بهار 1393)

Today, air pollution is one of the most important problems of urban and industrial life and naturally the life of all people are affected by this subject. The aim of this was to determine air pollution in different areas of Mashhad in 2011and to compare it with standards. This cross-sectional study was designed to determine and compare air pollution in different parts of Mashhad city in the winter of 2011. Totally 12 stations were selected in Mashhad city. In each station pollutants such as CO, NO2, NOX, O3, SO2, PM10, PM2.5 were measured. Data were collected analyzed by SPSS16 software and presented with Oneway ANOVA and Tukey post hoc test. Finally, AQI levels were calculated and air quality was determined. The results of this study showed that according to AQI, 52% of the total measurements in Mashhad stations had a medium range air (51 to 100) in winter and the maximum value of it (52%) was in march. 26.6% was unhealthy for sensitive groups in winter and this amount was highest(35.8%) in January. The highest air pollution days was observed in January. Sakhteman and Resalat stations AQI values were the highest and lowest respectively. Therefore, it seems attention to sensitive groups in these circumstance can be helpful to keep their health.

High homocysteine level is considered as a risk factor for placental abruption. The purpose of this study is to determine the role of high homocysteine level in placental abruption. This case- control study was conducted on 120 pregnant women (60 ones in case group and 60 in control group) who referred to Ayatollah Rouhani Hospital of Babol for delivery. Case group was women with clinical diagnosis of placenta abruption and control group was women without medical problems. Serum samples of fasting blood homocysteine were measured in a single lab. The obtained data were statistically analyzed after being collected. Maternal age and number of deliveries in two groups showed no statistical difference. The mean serum homocysteine in mothers of case group was 10.76±1.55 micromoles and in mothers of control group was 8.48±1.65 micromoles. A significant statistical difference was observed between the serum homocysteine of mothers of two groups (p<0.001). There was a significant statistical relationship between the mean serum homocysteine in patients with history of abortion and gestational diabetes. Median level of serum homocysteine was higher in placenta abruption group and showed the role of hyper hemocysteinemia as a risk factor.

Asthma as a chronic inflammatory process, for management of moderate to severe asthma, needs to use of inhaled anti inflammatory agent, including inhaled corticosteroids. Long term use of corticosteroids may be associated with subtle or potential side effects, including growth suppression or decreased bone mineral density. The purpose of this study was to compare bone density in asthmatic children, receiving long term ICS (longer than 6 month), with standardized bone mass values for healthy children adjusting for age, ethnicity, gender, height and weight and bone area. In 30 asthmatic children, 5 to I5 years of age, prescribed long-term Fluticasone propionate 400 microgram/day (longer than 6 month) and normal level of serum calcium, phosphorus, Alkaline phosphatase, scheduled for bone density test by DXA and results were compared with bone mass reference values of healthy children. 18 Patients (60%) had significantly lower Z SCORE compared to standardized bone mass values of healthy group (- 1< ZSCORE<-2. 5), with no significant difference between girls and boys. In low bone mass children, assessed serum 25 (OH) D by ECL (Electrochemiluminescence), in 17 was normal and 1 child (despite normal calcium, phosphorus and Alkaline phosphatase, and no clinical finding) was lower than normal range. in children with asthma receiving high dose corticosteroids, early detection of BMD in essential. This finding warrant investigation with the ultimate goal to promote bone health by increase number and time of study, for children with asthma receiving long term ICS who at risk for compromised bone mass.

Zinc-dependent beta-lactamases inactivate a wide range of beta-lactam drugs, especially the carbapenem. One of the causes of antibiotic resistance in Pseudomonas aeruginosa is production of these enzymes. The aim of the present study was to identify clinical isolates of P. aeruginosa in Mashhad based on biochemical and molecular methods and to compare the antibiotic resistance pattern between methallo-beta-lactamase (MBL)-producing isolates and nonproducers. In this study, 64 clinical isolates of P. aeruginosa were collected and identified from various samples of patients in 2012. Confirmatory identification of bacteria was performed using polymerase chain reaction and specific 16S rRNA primers. MBL-producers were identified by using imipenem disk adjacent to a disk containing imipenem and EDTA. Antibiotic susceptibility assay was performed by agar diffusion method based on standard Kirby-Bauer method. Out of 64 bacterial isolates, 22 (34.38%) were MBLproducers which 81.8% were resistance to imipenem. Among MBL-producers, resistance to meropenem, imipenem, ceftazidime, and carbenicillin were significantly higher than non- MBL-producing bacteria (p < 0.05). This study shows the high number of MBLproducing Pseudomonas aeruginosa in studied community and increased resistance to imipenem among them. It appears the prevalence of MBL-producing strains to be increasing in our country which emphasize the need for further strategies on antibiotic prescribing management and control of antibiotic resistance.

Pediculosis is one of the common social and health problems among human population that is very prominent among students. Determination of presence and prevalence of Pediculosis could be a good health indicator in each area. Given that the importance of this health problem among students, we aimed to study the prevalence of head lice (Pediculosiscapitis) at primary schools of Mane-va- Semelghan district. In this descriptive analytic study data were gathered using a checklist consists of demographic characteristics such as age, gender, school grade, parents’ occupation and habitual area. Statistical tests as t-student and chi square was used to analyze data. All data analysis was done using SPSS version 16. There was statistical significant relationship between gender, number of family members, habitual area, the related health center, using scarf at home, and the previous history of Pediculosis with the present involvement with Pediculosis. Pediculosis infestation is still an important health problem in most communities. The result of this study showed the relationship between the prevalence of Pediculosis with different factors such as individual, behavioral, socio-cultural, geographical, and availability to health services. Precise policy making and health education could help to prevent this health problem.

In this study we attempted to search important sources of Aspergillus spores and Candida elements in hospitals indoor spaces using two identification methods of morphology and molecular. From February 2008 to September 2009, total of 198 clinical and environmental specimens were collected from two Iranian training educational hospitals of Urmia. Clinical specimens included bronchoalveolar lavage, sputum, sinus discharge and urine. Also 111 environmental specimens including air samples and surface swabs were obtained from the rooms where our cases were hospitalized. All specimens were tested for Aspergillus and Candida species. The Identification of isolated fungi was confirmed using PCR-RFLP method. Totally 93 (47%) clinical specimens were positive for fungal or bacterial infections. 54 (58%) fungi isolated from clinical specimens included 36 (66.6%) Candida spp., 17(31.4%) Aspergillus spp and also only other one fungal saprophytic agent. Environmental isolates were included Candida spp., 35 (31.5%), Aspergillus spp., 48 (43.2%) and other saprophytic fungi, 28 (25.3%). Our findings of PCR-RFLP on rDNA gene of Candida and Aspergillus isolates showed a similarity between some environmental isolates and the relevant clinical isolates but use of method RAPD–PCR confirmed only 20-40% similarity with two of 5 random primers for some clinical isolates and related environments. We conclude that fungal contamination of the hospital indoor environments maybe important factor for the hospital acquired fungal infections.

The aim of current study was the comparison of Bone Mineral Density (BMD) and Bone Mineral Content (BMC) of femur in physical educating and non-physical education students at universities of Bojnurd. Methods and materials: Fifteen physical educating (age: 22/33 ± 2/22 years) and Fifteen non-physical education students (age: 23/40 ± 1/29 years) from the different Bojnurd Universities participated in this study. Subjects were randomly selected in each group. BMD and BMC of femur measured using a Dual- Energy X-ray Absorptiometry (DEXA) system. SPSS software used to analyze data. Independent T test used to compare BMD and BMC between two groups. The significant level set at p≤ 0.05 for all statistical procedures. Data were normalized using kolmoghrov and Smirnoff test. The result of the current study showed that BMD and BMC, T- Score and Z- Score at different locations of the femur in physical education students were higher than non-physical education students. However this difference was not statistically significant. It seems that the practical courses for physical education student were not intensity enough to increase BMD and BMC in bone.

The use of technology has increased occupational diseases. People in work zone may be exposure to various harmful agents such as physical, chemical, ergonomic, biological and psychological agents. These factors can lead to many of occupational and work related diseases. This study aimed to determine the work related diseases among staff of a hospital in Tehran.This descriptive cross-sectional study was conducted on 233 hospital`s staff. Job records and the check list of work related diseases were used to collect data. Descriptive and analytical statistics using SPSS version 16 were applied for analysis. The results showed that 62.7 % of workers had musculoskeletal disorders. These disorders were more reported among people aged 30 to 39, females, paramedics and people with more than 10 years of work history. Prevalence of mental disorders was 18% and working age group of less than 29 years had the highest frequency among them. Skin diseases related to work with a prevalence rate about 24.1% among people aged more than 40 years was considerable. Work-related diseases in hospital are common especially musculoskeletal that caused by ergonomic agents. Regarding to high prevalence of work related diseases especially musculoskeletal disorders, among participants, applying educational interventions adjusted to job type of personnel could be a practical suggestion.

Knowledge about the nature and types of learning styles in learners can help teachers to adjust their teaching methods with students, learning styles to achieve the desired educational outcomes. This study was conducted to determine students’ learning styles based on Kolb learning pattern in North Khorasan University of medical sciences. This descriptive cross sectional study was conducted on students of North Khorasan university of medical sciences in 2012. Kolb's Learning Style Inventory was used to conduct the research. Data were analyzed by spss16 software and presented with chi-square test. Of the 240 subjects, 79(32/9%) of subjects were male and 161(67/1%) of subjects were female. Mean age (s) and score were 20/82 years and 16/25 respectively.Percentage of the students’ learning style for converging, accommodating, absorbent and divergent was 45/4, 17/1, 23/3 and 14/2 respectively. There was a statistical significant difference (P≤0/05) between learning styles of the nurse school students and health school students. The most learning style in the nurse school students and health school students was converging and divergent respectively. According to our results the most prevailed learning style was converging style and so traditional education methods were boring. Therefore use new education methods according to student fields for example group discussion and problem solving are recommended.

fruits and vegetables are an important part of human diet after cereal. One of the concerns of today's world is heavy metal contamination of agricultural products. In this study, heavy metals, lead and cadmium were studied in the edible parts of mint, leek, and scallion, radish, in two areas (East and West) of Mashhad. This study was descriptive – analytical. During the first six months, three samples from each area and vegetable were collected. The amounts of heavy metals were determined by graphite atomic absorption Varian model, after acid digestion of the samples. The data were analyzed using tests of Post Hoc with significance level 0/05. The results indicated that the average maximum and minimum lead concentration with 95% acceptable level was observed in Leek (33/88mg / kg), radish (mg / kg24/45) respectively and for cadmium in Leek (0/83mg/kg) and scallion (0/46mg/kg). The comparison between the East and the West planting vegetables in the city of Mashhad showed that average lead concentration (42/13mg/kg)and cadmium (mg/kg0/89) were related to the East. In contrast Sample times, highest concentrations of lead and cadmium were observed in scallion (58/71mg / kg) and leek (2/99mg / kg) in August respectively. The average concentration of cadmium in types of studied vegetables was in proposed standard limits for plant (0/2, 0/8 mg/kg) but concentration of lead was higher than standard (0/1, 10mg/kg).

Avicennia marina (Forssk.) Vierh is the most current species among these plants in Iranian mangrove forest. Regarding to the biologically active compounds and traditional use of the leaves for treatment of smallpox and wounds, it seems that this plant has significant anti-microbial effects. The aim of this study was to evaluate antimicrobial effects of various concentrations of mangrove leaves on Staphylococcus aureus, Escherichia coli and Penicillium digitatum. In this study, antimicrobial effect of extracts evaluated by two methods, “Collins method” and “disk agar diffusion method” on Staphylococcus aureus PTCC 1337, Escherichia coli PTCC 1330 and Penicillium digitatum PTCC 5251 microorganisms. The minimum inhibitory concentration (MIC), minimum fungicidal concentration (MFC) and minimum bactericidal concentration (MBC) for both species were determined by using a dilution method. The results showed that in "disk agar diffusion test ", extract with 20, 40, 60 and 80 percent concentration has inhibition effect on Staphylococcus aureus and Penicillium digitatum, but only 60 and 80 percent of alcoholic extract has prevention effect on Escherichia coli. There was inhibition effect for watery extract in 60 and 80 percent on Staphylococcus aureus and 80 percent on Penicillium digitatum. MFC for mangrove alcoholic leaves was 16 mg/ml for Penicillium, however, MFC of aqueous extracts was 64 mg/ml for Penicillium. Alcoholic extract was more effective than watery extract as antimicrobial against on Staphylococcus aureus, Escherichia coli and Penicillium digitatum. The mangrove leaves extract, in vitro showed significant antimicrobial effect on studied microorganisms.

Staphylococcus aureus is the most common bacteria in nosocomial infections. Nosocomial infections which caused by this bacterium in recent years, considerably, have been increased. This study was conducted in aim of prevalence of Staphylococcus aureus nasal carriage and antibiotic resistance patterns in health care workers, in Imam Reza hospital in Bojnurd. A cross-sectional study was conducted on a total of 200 health care workers for 4 months. Nasal swabs were collected. After detection of Staphylococcus aureus isolates, the susceptibility to commonly used antibiotics was determined by disk diffusion method. Methicillin disk diffusion method was applied for detection of methicillin-resistant strains. From 200 patients, 22 (11%) were nasal carrier of Staphylococcus aureus, and 3 of these (13.6%) were resistant to methicillin. In this study, the results indicated that from three nasal methicillin-resistant strains, two were resistant to vancomycin. Presence of nasal carriers, indicated presence of methicillin resistant S. aureus in hospital personnel of Imam Reza in Bojnurd. Although the prevalence of S. aureus nasal carriage was not very high, otherwise, with no attention, presence of MRSA, indicated wide distribution. We advice control measures for prevent MRSA transmission in high risk persons.

The use of complex sampling designs in data collection of some studies such as case-control studies is becoming common, yet this method has often been ignored in analysis. Ordinary logistic regression is used to estimate the coefficients of model, instead. The purpose of the present study is to evaluate the fitting of weighted logistic regression compared to that of ordinary (OLR) and post stratified (PSLR) logistic regression. The data used in this study were collected using complex sampling method among urban women in four provinces of Iran. Age, educational level, BMI, marital age, number of pregnancies and abortions, total and vaginal number of deliveries were considered in this research. Dependent variable was pelvic organ prolapse. Ordinary, post-stratified and weighted logistic regression was fitted to the data. To compare models’ goodness of fit, ROC curve analysis was used. In post-stratified and weighted methods the standard errors of estimates were almost equal and both larger than that of ordinary method. In ordinary method, number of vaginal deliveries, age, employment and BMI showed statistically significant association with prolapsed pelvic. Area under ROC curve in ordinary, post-stratified and weighted methods obtained as 0.75, 0.72 and 0.73, respectively. Results showed that although weighting reduces the bias of estimates by adjusting sampling errors, it does not necessarily shrink their variance.

Bacterial pneumonia occurs in most hospitalized patients and contributes the main leading cause of morbidity and mortality. We aimed to determine the incidence of pneumonia, isolate the bacterial agents of pneumonia and identification of risk factors for pneumonia. This is a cross-sectional and descriptive study. From total number of542 patients hospitalized in the intensive care unit of Imam Reza Hospital due to various reasons, 78 patients with pneumonia and bacterial infections were selected. After identifying patients with nosocomial infection the required tests were done. The collected data were analyzed using the software INIS. The incidence of nosocomial pneumonia was 14/4%, 38 (48/8%) were male and 40 (51/2%) were female. The mean age was 54/3 ± 26/2, 94/7% of patients with intubation, ventilator and suction was suffering from pneumonia. Also, 8/97% had a history of bronchitis and (28/1%) of asthma. The most frequent pathogens were Escherichi coli (26/15%), Pseudomonas aeruginosa (21/53%), Staphylococcus saprophytICUs (18.46%), Enterobacter spp. (15/38%), Klebsiella spp. (12/30%), Staphylococcus epidermidis (4/61%) and Streptococcus viridance (1/53%). Tracheal tube and mechanical ventilation increase risk of pneumonia. It is recommended, to avoid as much as possible any unnecessary interventions in intensive care unit and in case of mechanical ventilation, care and hygiene items must be taken to reduce the incidence of pneumonia.

Cyprus Longus is a traditional herbal medicine widely used as a mild sedative, spasmolytic and antibacterial agent. In this study the effect of methanol extract of Cyprus Longus on visceral pain was investigated. This experimental study performed on 40 N-MRI male mice (28±3g). Animals were randomly grouped into control, positive control and receivers of Cyprus Longus extract. Control and positive control groups received normal saline and indomethacin (5mg/kg), respectively. Treatment groups were injected with 100 and 200 mg/kg of methanol extract of Cyprus Longus. All injections were performed intraperitonealy (IP). Animals were injected with acetic acid 0.6% (10ml/kg) for visceral pain induction, 30 minutes after of each intraperitoneal administration. Antinociceptive effects were recorded by counting the number of writhes during 30 minutes. The data were analyzed by SPSS statistical software and One- Way ANOVA test. The significant was shown with (p <0.05). methanol extract of Cyprus Longus at 100 and 200 mg/kg and Indomethacin (5mg/kg) induced a significant reduction in pain response when compared with control group. This study confirms the antinociceptive properties of Cyprus Longus in comparison with Indomethacin, however other studies are necessary to confirm analgesic effect of Cyprus Longus.

Gastrointestinal Endoscopy is a diagnostic tool and treatment of gastrointestinal diseases in children. Due to severe response and muscular spasm of the digestive tract created during endoscopy, it often face with difficulty.The aim of this study is to evaluate peppermint effects in pyloric spasm in children undergo endoscopy. In this clinical trial study, 120 children (under 14 years old) in Ghaem hospital that Pyloric spasm during endoscopy were randomly divided into two groups, peppermint(n=60) and control(n=60) respectively. Case group received peppermint and control group received placebo. Data were analyzed using SPSS version 11.5 and presented with descriptive and analytical tests (T-test, Corraletion, Mann- Whitney). Pyloric sphincter stayed open in 48.3% of peppermint group patients and 5% of control group (P<0.000). The mean time to endoscopy in peppermint group (9/301+0/351) and control group was (10/149+0/337) and this difference was significant(P<0.05). Pyloric spasm duration in peppermint group was less than 60 seconds and in control group at 60% of them, was more than 60 seconds. Peppermint could reduce endoscopy duration and pyloric spasm in children and increase endoscopic team satisfaction.

According to the important role of nurses, it is required to apply proper learning techniques for education of theoretical and practical skills for nursing students. Therefore this study aimed to compare the effects of tow methods including lecture and multimedia learning in learning of fundamental of nursing in nursing students. This study was conducted on 50 nursing students of nursing faculty of Esfarayen-2012. Samples were randomly divided into two groups (lecture teaching methods and teaching multimedia groups) and were trained. They were examined before and after the intervention and another test (remember) were done after 4 weeks. Data were analyzed by SPSS18 statistical software. Pre-test mean scores were significantly different with post-test and remember stage in two educational groups(p<0/001). Post-test mean scores of two groups was not significantly different, but in remember stage Multimedia training group had better mean(p<0/05). Both methods had the effect on student learning, but the effect of multimedia training method was more enduring over time. our results showed multimedia education method has more lasting effects than lecture education method. It is hoped that this method is more widely implemented with other methods to training nursing students.

mainly due to increased unintentional side-effects of synthetic antioxidants and antimicrobials, This study evaluated the antioxidant and some antibacterial properties of different aerial parts’ extracts in Cyperus longus. The Hexane, Dichloromethan and Methanolic aerial parts’ extracts of Cyperus longus were obtained by maceration method. Antibacterial activity of extracts determined by Disc Diffusion Method. The antioxidant capacity of extracts was assessed through DPPH method. The results of DPPH assay were showed by IC50. The total phenolic content was measured using the Folin-Ciocalteu’s reagent. The total flavonoid content was assessed by a colorimetric method based on Aluminum Chloride, has been associated with some changes. The anthocyanin content was measured by (Mita et al., 1997) method. The Methanolic extract of aerial parts exhibited slight antibacterial effects against B.cereus at the concentration of 3 mg/disc. The IC50 values for Methanolic, Dichloromethan and Hexane extracts in DPPH assay were 10.071 ± 1.529, 8.756 ± 0.206 and 29.551 ± 6.457mg/ml, respectively. The phenolic content of the Methanolic, Dichloromethan and Hexane extracts were obtained 56.66, 14 and 11 mg/ml, respectively. The total flavonoid content of the Methanolic, Dichloromethan and Hexane extracts were obtained 22, 84.15 and 51.9, respectively. Anthocyanin amount, contained in one gram sample of dried aerial Cyperus longus was 11 mg. Antibacterial test results were showed that it has no effect on Gram-negative bacteria. But it is effective on Gram-positive bacteria. All extracts showed antioxidant activity in DPPH method and the Dichloromethan and Hexane extracts were found to have maximum and minimum activity in DPPH assay, respectively.

Backgrounds and Since chromium is considered as a major risk in skin، lung cancer، kidney and liver disorders، so the aim of present study was investigation to the removal of Cr (VI) using zeolite clinoptilolite from aqueous solution. In this study، the adsorption of Cr (VI) from aqueous solution has been studied onto pretreated zeolite clinoptilolite by using batch test. Potassium dichromate (K2Cr2O7) was used as the aqueous source of Cr (VI) and stock solution prepared by distilled water. Residual concentrations of Cr (VI) were measured by spectrophotometer at 540nm. The results showed that with increasing Cr (VI) concentration removal capacity increased but decrease the time of equilibrium. Whit decreasing pH of 4 to 10، removal efficiency increased. Also time for contact zeolite was 70 minute. In overall، among the aforementioned Pretreated Zeolites (i. e.، Al3+ and Fe3+ -modified zeolites)، raw zeolite whit adsorption 45‰ was particularly found to create adsorption media with high capacity and specificity for Cr (VI). In general، it can be concluded that raw zeolite clinoptilolite economical method to remove for Cr (VI) from groundwater but don’t removal efficiency method.

Despite extensive studies conducted on single nucleotide polymorphisms (SNPs) effects on different diseases, but the necessity of investigation into interaction of these SNPs together in diseases in particular genetic based diseases in one hand and existence of a large number of these variables and also weakness of classical statiscal models in including such variables in the other hand, underline the necessity of applying new statiscal method to determine these interaction effects. In this study we used logic feature selection approach to determine important SNP interactions associated with systemic lupus erythematosus. We use information of 11 SNPs located in the genes IL-1 cluster، IL-10، TNF-α، IL-4Rα for 376 subjects (188 control subjects and 188 case) to determine influential SNP interactions in patients affected with systemic lupus erythematosus disease using logic feature selection. Consequently, the results were used in logistic regression model. the result of the logic feature selection approach led to the identification of two two-way interactions, but in the final logistic regression model only two-way interaction related to polymorphisms in TNF-α was shown to be significant on occurrence of systemic lupus erythematosus disease. According to our results, it seems that the results of the modern statistical methods like logic feature selection can helpful to find the important SNP interactions associated with disease in studies with large number of variables.

Substance abuse is one of the four crisis threatening humanity with the environmental, nuclear and population. Iran is among the countries due to the proximity of Afghanistan, the world's largest producer of opium and heroin extremely affected by substance dependency issue. Currently, there are about 2 million drug dependents living in Iran and this is a major health and social priority. this research is a cross sectional study in 2012 -2013 on substance dependent patients treated in methadone maintenance clinics. Subjects assessed by clinical psychologists interviewing and a checklist include demographic characteristic, social, economical and pattern of abuse. We used Chi square for comparison of qualitie's variables between gender and T Student and mann whitney test for quantitive variables. Data were analyzed with spss 11.5 software. in this study 7342 patients who treated in methadone maintenance clinics were assessed. 82.5% male and 17.5% were female.87.5% of all subjects were married.6.6% single and 5.9 % were divorced.95% of patients had history of opium dependency and 14% had history of heroin and crack and 2.8% had history of codependency with methamphetamine. our results showed significant differences between demographic characteristic of patients under maintenance treatment and other groups of addicts especially in mean age and male/female ratio.

Increased rate of mortality and morbidity due to coronary artery disease (CAD) could result into defining the involved factors, since different parts of artery are involved in CAD so the aim of this study was to determining the role of cardiovascular risk factors in involvement of coronary arteries, as a predictive model. This study was case series and performed on all patients in angiography center of Imam Ali hospital in Bojnurd. Variables of study included age, sex, history of diabetes, hypertension, smoking, level of cholesterol, level of fasting blood sugar, level of triglyceride, the location and number of vessels involved on angiography and angina’s grade. Data were evaluated by SPSS 16 and presented with t test, ANOVA and post hoc tests. The results of this study showed that there was significant relationship between age, sex, history of diabetes, smoking, angina grade and number of vessels involved. It was also showed that there was significant relationship between history of diabetes, smoking, triglyceride and systolic blood pressure. Another significant relationship existed between age, history of blood pressure, systolic blood pressure and angina grade.Despite significant relationship between the type and location of coronary artery disease with several risk factors, we can’t able to predict the location of the involved artery angiography before starting the process, Because of the overlap between multiple cardiovascular risk factors vary with the type of vessel involved.

complementary and alternative medicine is a set of procedures for diagnosis, treatment or prevention, and healthy lifestyle and natural. Due to the being holistic, along with conventional medicine is used around the world to reinforce it. This comprehensive review was conducted based on extensive search of databases including Scopus, Pub med, Science direct, Google scholar and Iran medex by using keywords such as complementary and alternative medicine, touch therapy, nursing. Relevant articles were selected based on the relationship of articles and expert comments. The purpose of complementary and alternative medicine is health promotion and quality of life with increase life span with using natural approaches and different methods according to clinical experience and research. Touch therapy is a therapeutic intervention for human energy management and its clinical concepts is supported by the Rogers’ theory of Unitary Human Beings. Complementary medicine can be used to facilitate the therapeutic relationship between nurse and patient through building trust and enhancing communication. Today complementary medicine has simply provided the opportunity for nurses in holistic care. Health care providers can play a more effective role in achieving care and therapeutic targets by identification of complementary and alternative medicine.

One of the most important roles of nurses in maintains and promotion health is providing good quality of health service. There are several ways to change health quality improvement. In practical terms Action research is one way to change health quality This is a review article that investigates valid resources from CINHAL; Scopus, Medline, PsycINFO, Embase, SID and the World Wide Web were undertaken using MeSH key words including: 'action research'; 'health care research', 'health services evaluation'. Action Research is done by participants in social situations to boost logic of social and justice of educational functions. This approach is a new paradigm of research that can be done through cooperation and collaboration. In recent years many studies have been carried on research into the field of nursing care based on action research that indicate the positive impact of growth and promotion in the field of nursing education and clinical management. Action research can solve the problem by providing improved quality problems in health care. Action research has been used successfully to facilitate change and improve service provision in management, education and nursing clinical.

Congenital agenesis of corpus callosum is one the rare brain anomalies that occurs in various forms. Its most common forms consist of complete or partial agenesis of corpus callosum. The main leading cause of agenesis of corpus callosum has not been definitely recognized. Here we are reporting a rare congenital complete agenesis of corpus callosum with developmental ventricular system and diencephalon anomalies.