مجله دانشگاه علوم پزشکی مازندران
پیاپی 126 (تیر 1394)

Background and Acinetobacter spp. is a non-fermentative gram- negative bacterium involving in various nosocomial infections. During last decade increasing number of multidrug-resistant isolates of Acinetobacter spp. have been reported. This type of resistance is possibly related to efflux pumps. This research aimed at identifying the phonotypic and genotypic characteristics of efflux pump in resistance to antibiotics in Acinetobacter spp. isolated from hospitalized patients in Kermanshah, 2013. In this descriptive-analytical study, 100 Acinetobacter spp strains were isolated from different clinical samples including blood, wound, and liquid specimens of hospitalized patients in Imam Reza and Taleghani hospitals in Kermanshah. All isolates were identified by standard biochemical tests. The antimicrobial susceptibility patterns were determined by disk diffusion according to CLSI (Clinical and Laboratory Standards Institute) guidelines in presence and absence of CCCP (carbonyl cyanide m-chlorophenylhydrazone) as an efflux pump inhibitor. PCR was used to detect the adeABC efflux pump genes. The rate of resistant to imipenem was 58%, ampicillin 63%, ceftazidime 94%, erythromycin 55%, clarithromycin 36%, azithromycin 29%, gentamicin 83%, tobramycin 54%, and tetracycline 50%. Highest and lowest levels of resistance were observed for ceftazidime and azithromycin, respectively. Among the Acinetobacter spp. 68% were positive for adeA gene, 88% for adeB gene, and 86% for adeC gene. Frequency of resistance using efflux pump inhibitor was found to be higher in adeA, adeB, and adeC positive Acinetobacter spp. isolates. The highest rate of resistance by efflux pump was observed in ceftazidime (13%) and tetracycline (12%).

Background and Wastewaters are the most important sources of antibiotics entrance into the aqueous environments. Conventional wastewater treatments cannot eliminate these micropollutants and antibiotic resistant bacteria. The aim of this study was to determine the antibiotic resistance pattern in bacteria isolated from untreated sewage and effluent of municipal wastewater treatment plant in Tabriz. In this cross sectional study, in addition to counting the number of different types of bacteria in raw sewage and municipal wastewater effluent, various bacteria including Enterobacteriaceae and Staphylococcus, Bacillus and Pseudomonas were identified using specific mediums, API E20 kits and biochemical tests. Susceptibility test of bacteria to antibiotics was determined by Kirby-Bauer's disc diffusion. The results showed lower than one log removal efficiency for coliforms bacteria by the wastewater treatment plants. The difference in the number of colonies apart from staphylococci was not significant in wastewater influent and effluent. Aeromonas and staphylococci were the most frequent bacteria in wastewater influent and effluent, respectively. Enterobacteriaceae were generally more sensitive than other bacteria. Resistance to antibiotics was found to be higher in the penicillin member of antibiotics. Resistant to four antibiotics including cephalexin, ampicillin, methicillin and amoxicillin were between 60 to 100%. The resistance of all species increased in the effluent of wastewater treatment plant. Growth and survival of antibiotic resistant bacteria increases in wastewater treatment plants and conventional treatment processes do not demonstrate enough efficiency for removal of these strains.

Background and Salivary alpha amylase (SAA) is used as a noninvasive biomarker to assess the activity of the sympathetic-adrenal-medullary system. The aim of this study was to evaluate the salivary alpha-amylase level under psychological stress and its relationship with rumination and the five personality traits. In a cross-sectional study, 45 medical students who wanted to take final exams were selected using simple random sampling. NEO Personality Inventory-Short Form and emotional control questionnaire (ECQ) were completed two months before the exam. Saliva samples were taken from the students in non-stressful (control) and stressful conditions. SSA level was measured by photometry and data was analyzed using paired samples t-test, Pearson correlation analysis and stepwise regression. A significant difference was found between the mean of SAA level in the rest and under exam stress. Also, we found a significant correlation between SAA level with neuroticism (P<0.01), agreeableness (P<0.05) and rumination (P<0.01), explaining 49% of the variance of salivary alpha-amylase under stress exam. According to this study, the SAA level may increase in individuals with traits of neuroticism, agreeableness and ruminative thoughts in response to psychological stressors (e.g. exam). Also, measuring SAA levels could be used in assessing physiological responses to stress, as a non-invasive method.

Background and Recent studies reported that not only the quantity, but also the quality of dietary fatty acids can affect lipid parameters. Elaidic acid as one of the most important by-product of partially hydrogenated vegetable oil, participate in the development of cardiovascular diseases, especially atherosclerosis through changing in lipid profile and exacerbation of inflammation and inflammatory factors. On the other hand, the role of TNF-α is evident in inflammation and inflammatory pathways leading to atherosclerosis. Thus we investigated the effect of elaidic acid on TNF-α gene expression. J744 cells were treated with 100 and 200µm concentrations of elaidic acid for 24 hr. The expression of TNF-α gene was evaluated after RNA extraction and cDNA synthesis using Real-Time PCR. Gene expression of TNF-α in J744 macrophage cell line showed no significant difference compared with that of the control group at both concentrations of elaidic acid. These results indicated that the elaidic acid does not affect the development of atherosclerosis, through TNF-α gene expression.

Background and Prehospital emergency medical service (EMS) is an important part of the health care system. Today, the need for integrated emergency care services and delivering qualified preventive and care services felt more than before in accidents and emergencies. This survey aimed to investigate the views of emergency medical personnel on the concept and nature of preventive and care services and current challenges in delivering these services in prehospital EMS centers in Golestan province, Iran. A qualitative study was done with 16 emergency medical personnel working in EMS sites in Golestan province using purposeful sampling. Data was collected by semi-structured interview guide and framework analysis was implemented to analyze the data. Two general themes were identified including 1) the concept of preventive and care services in the EMS and 2) the challenges in providing qualified services in the EMS sites in Golestan province. Also, five sub-themes and 12 subclasses were determined. To enhance and promote services, the EMS system of Golestan province need reforms in organizational structure, laws and administrative regulations, training programs, the system of monitoring and evaluation of personnel, also provision of equipment and manpower and provision of personnel amenities to improve the staff performance. Furthermore, it is necessary to boost emergency services at the community level through training people and enhancing collaboration and participation with other organizations.

Background and Moral distress is a common phenomenon in nursing professional and burn nurses are constantly faced with making different moral decisions for patients who are in terrible conditions. Therefore, nurses in burn units experience moral distress as mental tension. This study was conducted to determine the severity of moral distress and the factors associated with that in burn nurses. A descriptive- analytical study was conducted using census sampling on 172 nurses working in Mazandaran burn center, 2014. Data was collected through identifying demographic and occupational characteristics of the nurses (using relevant questionnaires) and Corley’s Moral Distress Scale. Data analysis was performed applying Mann-Whitney and Kruskal-Wallis test. The mean score for moral distress was 105.65±52.39 which indicates a moderate level experienced by nurses. Kruskal-Wallis test showed a significant positive correlation between educational level and level of moral distress (P=0.011). There was no significant association between moral distress and other individual and professional characteristics (P>0.05). Moral distress is accompanied by many complications that have direct effects on nurses’ professional practice. Therefore, nurse managers should consider this issue and plan for programs on appropriate coping strategies. Keywords:

Background and Medicinal plants are the main source of very potent antioxidants. Myrtus communis L. (Myrtle, Myrtaceae) is a medicinal plant used worldwide in traditional medicine. It is a well-known plant with distinctive antioxidant activity. This study aimed at investigating the effect of solvents extraction on total phenolics and antioxidant activity of extracts from Myrtle (Myrtus communis L.) leaf. The shade-dried leaf was extracted separately or successively with 6 solvets with different polarity: n-hexane, chloroform, ethyl acetate, n-butanol, methanol, and water. Twelve extracts were prepared. Antioxidant capacity was assessed using DPPH and nitric oxide (NO), free radicals scavenging, reducing power and iron chelating activity. The total phenolic and flavonoid contents were also determined. The highest yield of extraction was achieved by the most polar solvent, water. It also showed highest amount of phenolics but the extract did not contain the highest amount of flavonoids. Polar solvent extracts showed the best antioxidant capacities in DPPH and NO free radicals scavenging and reducing power. Nonpolar solvents, such as Chloroform, n-butanol and ethyl acetate had the highest amount of flavonoids and were also detected with the best iron chelating activity. The results clearly showed that utilization of polar solvent results in extraction of significant amounts of phenolics. Those components were the most potent antioxidants present in these extracts. Nonpolar solvents are more suitable for extraction of favonoids.

Background and Kidney transplant is the most cost-effective strategy in treatment of patients with kidney failure. But allograft dysfunction is still discussed as one of the main problems in these patients. The aim of this study was to identify the factors associated with the development of complications after kidney transplant. This correlation- descriptive study was performed in kidney transplant recipients (2002-2006) in Mashhad Imam Reza Hospital. Data was recorded in a researcher-made check list including type of dialysis, history of dialysis, cause of kidney disorder, donor kidney anatomy, parathormone hormone level, and complications after kidney transplant including length of hospitalization, urinary infection, and post-renal transplant diuresis. The results showed relationships between age of recipients and wound infection, donor kidney anatomy with lynfocel, deceased or live donor with length of hospitalization, and post-renal transplant diuresis with acute tubular necrosis. We found relationships between history of transplant with length of hospitalization, lynfocel, and acute tubular necrosis. Also, a significant correlation was found between history of dialysis with length of hospitalization (B=0.153, P=0.002) and acute tubular necrosis (B=-0.137, P=0.002). Moreover, there was a significant association between parathormone hormone level with length of hospitalization and post-renal transplant diuresis (B=0.473, P= 0.004 and B=0.398, P=0.011, respectively). Old age recipients, high frequency of dialysis, low level of parathormone hormone, deceased or live donor, and donation of right kidney were amongst the main factors in development of post-transplant complications.

Background and Postpartum hemorrhage is one of the most common causes of maternal deaths worldwide. Most deaths associated with hemorrhage occur due to delay in diagnosis and proper management of bleeding. This study aimed to evaluate the accuracy of postpartum hemorrhage estimation using artificial blood. This descriptive study was performed in 92 midwifery students, in Mashhad School of Nursing, 2013. The samples were selected using convenience sampling. Data was collected through questionnaires and objective structured clinical examination. Scenes similar to postpartum hemorrhage were created using artificial blood in six stations. The students saw each station and estimated the volume of blood. Data was analyzed applying central tendency and dispersion indices, paired T-test, and chi-square in SPSS V.16. Accuracy of visual estimation of blood loss was between 2- 20%. In estimation of postpartum hemorrhage it was found that about 40.21% of the students have underestimated, 10.34% had accurate estimation of blood loss and 49.45% estimated higher volume of postpartum hemorrhage than their actual volume. Visual estimation of blood loss was not accurate in most of the subjects. Authorities should focus more on skills and competencies required for accurate estimation of blood loss after delivery by revising the educational curriculum.

Background and Microleakage occurs in posterior composite restorations due to polymerization shrinkage. In recent years low shrinkage silorane-based composites have been introduced to reduce microleakage. The aim of this study was to evaluate the effect of three different restoration techniques on gingival microleakage of a silorane-based composite in class II restorations. In this experimental study, class II cavities were prepared in mesial and distal surfaces in 40 sound human premolars. The gingival floor was located 1.0mm below the CEJ. Dimension of cavities were 3mm buccolingually and 1.5mm in axial depth of gingival floor. The specimens were randomly divided into 4 groups. Group1 (control) was restored incrementally with silorane based composite (Filtek P90). Group 2, 3 and 4 were restored using glass fiber, flowable composite and resin-modified glass ionomer (RMGI) liners, respectively. After finishing and polishing of the restorations and thermo-cycling, the specimens were immersed in 2% Basic Fuschin for one week. Microleakage was determined under a stereomicroscope (40X). Data was statistically analyzed by Kruskal-Wallis test (P<0.05). The statistical analysis revealed no significant difference in microleakage among study groups (P=0.243). The sealing ability of glass fiber inserts, flowable composite and resin modified glass ionomer liners is not better than that of the silorane-based composite alone in gingival margins of Class II restorations.

Background and Spiritual health has an important role in different dimensions of health. It affects student's educational progress and enhances their life expectancy. Holy Quran has emphasized on the role of spiritual health on human's worldly and otherworldly happiness. This study aimed to survey the level of spiritual health in students in Mazandaran University of Medical Sciences. In a descriptive-analytical study 452 students in Mazandaran University of Medical Science were selected by stratified random sampling in 2013-2014. Data was collected by a researcher-made questionnaire consisting of 36 questions concerning Quran teachings. Cronbach's coefficient alpha for the reliability of questionnaire was 0.88. The results showed a significant association between cognitive dimension (4.07+0.45), emotional (3.89+0.64), and behavioral dimensions (3.935+0.60). Significant relationships were found between spiritual health and field of study, level, gender, and marital status. But there was no significant relationship between the scores achieved for spiritual health and age. The students in this study were found with a relatively high level of spiritual health in cognitive and emotional dimensions, and a poor level in understanding the purpose of life (in cognitive dimension) and behavioral dimension. The authorities responsible for enhancing spiritual health in universities should pay serious attention to the factors associated with that.

Background and Anxiety is a normal reaction to stress influencing behavioral, physical and mental aspects of human life. This study aimed to apply Neuman Systems Model in reducing the patient's anxiety level before surgery. In a randomized controlled trail, 104 patients undergoing orthopedic surgery in Imam Ali Hospital, Bojnourd were studied. Data was collected using a demographic questionnaire and the Spielberger State-Trait Anxiety Inventory (STAI). Intervention was performed according to Neuman Systems Model that includes assessing the actual and potential stressors, identifying the objectives and strategies for action, and strengthening the defense and the natural flexibility. Assessment of anxiety was done in two groups (the experimental group according to Neuman Systems Model and the control group without any intervention) before and after the intervention. Data was analyzed by Chi-square test, t-test, and paired t-test using SPSS V. 16. The results showed no significant difference in the level of anxiety before the intervention between the two groups. But after the intervention the anxiety level reduced significantly in experimental group (-18.94±16.1, P<0.001). A significant increase in anxiety was seen in control group (+12.73±9.98, P<0.001). The Neuman Systems Model was found to be efficient in reducing the level of anxiety before orthopedic surgical procedures. This study supports the role of Neuman Systems Model in reducing anxiety before orthopedic surgery, so, this model could be applied in both educational and clinical settings.

Background and To organize oral health promotion programs in Iran, assessing the knowledge, attitude and practice (KAP) of students is important.The aim of this study was to design a comprehensive and validate questionnaire on KAP of oral health in 12-year old children in Iran. This cross-sectional study included 1554 children aged 12 years old who were selected from 5 provinces in Iran. First, an Internet search of the major databases of medical articles published between 2003 and 2013 was performed. After a systematic review of literature, a questionnaire was prepared in English, and was translated and back-translated using standard methods. Then the face and construct validity of Persian version of the questionnaire were assessed. Internal consistency was performed using Cronbach's alpha coefficients for reliability testing. The final Persian version of the questionnaire was included the most important issues in the field of knowledge (influencing factors, and the effect of carbohydrates on dental caries), attitude (fear of dentist and dental care) and practice (how to brush, diet and dental appointments). The Persian version was consistent with the English version. Participation rate of 92% was reported. Construct validity was assessed using known groups approach, internal consistency and exploratory factor analysis which was found to be in an acceptable level. The Cronbach's alpha for questions, knowledge, attitude and practice, were 0.88%, 0.86%, 0.87% and 0.78%, respectively, indicating an acceptable consistency of the questionnaire. The Persian version of the questionnaire is a precise, valid and reliable instrument for assessing KAP of oral health in 12- year old children.

Background and Telemedicine programshave been implemented and evaluatedby various military organizations to improve veteran's access to specialized health care. The purpose of this study was to compare the requirements of military telemental health-care servicesin selected countries. Inthis descriptive-comparative studywe compared the needs formilitary telemental health-care servicesin USA, Australia, Canada, and Iran. Data was collected by searching library resources, publications and the United States Department of Veterans Affairs websiteandanalyzedusing comparative tables. USA, Australia and Canada have wisely taken advantage of military telemental health services regularly.But in Iran no practical use of this technology was observed and only phone services known as voice consultantis appliedfor veterans. According thesuccessful experience of some countries in usingtelemental health-care servicesit is believed that this technology couldincrease the quality of services and reduces unnecessary refers to military medical centers.

Background and Today, with the advent of electronic medical record system (EMRS) the security and confidentiality of information ought to be reasonably considered. The purpose of this study was to assess the privacy and security requirements for implementation of EMRS in all hospitals in Isfahan in 2014. An analysis framework was used in an applied study performed in IT authorities in private hospitals and the hospitals affiliated to Isfahan University of Medical Sciences and social security organization in 2014. Data was collected using a researcher-made questionnaire and analyzed in SPSS V. 20. Meeting the requirements for security and confidentiality of information was found to be high (100-67, mean score=85) in the implementation of EMRS in hospitals in Isfahan. The hospitals in Isfahan were believed to be prepared for the implementation of EMRS regarding security and confidentiality of information in 2014.

Background and Pastry products are an important part of food products in Iran. They are highly consumed now and there is high risk of bacterial contamination in these products. The present study investigated bacterial contamination of creamy pastries with Staphylococcus aureus and Bacillus cereus. A total of 945 pastry cream (jelly, fruit and plain) samples were randomly taken. All samples were tested according to Iran national standards for microbial tests and data was analyzed in SPSS V.18. The highest level of contamination was found to be with Staphylococcus aureus in summer in pastries with fruit cream (19%). No significant difference was observed in contamination of pastry cream (jelly, fruity and plain) in different seasons (P≥0.05). High level of bacterial contamination in pastry cream calls for more personal and workplace hygiene.

Background and Trigonellafoenum-graecum seed has galactogogues properties due to phytoestrogens structure and can increase the volume of breast milk. This study aimed to evaluate the effect of herbal tea containing Trigonellafoenum-graecum seed consumed by mothers on growth parameters of baby girls (0-4 months of age) attending health centers in south of Tehran, 2014. This clinical trial study was performed in 78 mothers breast feeding their 0-4 month old baby girls. They were randomly assigned into two groups (n=39 per groups). The intervention group received herbal tea containing 7.5g Trigonellafoenum-graecum seed powder and 3g black tea and the control group received herbal tea containing 3g black tea powder. The mothers used the beverages three times a day for 4 weeks,. The weight, height and head circumference of the babies were measured using baby weight measurement scale, stadiometer and tape measure in the beginning of the study and each week until 4 weeks. Data was analyzed by independent sample t test and repeated measurement test in SPSS. No significant difference was found between the two groups in weight, height and head circumference before the intervention (P>0.05). After four weeks Trigonellafoenum-graecum significantly increased the babies’ weight from 5282.05 ± 1021.51 to 6383.07 ± 952.06 and head circumference from 38.31 ± 1.62 to 39.92 ± 1.50 (P<0.001), but it had no effect on the height of studied girls (P=0.078). The results showed that consumption of Trigonellafoenum-graecum seed-containing herbal tea by mothers could improve the weight and head circumference of breastfed babies. (Clinical Trials Registry Number: IRCT201312102751N10)

Background and Considering the working problems of nursing staff who are concerned with human life in emergences is of great importance in emergency departments. Mental workload affects individual’s health and performance. Therefore, this study aimed at investigating the mental workload and the factors that influence it among the nursing staff in emergency centers. A descriptive analytical study was conducted in nursing staff in emergency centers in Isfahan, Iran, 2015. Data was collected by census among 230 nurses in seven emergency departments using NASA-TLX scale to assess the nurses’ workload. Data was analyzed in SPSS V.16 applying t-test, one way ANOVA and Pierson correlation confession analytical tests. Total mental workload was estimated to be 66.44±11.92. The highest and lowest scores were observed for effort (80.00±19.43) and frustration (34.47±26.08), respectively. There were no significant associations between age, experience, sex and shift work with mental workload (P>0.05). But significant relationship was seen between type of contract and mental workload. Mental workload among emergency nursing staff was found to be high, therefore, appropriate actions are required to reduce the mental workload and mental pressure.

For years, fungi have been associated with asthma and other reactive airway diseases. In contrast to type I-mediated allergies caused by pollen, fungi cause many allergic diseases such as rhinitis, allergic bronchopulmonary mycoses, hypersensitivity pneumonitis and allergic sinusitis. Aspergillus fumigatus is the most prevalent fungi which causes severe pulmonary allergic diseases, including allergic bronchopulmonary aspergillosis (ABPA). ABPA is associated with chronic lung injury and worsening in pulmonary function in patients with cystic fibrosis (CF) and chronic asthma. Diagnosis of ABPA is demanding since it is based on different clinical and laboratory findings but serology results are of great importance in diagnosis of ABPA. Production of recombinant allergens has contributed to improve a component resolved diagnosis of the disease. Serological studies showed that the responded specific IgE to four A. fumigatus allergens (Asp f2, 4, 6, and 8) are specific for ABPA. These specific allergens allow a serological discrimination between ABPA and other A. fumigatus-sensitivity. However, to reconstruct the whole allergenicity of the fungal extract it is required to produce and clinically evaluate more recombinant allergens. With the rapid development in knowledge about 3D structures of allergens, researchers could expand their knowledge about the function of each single structure in the pathophysiology of ABPA and, perhaps, could develop a group of allergens for the immunotherapy of the disease.