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Gastro-enteritis due to Vibrio Cholera was increased suddenly in summer of 1998 in our country. In this research we studied epidemiological and clinical features of Cholerae patients. Vibrio Cholera isolated from 189 (3.3%) patients from 56II stool samples. 182 (96.2%) Vibrio Cholera O1 isolated. 46 (24%) patients with positive stool cultures for Vibrio Cholera were hospitalized. 50% patients were 15-45 yrs. No sex predominency was seen. The important observations in this study including: Fever in 28.1% (13) of patients, sever leukocytosis in 15% (7) of patients, RBC in stool in 33% (15) of patients. Fever and neutrophilia and RBC in stool probably shows co-infection with order intestinal pathogens or different serotypes of Vibrio Cholera with new characteristics. So we are recommending extensive research to be done on serotyping of all of the isolates of Vibrio cholera and other intestinal pathogens simultaneously.

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Background & Objective: One of the most important principles in education is adopting a teaching method in concordance with objectives, contents and learners. Teaching and learning clinical skills is a challenging aspect of education in field of medicine and allied health profession. Some of the new researchers have shown that video-based instruction has many advantages in comparative to others. But in the domain of the psychomotor learning there is not enough evidence to show that video-based instruction is an effective teaching method. The current study has compared students learning in video-based and demonstration methods. Materials & Methods: An experimental study was conducted on 40 first year nursing and midwifery students. The students were randomly assigned to case (N=20) and control (N=20) groups based on the their course. The data were collected from a pre-test, a post-test and a questionnaire for demographic information. Pre-test was given 24 hours prior to the presentation sessions. Then each group has received one skill with video-based and another skill with demonstration. Skills included the dressing changing and surgical hand washing. After 24 hours post-test was taken with previous criteria. The differences between the pre-test and post-test scores were considered as they are at learning level. Results: The overall learning in the demonstration method was higher than the video-based method (P<0.05). However the scores of students in 2 methods was at acceptable level. The scores of students in the cognitive domain of hand washing by the demonstration were 16.20±1.5 and by the video-based method were 15.25±1. The scores of students in the psychomotor domain of hand washing by the demonstration was 16.85±1.4 and by the video-based method was 15.94±1.4 (P<0.05). The scores of students in the cognitive domain of dressing change by the demonstration was 25.60±1.8 and by the video-based method was 15.50±1. The scores of students in the psychomotor domain of dressing change by the demonstration was 16.78±1.3 and with the video-based was 16.12±1 (P<0.05). Conclusion: The results indicated that demonstration method is more effective in the students learning. However, both video-based and demonstration have led to the high level of cognitive and psychomotor learning. It could be concluded that video-based instruction can be an effective method for replacing the demonstration, especially when there is not access to demonstration, in addition according to the findings, video-based education is a effective methods for transporting knowledge, information and other topics in the cognitive domain. Therefore, considering the cost-effectiveness of video-based instruction and its ease of use, this method can facilitate education in where lack of experienced instructors and equipment is most pronounced.

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Tibiotalar dislocation without concomitant fracture in the surrounding bones is a rare injury. We report one of them presenting unreduced after a 10 month interval. A 23 y/o female presented to our clinic 10 months after Bam earthquake, during which she had sustained an anterior tibiotalar dislocation without any associated fracture. Open reduction was tried two times, but both attempts were unsuccessful because of the very poor quality of bone. Although ankle dislocation has been reported to be associated with good prognosis, it was not the case with our late presenting patient.

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Background and Objective: One of the most important routes of hepatitis B virus (HBV) transmission is from asymptomatic carrier mothers to their infants. It has been concluded that over 50% of Iranian carriers have contracted the infection perinatally, making this the most likely route of transmission of HBV in our country. In this study, we assessed the rate of HBV infection in children were born to HBsAg positive mothers that received hepatitis B immunoglobulin (HBIG) and the first dose of vaccine at birth and the second and third of doses of vaccine at 1 and 6 months of age, respectively. Materials and Methods: In this descreptive study, 123 infants born from HBsAg positive mothers assessed and serum sample of these subjects were tested by ELISA technique for detection of HBsAg, Anti-HBs and Anti-HBc markers. Data were then analyzed by the chi-square and fisher exact tests. Results: From 31241 pregnant women with delivery during this 5-years study about 140 (0.45%) of them were HBsAg positive. Children born to these mothers follow-up and 123 serum samples of them tested for serologic markers of HBV infection. HBsAg was found in 0.8% of the children and 91.9% had one or more serologic markers of HBV infection. Protective rate (Anti-HBs positive) and Anti-HBc positive were 82.1% and 8.9% respectively. Conclusion: This study showed that after having focuced on the vertical transmission route for many years, and implementing strategies such as vaccination and HBIG injection to neonates of HBsAg positive mothers, nowadays it seems that we should pay attention to horizontal route of HBV transmission in this area.

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Background and Objective: There is growing evidence that excess generation of highly reactive free radicals, largely due to hyperglycemia, causes oxidative stress, which followed by further exacerbating the development and progression of diabetes and its complications. The purpose of the present study was to determine the effect of alpha-lipoic acid (ALA) on blood glucose and HbA₁c in type 2 diabetic patients.

Materials and Methods: In this clinical trial study, fifty-seven type 2 diabetic patients (14 male and 43 female) with the mean age of 53.5 years old were involved in this study. Upon arrival, subjects were randomly divided into either experimental (n=29) or control (n=28) groups. Experimental group received 300 mg alpha-lipoic acid daily for eight weeks where control group received placebo for eight weeks. After an overnight fast patients' blood samples, were drawn and analyzed for fasting blood glucose, 2 hours post-prandial glucose and HbA₁C. In addition, antropometric indeces for each subject was measured at the beginning and at the end of the study.

Results: There is no significatn differnces regarding weight and BMI in two groups before and after intervention. Also our findings indicated significant decrease in fasting and post-prandial glucose level, in experimental group, after intervention (p<0.05), but no significant change was seen in HbA₁c level. There were no significant changes in parameters measured in control group. There was also a significant decrease in fasting blood glucose in experimental group when compared to control group (p<0.05), but there is no significant changes in HbA₁c level.

Conclusion: This study showed that alpha-lipoic acid supplement as an important antioxidant reduce blood glucos concentration in type 2 diabetes.

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Background and Objective: Autism is a neurodevelopmental disorder of the brain,which occures in first few years of life, and characterized by symptoms such as qualititative impairments in verbal and non verbal communication, reciprocal social interactions, inability to communicate with others, stereotyped patterns of behavior, loss of eye contact and inappropriate facial expressions. Its prevalence is 2-5 in 10000 children and is greater in boys. Due to retarded language development, differential diagnosis other than those used with communication, behavioral and sensorial deficits should be made with Sensorineural or conductive hearing loss. The aim of this study was to determine whether children with autism have abnormalities affecting the cochlear nerve or auditory pathway in brainstem.

Materials and Methods: In this case – control study, auditory brainstem responses were recorded from 12 autistic children and 12 normal children aged 3-12 years in rehabilitation Zafar central in Tehran – Iran during 2005. Absolute latency values of waves I, III and V and interpeak latencies of I-III, III-V and I-V were compared with the results of 12 normal children as control group.

Results: Wave V could be traced down to 25 dB nHL in both normal and autistic groups. Absolute latency of Wave V and Interpeak latencies of III-V and I-V were significantly prolonged in Autistic children in comparison with control group.

Conclusion: This study showed a slowing in nerve conduction in auditory pathway in brainstem of autism patients. The brainstem lesion may be a part of neurological damage in autistic children that accounts for deviant language, cognition and social development. Prolongation of wave V, III-V and I-V IPLs can be a marker for early diagnosis of autism.

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Background and Objective: Colorectal cancer is the third common malignancy in the world. Personal habits including life style and nutrition have been proposed as risk factors of colorectal cancer. We conducted this study to assess the nutritional characteristics in colorectal cancer patients in Golestan province of Iran.

Materials and Methods: This case-control study was done on 47 colorectal cancer cases, diagnosed during 2004-05 and 47 healthy controls. A questionnaire containing socio-demographic and nutritional characteristics (FFQ) was filled for each of the participants. Chi square test was used to assess the relationship between variables.

Results: In each of the two groups, 40.4% were females and 59.6% were males. The mean±SD age of age in cases and controls were 52.4±13.4 and 52.1±13.1 years, respectively. Total energy expenditure of higher than 1837.5 Kcal/ day was significantly related to colorectal cancer (OR=3.8 95% CI: 1.2-11.3). Colorectal cancer risk was higher in individual with frying cooking method (OR=3 95% CI: 0. 8-11.1). The risk of colorectal cancer was 6.5 times higher in individuals with fat consumption of higher than 118.5 grams/day (95% CI: 1.5-28.8). No significant relationship was seen between vegetables consumption and the risk of colorectal cancer.

Conclusion: This study showed that high total energy expenditure, high fat consumption and using frying method for cooking are risk factors of colorectal cancer in Golestan prevince in Nothern of Iran.

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Background and Objective: Destructive effects of thyroid diseases in pregnancy and fetal frowth is well established subclinical autoimmune thyroid diseases can double the rate of preterm labor, abortion and postpartum thyroiditis. This study was done to compare thyroid function and autoimmunity derangment in goiterous and non-goiterous pregnant women. Materials and Methods: This case – control study was done on 100 healthy and 100 goiterous pregnant women in Dezyani hospital located in Gorgan, Northern Iran during 2005. Five mililiter of blood sample was obtained from each subject to measure thyroid hormones concentration including T3/ T4/ TSH/ T3 RUP and thyroid autoantibodies (Anti Tg/Anti TPO). Thyroid hormone and auto antibodies were measured using IRMA and ELISA techniques. Results: Thyroid volume was enlargel twice and tripl of its orginal size in 34% and 66% goitrious pregnant women respectively. Mean serum TSH in cases and controls were 1.81+/-1.33 microU/ml and 1.84+/-1.4 microU/ml respectively. The mean of Anti TPO and Anti Tg in cases were 373.91+-197.36 U/ml and 248.80+-70.59 U/ml respectively. The same indecs for controls were 79.52+-63.99 U/ml and 248.80+-70.59 U/ml respectively. In pregnant women with goiter 36% had high Anti TPO and 9% had high Anti Tg, but in control group 16% and 4% of controls had elevated Anti TPO and Anti Tg, respectively. Conclusion: According to thyroid function tests there were elevation of antibody in 20% of the healthy subjects and 45% of the goiterous subjects, therefore it is advisable to measure thyriod function tests accompanied with thyriod antibodies in all pergnant women either with or without goiter in order to prevent feto-maternal disorders.

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Background and Objective: Placenta previa (PP) is a common cause of pri-partum bleeding leading to high mortality and morbidity in mothers and neonates. This study was conducted to determine risk factors and outcomes of PP in Golestan province of Iran. Materials and Methods: This case-control study was done on pregnant women admitted for deliverly to the Dezyani hospital of Gorgan, Iran during 2002-07. All PP cases were recruited as case group and 251 non-PP ones were entered into the study as control group. Student t-test and Chi-Square test were used to assess the relationship between variables. Results: In this study out of 33473 pregnant cases, 82 women (0.24%) had PP. The mean (±SD) age of mothers with PP was 28.5 (±6.2) years. There was a significant correlation between PP and delivery method (P<0.05). History of cesarean section was significantly higher in cases than controls (P<0.05). The prevalence of hysterectomy due to PP was significantly higher in women with history of cesarean section (24%) than other ones (5%) (P<0.05). Conclusion: We found a significant relationship between history of cesarean section and hysterectomy due to PP. Therefore, PP should be considered in women with a history of cesarean section.

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Background and Objective: Celiac is a hereditary disease presented with chronic inflammation of small intestine. Several studies supposed a relationship between Celiac disease and Inflammatory Bowel Disease (IBD). Tissue trans-glutaminase antibody is one of the best serological markers in Celiac disease. This study was designed to evaluate the association of Celiac and IBD using tissue trans-glutaminase antibody.

Materials and Methods: In this descriptive study 127 confirmed IBD patients who were referred by gastroentrologists 2005-08 enrolled into the study. A questionnaire was completed and tissue trans-glutaminase antibody was evaluated with ELISA method with a Cut-off=12 U/ml.

Results: Among 127 referred patients, serum samples of 102 patients were collected. Mean±SD of age was 36.17±15.2 years and 48% were males. Ulcerative colitis, Crohn’s disease and other colitis were observed in 76 (74.5%), 7 (6.9%) and 19 (18.6%) of patients, respectively. Tissue trans-glutaminase antibody was positive (19.8 U/L) in one 46-years-old male patient with ulcerative colitis.

Conclusion: Tissue trans-glutaminase antibody titer was not significantly different between IBD patients and controls, thus it seems not appropriate to suggest as one of the routine tests in IBD patients.

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Background and Objective: Patellofemoral is a pain syndrome, common among athletes and the theraputic regiment based on the improvement of muscle involved in this disorder. This study was done to compare electromyography activity of the vastus medialis obliques and vastus lateralis longus during squat with isometric hip adduction in athletes with patellofemoral pain syndrome and healthy athletes.

Materials and Methods: This case – control study was carried out on 16 national team male athletes (volleyball, handball and taekwondo) aged 30-18 years with patellofemoral pain syndrome and 16 healthy male athletes. Subjects were matched based on weight, height, age, dominant of lower extremity and voluntarily participated. Electromyography activity of vastus medialis obliques and vastus lateralis longus muscles recorded by surface electrodes at 15, 30 and 45 knee flexion degrees. Paired t test was used to compare electromyography activities in each group and One-way ANOVA and Tukey post hoc test was used to compare each muscle in different angles.

Results: There was significant differences in the activity of vastus medialis obliques and vastus lateralis longus muscles in athletes with patellofemoral pain syndrome at 45 knee flexion degree (P<0.05). There were no significant differences between the muscle activities in healthy athletes at none of the knee flexion degrees. There were significant differences in the activity of vastus medialis obliques (P<0.05) and vastus lateralis longus (P<0.05) muscles at 45 degrees in comparison with muscle activities in each group in knee flexion degrees.

Conclusion: Electromyography activity of the vastus medialis obliques in healthy athletes during squat with isometric hip adduction at 45 knee flextion is greater than other degrees and in athletes with patellofemoral pain syndrome is greater than healthy athletes.

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Background and Objective: Low birth weight (LBW) is one of the most important problems in the world. Many morbidity are more prevalent in LBW included in attention deficit and hyper activity disorder (ADHD). This study was done to find the Relation between low birth weight with attention deficit and hyper activity disorder in children. Methods: This historical cohort study was done on 226 rural children in Yazd province, central area of Iran. ADHD symptoms were evaluated in LBW and NBW using DSM-IV criteria. Results: Frequency of ADHD was 22.8% in LBW and 12.5% in NBW (P<0.05). The mean of family members was 4.7±0.6 and 4.2±0.8 in child with ADHD versus child without ADHD (P<0.05). Odd's ratio for ADHD was 3.1 in patient with more than one sister or brother (95% CI: 1.2-7.9, P<0.001), and 5.7 in patients with positive familial history (95% CI: 2.6-12.4, P<0.001). Conclusion: Relationship between ADHD and LBW was statistically significant. Positive familial history for ADHD and over-crowded family were social factors related with ADHD. LBW is one of the risk factors for ADHD and can be considered in children health program ADHD was frequent in child with low birth weight than child with normal birth weight.

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Background and Objective: Obesity presented as the most pivotal public health problem. Motivational interviewing is a client-centered and direct technique to improve intrinsic motivation of people to change behavior using search and resolve ambivalence that its beneficial outcomes have widely been confirmed. This study was carried out to evaluate the effect of motivational interviewing on weight loss in women. Methods: In this randomized clinical trial study, 150 women with overweight and obesity were randomly divided into control, motivational interviewing and motivational interviewing and intention implementation groups. Data were collected through a researcher made questionnaire at baseline and 2 month follow up. Results: The score of protection motivation theory constructs including susceptibility, severity, rewards, self-efficacy, response efficacy and cost were significantly increased in the two intervention groups compared to the control group (P<0.05). Anthropometric characteristics were significantly reduced in the motivational interviewing and motivational interviewing with intention implementation group (P<0.05) in compare to the control group (P<0.05). Conclusion: Motivational interviewing integrated into intention implementation causes weight loss and increase the constructs score in women.

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Background and Objective: Smoking is one of the important risk factors for many diseases and increases the premature death.Transtheoretical models is one of the behavioral models for behavior understanding specifically in addictive behaviors. This study was done to evaluate the application of transtheoretical model to determination of smoking behavior among smokers.

Methods: This descriptive - analytical study conducted on 450 male smokers in Gorgan, northern Iran during 2014. Data gathering instruments were Diclemente smoking stages of change, Velicer decisional balance and temptation, Prochaska processes of change measurements along Fagerstrom test for nicotine dependency.

Results: Based on the stages of changes, 39.1%, 13.8%, 42.4%, 2.7% and 2% of subjects were in precontemplation, contemplation, preparation, action and maintenance stage, respectively. There was a significant relationship between stages of change with all transtheoretical model variables and nicotine dependency (P<0.05). Cons of smoking, self-reevaluation, self-liberation, and social liberation had the highest effect while helping relationship had the lowest effect.

Conclusion: Cons of smoking, self-reevaluation, self-liberation, and social liberation had the strongest predictors of smoking stages movement. Helping relationship had the lowest predictor of smoking stages movement.

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Background and Objective: Hyperlipidemia can be considered as one of the main risk factor, involved in cardiovascular disease and it is a major cause of death. This study was done to determine the effect of air part of Echinophora platyloba extract on Pituitary - thyroid axis hormones and lipid profile in hypercholesterolemic rats.

Methods: In this experimental study, 40 male Wistar rats were randomly allocated into 5 groups (n=8) including control group with normal diet, hypercholesterolemic group along with high cholesterol diet, and the three treatment groups with hypercholesterolemia which animals were received daily doses of 100, 200 and 300 mg/kg/bw of the hydroalcoholic extract of Echinophora platyloba, respectively by gavage during 42 days. At the end of this period, blood sample was obtained. Lipid profile, including total cholesterol, triglycerides (TG), low-density lipoprotein (LDL), very low-density lipoprotein (VLDL), high density lipoprotein (HDL), triiodothyronine (T3), thyroxine (T4) and thyroid hormone stimulation (TSH) were measeared using Radioimnoassay method.

Results: The level of LDL and cholesterol and TG, significantly reduced in treated group receiving the lowest dose of the extract (100 mg/kg/bw) in compare to hypercholesterolemic group (P<0.05). The level of HDL, TSH and T4 significantly increased in the treated group receiving the highest doses of the extract (300 mg/kg/bw) in compare to hypercholesterolemic group (P<0.05).

Conclusion: Echinophora platyloba extract dose dependly can alter Pituitary- thyroid axis hormones and lipid profile in hypercholesterolemic rats.

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Background and Objective: Breast cancer is a cancer in women with high prevalancy worldwide. Vascular endothelial growth factor (VEGF) is one of the most important Pro-angiogenic factors. +405C/G is one of the common VEGF polymorphism which may have an impact on the level of gene expression and over loading of gene products. This study was done to evaluate the association between VEGF +405C/G gene polymorphism and breast cancer risk in north of Iran.

Methods: This case-control study was carried out on 50 patients with breast cancer and 50 normal aged-matched controls in north of Iran. Genomic DNA was extracted from peripheral blood cells. To determine the genotype of +405 C/G VEGF gene polymorphism, PCR-RFLP method was used.

Results: The prevalence of genotypic frequencies of GG, GC and CC in controls were 42%, 48% and 10%, respectively  and in patients were 22%, 46% and 32%, respectively (P<0.05). The +405C allele was considered as a risk factor in breast cancer (P<0.05).

Conclusion: It seems +405 C/G VEGF gene polymorphism may be associated with the breast cancer in northern Iran.

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Background and Objective: Individuals habit has been changed due to technology improvement as a result fast food consumption has dramatically increased in Iran. This study was done to determine the effective factors on Fast food consumption among high-school students based on planned behavior theory.

Methods: This descriptive-analytic, cross-sectional study was conducted on 500 high-school students in Aliabad city in Golestan province in north of Iran in one year study from October 2014-2015. A valid and reliable researcher-made and self-administered questionnaire based on TPB constructs (including attitude, subjective norms, perceived behavioral control and behavior intention) was utilized to collect the data.

Results: The frequency of fast food consumption was 4.01 per month and hamburger and pizza were the most prevalent fast foods. TPB explained fast food consumption behaviors with relatively high R2 around 0.65, effectively. Frequency of fast food consumption was significantly associated with behavioral intention and subjective norms (P<0.05).

Conclusion: As friends are the effective subjective norm for student fast food consumption therefore, they must specifically be considered in developing beneficial educational interventions.

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Background and Objective: A high percentage of patients with multiple traumas sustained at least from an orthopedic problem. One of the high frequent lesions was femoral shaft fracture. The aim of this study was to determine the amount of bleeding and the need for blood transfusion in femoral shaft fractures and risk factors.

Methods: This descriptive, retrospective study was done on 84 patients with femoral shaft fractures whom were operated in Imam Khomeini Hospital in, Sari, in northern Iran during 2012-15. Age, sex, comorbidities, type of fracture, hospitalization period, pre and post-operative hemoglobin and blood unit's loss were recorded for each patient.

Results: In 43 patients (51.19%) plate and in 41 patients (48.80%) intramedullary naling were used for treatment of fractures.13 (15.47%), 33 (39.28%) and 37(44.04%) of patients were received one, two and three blood units, respectively. There was no significant relationship between energy intensity and age. There was significant relationship between the intensity and the type of fracture (P<0.05). A significant correlation existed between blood unit transfusion with sex, fracture type, hemoglobin before surgery and fracture energy intensity (P<0.05).

Conclusion: Based on the results of this study, it is recommended for hip fracture at least 3 units of blood should be reserved.

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Background and Objective: Considering the importance of coverage and quality of data in Golestan population-based Cancer Registry (GPCR), northern Iran. This study was conducted to determine the effect of the referral of cancer patients to medical centers outside Golestan province on the coverage of the population-based cancer registry program.
Methods: This descriptive-analytic study was performed on all cancer patients registered in the diagnostic centers of Golestan province, northern Iran during 2008-10. Data of patients referred to the centers of the province from the bank of the Golestan province cancer registry program and data of patients referred to the centers outside the province were received from the Ministry of Health Department of Cancer. Data were analyzed using the record linkage method.
Results: A total of 6083 new cases of cancer were registered in Golestan province. According to the cancer data, 678 (11%) of them were referred to outside of Golestan province centers. 343 of these 678 patients (50.6%) were found as duplicate records between the two datasets. The most frequent cases were gastric cancers (70.4%), breast (63.5%) and esophagus (62.5%).
Conclusion: This study suggested that referrals of cancer patients to centers outside the Golestan province may result in an underestimation of about 5% in GPCR. This level of underestimation seems to have no considerable effects on completeness and quality of data in the GPCR.

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Background and Objective: Spirituality refers to considering the cultural-religious beliefs of the people in the therapeutic process and taking into account the transcendental dimension of the clients who lead them to the transcendental source. This study was conducted to determine the effect of spirituality therapy on the resilience of women with breast cancer in Tehran, Iran.
Methods: This quasi-experimental study was performed on 30 women with breast cancer referred to the oncology and chemotherapy clinic in Tehran, Iran during 2016. Subjects were selected by available sampling method and then non-randomly divided into two groups of 15 intervention and control groups. The intervention group was subjected to psychological intervention during 11 sessions of 60 minutes and the control group did not receive intervention. Patients completed the Conner and Davidson resiliency questionnaire (2003) before and after the end of the treatment period.
Results: The mean and standard deviation of the resiliency score of the intervention and control groups in the beginning of the study were 3.64±0.22 and 3.77±1.13, respectively. This rate was 4.30±0.41 and 3.68±0.1 in patients in intervention and control groups, respectively (P<0.05).
Conclusion: Spiritual therapy intervention increased the resiliency of women with breast cancer.