Introduction:The arteriovenous (AV) fistula is a gold standard method for safe and effective repeated vascular access for patients on hemodialysis (HD). The patients, with AV-fistula access in their upper limb, have some limitations in using the involved limb both in daily living and during the dialysis process. The aim of this study was to compare range of motion (ROM), muscle strength and arm circumference of fistula created limb with the contralateral upper limb.

Material and Methods: 23 patients (50-85 year), receiving HD through AV fistula in one of their upper limbs, at least for 3 months, were enrolled. ROM, muscle strength, and arm circumference of both upper limbs were measured using goniometer, dynamometer and tape-measure, respectively. Then the values of the both sides were compared together.

Results: In ROM tests shoulder forward flexion, backward extension, internal rotation, external rotation, horizontal extension, and horizontal adduction, and in muscle strength tests shoulder abduction and hand grip were significantly (p<0.05) more limited or weaker at the fistula side. Arm circumference was significantly greater at the fistula created limb.

Conclusion: The upper limb, which is involved during HD process, is weaker and has more limited ROM in comparison with the contralateral limb. We suggest more attention to develop specific exercise programs for maintaining the abilities of the limb with AV-fistula access.

Introduction: Rhinoplasty is one of the most challenging plastic surgeries in which achieving the desired outcome requires high techniques as well as a great aesthetic vision. The aim of the current study is to compare the functional and aesthetical priority of the unilateral placement of the spreader graft in the concave side of the nose over the convex side.

Material and Methods: A descriptive study was conducted on 282 volunteer patients for primary rhinoplasty during from 2011 to 2013. Nasal examination and desirable lab data’s photography of face and nose was taken. Preoperative nasal deviation from midline of face was evaluated with the guide of preoperative photo. Then it was compared with intraoperative finding and nasal septal deviation evaluated with type  and  number of  cartilage graft .

Results: A total of 282 of patient consisting of 195 females and 87 males with a age range of 17-51 years old underwent primary rhinoplasty and were evaluated. Most operations performed on patients who are under 30 years old and 69.1% of patients were females. Two hundred and eighty cases were done through open rhinoplasty and 2 case closed rhinoplasty. One hundred and ninety one patients  (67.7%) for the cause of aesthetic and 91 patients  (32.3%) for the cause of aesthetic plus functional came for primary rhinoplasty.  Amount of pre-operative nasal deviation degree was (71.5%) and intra operative septal deviation was (91.5%), which septorhinoplasty was mostly performed  (91.5%). Fifty nine patients  (20.9%) had mild deviation and 146 (51.5%) had moderate and 77 (27.3%)  patients  had  sever  deviation.

Conclusion: Success in rhinoplasty needs to pay attention to the patients desire as well as careful nasal analysis  and  evaluation of  its  subunits together. More than 99% of patients had an open septorhinoplasty that mostly had moderate nasal deviation  (51.8%). These patients were treated with spreader graft (unilateral or bilateral) ± scoring   or batten graft usage of  different  surgical  techniques  was like  other  scientific  and  reliable  centers  in  world. 

 Introduction: Headache or facial pain, nasal obstruction, nasal discharge, PND and hyposmia or anosmia are all symptoms of rhinosinusitis. Approximately 10% of people will experience these symptoms throughout their lives. Acute and chronic rhinosinusitis causes both symptomatic inflammation of the nasal and sinus mocusa. The role of anatomical variations of osteomedal complex (OMC) in development of these symptoms has so far been discussed. The purpose of this study is to determine the frequency of these disorders in the target population and determine their possible role in the occurrence of sinonasal symptoms.

Material and Methods: This is a descriptive cross-sectional study in which patients with sinonasal symptoms referred to the ENT clinic of Loghman Hakim hospital during the period of September 2014 to September 2015 were enrolled in the study and their CT scan in the coronal view, reviewed for the existence of different anatomical variations of osteomalacial unit. Their symptoms were recorded in the table of symptoms. At the end of the study, we searched for any relation between anatomical variation of OMC and sinonasal symptoms.

Results: A total of 100 patients were enrolled in the study, of which 66 were female and 34 were male. The most common symptoms in these patients were nasal obstruction 72%, headache 67%, nasal discharge 31% and hyposmia 29%. Nasal anatomical variations were also prevalent: nasal deviation 49.57%, nasal spur 25.21%, concha bollusa 23.5%, and Infraorbital cell 1.6%.

Conclusion: The incidence of headache was higher in a group of patients with septal deviation than those with other anatomical variations and this difference was significantly higher in the group with septal spur and septal deviation at the same time than other anatomical variants. The incidence of nasal obstruction in patients with septal deviation and patients with septal deviation and septal spur at the same time was significantly higher than other variances. There was no statistically significant relationship with the effect of other anatomical variations on sinonasal symptoms.

Introduction:Edema and ecchymosis after septorhinoplasty is an unpleasant manifestation for both the patient and surgeon. Although routine nasal packing is frequently done after septorhinoplasty, assessing the relevancy of post-surgical periorbital edema and ecchymosis with nasal packing eventually may helps to clarifying more prohibitable causes of these complications that are unintentionally perform.

Materials and Methods: In an interval of 1.5 years, 124 patients whom were candidates of septorhinoplasty by one surgeon in a center of plastic and reconstructive surgery in Tehran participated in our study. Patients were randomly divided in two groups. For half of them at the end of operation bilateral routine nasal packing was done and for the rest a light dressing limited to the nostril was performed. Thereafter, sequentially in the 1^st, 3^rd, 7^th and 30^th postoperative day severity of periorbital edema and ecchymosis were recorded based on a scaling system by a third person who was not informed about the study.

Results: Conventional nasal packing is relevant to an increasing number of cases with periorbital edema and ecchymosis after septorhinoplasty. The difference between patients whom were nasally packed or not was not significant at the first postoperative day but in the 3^rd and 7^th day it was meaningfully less in number and severity in the unpacked group.

Discussion: This shows that it is not necessary to do pack in every patient after septorhinoplasty and performing a light dressing may suffice.

Background   

Free-living amoeba (FLA) such as Acanthamoeba are ubiquitous and amphizoic protozoan parasites. These parasites can cause severe human infections. Water resources are one of the important habitats for FLAs. Waters in tanks and wells can be a habitat for Acanthamoeba species, particularly in warm climates. The present study was conducted to evaluate the presence of Acanthamoeba species in tap water resources of selected cities of Hormozgan Province, Southern Iran.

Material and methods

In this cross sectional study, 50 water samples (approximately 500 mL) were collected from tap water resources (25 samples from tanks and 25 samples from wells) of Hormozgan province. The samples were filtered, cultured on 1.5% non-nutrient agar medium. After incubation at room temperature, cloning was performed. Investigation of Acanthamoeba species was performed using the microscopic method and page key.

Results

Out of 50 samples, 14 samples (28%) were found positive. Out of 25 examined well samples 9 samples (36%) were found contaminated with Acanthamoeba spp., while only 5 (20%) of 25 tank samples were found positive. All samples were cloned successfully.

Conclusion

The high occurrence of Acanthamoeba spp. in water resources of Hormozgan province could be as a hazard for public health of the region, and using effective disinfectants and accurate monitoring may be a good suggestion.

 Background: The aim of the this prospective study was to evaluate  the endoscopic ultrasonography (EUS) in detecting the cause of common bile duct (CBD) dilatation in patients in whom ultrasonography(US) could not indicate  the cause of dilation.

Methods: Seventy patients with the search criteria of unexplained dilated CBD (diameter > 7 mm) were examined by EUS. All patients (except 4 patients with pancreatic mass) were further evaluated by ERCP.

Results: The following diagnoses were made by EUS and ERCP: choledocholithiasis in 45, pancreato-biliary malignancy (PBM) in 17, papillary stenosis in 5, and no finding in 3 cases. We found that the majority of patients (95.7%) had findings on EUS to explain the etiology of their dilated CBD. The prevalence of pathology is lower (76.9%) in patients with normal liver function tests (LFTs).The yield of EUS is higher (100%) when elevated liver enzymes. Lower hemoglobin levels, larger diameter of CBD and pancreatic duct (PD) and ESR greater than 30 mm/h were independent risk factors for PBM, whereas, patients with previous cholecystectomy, normal LFTs and abdominal pain were less likely to have this diagnosis.

Conclusion: the majority of patients referred for EUS for dilated CBD will have an etiology discovered

Therefore, EUS should be the first diagnostic strategy for dilated CBD of unexplained origin, even in patients with normal LFTs. In patients with dilated CBD accompanied by anemia, abnormal LFTs and ESR or dilated PD, malignancy should be considered.

Introduction: The abuse of prescription drugs is considered as an important challenge for societies. Regarding many factors contributing to this challenge and its negative impact especially on young and educated people, there is an attempt in this paper to survey the impact of education on knowledge and attitude of medical students about the abuse of prescription drugs.

Material and Methods: This was a quasi-experimental study, which was conducted on medical students. Two groups of 53 medical students were selected as participants for both intervention group and control group. These participants were studied using the researcher-made questionnaires about knowledge and attitude toward the abuse of prescription drugs.

Results: Education plays a significant role in both raising the students’ awareness and changing their attitude about the abuse of prescription drugs. The age variable had a significant relationship with pre-training knowledge. The female participants had less pre-training knowledge about drug abuse so that it was not observed after intervention.

Discussion: It is suggested that education can be considered as a strategy to prevent drug abuse and reduce the demand for drug abuse by raising the awareness and amending the attitudes as well as promoting the anti-consumption culture.

Introduction: Leadership style is one of the most important elements of leadership or management position in labor industries. Leadership style is not how a manager or leader behaves in a given situation, but also how other employees and subordinates understand a behavior. Leadership style of a manager is a field in which such differences may occur easily. Therefore, managers not only should pay attention to the exact perception, but also predict other perception and be able to properly respond in different situations.

Material and Methods: The statistical sample consists of 18 senior executives (manager and matron) of teaching hospitals and 125 middle managers at clinical and administrative departments of hospitals. Data collection tool is a standard questionnaire of leadership effectiveness and flexibility by Hersey and Blanchard. Data were analyzed using descriptive and non-parametric tests (Kruskal-Wallis, Fisher) through SPSS 17 software.

Results: The results showed significant difference of leadership style from perspectives of managers and their subordinates based on Fisher test p=0.024.

Conclusion: There is a significant difference between leadership style from perspective of managers and their subordinates that reflects the weakness of managers communicating with subordinates. Thus, providing feedback by subordinates can improve the relationship between managers and subordinate as well as increase the awareness of managers and their subordinates. 

Introduction: Parents of children with autism are increasingly are considered as one of the primary source of intervention for their children, also there is an increasing demand for access to effective interventions for families who have children with autism. The aim of this study is to investigate the impact of parent-based pivotal response treatment (PRT) on social health (the amount of interaction a person has with their community) among mothers with autistic children.

Methods: The present study is a semi-experimental research and its design consists of pretest, posttest with control group and a sample of 40 mothers with autistic children referring to the educational and rehabilitation center of Tehran and Karaj from fall to winter of 2016., participants  were selected in two groups of control (20 people) and tested (20 people). To measure the independent variables in the pretest, post-test questionnaires, Reef psychological well-being and the social health of Keyes and Shapiro (short form) were used. The experimental group was trained for PRT during three months. Ultimately, the collected data were analyzed applying SPSS software via paired t-test and independent t-test method.  

Results: The results showed that there was significant increase in scales of social heath and psychological well-being in both experimental group and control group; but the increment was significantly higher in experimental group (P < 0.001; P < 0.023 respectively).

Conclusion: According to benefits of parental intervention in treatment and importance of increasing therapy sessions for children with autism, it is recommended that this therapy method in conjunction with conventional methods is offered to parents of children with autism specially mothers.

Background and Aim: Martyrs and veterans progeny students have unique status due to their special life condition comparing with non-veteran students. The aim of this study is to compare the psychological hardiness and resilience against educational stressors in veterans and  non-veteran students.

Materials and Methods:  Causal-comparative research method was utilized for this study.  Sample population included all veterans and non-veterans high school students of Ilkhechi (Tabriz) in the academic year of 2016 and 2017.  Sample of 80 students (40 veterans and 40 normal students) were randomly selected using Cochran formula. Data collection tools included Kobasa Hardiness Scale and Connor-Davidson Resilience Scale. For data analysis, MANOVA were performed, using SPSS version 19. The significance level was considered to be 0.05. 

Results: Results showed that there are significant differences in the psychological hardiness and resilience variables between veteran and non-veteran students (P<0.001). Based on the results, veteran students are less than average in psychological hardiness and resilience variables.

Conclusion: Our results, consistent with previous findings,indicate that students with high levels of psychological hardiness and resilience are able to maintain their psychological health in stressful and tough situations and are more prone psychological adaptation.

Background: Among the cardiovascular diseases, myocardial infraction is one the main cause of mortality around the world. People with myocardial infarction are significantly more likely to suffer from psychological problems, such as depression, anxiety and stress. Therefore, psychological interventions can help their routine treatment. The purpose of this study was to determine the effectiveness of emotional regulation therapy on depression, anxiety and stress in patients with myocardial infarction.

Methods: In this single-case design, 5 patients with myocardial infarction referred to the Taleghani Hospital were selected using convenience sampling method. They received eight sessions of emotional regulation psychotherapy. These patients were evaluated by anxiety, stress, and depression scale (DASS-21) before starting treatment and after each session.

Results: The results showed that emotional regulation therapy significantly reduced depression, anxiety and stress in patients with myocardial infarction.

Discussion: According to the findings of this study indicating the effectiveness of emotional regulation therapy on depression, anxiety and stress in patients with myocardial infarction, this treatment can be used as part of a comprehensive treatment process for these patients.

Ischemic colitis is the most common form of intestinal ischemia and is more common in the elderly and among individuals with risk factors for ischemia. Ischemic colitis is a rare complication of colonoscopy. The predisposing conditions for developing ischemic colitis following colonoscopy are connective tissue disease, advanced age and cardiovascular disease. Ischemic colitis may rarely occur following a colonoscopy without these risk factors. The data collection of 22 case of ischemic colitis (21 cases in previous reports and one case in our case) were reviewed.  Here, we report a case of ischemic colitis after a routine colonoscopy in patient without risk factors for ischemia.

Conclusion: Colonoscopy could be induced ischemic colitis, that should be brought to attention of gastroenterologist.

Background: There have been a few studies that examined the association between insight and the clinical symptoms of obsessive-compulsive disorder (OCD)  among the Middle Eastern population. The current study aimed to find a relationship between insight, general score and the specific dimensions of OCD among Iranian clinical sample.

Method: The cross-sectional research method was conducted on 108 OCD patients from 18 to 61 years old. Participants were interviewed with a semi-structured interview based on DSM-V, and those who were diagnosed with other psychiatric disorders were excluded. Also, participants filled out some self-report scales including Obsessive-Compulsive Inventory-Revised, Overall Anxiety Severity and Impairment Scale and Beck Depression-II Inventory.

Result: The results showed that poor insight has a relationship with OCD symptoms except for hoarding. Moreover, anxiety was significantly correlated with the severity of OCD.

Introduction: Hearing loss is the most common congenital disorders occurring among newborn. Identifying the factors affecting it would reduce the incidence of this disorder. Therefore, the aim of this study was to examine the etiology of congenital hearing loss in patients referring to Isfahan Cochlear implantation center.

Materials and Method: This study was performed on 689 patients with cochlear implantation. Demographic data and relative frequency of different causes of congenital hearing loss (acquired and genetic) were determined and recorded. T-test, Chi-Square and Mann-Whitney tests were used to compare the variables studied.

Results: Our findings showed that 50 patients (7.7%) had history of drug use, 9 (1.3%) had history of taking ototoxic drugs, 99 (14.3%) had history of kernicterus, 157 patients (22.8%) had a history of hyperbilirubinemia, 15 (2.1%) history of meningitis, 57 (8.3%) had a history of seizure, one (0.1%) had a birth weight less than 1500 grams, 4 cases (0.06%) had history of hypoxia, 18 cases (2.6%) had history of trauma, one (0.1%) had CMV history, and one (0.1%) hearing loss due to syndromicity. On the other hand, it was determined that the probable causes of hearing loss were not related to the severity of hearing loss and age of the patients (p <0.05)

Conclusion: Although the prevalence of congenital hearing loss is low, it is important to identify and screen for postnatal congenital hearing loss, especially in people with risk factors known in this study, including patients with kernicterus.

Introduction: Stress is a public health problem in today’s world. Spiritual health is one of the health dimensions that can affect the other ones. This study is about the connection between spiritual health and stress and cortisol level among nursing students.

Materials and Methods: This study was a descriptive analytic search that was done in Azad University, Rasht on 2013. Total of 100 students were participated in this study. Our tools for collecting data were included: demographic information such as, age, sex, occupation and marital status situation. Also, questionnaire about depression, anxiety and stress measurement (Dass_21) were utilized. Additionally, standard questionnaire about spiritual health (SWB) were used. The cortisol plasma was measured with Eliza method.

Results: According to this study, increasing the spiritual health will decrease depression, anxiety and stress among students. We also can conclude that by increasing the depression and anxiety, the cortisol level will increase. There is no connection between cortisol level and stress and spiritual health among these students, but there is a connection between believing in God (as a solution of problems and enjoying the life) and cortisol level.

Drug rash with eosinophilia and systemic symptoms (DRESS) is a critical type of drug reaction with signs such as fever, skin rash, lymphadenopathy, hematological abnormalities particularly eosinophilia, and internal organ involvement like hepatitis two to eight weeks after a drug is first used. The present case is an example of hepatitis as a manifestation of drug reaction with eosinophilia and systemic symptoms syndrome.

Case Presentation

A 17 year-old man is reported as a known case of epilepsy from childhood, who presented anti-epileptic-induced “drug reaction with eosinophilia and systemic symptoms syndrome” with a seven-day history of pruritic rash, periorbital, face and upper extremities edema, hepatitis and fever was admitted at Loghman Hakim Hospital in Tehran, Iran in December, 2015. Laboratory tests showed an eosinophilia and elevated serum liver enzymes. The patient's history showed no drug allergies, but five weeks prior to hospital admission, his therapy regimen had been changed from sodium-valproate to carbamazepine. Carbamazepine was discontinued on hospital admission, and after nine days of high-dose corticosteroid therapy the patient's symptoms and laboratory markers were stable.

Conclusion

Given the high morbidity and mortality rate of DRESS syndrome, physicians should bear in mind this severe hypersensitivity reaction particularly when starting anti-epileptic drugs. Early diagnosis of drug reaction with eosinophilia and systemic symptoms syndrome and initiation of appropriate treatment plays a key role in limiting morbidity and mortality.