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Background and Objective: Nanosilver particles are one of the functional nanotechnology filed. These nanoparticles have antibacterial characteritics. Combination therapy is one of new and specific therapeutic regiment in medicine. Eucalyptus plant is useful in growth inhibition of bacteria. This study was done to evaluate the inhibitory effect of alcoholic eucalyptus extract with nanosilver on E.coli growth. Materials and Methods: In this laboratory study, E.coli was cultured in nutrient agar medium. Primarily 50 l of bacteria was inocolulated in each plate, antibiograms disc contiminated with 3.1, 6.25, 12.5, 25 and 50 ppm concentration of nanosilver accompanied with 100% of etanolic extract of eucalyptus were placed in each plate subsequently. Diameter of inhibitory zone were evaluated following 24, 48, 72 hrs in 6th and 8th days. Data were analyzed using SPSS-15, ANOVA and Tukey tests. Results: After six days, inhibitory growth zone diameter of E.coli was 0.5 mm. This diameter in experimental group with 3.1, 6.25, 12.5, 25 and 50 ppm of nanosilver in combination with etanolic extract of eucalyptus were 0.55, 0.58, 0.82, 0.83 and 1.02 mm. Inhibitory growth zone in group of 12.5, 25 and 50 ppm of nanosilver was significant in compared to the control (P<0.05). Conclusion: The most proper time of inhibitory effect on E.coli growth is six day after treatment in combination of 50 ppm nanosilver particles with extract of eucalyptus.

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Background and Objective: Improvement in self-care and self-efficacy behaviors has proved to be a vital factor in a successful management of asthma. This study was carried out to determine the relationship of patients self-efficacy with control of asthma symptoms. Materials and Methods: This correlation study was carried out on 257 asthmatic patients (133 men and 124 women) aged 18-35, who referred to Sheykholrayis clinic of Tabriz, Iran, during 2011. Data collection tools included a questionnaire of social-personal specifications, asthma self-efficacy scale questionnaire and asthma control questionnaire as well as patients’ spirometer parameters. Data were analyzed using SPSS-17 and Pearson Correlation Coefficient test. Results: Among aspects of self efficacy, the regular use of medicine and patient relation with physician were demonstrated to be 4±0.6 and 2.7±0.7, respectively. Among aspects of asthma control, the level of activity restriction resulted by the disease during the past week and the number of spray puffs used during past week were 3±1.1 and 1.5±1.2, respectively. There was a significant relation between self-efficacy and asthma control (P<0.001, r= -0.378). Conclusion: This study showed that in asthmatic patients, self confidence is an effective factor in the control of asthmatic symptoms.

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Background and Objective: The incidence of neural tube defects (NTDs) is varied according to race, geographical situation and other predisposing factors. This study was carried out to determine the incidence rate of NTDs and its risk factors in Yasuj, Iran. Materials and Methods: This case - control study was done on live newborns in Imam Sajad hospital, Yasuj, Iran during 2000-10. 78 neonates with NTDs out of 36755 live newborns were considered as cases. The control group was also consisting of the same number of healthy neonates who born at the same period and in the same hospital. Data were collected by a check-list and analyzed using SPSS-19, Chi-Square, Logistic regression and odd’s ratio. Results: The incidence rate of NTDs was 2.12 per 1000 live births. Anencephaly and Spina Bifida was detected in 59 (75.6%) and 19 (24.3%) of affected newborns, respectively. The ratio of females to males was 1.5 times. 53.85% of mothers with affected newborns were grouped in 27-36 years age range. The mean number of pregnancies and abortion between two groups of mothers had no statistical significant differences. There is no significant relation between the mothers occupation and the incidence of NTDs. 10 (12.8%) of mothers from case group and 7 (8.97%) of mothers from control group have used tobacco. 52 (66.7%) of mothers of case group and 30 (38.5%) of controls did not consumed folic acid. The relation between non-user folic acid during pregnancy with NTDs was significant (95% CI: 1.4-6.15, OR=2.93, P<0.001). Conclusion: This study showed relatively high incidence of NTDs in Yasuj. Non-consuming folic acid increased the risk of NTD by 2.93 times.

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Background and Objective: Attention deficit / hyperactivity disorder (ADHD) is a neurodevelopment abnormality. Inattentive behavior is considered a core and pervasive feature of ADHD. This study was done to compare the executive function and working memory in attention deficit / hyperactivity disorder and healthy children. Materials and Methods: This case – control study was done on 50 children with ADHD as cases and 40 healthy children as controls. The disorder was diagnosed by applying Kanerz teacher test and confirmed by a psychiatrist. Stroop test, Wisconsin Card Sorting Test (WCST), Continuous Performance Test (CPT) and n-back test were used to assess the executive function and working memory. Results: There was a significant difference between case and control groups in regard to executive function and working memory (P<0.05). Error omission was 16.98±8.157 and 7.3±3.824 in cases and controls, respectively (P<0.05). Conclusion: Attention deficit / hyperactivity disorder reduces executive function and working memory in children.

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Background and Objective: Klebsiella species are gram-negative bacteria with positive voges proskauer (VP) reaction. Klebsiella species are found as commensal in human digestive and respiratory system. This group of organisms can create a serious health hazards in hospitalized patients, and their ability to drug resistance is a major health problems. This study was done to evaluate the efficacy of Ciprofloxacin, Ceftizoxims and Carbenicillin on Klebsiella species isolated from hospital specimens. Materials and Methods: In this laboratory study, 1200 clinical samples were isolated from patients in Imam Khomeini hospital, Tehran, Iran. The identification Klebsiella species were carried out according to conventional biochemical tests. The minimum inhibitory concentration (MIC) of carbenicillin, ceftizoxime, and ciprofloxacin antibiotics were determined using Macrodilution broth test. Results: Out of 1200 isolated samples, 25% were identified as Klebsiella species. 73% of identified Klebsiella were obtained from urine samples. Klebsiella.peumoniae with rate of 94% was the most abundant among other species. The results of MIC and minimum bactericidal concentration by using standard microdilution method showed drug resistance range of 16-1024 μg/ml, 4-256 μg/ml and 0.25-16 μg/ml for carbenicillin, ceftizoxime, and ciprofloxacin, respectivley. In general, 94%, 6% and 1% of species were resistance to carbenicillin, ceftizoxime and ciprofloxacin, respectively. Conclusion: Ciprofloxacin and Ceftizoxime are suitable for the treatment of infections due to Klebsiella species.

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Papillon-Lefevre Syndrome is a rare autosomal recessive disorder. This syndrome accompanied by palmoplantar hyperkeratosis and severe periodontal destruction of primary and permanent teeth. The teeth erupt normally but due to the severe alveolar bone loss both in deciduous as well as permanent dentitions, these teeth are exfoliated within two or three years after eruptions and by the age of 15 or 17. Patients are usually edentulous. Due to periodontal disease, the dentists are often the first ones who diagnose the syndrome. A 15-year-old girl was referred to dental clinic complaining of permanent teeth mobility. All patient’s teeth except 13, 14, 17, 23, 27, 37, 43, 44 and 47 had been extracted. The third molars were impacted. Patient has advanced periodontal disease and all teeth have mobility. There was hyperkeratosis at the palms and soles. The teeth were extracted and treated with complete denture. Early diagnosis of the papillon-lefevre syndrome can help to preserve teeth. Dental treatment included extraction of all deciduous teeth, professional prophylaxis, conventional periodontal therapy, systemic antibiotics, oral retinoid, complete dentures and implants.

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Background and Objective: Chronic osteomyelitis with huge bone defect is one of the most catastrophic problems in long bone fractures. This study was done to evaluate the distraction osteogenesis with AO tubular external fixator in chronic osteomyelitis with huge bone defect. Methods: In this descriptive study, 12 patients (11 males, 1 woman) with chronic osteomyelitis with huge bone defect underwent distraction osteogenesis with AO tubular external fixator in 5th Azar teaching hospital in Gorgan, Iran. Patients were followed up for 16 months and the onset of re-infection, bone graft, pin loosening, refracture and neurovascular injury were evaluated. Results: All of fractures were open, due to vehicle accident. The fractures include four legs, seven femurs and one tibial plateu fracture. Primary fixation was done with plate (5 cases), Intramedullary Nail (5 cases) and skeletal traction (2 cases). Mean time onset of fracture to treatment with AO tubular external fixator was 75.5 days. Mean sequestrum length was 8.8 cm which it was in femur 10.71 cm and in leg was 6 cm. Mean overall treatment was 16.08 months or 1.91 month/cm. Re-infection and neurovascular injury were not seen. Eight superficial infections treated with antibiotic and four cases of pin loosening were assembled with pin fixation. Seven cases required bone grafting. Premature consolidation in five cases and deviation of bone transport segment were found in four patients which treated with modification in external fixation. Conclusion: Distraction osteogenesis using AO tubular external fixator in chronic osteomyelitis with huge bone defect is suitable treatment method, saving the organ and prevents the amputation.

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Background and Objective: Cardiovascular diseases are the most frequent cause of death among hemodialysis patients. Left ventricular hypertrophy and systolic dysfunction are potent predictors of cardiovascular morbidity and mortality in hemodialysis patients. Cardiac troponin T and I are the indices of myocardial cell damage. This study was done to determine the relationship between serum cardiac troponin T and I with left ventricular hypertrophy and systolic dysfunction in hemodialysis patients. Method: In this case-control study, 56 hemodialysis patients were divided into two groups according to echocardiographic findings. The first group included 35 patients with left ventricular hypertrophy as case group and 21 patients without left ventricular hypertrophy as controls. Serum level of cardiac troponin T and I were measured using electro chemiluminscence immune assay. Results: Serum level of cardiac troponin T and I was significantly higher in patients with left ventricular hypertrophy (0.99±0.12 ng/ml and 0.17±0.09 ng/ml, respectively) in comparison with controls (0.37±0.05 ng/ml and 0.13±0.09 ng/ml, respectively) (P<0.05). There was no correlation between serum cardiac troponin T and I level with left ventricular systolic dysfunction. Conclusion: Cardiac troponin I and T do not have any value for the diagnosis of left ventricular systolic dysfunction in hemodialysis patients.

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Background and Objective: Attention deficit and hyperactivity disorder (ADHD) is the most common neurodevelopmental disorder in childhood. 20-50% of ADHD affacted children have sleep disorders which can cause cognitive and behavioral disorders. This study was done to determine the sleep problems in children with ADHD. Method: In this case control study, 52 children with ADHD was considered as cases and 52 school age children without ADHD as a control group in Gorgan, northern Iran during 2013. Sleep habits (CSHQ) and DSM-IV questionnaires were filled for each child. Results: Sleep problems were observed in 45 (86.5%) and 36 (69.2%) of children in case and control group, respectively (P<0.05). The mean score of sleep problems in case and control group was 48.25±6.61 and 45.87±6.23, respectively (P<0.05). The score of resistance to sleep, anxious habits of sleep and waking during night in cases were more than controls (P<0.05). Conclusion: Sleep problems in children with ADHD are more frequent than children without ADHD.

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Background and Objective: Hyperactivity / attention deficit disorder (ADHD) with 3-5% is the most common disorder in children. This study was done to compare the efficacy of behavioral, medicinal and combination of behavioral and medicinal therapy on reduction of ADHD symptoms in children. Methods: This quasi-experimental study was carried out on 40 male elementary students with ADHD in Gorgan, Northern Iran during 2011-12. Subjects were divided into the four groups including control, behavioral, medicinal (Ritalin 10 mg three times per day) and combination of behavioral and medicinal therapy. Conner's Rating Scale for parents (home) and teachers (school) were used in pretest-posttest spot after 8 weeks therapy. Results: After intervention ADHD symptoms significantly reduced in behavioral, medicinal and combination of behavioral and medicinal therapy in compared to controls (P<0.05), but this reduction was more in medicinal and combination of behavioral and medicinal therapy groups than behavioral group. Conclusion: Medicinal and combination of behavioral and medicinal therapy has the same efficacy in reducing ADHD symptoms in children.

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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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There is not comprehensive information available about the control, complications and treatment methods of factor VII deficiency. Online registry system called seven treatment evaluation registries (STER) has been created which investigated the disease as an international multi-center prospective observational project in order to provide information about the effect and immunity of available therapies. In this report, five patients with factor VII deficiency were diagnosed and registered in Golestan Province, Northern Iran, during 2010-11. All treatment protocol, demographic charectristic of patients were collected and registered in www.targetseven.org on the basis of STER´s protocol.

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Background and Objective: The national screening program for G6PD enzyme deficiency is not able to detect all affected neonates. This study was done to compare the fluorescent spot test (FST), decolorization test, and quantitative enzyme assay (QEA) for detecting G6PD enzyme deficiency in neonates. Methods: In this descriptive study, cord blood samples of 365 neonates were collected. Decolorization test, QEA and DNA test was done for each sample. All of the neonates were tested by FST as a part of national screening program on heel-prick blood sample collected on day 3–5 after birth. QEA was considered as the gold standard. According to QEA test results, neonates with <20% and 20–60% of mean normal enzyme activity were considered as total deficient and partial deficient, respectively. Results: Fluorescent spot test detected 13 male neonates with G6PD enzyme deficiency while decolorization test identified 18 male and 1 female neonates. Using QEA, 19 of male and 28 of female neonates with G6PD enzyme deficiency (26 cases with partial and 2 cases with total deficiency) were diagnosed. DNA analysis detected 34 female case as heterozygote and 14 male neonates as hemizygote for the disease. Conclusion: Fluorescent spot test do not have required sensitivity for screening of neonates with G6PD enzyme deficiency. QEA test is recommended to replace the fluorescent spot test in national screening program.

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Background and Objective: Deferoxamin is the current “gold standard” chelator in comparison with new chelators. Combined therapy of Deferiprone and deferoxamin reduces the cardiac iron overload in patients with major talassemia. This study was done to evaluate the effect of defriprone-deferoxamine on heart function in patients with major thalassemia. Methods: In this historical cohort study, 8 patients with major beta thalassemia treated by subcutaneous deferoxamine were randomly selected and LVEF (the rate of blood that exited from heart in each beat) and serum ferritin were measeared. The patients were treated by deferiprone (50-100 mg/kg/day) compained with dferoxamine (30-50 mg/kg as 3 times in a week). In the end of each year, LVEF and serum ferritin of patients were measured. Results: The ferritin level changed from 3243.12 in the first year to 2672.75 mg/kg at the end of third year. The mean of LVEF changed from 71.12% to 64.62 %. The correlation of serum ferritin and LVEF only at the end of third year was significant (P<0.05). Conclusion: Combined therapy of deferiprone-deferoxamine during 3 years reduces ferritin and LVEF in patients with major thalassemia.

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Background and Objective: Birth defects are important causes of childhood morbidity and disability. This study was done to determine the incidence and pattern of birth defects in live birth in cities of Golestan province, north of Iran. Methods: This descriptive study was carried out on 92420 live births in 13 hospitals in Golestan province, northern Iran from 21 January 2008 to 20 March 2011. The newborns were examined for the presence of birth defects. Gender, type of birth defects and residency of parents according to city in Golestan province was recorded for each newborn. Results: The incidence rate of birth defects, in Gorgan, Kordkoy, Aliabad and Gonbad was 20.46, 12.53, 10.86, and 8.99 per 1,000 live births, respectively. The incidence rate of birth defects western area (including Kordkoy, Bandargaz and Kordkoy), center (Gorgan, Capital city) and eastern area (including Aliabad, Gonbad, Minodasht and Kalaleh) of Golestan province) was 9.3, 20.46 and 8.79 per 1,000 live births, respectively. Cardiovascular anomaly was the most frequent birth defects. Conclusion: The incidence rate of birth defects varies in diferent area of Golestan provine and overally was lower than the other region in Iran.

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Background and Objective: Neonatal mortality rate is one of the most important health criteria, worldwide. Understanding the major neonatal mortality causes will help to plan for better pregnancy, prenatal and neonatal care systems. This study was conducted to determine the neonatal mortality risk factors in Maraveh Tapeh County in Golestan province, north of Iran. Methods: In this case-control study, according to either death or live in 28th day after birth, 52 neonates were considered as case group and 201 neonates were considered as control group. Data collection questionnair were adjusted and completed for each neonate. Results: Neonatal mortality rate was 11.76, 13.36 and 6.46 per 1000 live birth in 2011, 2012 and 2013, respectively. Five main causes of death were prematurity, events, birth defect, respiratory distress syndrome and sepsis, respectively. There was a significant relation between death and prematurity, birth weight and gender (P<0.05). There was relationship between birth weight and neonatal mortality (Odds Ratio=29.6). Conclusion: Prematurity and low birth weight were the most important causes of neonatal mortality in Maraveh Tapeh county in Golestan province, north of Iran.

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Background and Objective: Diabetic neuropathy is one of the most prevalent complications of diabetic micro-vascular that causing sensory loss of the legs, pain and disorder in proprioception after destroying of the lower limbs nervous system afferents consequently leads in balance disorder. This study was done to determine the effectiveness of reflexology and Yumeiho massages on lower limb pain and keep balance in females with diabetic neuropathy.

Methods: In this semi-experimental study, thirty-four patients with diabetic neuropathyin lower limb non-randomly divided into reflexology, Yumeiho and control groups. Pain and balance were measured using the visual analogue scale, Sharpened Romberg and berg test respectively that were completed at baseline and after 6 weeks. Six weeks of Yumeiho and reflexology massaging were applied over 3 days in week for 30 minutes on the experimental groups.

Results: Pain and balance of patients singnificantly improved in reflexology and Yumeiho groups in compared to controls (P<0.05). There was no significant difference between reflexology and Yumeiho groups.

Conclusion: Reflexology and Yumeiho massages have a same impact on the pain rate and balance of lower limb in women with diabetic neuropathy.

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Background and Objective: Attention deficit hyperactive disorder (ADHD) is commnest psychological disorders in children. This study was done to evaluate the effectiveness of rhythmic games on social skills of children with ADHD.

Methods: In this quasi -experimental study with pretest, post test and follow up with control group, 30 boys student with ADHD were non-randomly divided into the two groups. Conners rating scale and social skills checklist were used.

Results: Social skills significantly increased in ADHD students and this effectiveness continued in follow up stage (P<0.05).

Conclusion: Play therapy is effective on social skills of children with ADHD.

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Color vision deficiency (CVD) is a defect of vision with disability to distinguish colors. Color vision deficiency can be divided into the two categories, congenital and acquired. Congenital color vision deficiency divided into anomalous trichromacy, dichromacy and monochromacy. The most common congenital CVD was deuteranomalous that mode of inheritance is X linked recessive occurring mostly in males. Acquired CVD can occur as a direct result of illness or any related medicine. Color perception changes in acquired CVD may be secondary to primary ocular disease, drug side effect, or serious systemic disease such as diabetes. Dystrophy of cone, types of maculopathy, crystalline lens changes associated with aging, diabetes, glaucoma, optic nerve diseases and traumatic brain injuries can cause CVD. For acquired CVD, type of defect may not be easy to classify; nevertheless, predominantly is tritanopia and type and severity of the defect fluctuates during of disease. It has been suggested that human evolution to industrialized civilization has led to an increased prevalence of CVD in most population. An acquired CVD can reflect a deficiency in color information processing at anywhere along the related visual pathway, from the photoreceptors to the cortex. Sometimes, assessment of color vision can be helpful to detect a visual impairment in early stages.

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Background and Objective: Although lifestyle-related factors have separately been examined in relation to functional gastrointestinal disorders (FGIDs), there is no epidemiologic data on the combined association of lifestyle factors with these conditions. We aimed to examine how combinations of several lifestyle factors were associated with functional dyspepsia (FD), its symptoms and gastro-esophageal reflux disease (GERD) in a large group of Iranian adults.

Methods: This descriptive -analytic study was conducted on 3363 Iranian adults (19-70 yr), whom were working in 50 health centers across Isfahan province in Iran during 2012. We used easy non-random sampling to select participants. The “healthy lifestyle score” for each participant was calculated by summing up the binary score given for five lifestyle factors, including dietary habits, dietary intakes, psychological distress, smoking and physical activity. A dish-based 106-item semi-quantitative validated food frequency questionnaire, General Practice Physical Activity Questionnaire, General Health Questionnaire and other pre-tested questionnaires were used to assess the components of healthy lifestyle score. A validated Persian version of ROME III questionnaire was used, to assess functional gastrointestinal disorders.

Results: The prevalence of FD and GERD among study participants was 14.5 and 23.6%, respectively. After adjustment for potential confounders, we found that individuals with the highest score of healthy lifestyle had 79 and 74% lower odds of FD (95% CI: 0.05-0.92, OR: 0.21, P=0.03) and GERD (95% CI: 0.09-0.69, OR: 0.26, P=0.01), respectively, compared with those with the lowest score. They were also less likely to have early satiation (95% CI: 0.11-0.73, OR: 0.28, P=0.001), postprandial fullness (95% CI: 0.09-0.50, OR: 0.22, P<0.001) and epigastric pain (95% CI: 0.21-0.92, OR: 0.44, P=0.03). In addition to the combined healthy lifestyle score, low levels of psychological distress, a healthy diet, healthy dietary habits and non-smoking were separately associated with FGIDs (P<0.05).

Conclusion: This study showed that adherence to a healthy lifestyle was associated with lower odds of GERD, FD and its symptoms in this group of Iranian adults. Individual lifestyle-related factors were also associated with these conditions.