فصلنامه نفس
سال یکم شماره 4 (زمستان 1393)

Vitamin D is classically recognized for its role in calcium homeostasis and skeletal metabolism. Over the last few decades, vitamin D deficiency has increased in prevalence in adults and children. Potential extra skeletal effects of vitamin D have been under investigation for several diseases.Epidemiologic data suggest that low serum vitamin D in patients with asthma is associated with more symptoms, exacerbations, reduced lung function, increased medication usage and severe disease. In vitro studies have demonstrated that vitamin D enhances steroid responsiveness in adult asthmatics. Vitamin D may play an important role in pulmonary health by inhibiting inflammation, in part through maintaining regulatory T cells, and direct induction of innate antimicrobial mechanisms.More research is required to fully understand the role of vitamin D in the maintenance of airway homeostasis and address its diagnostic and therapeutic implications, however, the future investigations may show that vitamin D has some roles in asthma management. This review will examine the current clinical literature and potential mechanisms of vitamin D in asthma diseases.

Sleep apnea is a common sleep disorder which is characterized by pauses or instances of infrequent breathing during sleep. Several efforts have been made to detect breathing pauses using HRV (Heart Rate Variability) and EEG (Electroencephalography) signals. As physiological rhythms have chaotic patterns with nonlinear behavior, nonlinear analysis of these characteristics in healthy and diseased conditions provides important information about the pathophysiology of diseases. The aim of this paper is to diagnose sleep apnea using Detrended Fluctuation Analysis (DFA) of EEG signals. After noise and artifact elimination, we separated healthy sleep periods from apnea and calculated DFA for each of them. They were significantly different in stages 1 and 2 of non-REM sleep as well as REM sleep (P<0.05). Since fractal alterations of EEG happen before breathing pauses, apnea is predictable with DFA analysis of EEG signals before it actually happens.

As an important health care problem, nosocomial infections are associated with high mortality rate and increasing hospital costs. The pathogenic organisms of these infections usually transmit to patients via hospital personnel and medical devices. Among them, Candida species are the most common fungi isolated from biofilms. Particularly, the biofilms formed by these organisms are identified in immunocompromised patients. The aim of this study was the molecular identification of isolated Candida spp. from endotracheal tubes of ICU patients.Ninety five intubated and mechanically ventilated ICU patients were evaluated for the presence of endotracheal tube biofilms. The endotracheal tubes were cultured on Sabouraud Dextrose agar. Using PCR-EFLP method, the ITS1-5.8S-ITS2 region was amplified and digested by the restriction enzyme MspI.By the evaluation of 51 isolates which were derived from all samples, C. albicans was the most frequently isolated species 20 (39.2%), followed by non albicans spp. of C. glabrata 14 (27.4%), C. tropicalis 8 (15.6%), C. krusei 6 (11.7%), and C. parapsilosis 3 (5.8%).The results show that Candida albicans was the most frequent species isolated from endotracheal tubes. Knowledge about the species identification of Candida biofilms can be helpful for clinicians to manage intensive care unit patients.

Substance abuse is a major obstacle in Iran. The majority of addicted people in Iran is likely to be male, married and employed. Actual function of substance abuser employees is at about two thirds of their capability and they are three times more likely to be late for work. They have higher rate of absenteeism in work and lower productivity in their job and performance.
Our country needs some program which makes drug-free work places, because it is essential to have employees with the highest possible efficiency. We conducted this study to assess the efficacy of Employee Assistance Programs on substance abuse treatment of Dr. Masih Daneshvari hospital.
Firstly, the study collected data of 1000 full or part time employees of Dr. Masih Daneshvari hospital between Mars 2010 and June 2014. They were randomly assigned to do urine analysis. The individual who had at least two times positive urine analysis were considered as drug abusers and followed up for a period of four years. A physician was available for consultation during the program. At baseline and follow-up interviews, the participants were asked about substance abuse in past 30 days and also in past year. A negative answer to use of all substances was defined as abstinence.
All participants were male (100%). Their mean age was 37.23±6.90. Experiencing any type of tobacco amongst participants was 92.9%. The mean age of starting substance abuse was 26.25±5.79 years. In this study the mean of abstinence period of the participants was 160.75±85.28 days.
Concerning substance abuse treatment and having our experience, the quit process in workplace with a resident physician or medical team, sounds to be more effective and has the lowest rate of relapse.

In holistic care the patients are considered comprehensively, not merely as an involved organ. So, the physical and psychological managements are needed to achieve the optimum treatment results.
The current analytic cross-sectional study tried to assess the amount and pattern of substance abuse among the hospitalized COPD patients of Dr. Masih Daneshvari Hospital, in order to provide more appropriate treatment for them. Ninety COPD patients with the history of substance abuse were compared with 90 ones without any abuse history. Using ASI questionnaire and SPSS software (V21) software, the patient’s information was obtained and analyzed.
The participant’s mean age was 66±11 years, while 90% were male and 84% were married. At the time of study 37.9% was smoker which among them, 51.2% lit their cigarettes in the first 5 minutes upon waking up. Most patients (50.9%) started to use opium at the age of 20-39 years. Regular opium usage was seen in 71%; in them inhalation (64.8%) and oral (35.2%) were the intake routes. The Pattern of opium usage and number of hospital admission were related. Also, job and pattern of substances abuse were significantly related.
Most of the COPD patients continue to smoke and use opium, regardless of their progressive pulmonary disease. Thus, they are noncompliant with treatment and have obligatory multiple hospitalizations. As a result, comprehensive treatment of these patients - including both pulmonary disease and addiction - is needed to be addressed.

Cystic fibrosis (CF) is an autosomal recessive genetic disease. A mutation in the cystic fibrosis transmembrane conductance regulator (CFTR) gene caused impaired transport of chloride ions across the cell membrane. The most common microorganisms, identified in the cultures of respiratory secretions, are Staphylococcus aureus, Pseudomonas aeruginosa, and Burkholderia cepacia; recurrent infections by these microorganisms are associated with morbidity and mortality of CF patients. Severe inflammation of airways is the main cause of destruction and bronchiectasis, which may result in respiratory failure in these patients. The aim of this study was monitoring the clinical findings of laboratory tests, bacterial colonization, and antibiogram in CF patients at the Pediatric Pulmonary Department of Masih Daneshvari Hospital (Tehran, Iran) between 2006 and 2011. This cross-sectional study was on 23 children and young adults with CF, including 12 (52.2%) female and 11 (47.8%) male. The patients had a mean age of 14.5 ± 6.7 years. The sputum cultures of 10 patients (43.5%), including 5 female (41.7%) and 5 male (45.5%) were positive for P. aeruginosa. Also, in 2 cases (8.7%) it was positive for S. aureus, including 1 female (8.3%) and 1 male (9.1%). The sputum cultures of 2 other patients (8.7%) were positive for nontuberculous mycobacteria (NTM). The purified protein derivative (PPD) skin test were negative in 10 male (46%) and 12 female (55%). Based on the antibiograms obtained from sputum cultures, we found that P. aeruginosa had the highest susceptibility to ciprofloxacin (71.4%), followed by amikacin (50%), ceftazidime (30%), and ceftriaxone (18%). In this study, the prevalence of respiratory infections in patients who did not received prophylactic nebulized antibiotic was significantly higher than those patients who receive them (P

Based on WHO reports smoking is the second cause of mortality and forth cause of morbidity all over the world. Hospitals have important commitments to reduce smoking. These commitments obligate hospitals to provide smoking free environment to protect nonsmokers and encourage smokers to quit smoking.
This study was held as a cross-sectional study in Dr. Masih Daneshvari Hospital in 2013. The authors made a questionnaire for the study. Totally 347 person was entered in this investigation. SPSS version 18 was used for statistical analysis and 0.05 was considered as the significance level.
Study results showed that 10.4% of participants were current smoker. Sex and financial income was related to smoking status (p0.05).
In conclusion the results of this study showed that smoking prevalence in studied hospital staffs was lower than previous reports and smoke free hospital policy may play a role in this situation.

Asthma is the most pediatric chronic disease while involving millions of adults globally too. Iran with a prevalence of asthma symptoms and signs around 5-10% in 13-14 years old children, had reported asthma ranged between 30-50%, particularly in the Eastern areas. This is not far from the global estimation of the disease regarding WHO reports. The most prominent affaire of such chronic respiratory disease would be the burden, especially direct one, which refers to the costs the illness direct to patients and their families. In average, each patient spends 3-4 thousand American dollars in a year to control his/her asthma. Asthma is also the main cause of hospitalization in children worldwide.
Referring to the country record of sold oral inhalers in respiratory field, provided by the department of Food and Drug, the Ministry of Health of Iran, the investigators tried to compute direct burden in this regard, focusing on the total payment for inhalers from 2010 through 2012. The commonly used inhalers were divided into two groups of standard and sub special drugs to prescribe.
Respectively, 39%, 56%, and 29% of total bought inhalers between 2010 and 2012 were of the sub special expensive ones.
Nowadays, more than 35% of prescribed and bought inhalers are of more expensive sub special group in Iran which is not justified actually. Making the prescription more rational in this regard even in 10% could provide great money saving by the patients, consequently the health providers in our country.