farzaneh esna ashari

Colorectal cancer (CRC) is the second leading cause of cancer-related deaths with high mortality rates worldwide. Accessible screening methods have facilitated its early diagnosis. In Iran, as in many Asian countries, an important barrier to CRC screening is the insufficient knowledge of healthcare providers, including physicians, and the lack of advice from them. Available data on this subject are insufficient, and more surveys are needed in this country.

This study aimed to investigate Iranian physicians' knowledge about CRC signs and symptoms, risk factors, and screening. Additionally, the association between their knowledge and their characteristics was assessed to provide more data for further interventions.

This cross-sectional study was conducted on 150 family physicians selected by convenience sampling from rural areas in Hamadan province, Iran, from June to September 2017. A self-administered, semi-structured questionnaire was used. Data were analyzed using SPSS 21, with a significance level set at P < 0.05.

The mean total knowledge score about CRC was 25.11 ± 4.64 (64.3%) out of 38 questions. The average scores for knowledge about CRC signs and symptoms, risk factors, and the screening program were 7.1 ± 0.81 (out of 8), 10.29 ± 1.83 (out of 13), and 7.77 ± 3.43 (out of 18), respectively. Family physicians had the highest accuracy in answering questions about CRC signs and symptoms (88.7%) and the lowest accuracy in answering questions about the screening program (43%). Since the Kolmogorov-Smirnov test rejected the normal distribution of the data, nonparametric tests were used to compare physicians' knowledge scores according to different variables. The study revealed a statistically significant reverse correlation between physicians’ knowledge of CRC and their age (r = -0.342, P < 0.001), years since graduation (r = -0.228, P = 0.005), and work experience (r = -0.247, P = 0.002). However, after multiple regression analysis, only higher age significantly predicted lower total knowledge scores (P = 0.002). No significant relationship was found between participants' knowledge scores and their gender (P = 0.929) or place of employment (P = 0.399).

Family doctors had insufficient knowledge regarding CRC screening programs. To address this issue, health education programs should be designed to enhance their knowledge of CRC screening guidelines.

Epidemiologic studies point to an increased prevalence of migraine in children in recent decades. Migraine treatment involves acute and prophylactic therapy. Recently, such anti-epileptic drugs as
Levetiracetam have been used to treat adult migraines. The present study aimed to compare the efficacy of Levetiracetam, Sodium Valproate, and Propranolol in preventing migraine headaches in children.

In this clinical trial, children with migraine were randomly divided into three groups. Each group consisted of 13 children. Two groups were treated with Propranolol and Sodium Valproate, respectively. Another group (the case) was treated with Levetiracetam. The patients were assessed based on headache score, PedMIDAS, and headache frequency before and three months after the intervention. Finally, the data was analyzed using descriptive and analytical statistical methods.

Levetiracetam significantly reduced the headache severity (P=0.026), frequency (P=0.024), and PedMIDAS score (P=0.001) in children with migraine. However, no significant difference was found between the three groups. The percentage of patients who experienced pain relief was detected as 69.24%, 92.31%, and 30.76% in the Propranolol, Sodium Valproate, and Levetiracetam groups, respectively.

This study concluded that Levetiracetam can be used as a migraine prophylaxis drug in children.

Health-promoting lifestyle is one of the most important ways to control hypertension. It is a way by which people try to prevent diseases and disabilities and improve their health. This study aims to investigate the health-promoting lifestyle and its effective factors in patients with hypertension in Hamadan, Iran.

This cross-sectional study was conducted on 310 patients with hypertension referred to comprehensive urban health services centers in Hamadan in 2020, who were selected by a multi-stage sampling method. The data collection tool was a two-part questionnaire including a demographic form and the health-promoting lifestyle profile (HPLP). The findings were analyzed using the chi-square test, t-test, Mann–Whitney U test, analysis of variance, and Spearman correlation test.

The mean score of HPLP was 129.8±16.6 (ranged 49-196), indicating a moderate level. The difference in HPLP score in terms of age, sex, marital status, educational level, comorbidity, and family history of hypertension was statistically significant. The HPLP score had a significant negative correlation between age (P<0.001), systolic blood pressure (P= 0.01), and diastolic blood pressure (P<0.001).

The health-promoting lifestyle of hypertensive patients in Hamadan is not at a good level. Therefore, it is necessary to emphasize these behaviors in the educational programs for these patients and make them aware of the consequences of a poor health-promoting lifestyle.

Hypertension is one of the most important modifiable risk factors for cardiovascular diseases and adherence to treatment is an important factor in controlling hypertension and preventing its complications. In this study, beliefs related to medication and adherence to treatment in patients with hypertension were examined.

570 patients with hypertension covered by comprehensive centers of urban health services in Hamadan from disadvantaged, semi-privileged and privileged areas were selected by multi-stage sampling method. Patients' treatment adherence was assessed with the 8-item Morisky medication scale and their medication-related beliefs were assessed with the Beliefs about Medicines Questionnaire (BMQ) groups. The findings were analyzed using chi-square, Kruskal-Wallis and Spearman's correlation coefficient.

Of 570 patients, 45.7% had poor drug adherence, 33.2% had moderate adherence and 21% had good drug adherence. The mean score of medication belief was 57.99 ± 7.40. Low medication adherence was significantly related to being divorced and widowed, low economic status, low physical activity, and coexistence of other diseases, and better adherence was associated with blood pressure complications and shorter disease duration (P<0.05). A significant relationship was observed between medication adherence score and treatment harm belief (P=0.022) and drug-specific final belief (P=0.012).

Most patients with hypertension do not have good medication compliance. Beliefs related to drug therapy are effective only in the area of treatment harm and drug-specific belief on drug compliance of hypertensive patients

Cancers are the second cause of death among children. In this study, the clinical manifestations of leukemia and lymphoma in children under 15 years old, referring to Besat Hospital in Hamadan from 2010 to 2020, were investigated.

This descriptive cross-sectional study was conducted retrospectively on 203 patients with leukemia and 77 patients with lymphoma aged less than 15 years. Required data including age, gender, place of residence, initial clinical symptoms and manifestations, first laboratory findings, and type of leukemia and lymphoma were extracted from the patients’ records. Data were analyzed using independent t-test and chi-square test.

Leukemia and lymphoma showed more frequency in boys. The most frequent manifestation of the disease in leukemia was fever or weakness in 13 people (39.9%), and the symptom of the disease was pallor in 77 people (37.9%). There was a significant difference between the two types of leukemia in terms of average age (p=0.005), bleeding (p=0.011), and lymphadenopathy (p=0.038). The frequency of Hodgkin's and non-Hodgkin's lymphoma was 38 (49.4%) and 39 (50.6%), respectively. Cervical lymphadenopathy was the most common type of lymphadenopathy in patients (56 cases, 72.7%). Lymph node pain and edema were the most common symptoms (57 people, 74%). There was a significant relationship between mediastinal lymphadenopathy and the type of lymphoma (p=0.018), so that mediastinal lymphadenopathy was more frequent in Hodgkin's lymphoma.

Fever is the most common clinical manifestation and pallor is the most common initial clinical symptom of leukemia, and in children with lymphoma, lymph node pain is the most important clinical manifestation.

Despite the existence of very effective drugs in controlling blood sugar in diabetic patients, unfortunately, a small proportion of patients follow their medication. Several factors may affect in drug adherence. In this study, the effect of drug-related beliefs on medication adherence in diabetes was investigated.

In a cross-sectional study using available sampling method, 248 patients with type 2 diabetes referred to the specialized diabetes clinic in Hamedan in 1400 were selected. Medication compliance was checked with MMSQ-8 and medication belief was checked with BMQ questionnaire. Data were analyzed using chi-square, ANOVA, Kruskal-Wallis and Spearman's correlation at significance level of 0.05.

The mean age was (16.9) 52.6 years. 51.6% were women, 61.3% were men. poor, moderate, and good medication adherence rate were 53.2%, 25.8% and 21%, respectively. In patients with poor, moderate and good drug treatment, the mean (SD) of the belief score for the Specific Necessity were 17.9 (5.8), 17.2 (3.7) and 17.7 (1.2), respectively. Belief of Specific concern 16.6(0.6), 17.6 (2.3) and 1/17(1.8), belief of General overuse 13.2 (2.2), 12.6 (2.6) and 12.2 (2.3), belief in General harm were 10.6 (2.9), 10.2 (3.5) and 8.5 (0.3) and the total score of belief in drug treatment were 58.3 (1.8), 57.6 (6.8) and 55.5 (4.7) and which only the belief of General harm was statistically significant (P<0.05).

More than half of patients do not follow appropriate medication adherence. Belief about harmful side effects of diabetes drugs were significantly associated with a decrease in medication adherence.

In children suffering from febrile seizure, the likelihood of recurrence seems to be high in the early hours following the first episodes in the absence of proper interventions. The present study was aimed  at assessing and comparing the outcomes of different preventive interventions in the acute stage after febrile seizure in children.

This randomized clinical trial study was performed between September 2015 and September 2016. We enrolled patients aged between 6 and 60 months suffered from febrile seizure and referred to the Pediatric
Emergency Department at Besat Hospital in Hamadan. The eligible patients were randomly assigned to the following four receive one of the following groups: group 1 (not receiving any anti-seizure drugs), group 2 (receiving a single dose of phenobarbital) on admission, group 3 (receiving a single dose of phenobarbital on admission continued until the fever is resolved), and group 4 (receiving diazepam until the disappearance offever).

The study population consisted of 248 children. The recurrence rate of seizure in the acute stage was 4.84%. Also, the impact of diazepam and phenobarbital (either as a single dose or as continuous) on the prevention of febrile seizure recurrence in the acute stage has been established. None of the patients had febrile status epilepticus.

Controlling seizures without prescribing anti-seizure drugs increases the risk for the recurrence of febrile seizure in the acute stage. Different drug regimens for controlling seizure, including diazepam and phenobarbital (as stat or maintenance), may play a similar role in preventing the occurrence of febrile seizure

Brucellosis is a common zoonotic disease with protean clinical manifestations. Osteoarticular involvement is the most common complication of the disease. This study aimed to compare the clinical and para-clinical manifestations of brucellosis among the patients with and without spondylodiscitis.

In this comparative and cross-sectional study, 135 patients having brucellosis with and without spondylodiscitis and admitted to Sina hospital in Hamadan, Iran from March 2009 to March 2014 were included. Clinical and para-clinical data of the patients were obtained from their medical records in the hospital based on a designed checklist.

Thirty-five patients having brucellar spondylodiscitis (BS) with the mean age of 55.60 ± 14.31 years, and 100 patients having brucellosis without BS with the mean age of 43.27 ± 18.35 years were examined. A significant difference was found between the mean age of the patients with spondylodiscitis and that of those without spondylodiscitis (P < 0.001). All patients with spondylodiscitis complained of back pain and vertebral tenderness, while 60% of the patients without BS suffered from back pain but experienced no vertebral tenderness (P = 0.003). The most common vertebral involvement in spinal MRI of the patients with BS was L4-L5 (45.7%). Patients with spondylodiscitis had more increased ESR and CRP than those without spondylodiscitis (P < 0.001).

It is recommended that Brucellar spondylodiscitis be considered in the differential diagnosis of the patients with prolonged fever, back pain, and vertebrae tenderness in the endemic areas.

Gestational diabetes is a metabolic disease that can have multiple maternal and fetal complications. Therapeutic adherence can help controlling blood sugar and reducing its complications. This study investigates the medication adherence among pregnant women and effective factors on it.

This cross-sectional study was conducted on 104 pregnant women with gestational diabetes who referred to endocrinology clinic of Shahid Beheshti hospital in Hamadan, Iran, in 2018. Input criteria were those over 18 years of age and output criteria included heart, kidney and thyroid disorders. Medication adherence was evaluated using the Morisky's 6-question questionnaire (MMAS-6). Analyzes were conducted using SPSS version 21 at the significance level of less than 0.05.

Based on the results, 77.9% of the women lived in the city, 65.4% had a college education and 73.1% were housewives. 58.7% of them had good medication adherence. There was the significance relationship between adherence and glycemic control. Address and level of education had a significant relationship with medication adherence. People with higher levels of health literacy had significantly higher medication adherence.

Low education level, rural residence and low health literacy level are determinants of poor medication adherence in pregnant women with gestational diabetes, which indicate the need for more training to these people.

Coronavirus disease 2019 (COVID-19) has spread widely throughout the world and become a pandemic disease. In this study, we decided to investigate the chest computed tomography (CT) findings in COVID-19 patients in Hamadan, west of Iran. 

This cross-sectional study was conducted on 101 patients with confirmed COVID-19 infection from February to March 2020. Demographic, clinical, laboratory, and chest CT findings of identified COVID-19 patients were assessed. 

The mean age of the patients was 55.21 ± 14.08 years, and 54 (53.47%) of them were male. With regard to clinical manifestations, 82.18%, 72.28% and 54.46% of COVID-19 patients had dry cough, dyspnea, and fever, respectively. The right lower lobe was the most commonly and severely involved lope (69%), followed by left lower lobe, right middle lobe, and lingual segment; however, the anterior segment of upper lobes showed the least involvement with abnormality in the late course of the disease. The most common pattern was ground glass opacity (GGO), but atypical patterns such as round pneumonia, moderate to severe pleural effusion, and segmental lobar consolidation were seen without evidence of mediastinal adenopathy, cavitation, or nodular lesion. Chest X-ray (CXR) was not a sensitive method as the first-line imaging method because 34.65% of them were normal. 

CXR is not a sensitive method as the first-line imaging method (34.65% normal first CXR), but chest CT is a very sensitive and nonspecific modality for diagnosis of COVID-19. The lower lobe and posterior basal segments of the lungs are the most involved sites in most cases. About 12% showed atypical chest CT findings.

In cases with previous negative biopsies and a persistently elevated prostate-specific antigen (PSA) level, one of the best method for the definitive diagnosis of prostate cancer is the use of transurethral resection of the prostate (TURP). Therefore, this study aimed to compare the pathology results after the biopsy of such patients with the results obtained from TURP or open prostatectomy. 

This cross-sectional descriptive study included 95 patients referred to Shahid Beheshti Hospital, Hamadan, Iran, during 2014-19. The participants were selected by a census with a mean age of 68.81±8.38 years with total PSA>3 ng/ml and benign primary biopsy. Following that, they underwent TURP surgery. Data were extracted from hospital archives and recorded in the designed checklist. The variables including age, total and free PSA amount, prostate volume, frequency of biopsy, and the results of TURP or prostatectomy were examined in this study. Student t-test and non-parametric test of Mann-Whitney were used to analyze the data (P< 0.05).

Out of 95 patients studied after TURP or prostatectomy, 4.2% (n=4) of the cases were reported with cancer, and 25% (n=1), 50% (n=2), as well as 25% (n=1) of the patients, had Gleason scores of 5, 6, and 9, respectively, all of which were reported in the initial BPH biopsy. There was no statistically significant difference between cancer and non-cancer groups in terms of age, serum PSA, and prostate volume (P>0.05).

In patients whose PSA levels persistently increase despite previous negative biopsies, the TURP or open prostatectomy method can be used to diagnose prostate cancer more accurately.

Colorectal cancer is one of the most common cancers in Iran. Regarding the prevalence of this cancer and its mortality and morbidity, in this study, 5 Year Survival Rate and its Effective Factors of patients with colorectal cancer investigated.

This study was conducted using retrospective cohort method. All patients diagnosed with colorectal cancer during the 2006-2011 years in Hamadan Imam Khomeini Clinic of Hematology and Oncology and Mahdieh Oncology Center were studied. Require data were extracted from their medical records. To obtain information about patients, telephone calls were made. The data were analyzed by SPPS version 16 and assessment of survival rates was conducted using Kaplan-Meier methods and Cox regression method.

A total number of 108 patients with colorectal cancer were included in the study. The status of 74 patients was determined at the end of the study by follow up call   . The one, two, three, four and five overall were 77, 66, 50, 45 and 42%, respectively. The median overall survival was 46.8 months (1.3-135.6 months). Cox regression analysis showed that Metastatic tumor (p value= 0.001), lymphatic involvement (p value= 0.043) and being associated with underlying disease (p value= 0.025) was accompanied by increased risk. Multivariate cox regression test showed that metastasis was associated with increasing risk of death significantly (HR=2.83, p value= 0.013).

According to the findings of the study, early screening for increasing the survival rate is recommended for people with greater risk.

The aim of this study was to investigate the level of knowledge, attitude and practice of technicians and Radiologists, Medical Physicists and Radiographers in quality control of MRI devices.
Methods and Material: 78 radiologists, medical physicists, and radiographers in seven medical centers of Hamadan were included in this study. Each member duties were determined based on the latest changes in the MRI quality control booklet designed by ACR. Moreover, three questionnaires for each group and one questionnaire related to the specifications of the device were prepared and completed by the relevant personnel. Data were analyzed using SPSS software version 16.

The results of Spearman correlation test show that there is a weak relationship between knowledge and performance (r= -0.005), knowledge with attitude (r= -0.032) and performance with attitude (r = 0.111) in radiographers. There is a weak relationship between knowledge and performance (r= 0.3), knowledge with attitude (r= 0.246) and performance with attitude (r = -0.109) in radiologists. In addition, there is a weak relationship between knowledge and performance (r= -0.177) in Medical physicists. Although there was a strong relationship between the level of knowledge with attitude (r= 0.559) and performance with attitude (r=-0.109) in medical physicists, this relationship was not statistically significant.
Discussion and

Factors including the presence of a complete quality control group, knowledge of performance, attitude of the group, appropriate and continuous training during service, availability of appropriate tools, mandatory rules for QA and the appropriateness of the number of patients to staff are the most important factors in control the quality of MRI.

 Pulmonary hypertension (PH) in congenital heart disease affects the patient’s prognosis. Prolonged QRS and QTc intervals in ECG may intensify life-threatening dysrhythmia in patients. We aimed to investigate the correlation between QRS, QTc, and JTc intervals prolongation in ECG with PH in Congenital Heart Disease (CHD) patients.

This cross-sectional study was performed in the pediatric cardiology clinic of Be’sat Hospital in Hamadan, Iran, in 2016-2018. Patients with CHD and PH were compared with CHD patients without any evidence of PH as the control group. Afterward, QRS, QTc, and JTc intervals in ECG, RV MPI, and TAPSE echocardiography were compared between the case group (PH group) and the control group. We also compared the ECG and echocardiographic results between mild and severe PH patients in the case group.

In this study, 40 patients in the case group (with CHD and PH) were compared to 40 patients in the control group (only CHD without PH). There was a significant difference in QRS (p=0.005) and QTc (p=0.036) intervals between the two groups, but no significant difference in the JTc interval was observed.  Of 40 patients with PH, 19 were in the mild PH subgroup, and 21 were in severe PH subgroup, in which 9 patients had irreversible PH or Eisenmenger syndrome (ES). QTc (p<0.001) and QRS (p=0.018) intervals in the severe PH subgroup with ES were significantly different from the mild PH subgroup, but the JTc interval was not significantly different.

Despite longer QRS and QTc intervals in the PH group of CHD, JTc interval did not show a significant prolongation.

Intrauterine growth retardation (IUGR) is a major problem in midwifery medicine for which no effective treatment has been established. This problem has been associated with significant morbidity and mortality, as well as perinatal mortality. IUGR could be prevented when the treatment is administered before the occurance of irreversible changes. Hence appropriate methods for early detection and successful treatment deem necessary. The purpose of this study was to investigate the relationship of vitamin D serum level with IUGR in pregnant women.

This nested case-control study was conducted on pregnant women who had referred to Fatemieh hospital during 2016. Each of case and control groups included 130 pregnant women. Serum levels of vitamin D were tested in the blood samples obtained from the participants. At the end of the study, all data were analyzed in SPSS software version 16, and χ2 , Fisher exact and t tests were utilized for data analyses. Level of 0.05 was considered statistically significant.

Our results showed that the average age, body mass index at the beginning of the pregnancy, blood group, employment status, and education level were not significantly different between the two groups. Moreover, average serum levels of vitamin D were about 14.74 ng/L and 25.34 ng/L in the case and control groups, respectively. In those with vitamin D deficiency, the chance of IUGR was higher compared to those who had sufficient levels of vitamin D (6.27 times). Therefore, women who had vitamin D deficiency, had almost 6 times more chance of IUGR incidence compared to the women with adequate levels of vitamin D (P<0.05).

The results verified that serum levels of vitamin D can affect the risk of IUGR; therefore, the incidence of IUGR in babies whose mothers have enough vitamin D level during pregnancy is lower than that in other babies.

Millions of children and families suffer from child abuse worldwide.

This study aimed to investigate the related variables for different types of child abuse and their perpetrators.

This was a cross-sectional study that was conducted on high school students in Hamadan, Iran in 2016. Samples were selected by multiple cluster sampling method in which 571 students were enrolled in the study. A standard, valid and reliable self-reported questionnaire was used for recording child abuse and another part for demographic variables and perpetrators of child abuse (including: parents or other relatives, teachers, friends or classmates, strangers). After data collection, SPSS V. 21 software was used for data analysis. All P values less than 0.05 were considered as significant.

The most common types of neglect were students' discomfort and lack of welfare at home (51.0%), attention ignorance to students' demands (46.6%), and parent’s excessive expectations (39.2%). In physical abuse domain, corporal punishment conducing abrasion and burns scare (51.8%) was in top of the list and the most common forms of psychological abuse were parent’s strict behaviors (25.7%), insulting and disrespecting the students (25.4%) and humiliation of them (24.9%). Psychological and physical abuse in girls and private schools were significantly higher than others (P < 0.001). There was significant relationship between psychological abuse and smoking or substance experience in adolescents (P < 0.001). Addicted and low educated parents were reported as perpetrators for all kinds of abuse.

Understanding related variables and perpetrators of child abuse could raise the society perspectives about the importance of the subject and help decision makers for intervention programming aimed at reducing child abuse.

Background:

Pulmonary hypertension (PH) in congenital heart disease (CHD) affects the patient prognosis. QRS and QTC intervals prolongation in ECG may exaggerate life-threatening dysrhythmia in these patients. We aimed to investigate the correlation between QRS, QTC and JTC intervals prolongation in ECG with PH in CHD children.

 Materials and Method:

sIn a cross-sectional study that was performed in pediatric cardiology clinic of Besat hospital (Hamadan, Iran), during 2016-2018, patients with CHD and PH as case group (n=40) were compared to simple CHD patients without any evidence of PH as control group (n=40). Based on Pulmonary Artery (PA) to systemic pressure ratio, lower than 1/2 was considered as mild PH and equal and more than 1/2 was considered severe PH; then QRS, QTC, JTC intervals in ECG and RVMPI, TAPSE in echocardiography were compared between case (PH group), and control groups. We also compared these ECG and echocardiographic findings between mild and severe PH group.

Results:

There was significant difference in QRS (p=0.005), and QTC (p=0.036) intervals between two groups, but there was not any significant difference between JTC interval between two groups (p=0.714). Of 40 patients with PH, 19 subjects were in the mild PH group and 21 subjects were in severe PH group, in which nine patients had irreversible PH or Eisenmenger syndrome. QTC (p).

Background Preterm birth significantly affects the neonates’ survival. It also increases the risk of neonatal complications, prolongs the hospitalization period, and imposes high costs on the public health system. This study is aimed to assess the risk factors of the preterm birth. Materials and Methods This case-control study was carried out at a maternal referral hospital in Hamadan. The participants consisted of 470 preterm infants born in less than 37 weeks of gestational age (case group), and 470 term infants with normal gestational age (control group). Several variables including the neonatal birth weight, gestational age, type of delivery, the maternal age, history of infertility, birth order and maternal disease were compared in both groups. The collected data was extracted from the medical file and recorded in a pre-designed checklist; they were then analyzed using SPSS software (version 16.0). Results Mean gestational age (34.4±3.34 vs. 39.1±1.09 weeks, p=0.001), and mean neonatal weight (2475.43±683.28 vs. 3122.64±409.89 gr, p=0.001) were lower in the case group compared to the control group. Multivariate logistic regression analysis showed a statistically significant association between the preterm birth and older maternal age (OR: 1.07), history of infertility (OR: 0.5), mother exposure to smoking (OR: 2.4), intrauterine growth restriction (IUGR) (OR: 0.99), C-section delivery (OR: 0.39) and maternal diseases (OR: 0.96). Conclusion This study showed that older maternal age, history of infertility, mother’s exposure to smoking, IUGR, C-section delivery, and maternal disease were independent risk factors for preterm birth. The identification of these factors is essential in reducing the risk of preterm birth.

Gestational diabetes is a health problem and is one of the most commonly occurring complications of pregnancy worldwide, which has many effects on the mother and the fetus. The present study was conducted to determine the prevalence of gestational diabetes and its risk factors in Hamadan city, Iran. In this cross-sectional study, the study population was 534 pregnant women who were referred to control pregnancy to Hamadan health center from April 2014 to December 2016. The study participants were 534 with the age range of 15-42 years old with an average age of 26.8 and a standard deviation of 5.56. The gestational age was 4 to 29 weeks with an average of 8.32 weeks with a standard deviation of 2.68. Of the 534 participants in this study, 211 (39.5%) had gestational diabetes and there was a significant relationship between factors such as macrosomia and history of impaired glucose tolerance with the prevalence of gestational diabetes. Gestational diabetes has a relatively high prevalence in Hamadan, further information is needed in this area as well as studies based on new guidelines in different parts of the country.

  The prevalence of metabolic syndrome is on a growing trend. Weight and age are among the most important factors affecting this condition. Evidence is indicative of a relationship between coronary heart diseases and metabolic syndrome. The present study was conducted to determine the prevalence of metabolic syndrome among patients admitted to the Cardiology Department of Farshchian Hospital in Hamadan city, Iran. The present descriptive cross-sectional study was conducted on 390 patients admitted to the Cardiology Ward of Farshchian Hospital in 2015. The diagnosis of metabolic syndrome was accomplished according to the Adult Treatment Panel III criteria. The data were analyzed in SPSS software (version 16) using descriptive statistics, Chi-square test, and Student’s t-test. Metabolic syndrome was observed in 53.3% of the patients. This condition was mostly associated with ischemic heart disease (62.5%) and hypertension (50%). Abdominal obesity, high systolic and diastolic blood pressures, high fasting blood sugar, low high-density lipoprotein (HDL), and high triglyceride were significantly more frequent in patients with metabolic syndrome than in those without such condition. The results revealed no significant relationship between body mass index (BMI) and metabolic syndrome. Metabolic syndrome is highly prevalent among the patients with ischemic heart disease. Abdominal obesity, low HDL, high triglyceride, and elevated systolic blood pressure are among the proper predictive factors of metabolic syndrome. However, BMI cannot properly predict this condition.

Diabetes mellitus (DM) is a chronic disease which increases the risk of coronary artery disease (CAD). We sought to determine the relationship between the serum HbA1c level and the severity of CAD in diabetic patients. This cross-sectional study enrolled 138 patients with DM who were candidated for ive coronary angiography. HbA1C was measured in all the patients. The study population’s demographic information was collected through questionnaires. The data were analyzed with the SPSS software, version 16, and the descriptive statistical method was used to present the results. ive coronary angiography was normal in 4.3% of the patients, while 26.1% had single- vessel disease, 47.8% had double-vessel disease, and 21.7% had triple-vessel disease. The serum HbA1c was less than 7% in 23.9%, between 7% and 9% in 39.1%, and more than 9% in 36.9% of the patients. A serum HbA1c level of more than 9% was reported in 42.1% of the patients with triple-vessel disease. Our results indicated a relationship between the serum HbA1c level and the severity of CAD.

Cardiovascular patients are susceptible to drug interactions due to the simultaneous use of several drug types. The purpose of this descriptive-analytic study was to evaluate the potential drug interactions and the related factors in subjects admitted to the Cardiology Department of Farshchian heart hospital of Hamadan, Iran. This descriptive cross-sectional study was conducted on 900 subjects. The data, including drugs, sex, type of illness, and length of hospitalization were extracted from files of the patients referred to Farshchian hospital in 2014 and 2015. Drug interactions were evaluated by the Micromedex 1630. The results were analyzed using SPSS software (version 16). Of the 900 cases, 424 (47.1%) were male and 476 (52.9%) were female. A total of 4318 cases of interference were detected, 1610 (37.3%) of which were strongly interfered and 2708 (62.7%) were moderately interfered. The mean ages of males and females were 61.00 and 60.50 years, respectively (P=0.602). It was reported that 815 (90.6%) cases had at least one interaction. Based on the results, 389 male patients (91.3%) and 426 (90.6%) female patients had a drug interaction (P= 0.258). The differences of mean age, number of drugs, and length of hospitalization were statistically significant between the groups with and without interactions (P=0.001). The highest frequency of drug-drug interaction was detected with moderate severity in atrovastatin and clopidogrel with 464 repetition times. Furthermore, aspirin and clopidogrel with major severity and 485 repetitions were reported the most interfering drugs. Based on the results of this study, the amount of drug intake, length of hospitalization, and sex affect the incidence of drug interactions.

Pain alleviation and improvement of functional status are the main objectives in the treatment of osteoarthritis. Artemisia absinthium (AA) was used traditionally in reducing pain and inflammation. The aim of the present study was to compare the effects of topical formulations of AA and piroxicam gel (PG) among patients with knee osteoarthritis.
In total, 90 outpatients aged 30-70 years with the diagnosis of primary osteoarthritis in at least one knee were enrolled in a randomized double-blind clinical trial. The patients referred to the Rheumatology Clinic at Shahid Beheshti Hospital in Hamadan province during 2012-2013. The patients were randomly assigned into three groups, 30 patients per group, and respectively received AA ointment (AAO) 3%, AA liniment (AAL) 3%, and PG; three times daily (TID) for 4 weeks. The patients were visited at baseline, week 4, and week 6. The effectiveness criteria were pain severity which was assessed with a 10-point visual analog scale (VAS), the Western Ontario and McMaster Universities osteoarthritis index (WOMAC) for total pain score (WTPS), total physical function score (WTPFS), and total stiffness score (WTSS). Repeated measure ANOVA, paired t test and post hoc were used to compare variables. Statistical analysis was performed using the SPSS software, version 13.0 (SPSS Inc., Chicago, Illinois).
All groups had similar patient demographics. The administration of PG significantly improved all tested criteria with no recurrence after discontinuing the treatment protocol. AAO alleviated all tested factors except for WTSS. Alleviation was comparable to PG. AAL only reduced pain factors (VAS, WTPS) in week 4 with recurrence in week 6.
Administration of Artemisia ointment may have beneficial effects in the treatment of osteoarthritis.

Thyroid nodules are one of the most common clinical conditions. Needle aspiration is used to detect malignancy. This study aimed to determine the diagnostic accuracy of fine needle aspiration in thyroid nodules.
In this cross-sectional study, fine needle aspiration slides of 115 patients were examined by two independent pathologists and the results were reported according to the Bethesda System. Then, the diagnostic accuracy of the cytological results of fine needle aspiration was compared with the pathology result of the surgical specimen.
A total of 115 patients were assessed, with a mean age of 40.12 years. Most cases were female (84.35%), most were unilateral and on the right side (50.4%) and the mean TSH was 2.13±1.1 in the study patients. The first pathologist reported 39.13% and 60.87% of cases, respectively benign and malignant while the second pathologist respectively reported 52.63% and 63.48% benign and malignant. Kappa agreement coefficient between the two pathologists was 0.69 for the diagnosis of benign and malignant cases in thyroid nodules. The diagnostic accuracy of the first and second pathologists was 79.13% and 90.43%, respectively, in comparison with surgical pathology samples.
The pathologist has a crucial role in differentiating benign and malignant nodules in FNA specimens and preventing surgery.

As a new supplementary therapeutic option, cardiac rehabilitation (CR) is getting more attention every day. Several studies have proved its positive impact on qualitative criteria; but few studies have been done on quantitative criteria. The purpose of the present study is to evaluate the impact of CR on non-invasive measurement of maximum cardiac output by Pulse Pressure index (PPI) at the peak of exercise.
This is a non-randomized prospective cohort study conducted in Hamadan, Iran in 2015. One hundred eligible patients who had undergone coronary artery bypass surgery participated in our study, after obtaining cardiologist permission and informed consent. The PPI was measured at the peak of exercise before and after standard CR program.
Mean PPI was not significantly different before and after CR. PPI was significantly increased in patients younger than 60 years old (P = 0.022). In contrast to hypertensive patients, PPI increased significantly after CR in non-hypertensive patients (P = 0.002). PPI was significantly increased in non-diabetic patients after CR (P = 0.046), but not in diabetic individuals. Other variables did not show any statistically significant effect on PPI in response to CR.
Findings from our study revealed that PPI is associated with vascular atherosclerosis, as well as cardiac output; Positive effects of CR diminish in older, diabetic and hypertensive patients with more progressive atherosclerosis.