nader zarinfar

Novel coronavirus disease 2019 (COVID-19) has become a public health concern with over 6.5 million cases and 390,000 deaths around the world. This research aimed to find an association between computed tomography (CT) scores and clinical and laboratory findings to estimate the extent of lung infection in patients with COVID-19. The study sample enrolled 129 patients diagnosed with COVID-19 from January to February 2020. The chest CT images and clinical data were reviewed, images were segmented and scored by the degree of involvement from 0 to 4, and the relationship between them and clinical and laboratory findings were analyzed statistically. This study included 74 men and 59 women with a mean age of 55.08 years. Different abnormalities were observed; the mean CT score was 8.52 (7.83 to 9.21) and the most frequent lesions were GGO and consolidation. Our results revealed significant differences between groups categorized by dyspnea, sore throat, and low oxygen saturation concerning CT scores. There was also a significant correlation between CT scores and WBC counts and CRP levels (P<0.05). The evidence from this study implies that clinical and laboratory data, such as CRP, dyspnea, lymphopenia, and symptom onset closely correspond to chest CT scores and may be employed as initial tools to estimate the extent of lung involvement in COVID-19 patients.

The today s most concerning problem in the world is the morbidity and mortality following covid19 infection. The aim of this study is to investigate different factors and their impacts on mortality rate of covid19 patients. In this review article, recent studies from February 2019 to April 2021 were assessed using English and Persian resources. The keywords were Covid19, mortality rate, underlying diseases, and demographic factors which were investigated through PubMed, Web of Science, Science Direct, Iran Medex, Ovid, Scopus, Scientific information database and Magi ran. At first 298 articles were collected. Then titles and abstracts were assessed. Due to inclusive, exclusive criteria, and aims of research, 51 articles were selected and entered to the study. Underlying diseases like hypertension, cardiovascular diseases, diabetes, and obesity could lead to the increase of covid19 complications and mortality by weakening the immune system, producing inflammation, inducing metabolic disorders, coagulopathy, and impairing respiratory system function. Demographic factors like age, sex, race and occupation could affect mortality rate of covid19 patients due to physiologic differences, rate of contacts, and protection measures. The impact of life-style on covid19 complications and mortality and preventing measures needed for modifications could be of high-interest in the future studies.

Today, with the introduction of the interferon-free direct acting antiviral (DDA) drug regimen, as well as the brilliant advances that have been made in the prevention, diagnosis and treatment of hepatitis C, medical science has come closer to eradicating hepatitis C infection. Now the question is why, despite the existence of such very effective treatments that can even eradicate the infection, the infection is still stable in many patients and reduces the quality of life of many people, the death of many patients and also transmission to other people and thus its prevalence has increased in the community. Therefore, in this study, we aimed to examine the treatment status of patients with hepatitis C and also the therapeutic capacity of these patients in Arak city.

In this study, which is a descriptive-analytical study, people with chronic hepatitis C in Arak city in 2018-19, whose disease was confirmed, were included in the study. Then, the information of these patients was collected in a questionnaire that contained demographic information, risk factors, tests and treatment process of the patient, through the information obtained from the laboratory and also during a telephone interview. Finally, the collected data were analyzed using SPSS software version 24.

In this study, a total of 429 patients whose PCR or Elisa test were positive in the years 98-97. We were able to conduct a complete telephone interview with 152 patients and prepare a complete questionnaire for them, of which 96 had a positive PCR and 56 had a positive Elisa. After interviewing the first group, it was found that 70% of patients have completed treatment and 30% have not started treatment or left it incompletely. In the second group it was found that only 43% of the patients followed and completed the treatment, and 57% did not follow the treatment. The main reason for not pursuing treatment was lack of knowledge about the disease and then addiction and treatment costs, respectively.

The treatment process in PCR-positive patients was more favorable than in ELISA-positive patients. In the first group, lack of knowledge about the dangers of the disease and in the second group, lack of knowledge about the disease was the main reason for not treating these patients. Therefore, one of the ways to eradicate hepatitis C in the community is to provide adequate information to patients.

Acinetobacter baumannii (A. baumanni) is one of the most important pathogens of Ventilator- associated Pneumonia in hospitals. Ventilator-associated pneumonia usually develops after more than 48 hours of tracheal intubation and mechanical ventilation. Prevalence of Multidrug-resistant (MDR) in Acinetobacter baumannii species is increasing. This organism can cause severe infections in hospital settings, especially in the ICU. In the past, carbapenems such as meropenem and imipenem have been used as the drug of choice in the treatment of multidrug-resistant Acinetobacter infections. Carbapenem resistance is currently increasing. Despite numerous studies to treat ventilator-associated pneumonia caused by Carbapenem- resistant A. baumanni, the best drug choice for the treatment of this pneumonia remains unclear. Although some studies suggest Colistin as a first-line drug choice for critically ill patients with ventilator-associated pneumonia, the results of a systematic review study in 2017 showed that monotherapy with sulbactam in the treatment of pneumonia caused by drug-resistant Acinetobacter is preferable to treatment with intravenous colistin. Researchers have recommended clinical trials to confirm the findings in this pneumonia. Therefore, the purpose of this study was to compare colistin based vs. Ampicillin-Sulbactam based therapy in carbapenem-resistant A. baumanni ventilator- associated pneumonia.

In this double-blind clinical trial study, 43 patients with ventilator-associated pneumonia who were admitted to the ICU of Valiasr Hospital in Arak, Iran, were included in the study and were assessed in two groups: colistin based vs. Ampicillin-Sulbactam based. Patients were evaluated at baseline and at the end of treatment for white blood cell count, ESR, and sputum culture and mortality. Inclusion criteria included age over 16 years and ventilator-induced pneumonia with carbapenem-resistant A. baumanni. Exclusion criteria included discontinuation of treatment and patient dissatisfaction to continue the study. Lower Respiratory Secretion was collected from these patients and sent to the laboratory. Isolation of bacteria was performed according to the standard bacteriological method and then using isolated biochemical methods, the isolated bacteria were identified up to the species. E-test was used to determine the lowest growth inhibitory concentration (MIC) to colistin and ampicillin sulbactam. The sample size was 33 patients in each group. There were 33 patients in the Colistin group. In the ampicillin-sulbactam group, 10 patients and 20 laboratory samples with ampicillin-sulbactam discs were also performed by antibiogram method. Laboratory sputum culture was used because antibiotic resistance was observed in the first 10 patients in the ampicillin-sulbactam group and there was no complete recovery and therefore due to concern for the lives of patients; The rest of the samples were performed in vitro. Patients were evaluated at the beginning and end of treatment on day 14. It should be noted that in order to double-blinded study, the patient and the data analyzer did not know about grouping. Data were analyzed by SPSS 20 software using descriptive statistics, t-test and chi-square. The normality of quantitative data distribution was checked by Kolmogorov-Smirnov test. The code of ethics of this dissertation was IR.ARAKMU.REC.1397.89. The registration code in Iran Clinical Trial Center for the above dissertation was IRCT20141209020258N126.

In this double-blind clinical trial study, 33 patients in the colistin group and 10 patients and 20 sputum culture samples in the ampicillin-sulbactam group were studied. The mean ± standard deviation of age of 43 patients was 48.23±16.85 years. The minimum age was 19 years and the maximum age was 85 years. In the cholistin + carbapenem group, out of 33 patients who were initially admitted to the study, 3 died before the end of the study and in the ampicillin-sulbactam group, out of 10 patients admitted to the study, 2 died before the end of the study. The number of WBC and the rate of ESR in the colistin + carbapenem group were decreased significantly (p<0.05) and 23 cases of sputum culture were negative for acinetobacter at the end of the study. in the colistin based group on day 14 of treatment, only 2 patients had higher than normal WBC counts and 24 cases had normalized chest X-rays. In the ampi-sulbactam+carbapenem group, at the end of treatment, 3 patients had normal WBC counts. Only one sputum culture was negative and 1 case had normal chest x-ray at the end of study. In 20 sputum culture samples that were examined in vitro, only two samples were sensitive to ampicillin-sulbactam and 18 cases were resistant to ampicillin-sulbactam.

The use of colistin+carbapenem improves clinical and laboratory response of patients. Therefore colistin-based therapy for the treatment of Carbapenem- resistant A. baumanni ventilator-associated pneumonia is recommended..

Impaired immune system provides favorable conditions for colonization by Acanthamoeba in the human body. In this case control study, we compared the molecular and culture methods in identifying Acanthamoeba in the nasal and oral secretions of HIV+/HIV human.

In a current case control study, nasal and oral discharge of 53, HIV+ patients and 53, HIV people were evaluated. The nasal and oral secretions of each patient were prepared by sterile swabs and transferred to the laboratory. All samples were cultured but only the positive samples used for molecular analysis.

By cultivation method, of the 53, HIV+ patients, a total of 11 samples, including 5 nasal and 6 oral samples, were contaminated with Acanthamoeba. Of the 53, HIV people, 3 samples of nasal discharge were contaminated with this parasite. The molecular method approved the contamination of 10 samples, including 5 oral and 5 nasal samples from HIV+ patients with this parasite. Statistical analysis showed the rate of infection in HIV+ patients was significantly different compared to HIV people

The results of the current study showed that the rate of Acanthamoeba infection in HIV+ patients was higher than that of HIV- individuals. Also, considering that in the control group (HIV- individuals) only the nasal discharge were infected with the parasite, it seems that in the case group (HIV + patients) the infection of the oral discharge with the parasites is due to the  entry of its cysts into the nose and transmission to the mouth

Needle Stick Injury (NSI) is one of the spread abroad and dangerous risks in nurse job that HIV, HCV and HBV are the most common infection which were transferred by blood. The aim of this study was evaluation of the education effect basis of the health belief model of knowledge and behavioral prevention of NSI. This study was a quasi-experimental that 165 nurses were selected incidentally from the hospitals they has been organized into experimental and control group. Data were collected with health belief model questionnaire and checklist before and after intervention and also for control group executive working environment was used according to universal precautions. Results showed that the mean score of knowledge and components of health belief model increased in the control group meaningfully and perceived barrier didn’t decrease meaningfully. Behaviors' scores increased and NSI decreased. Education program based on health belief model increased knowledge and most of health belief model constructs score and also improving prevention behavior and lead to decrease NSI.

Community-acquired pneumonia (CAP) is an acute infectious disease of respiratory system. CAP is a common and potentially serious illness and is associated with considerable morbidity and mortality particularly in elder adult patients and those with significant comorbidities. One of the important causes of pneumonia is Mycoplasma pneumonia which has a mild course and rarely leads to hospitalization. In this study we aimed to determine the prevalence of pneumonia caused by M. pneumoniae in hospitalized patients in Arak city.
This study was conducted in 415 hospitalized patients older than 18 years, diagnosed with CAP in Valiasr hospital in Arak city. Pharyngeal swabs or sputum were taken from all patients and tested for M. pneumoniae by real time PCR.
A total of 415 cases with mean age 53.73± 19.88 years were enrolled in the study. 54.7% of them were men and 45.3% were female. M. pneumonia was detected in 9.4% of patients. Cases were infected with M. pneumoniae had significantly lower age compared to patients with pneumonia due to other pathogens (P value: 0.001). The highest incidence of mycoplasma pneumonia was observed in the spring and summer.
This study showed that M. pneumonia is causative agent of pneumonia in 9.4% of hospitalized CAP patients. Due to highest prevalence of mycoplasma pneumonia in spring and summer and in younger cases, M. pneumoniae should be considered as a causative agent of pneumonia in younger hospitalized CAP patients in these seasons.

Spondylitis is a serious disease caused by a variety of pathogens. The identification of spondylitis etiologies is a very important medical issue. This study was conducted to compare clinical, laboratory and radiological features of the patients with tuberculous (TS), brucellar (BS) and pyogenic spondylitis (PS) in a central city of Iran.
In this retrospective study, we obtained the data of 100 patients with spondylitis from a hospital in Arak city. The patients were divided into three groups including TS (8 cases), BS (71 cases) and PS (21 cases), based on the spondylitis etiology.
The mean age of cases with TS, BS, and PS was 67.25±20.26, 55.39±15.60 and 52.19±12.74 years, respectively. The most common clinical feature was back pain followed by fever. Twenty-one cases had psoas abscess which was more common in PS group. No significant difference regarding the involved vertebral regions was observed between the groups. Intravenous drug use, history of vertebral surgery and chronic renal failure were frequent in patients with PS, and all TS cases had pulmonary involvement.
Our data showed that presence of concomitant pulmonary involvement and a confirmed history of tuberculosis are suggestive of tuberculous spondylitis. However, the distinction between TS and BS is still problematic and only a combination of clinical data, laboratory findings, radiological features and history of TB can be helpful in differentiation of TS and BS.

Brucella is a well-known intracellular bacterium entailing acute and chronic illnesses in humans and domestic animals. The infection chronicity may be affected by the cell-mediated immunity and cytokine patterns.
To evaluate the patterns of T-helper cytokines in patients suffering from chronic and acute brucellosis.
In this cross-sectional study, 22 individuals with acute brucellosis, 21 individuals with chronic brucellosis, and 21 healthy individuals with the same genetic background were recruited from October 2015 to April 2016. Peripheral lymphocytes were isolated and stimulated by phytohemagglutinin (PHA) and brucella antigen in cell culture. The lymphocyte proliferation was detected by MTT assay. After collecting the supernatants, and through the use of ELISA method, we quantified the interferon gamma (IFN-γ), interleukin (IL)-5, IL-17 and transforming growth factor–beta (TGF-β).
Patients with chronic brucellosis had a lower level antigen-specific stimulation index compared to those suffering from acute brucellosis (p=0.0001). Cases with chronic brucellosis had a lower level of IFN-γ compared to cases with acute brucellosis (p=0.001). Finally, patients with chronic brucellosis had higher levels of IL-5 and TGF-β in comparison with the acute group (p=0.01 and p=0.04, respectively).
Chronic brucellosis reduces lymphocyte proliferation and TH1 cytokine secretion, but it enhances IL- 5 and TGF-β production. Polarizing the immune responses plays a crucial part in the progression and development of chronic diseases.

Probiotics are known as a factor for prevention of infectious diseases such as urinary tract infection(UTI). The present study aimed to investigate the positive effects of probiotics on urinery truct infection of cateterized intensive care unit patients.
In a triple blind clinical trial, 125 cateterized intensive care unit patients were randomly selected and divided into two groups, Treatment group (n = 63) was well matched with placebo group (n = 62) for age and sex and duration of admission .Case group received one lactocare capsule for 10 days and control group with a same method received placebo for 10 days. In both groups urine analysis and urine culture were measured with a same method at the first day and then twentieth day and finally data were analysed with t-test.
The incidence of urinary tract infection between treatment and control group (respectively 17.4% and 22.5%) had no statistically significant difference (p=0.672). But, in terms of sex, incidence of urinary tract infections in women compared to men with the same condition was significantly different(p=0.002). In treatment group with long term cathetrization, urinary tract infections significantly were significantly different(p=0.041).
Administration of lactocare capsule has no statistically significant impact on the incidence of urinery truct infection of cateterized intensive care unit patients. In comparsion of cateterized men and women receiving probiotics, the reduction of urinary tract infection in women was more than in men. Probiotics had preventive effects on long term catheterization.

Brucellosis is one of the most common chronic diseases, with widespread distribution. In spite of cell-mediated immunity (CMI) modulated mainly via activated T-helper type 1 (Th1) cells, brucellosis can advance to chronic disease in about 10-30% of cases. Regulatory T cells (Treg cells) are involved the immune response to brucellosis; however, their role, particularly in the change from the acute to the chronic phase, have not yet been elucidated. The main hypothesis of this study was that Treg cells play critical roles in the progression of brucellosis from the acute to the chronic phase.
Forty-eight unrelated subjects participated in this case-control study. The percentages of CD4, CD25, FoxP3, and CD25/FoxP3 T cells in the peripheral blood mononuclear cells (PBMCs) of acute (AB) and chronic brucellosis (CB) patients and healthy controls were determined by flow cytometry. The mean florescence intensities (MFIs) of CD4, CD25, and FoxP3 T cells were also measured.
We found a significantly lower percentage of CD25/FoxP3 Treg cells in CB than in the AB and control groups (p We propose that the reduced number of CD25/FoxP3 Treg cells in the CB group leads to T cell anergy and this contributes to the development of chronic infection.

Regarding the role of probiotics in the balance of aerodigestive microorganism in the digestive system and the central role of bacteria colonization in the pathogenesis of ventilator associated pneumonia (VAP), the propose of this study was to investigate the effect of probiotics in prevention from ventilation associated pneumonia in ICU patients, who were undergoing mechanical ventilation with high risk for VAP.
Patients (n=60) hospitalized at ICU of Valiasr Hospital, Arak, Iran participated in a randomized, double-blind, placebo-controlled clinical trial. Patients were randomly divided into two groups (intervention and placebo). Intervention group received Lactobacillus rhamnosus Gagavage three times a day in addition to a routine care. Control group received placebo in addition to a routine care. Demographic and clinical data were recorded and clinical response to primary outcome (prevalence of VAP) and secondary (other clinical factors) was interpreted. Data were analyzed in SPSS 18, using student t-test and chi-square.
Twenty two patients (36.6%) were diagnosed with VAP, of which, 7 (23.3%), and 15 (50%) patients were in the probiotic and control groups, respectively. (p=0.03). The average of days spent in ICU (intervention: 14.2±4.7 vs control: 17.6±6.5, p=0.028), hospitalization (intervention: 24.1±5.6 vs control: 27.4±6.6, p=0.041), and number of patients with diarrhea caused by clostridium difficile (intervention: 1(23.3%) vs control: 6 (20%), p=0.04), were significantly lower in the probiotic group than the placebo group. The mean of intubation time till receiving VAP (intervention: 10.5±1.02 vs Control: 6.1±2.6, p=0.008) and full recovery (intervention: 25 (83.3%) vs control: 14(46.6), p=0.028) were significantly higher in the intervention than the control group.
These findings successfully presented that probiotics could effectively protect from VAP in a selected, high-risk ICU patients. As a result, the use of this therapy, in patients undergoing long-term intubation is recommended.

Brucella is an intracellular bacterium that causes chronic infection in humans and domestic animals. The underlying mechanisms that cause prolonged illness are complex and not fully understood. Immune responses may have an important role in the chronicity of infection. Here, we evaluated the lymphocyte proliferation responses in patients with chronic and acute brucellosis.
This descriptive - analytical study was performed on 22 patients with acute brucellosis, 21 patients with chronic brucellosis and 21 healthy people with the similar age, sex and genetic background as control group. Peripheral lymphocytes were isolated using Ficoll and the cellular proliferation was quantified in presence of antigen and phytohemaglutinin-A by MTT method.
The brucella antigen-specific stimulation index in patients with chronic brucellosis was significantly lower than the acute brucellosis patients (p=0.001). Also, stimulating the lymphocytes with phytohemaglutinin-A has shown that proliferative response in patients with chronic brucellosis was lower than the other groups (p=0.04).
The results indicated that chronic brucellosis inhibits lymphocyte proliferation. This inhibition of lymphocyte proliferation may be due to the induction of anergy.

Brucellosis is a highly contagious zoonotic disease between humans and animals known for high frequency of relapsing and ability to cause chronic infection. The function of immune system plays an important role in induction of chronic diseases. However, the role of immune system response is not completely studied. Therefore, this study designed to investigate the cytokine profile of the patients suffering from chronic and acute brucellosis. This descriptive- analytical study was performed on 22 patients with acute brucellosis (mean age 38±17), 21 patients with chronic brucellosis (mean age 43±10) and 21 healthy people (mean age 26±4) with the same age and sex as patients. The serum IFN-γ, IL-17, IL-5 and TGF- β levels were measured using ELISA method. The mean IFN-γ serum level in acute and chronic brucellosis patients group was significantly higher than control group (p=0.045). The mean IL-17 serum level in acute brucellosis patients was significant decreased once compared with control group and in chronic patients was significantly decreased when compared with control group (p=0.024). In addition, the mean IL-5 and TGF-β serum levels of acute brucellosis patients group were significantly decreased as compared to chronic patients (p=0.001). The results of current study indicate that cytokine profile of chronic brucellosis patients is more related to Th2 immune response. Hence, Th2 immune response inhibition would be an appropriate way to treat and prevent disease to become chronic.

Diarrhea is one of the most common complications of antibiotic usage. And clostridium difficile is the most common cause of Antibiotic-Associated Diarrhea (AAD). This study was aimed to investigate the infection with Clostridium Difficile Toxin (CDT) and Clostridium Difficile-Associated Diarrhea (CDAD) among hospitalized patients. This cross-sectional descriptive study was conducted on 195 patients admitted to different wards of Valiasr Hospital in Arak, Iran in the summer of 2013, by simple random sampling and considering inclusion and exclusion criteria. Demographic and clinical information of the patients was recorded using questionnaires. Among 195 patients, the prevalence positive toxin and CDAD were calculated as 14.4% and 4.1%, respectively. Incidence of CDAD had a significant relationship with antibiotic consumption history (p<0.05). Though the prevalence of positive toxin cases was more in female patients (p=0.001) and having significant relationship with diarrhea (p=0.036), no other significant relationship was found between the age, the type of hospital wards, the reason for hospitalization and antibiotic use with the results of CDT test. The CDT infection and CDAD were highly frequent in the hospital under our study. Therefore, it is suggested to implement care programs to decrease prevalence of the toxin of this organism in the patients admitted to hospitals and the related CDAD.

Background and Nosocomial infections are a major health problem worldwide. Hospital environment is a reservoir for nosocomial pathogens. This study aimed at determining the prevalence of antimicrobial resistance pattern of bacteria isolated from the environment and medical equipment in Valiasr Hospital in Arak. A total of 210 samples was collected from hospital and identified. Inducible clindamycin resistance in Staphylococcus was determined with D Zone and sensitivity to vancomycin was identified by using Mueller Hinton agar and E-test. The sensitivity of these strains to cefoxitin and oxacillin was determined by disk diffusion method. The resistance was confirmed by investigating the presence of mec A gene using PCR technique. To identify the ESBL producing gram-negative bacill standard method was used. Amp C beta lactamase resistance was assessed by Amp C disk test, and for carbapenemase resistant MHT was applied. E-test with imipenem and imipenem+EDTA were used to identify the resistance pattern of metalo beta lactamase. There were 240 isolates of which 185 (77%) were Staphylococcus. Among these isolates 136 (73.5%) were resistant to oxacillin and cefoxitin. Inducible clindamycin resistance was found in 46 (25%) isolates. Two samples of the Staphylococcus epidermidis were vancomycin resistant. The presence of Sa442 genes in Staphylococcus aureus and the mecA gene of MRSA was confirmed in all isolates expect in two. The frequency of gram-negative bacteria was 55(23%). ox51 gene was identified in acinetobacter baumannii. Fifteen nonfermenting gram-negative bacill and 40(65%) strains of Enterobacteriaceae were ESBL producers. Among the Klebsiella pneumoniae six (33.33%) were AmpC producers. MHT positive was found in nine (60%) nonfermenting bacills. According to this study presence of microorganisms in Valiasr Hospital environment and high incidence of antibiotic resistance are considered as major health problems. By determining potential pathogens in hospital setting and the pattern of antibiotic resistance markers physicians can perform more successful treatments.

Clostridium Difficile is the most common cause of antibiotic- associated diarrhea (AAD) and antibiotic associated colitis (AAC) in the hospital setting. In this Study, the preventive effect of Lactobacillus coagulance probiotic preparation was investigated on AAD and AAC. In this double blind randomized clinical trial study, 300 patients under antibiotics treatment according to our inclusion and exclusion criteria were enrolled to the study and randomly divided into two groups, case (tab probiotic, 100mg/day) and control group (placebo) from initial antibiotic administration till one week after termination of antibiotic consumption. All patients were trained about the signs of diarrhea and colitis. Colitis signs, incidence of diarrhea and its culture findings for the presence of the toxin of Clostridium difficile were recorded and compared between groups. Data were analyzed with appropriate statistical tests and using version 16 of SPSS statistical software. Antibiotic associated diarrhea (AAD) was seen in 10 (6.6%) and 16 (%10.6) patients of case and control group respectively. There was no significant difference between groups in AAD incidence and positive stool exam regarding the presence of Clostridium difficile toxin. Colitis syndrome were develop in 34 (22.8%) and 86 (57%) patients of the probiotic and placebo group respectively that was significantly low in case group (p<0.001). There was no statistically significant difference between probiotic group and placebo group in reducing AAD. But, consumption of Lactobacillus coagulance probiotic can reduce the incidence of antibiotic associated colitis.

Ventilator - Associated Pneumonia (VAP) is one of the subgroup of Healthcare - Acquired Pneumonia (HCAP) of which is one of the causes of death in hospitalized patients. The aim of this study is evaluation of epidemiological factors of Ventilator - Associated Pneumonia among ICU (Intensive Care Units) patients in Valiasr Hospital of Arak in 2012 summer. this cross - sectional study was conducted for 3 months (2012 June to August) and included all patients had been hospitalized in ICU wards of valiasr Hospital and in this time VAP diagnosis was made for them. Patients by using of checklist of which was included demographic, physical and laboratory results inf ormationwere studied and fallow up at study entry, during hospitalization and after hospital discharge. Finally the data were analyzed by using SPSS 16 statistical softwareandChi2test. Of the 67patients surveyed during the study, 60patients (89.6%) with VAP (Internal ICU (26.8%), Surgery ICU (62.7%)) were diagnosed. The most common pathogens cause s of VAP in patients were Acinetobacter spp(40%), Staphylococcus aureus(38.3%), Pseudomonas aeruginosa(8.3%) and Citrobacter (1.6%), respectively. Acinetob acters ppes the most common pathogens isolated from patients with VAP had the highest resistance and susceptibility to gentamicin with 69.6% and to imipenemwith90.9%, respectively. Among the60 patients with VAP in this study, at the end and after discharge from the hospital 11.7% full recovery, 18.3% partial recovery and 20%hadnorecoveryand also 50 % of whom were died. Results indicated that the frequency of VAP is high in the ICU of hospital. Consequently, Observance of appropriate standards is recommended to prevent of VAP in the ICU of hospitals in each center, separately.

Motivation is one of the most important tools to push faculty members to perform effectively and efficiently in the workplace is. This study is based on Herzberg''s theory of motivating factors to consider requiring faculty at the University of Medical Sciences deals. In this cross-sectional study، a total of 168 faculty members of Tehran University of Medical Sciences، 102 persons conducting a completely free and informed، a 40-question questionnaire based on Herzberg''s two-factor theory، design، a questionnaire. Data using t-test and Mann-Whitney U and indicators of central tendency and dispersion were analyzed by SPSS 16 software. Response rate to the questionnaires، 7/60، respectively. 5/24% of the faculty in the basic sciences and 5/74% at the clinical level of activity. Of «communication» and «progress and development»، the motivation faculty have the greatest impact. Factors «physical condition» and «salary» have been less effective. Between the ages of faculty motivating factors، «nature»، «responsibility and career» and «supervision and monitoring»، there was a significant correlation. The relationship between work experience and of «salary» and «job security» was also significant. Communication is one of the most important factors in increasing the motivation of faculty members in the physical conditions of work and wages are minimal impact in this area. With an aging faculty، salary، supervision and monitoring، and job security are more important motivation. In other words، with increasing age and work experience، academic expectations of the management of change and the proper evaluation of the activities of the officials do not have the decision-making، and because the quality of activities، good participate Ndah encouraged do not motivate members to create good will.

According to the studies، Iran’s per capita antibiotic consumption is remarkable. Since the emergence of Antibiotic Resistant Organisms (AROs) is considered a global problem in the community and hospitals، this study aimed to investigate the pattern of antibiotic resistance in Gram-negative bacteria isolated from patients in an academic and a non-academic hospital in Arak، Iran. This descriptive cross-sectional study included all specimens referred to the microbiology laboratory at Amir Al-Momenin Hospital (academic hospital) and Imam Khomeini Hospital (non- academic hospital) in a one-year period from June 2012 to June 2013. The susceptibility of the isolated Gram-negative bacteria against the important antibiotics used in clinical practice was determined using the disk diffusion method. A total of 846 specimens were collected from patients in the two hospitals where 520 (61. 5%) were Gram-negative bacteria، of which 63. 3% were E. coli. The prevalence of Gram-negative organisms in the academic and the non-academic hospital was measured 79. 8% and 20. 2%، respectively (P=0. 097). It was also determined that there is a significant difference between the two hospitals in the prevalence of ESBL (Extended-Spectrum Beta-Lactamase) Gram-negative bacteria (P=0. 003). There was a significant difference between the two hospitals in the prevalence of ESBL Gram-negative bacteria. Therefore، conducting regional surveillance programs to examine the patterns of antibiotic resistance is recommended.

Laboratory reference values are an important tool for clinical management of patients. Reference values being used in most laboratories in Iran have been provided from the established reference values from developed countries. However, several variables can affect on these laboratory parameters. Therefore, this study was carried out to establish the reference values of hematological parameters in the blood donors of central province of Iran as a general population. Blood samples of 1100 male blood donors were collected consecutively from Blood Transfusion Organization. Complete blood cell (CBC) count in 2012 and differential was performed using an automated hematology analyzer. The median and 95% reference values (2.5th-97.5th) for Hb and platelet counts were 15.5 g/dl (14.1-17.7) and 209 ×109 cells/L (151-322) respectively. The median for total WBC count, neutrophil, lymphocyte, monocyte and eosinophil were 6.7 ×109 cells/L (4.3-11.2), %58 (%50-%70), 40% (30-49%), 0% (0-2) and %1 (0-3%), respectively. The hematological profile of the population in central province of Iran was different from the reports of other countries and also the standards reference ranges described in textbook. So, further nationwide study should be carried out to establish the hematological reference values of the Iranian population as a whole.

Nowadays، faculty members'' developmental programs have been considered as modern strategies in order to promote and revenue teachers'' knowledge. This study aimed to comparative educational needs of faculty members in Arak University Colleges of Medical Sciences in 2012. In this cross-sectional study، educational needs of 158 faculty members were assessed in six ranges confirmed by followed ministry. These ranges contained: teaching skills، research، individual development، management executive، remedial services and outside-university activities. Data were collected by 61-section checklist in Liker. The validity and reliability of this checklist was confirmed. Data was analyzed through Epi6 and ANOVA test. In this study، the individual development priorities، research priorities، education al priorities، executive management priorities، preferences and priorities of health care services were evaluated as most of the educational needs. There was no significant difference between assessed ranges with sex and kind of faculty (P> 0. 05) but there was significant difference between type of employment، scientific degree، and record of service with assessed ranges (P< 0. 05). This study emphasizes on the necessity of needs and also adapted programs based on faculty members'' actual needs and mentioned as the main pivot to promote both medical educational quality and health services quality.

Influenza is an acute respiratory disease caused by influenza virus. Influenza epidemics are reported every year and worldwide pandemics occur with varying frequencies. The majority of mortalities are due to underlying diseases and complications associated with influenza. In this study, we evaluated ten fatal cases caused by the established type A influenza (H1N1) infection in the 2009-2010 pandemic.

This mortality survey was compiled by a review of the deceased patients’ files. The assessed variables were demographic data, underlying diseases, secondary infections, delayed commencement of therapy, and non-medication. Collected data were analyzed by measures of central tendency and dispersion using SPSS software.

In the ten deaths due to the established H1N1 virus, the median of age was 30 years and 90% of the cases had underlying diseases. Ninety percent of the deaths occurred during October and November and the rest took place in December and February.

The main cause of death was the delayed commencement of antiviral treatment. This emphasizes the importance of timely treatment in high risk patients. In flu pandemics, physicians should swiftly start specific therapy in at-risk groups to reduce the mortality rates.

Pyelonephrities is the urinary tract infection. Using supplemental dugs may decrease duration of treatment and hospitalization. We studied the effect of vitamin C on the recovery of symptoms due to pyelonephrities Methods and Materials: In this clinical trial, double blind, study, 64 patients with uncomplicated pyelonephrities were assessed in 2 groups randomly. Case group took vitamin C capsules, and control group took placebo capsules. In both groups, primary treatment was ceftriaxon capsules during hospitalization and they took ciprofloxacin capsules for 14 days after discharging. Symptoms and Urinary analysis were assessed in the first day of administration and then on the 7th and 14th days after discharging. Data were analyzed with Chi-Square test. Mean of fever duration in vitamin C group (1.130.34 SD day) and placebo group (1.560.62 SD day) significantly decrease (p=0.001). There was a significant difference in dysuria duration in vitamin C group 2.191.06 SD day with placebo group (2.971.06 SD day) (p =0.007). In flank pain, nausea and vomiting duration difference was not significantly (p≥ 0.05). It seems vitamin C, as a supplemental drug improves some pyelonephrities symptoms, such as fever and dysuria, decreases of the hospitalization period

Metronidazole has antibacterial and antiparasitic action. Therefore it can use for treatment inflammatory diseases as Crohn. The effect of metronidazole on human’s blood lipids to reducing levels of LDL and VLDL and increasing level of HDL is under investigation. Target of this research is consideration effect of metronidazole on hyperlipidemia case of death such as coronary artry disrase. Methods and Materials: This study is a triple blind clinical trial was done on 100 voluntaries between 25-65 years old. with hyperlipidemia. Samples divided in two equal groups. The first group received metronidazol, 500mg, BID, for 10 days, and control group received placebo with the same dose. Lipids of serum were measured before and after using drugs, then data analyzed by SPSS software. In metronidazol group amount of total cholesterol, LDL and Triglyceride were significantly less than placebo group. HDL’s amount in metronidazole group was significantly more than placebo group. Significant effect of metronidazole on reducing harmful blood lipids and increasing useful blood lipids. It can be suggested a probable candidate in treatment of hyperlipidemia. Maybe it can use with this application. Although it needs to more study by meta analysis to validate this effect.