neda zamani

Fluoxetine is a Selective Serotonin Reuptake Inhibitor (SSRI) that exerts its anti-depressive effect by blocking the presynaptic reuptake of the neurotransmitter serotonin, 5-hydroxytryptamine (5-HT). Although fluoxetine is usually considered safe for most patients, in the present case report, we describe a young patient with Mixed Anxiety and Depression Disorder (MADD) treated with fluoxetine 10 mg/day, who developed hypotension when the dosage was titrated up to 20 mg/day. After discontinuing the use of fluoxetine, the symptoms of hypotension improved. A temporal association and dose-dependent relationship between the hypotension and the use of fluoxetine was observed. To the best of our knowledge, this is the first case report that precisely associates regular doses of fluoxetine with the presence of hypotension. Because boosting central serotonergic function lowers blood pressure, it is suggested that a significant effect of fluoxetine on the vasomotor center may be responsible for the reduction of blood pressure. Thus, physicians should be aware of the possible risk of hypotension induced by fluoxetine and recommend patients discontinue the drug immediately if complications have occurred.

Lactobacilli are the most well-known strains with probiotic properties that have a great effect on promoting gastrointestinal health. The purpose of this study was to isolate and evaluate the probiotic properties of local Lactobacillus in dairy products in Fars province. Gram-positive and catalase-negative bacilli were isolated and analyzed from dairy samples by chemical methods. To evaluate the probiotic properties of the isolates, their growth rate was measured at different acidic and alkaline pHs, different concentrations of bile salt and NaCl salt. The antimicrobial activity of the isolates on pathogenic bacteria was investigated by agar well diffusion method and also susceptibility testing to common antibiotics was performed by disk diffusion method. Optimal strains were identified molecularly by 16 S rRNA gene sequencing. Out of 36 gram-positive and catalase-negative strains, 10 strains were biochemically similar to Lactobacilli that 5 strains being able to grow at pH 3 to 9 and different concentrations of bile salt and NaCl salt. These bacteria had antimicrobial activity against common pathogens and were resistant to the antibiotics Clindamycin, Ampicillin, Erythromycin, and Tetracycline. Strains M3 and Y4 had better probiotic properties. Molecular evaluation showed that these two strains are 100% and 99.98% similar to Lactobacillus brevis and Lactobacillus casei strains, respectively. As a result, it was found that these two strains of Lactobacillus with approved probiotic properties are available in traditional dairy products in Fars province, which can be used in the dairy food industry to improve the quality of livestock and poultry feed.

With looking and researching at the pyramid of the population in the developing countries, particularly Iran, the importance and the status of the elderly people in the community are revealed. The Elderly people, need several facilities and equipment in their living space and the presence of elderly in the community requires meeting their needs of urban architecture and spaces. Architectural spaces and urban development play basic and important role in personal life and social life of the elderly people. The elderly people residents should be designed in such a way that responds the needs of the elderly people, and to respond to needs of user is the ultimate goal of the lifelikeness (Zendevari) architecture. The lifelikeness or Zendevari architecture is a general and reconciling pattern (framework) among all the definitions of architecture that in its definition, it consists of 25 layers. these 25 layers include countable layer , spatial layer, geometric layer, Skeletal layer, motor layer, simple mechanical layer, automated mechanical layer, biological layer, environmental layer, climatic layer, sensory layer, visual layer, imaginary layer, unreality layer , media (symbols) layer , analytical( analyzing the elements) layer , historical(importance) layer, creativity (in the building)layer, economic layer, social layer, forensic layer , moral layer , aesthetic layer, political and faith layer and educational layer. Overall, it can be said that in the lifelikeness (Zendevari) development framework, the world and its beings consist of 25 layers ,which are in interaction with each other in an unpredictable way, yet a universal and natural relation can be found between layers in two directions. This musical piece is placed based on the external forces and effects on it in new conditions, which reaches alignment and new balance by the inner and outer pulse and finds lifelikeness (Zendevari) development. Each of these layers can contain sub-layers and particular dimensions. development is the result of interaction with the environment, namely that the information and forces applied to each phenomenon, leading to development in each layer, create the conditions of lack of balance in the phenomenon, which must reach balance in an internal interaction among layers so that the whole phenomenon is placed in new conditions of Development. These two processes are called the inner pulse and the outer pulse, which in case of alignment produce lifelikeness (Zendevari). And this is the basis of lifelikeness (Zendevari) development process .The objective of the present study is to present the design criteria of lifelikeness (Zendevari) space in old users. Research methodology of this research is descriptive-analytical and to collect data, two methods of field and library were used, which major part of studies were obtained through interviews with the elderly people, observing, features, as well investigating the their interests and expectations of elderly people residents . At the end of the study, recommendations are offered to design lifelikeness (Zendevari) spaces in elderly land uses (elderly people residents). Keywords: elderly people, residents , lifelikeness (Zendevari), architecture, design.

 Diplopia, or double vision, is a common ophthalmologic complaint with many underlying causes, ocular and neurological. Aripiprazole has been reported to have fewer adverse effects and better efficacy than other atypical antipsychotics. Although ocular side effects of aripiprazole are not remarkable, two cases of diplopia associated with aripiprazole have been reported in the literature.

Herein, we report the third case of diplopia, after the aripiprazole prescription in a woman with depressive disorder.

A 37-year-old woman was brought to our clinic with symptoms of sleep loss, displeasure, auditory hallucination, and pessimistic thoughts. After a clinical interview, the patient was diagnosed with depression with psychotic features according to the Diagnostic and Statistical Manual (DSM-V) of mental disorders. She underwent treatment with 15 mg/d aripiprazole and 20 mg/d fluoxetine. Her symptoms reduced after three months as indicated by the visual analog scale. However, the patient returned to the clinic and complained of double vision. Neither neurological nor ophthalmological problems were observed following examinations by specialists. When the dose of the drug decreased and eventually discontinued, diplopia disappeared over 24 hours.

Since the patient had no history of diplopia and two cases of diplopia associated with aripiprazole were previously reported in the literature, we expected that the diplopia was related to the recently prescribed aripiprazole treatment. Physicians should be aware of the possible risk of diplopia-induced by aripiprazole and recommend patients discontinuing the drug immediately if complications have occurred.

Nowadays, use of natural colors in food and medicine, due to toxic effects of synthetic colors is so important. Phycocyanin (PC) is an innate blue pigment with many mercantile usages in foods, cosmetics and medicines extracted from Spirulina platensis. In addition, it has been proven that phycocyanin has antifungal, antioxidant and anticancer activities. The present study was undertaken to value the antifungal activity of phycocyanin which was separated from the blue green algae Spirulina platensis cultured in Iran.  Phycocyanin extracted by sonication and centrifugation and purified by ammonium sulfate sedimentation and dialysis method. Purified sample was tested by UV Spectrophotometer absorption and FT-IR and antifungal activity of phycocyanin in different concentration was investigated against Candida albicans, on sabouraud dextrose (SD) agar plates, under sterile conditions. In UV Spectrophotometer, a wide peak range at 280, 615, 652 nm was gained. Also, structure and molecular bonds of phycocyanin was confirmed via FT-IR. An Anticandidal activity of phycocyanin was confirmed and maximum anti-fungal activity was observed in 20 and 25 mg/ml concentration of phycocyanin. In the present study, the use of phycocyanin has shown an antifungal effect against Candida albicans. This pigment seems to be a good alternative to chemical drugs in the treatment of Candidiasis.

The present study intends to shed light on 25 lifelikeness layers in Imam Jome’eh House (Khaneh Emam Jome’eh) in Isfahan as one of the prominent historical monuments dating back to Qajar dynasty. The present study intends to shed light on 25 lifelikeness layers in Imam Jome’eh House (Khaneh Emam Jome’eh) in Isfahan as one of the prominent historical monuments dating back to Qajar dynasty. The lifelikeness or Zendevari architecture is a general and reconciling pattern (framework) among all the definitions of architecture that in its definition, it consists of 25 layers. these 25 layers include countable layer , spatial layer, geometric layer, Skeletal layer, motor layer, simple mechanical layer, automated mechanical layer, biological layer, environmental layer, climatic layer, sensory layer, visual layer, imaginary layer, unreality layer , media (symbols) layer , analytical( analyzing the elements) layer , historical(importance) layer, creativity (in the building)layer, economic layer, social layer, forensic layer , moral layer , aesthetic layer, political and faith layer and educational layer. Overall, it can be said that in the lifelikeness (Zendevari) development framework, the world and its beings consist of 25 layers, which are in interaction with each other in an unpredictable way, yet a universal and natural relation can be found between layers in two directions. The study method used in the current research is of an analytic-descriptive type, and data collection was performed in a field-, interview- and library-based method, and some strategies were presented to strengthen the zendevari (lifelikeness) of the building under study in a SWOT analysis method. The study method used in the current research is of an analytic-descriptive type, and data collection was performed in a field-, interview- and library-based method, and some strategies were presented to strengthen the zendevari (lifelikeness) of the building under study in a SWOT analysis method.

The present study aims to evaluate the cost-effectiveness of Dynamic Interspinous Spacer (Coflex®) and Static Spacer (X-STOP ®) compared to Laminectomy (LAMI) in patients with lumbar spinal stenosis.
A decision-analysis model was developed to estimate the cost-effectiveness. The effectiveness parameters were obtained from a systematic literature review in relevant databases including PUBMED and EMBASE. A meta-analysis was performed using the STATA statistical package and a random model was used to collect measures of mean difference of visual analogue scale (VAS) pain score before and after intervention in X-stop, Coflex and LAMI (95% confidence intervals). Cost data were obtained from provider and associated literature based on health care provider prospective. We assumed that the probability of the success rate of surgery in each intervention from associated literature and calculated Incremental cost effectiveness ratio. A one-way sensitivity analysis was also carried out.
Twenty-four out of 294 studies are included in the Meta-analysis. The overall pooled estimate of the mean difference of VAS pain score were 3.49 (95% CI 3.7-4.2) and 4.14 (95% CI 3.09-5.19) for X-stop and Coflex, respectively. In addition, we assumed the overall pooled estimate of 5.3 (95% CI 2.15-7.4) on the basis of literature for LAMI. The average cost per LAMI surgery, X-stop and Coflex was US$ 3019, US$ 2022 and US$ 2566, respectively. Incremental cost effectiveness ratio of X-stop and Coflex versus LAMI was US$ 665.9 and US$ 780.7, respectively.
Static Interspinous Spacer (X-stop) appears to be the most cost-effective treatment strategy in base case scenario with success rate of LAMI (range between (55%-70%). A sensitivity analysis shows that the increase probability of success rate of LAMI was more than 70 % and less than 55% which lead to the cost effectiveness of the Coflex intervention.

Despite the descending trends of gastric cancer in many parts of the world, its mortality rate has still remained high globally. Meat, red and processed meat in particular, may induce gastric carcinogenesis through potential mechanisms. However, the role of this dietary aspect in the risk of gastric cancer has not well been investigated so far. Therefore, we designed a study to assess the relation between meat consumption and the risk of gastric cancer in Golestan Province, a high- risk area for gastric malignancies in Iran. Subjects of this population-based case-control study included 190 histologically confirmed cases of gastric cancer and 647 controls. Meat consumption was evaluated using a 116-item semi-quantitative food frequency questionnaire. A lifestyle questionnaire also collected data concerning demographic features, anthropometric measures, and other known risk factors of gastric cancer. We estimated crude and adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for the relation between meat intake and gastric cancer. After being adjusted for potential confounders, red meat intake was positively associated with gastric cancer which reached statistical significance (OR = 1.87, 95% CI: 1.01–3.47, Ptrend = 0.073). On the other hand, individuals in the highest quartile of white meat consumption had a statistically significant reduced risk of gastric cancer compared to those in the lowest quartile (OR = 0.36, 95% CI: 0.19–0.68, Ptrend = 0.005). We observed a positive association between red meat consumption and the risk of gastric cancer, and a reverse relationship regarding white meat intake and the risk of this malignancy.

Children account for 30-70% of all patients seen in outpatient clinics. Studies have shown integrated methods to improve quality of outpatient care in children. The present study aimed to compare quality of care between routine and integrated methods in pediatric outpatient setting.

This double-blinded prospective study was carried out in two pediatric clinics of Amin Hospital (Isfahan، Iran). Non-probability convenience sampling was used to select 100 children. Performance of medical interns in visiting these children was assessed by an observer through a checklist. Then، students in clinic A were trained in Integrated Management of Childhood Illness (IMCI) algorithms. The performance of the two groups in visiting 100 children was reevaluated at the end of the period again. The mean of their scores and frequency of each item of the checklist was calculated and compared between the two groups.

The mean scores of performance of the two groups had no significant difference. Only the frequency of few items of the checklist was significantly different between the two groups.

We found no significant difference between the two groups. It may be due to short training period، interest in textbooks، lack of knowledge about efficacy of IMCI algorithms in the future work، and not having adequate time for practicing. Another reason may be low power of our study.

In recent years, it is well-known that vitamin D deficiency has many complications, especially in elderly people and especially in Iran due to existence of multiple risk factors. So, awareness of vitamin D average and identify risk factors can be helpful to find ways to improve life in elderly.

This cross-sectional study was conducted in Isfahan, Iran, during 2011. Our cases were 180 women with the age of more than 60 years referred to 2 laboratories in Isfahan. The 25(OH)D serum level were measured by ELISA method and then, final statistical evaluations were analyzed.

The mean vitamin D concentration was 141.55 ± 70.13 nm/l and the minimum and maximum serum levels of vitamin D were 36.9 and 365.8 nm/l, respectively. The ANOVA test showed that the mean vitamin D level had a significant difference according to age group (P = 0.043) and body mass index (BMI) (P = 0.023). The mean vitamin D level was significantly higher in women using vitamin D supplements (P = 0.003).

According to this study, due to prevalence of vitamin D deficiency in Iran, it is necessary to identify its risk factors and prevent it in elderly people.

One of the major causes of mortality in patients with kidney failure requiring dialysis is cardiovascular diseases. Metabolic syndrome refers to a collection of metabolic disorders that causes systemic inflammation and therefore plays an important role in increasing the incidence of cardiovascular disorders and the associated mortality and morbidity. Given the increasing prevalence of metabolic syndrome in the general population, this study was designed to investigate the prevalence of metabolic syndrome in patients on peritoneal dialysis and hemodialysis. A cross-sectional study on 170 patients on dialysis was performed in Alzahra Hospital, Isfahan, Iran. Blood samples were obtained to examine glucose, lipid profile, hemoglobin, albumin, parathyroid hormone (PTH), calcium, phosphorus, and white blood cell count (WBC). Blood pressure, weight, height, and waist circumference were also measured by standard methods. The information of patients was recorded in a questionnaire. Metabolic syndrome was observed in 67% of the studied population. The prevalence of metabolic syndrome was higher in females than males (77% vs. 57%). The syndrome was also more prevalent among peritoneal dialysis patients than individuals on hemodialysis (73% vs. 47%). The highest prevalence in hemodialysis patients was seen in patients who were dialyzed through a temporary catheter. The average weight, body mass index, albumin levels, and WBC were significantly higher in patients with metabolic syndrome. However, the differences in hemoglobin, PTH, calcium, and phosphorus values were not statistically significant between patients with and without metabolic syndrome. The prevalence of metabolic syndrome is high in dialysis, especially in peritoneal dialysis, patients. In addition, women are more at risk than men. Therefore, in order to prevent cardiovascular mortality and morbidity, these patients need to be regularly examined to diagnose and treat the risk factors of metabolic syndrome as soon as possible.

As medicl cares improve and mortality rates decrease, an increase in elderly population is seen. These people need more attention for their health status. Among the different aspects of health, quality of life has a special importance, because of its ability to performance of daily life duties, general health emotion, and also effect of different physical, psychology, social and economic causes on it. This study aimed to design and validate a questionnaire to measure health related quality of life in Iranian elderly.

This triangulation study was developed in Isfahan city, Iran in 2008-9. An item pool was developed based on semi-structured interviews with some elder people and some experts in geriatics, literature review, and other quality of life questionnaires. We used principal component analysis and focus group methodology to reduce the items and assessment the face, construct, and content validity. Internal reliability was estimated using Cronbach’s alpha coefficient.

The finalised questionnaire contained 15 items and 4 dimensions including psycholosy, physical, social, and economic status. The validity was confirmed by experts and Cronbach’s alpha coefficient was 72.3%.

The prepared quality of life questionnaire is a valid and reliable instrument and will enable researchers to investigate quality of life patterns in the elderly and to assess the impact of interventions of quality of life change in this population. The instrument warrants further testing and development with different elderly populations.

The most important in hospital environment relationship is the relationship between doctors and nurses. This kind of connection is the most important relationship of the doctor-patient interaction involves creating collaborative relationships and provides information to achieve a common goal of treatment. Few studies in Iran about the current level of communication between doctor and nurse was done, so assessment of barriers of communication between these two groups was essential. This descriptive-analytical study was performed at the second half of 2009 in Al-Zahra hospital in Isfahan. The target population was 80 nurses and 80 physicians. Sampling for both groups was convenient; all of them completed a researcher-made questionnaire. Content validity of questionnaire was approved by leader professors. After a pilot study with 30 questionnaires, reliability was performed by split half method. Questions were in likert span and interpreted by Mann-Whitney and chi-square tests. All 160 people participated in the project were completed the questionnaire, 50% of physicians were disagreed with the failure of the communication of nurses in prescribing drugs and in total opposition to have opposing views than nurses and more there is quite the opposite, most opposition has been communication barrier in differences religious belief almost for other physicians agree with the obstacles mentioned. Both nurses and physicians completely agree and agree with communication situations and oppose almost completely absent. Relatively both groups agree and agree completely about ways to deal with the obstacles mentioned above. There were Significant differences between the attitudes of doctors and nurses, but significant relationship does not exist between the type of attitude of doctors and their gender, also significant relationship does not exist between the attitude of nurses and their gender. The highest mean score of the answers of physicians and nurses was about the third part of the questionnaire, namely methods to deal with obstacles and the majority have consensus on this issue. Considering that communication skills are also having extensive background and great value in improving health systems, it seems that communication skills, both through the inclusion of the important subjects of communication skills in nursing and medical education system or by creating understanding and conducting workshops for practical communication skills in the health system can increase.