فهرست مطالب reza besharati

Antibiotics are crucial in various scientific fields, including human and veterinary medicine, and are widely utilized medicinal compounds. Ciprofloxacin is a widely used antibiotic in the treatment of infections, most of which is excreted unmetabolized and finally enters water sources through the discharge of sewage and effluents. Even at low concentrations, ciprofloxacin in sewage and effluents can cause ecological harm and pose significant risks to human health. It is crucial to devise effective solutions for the removal of this antibiotic. Advanced Oxidation Processes (AOPs) are a promising method for the future removal of antibiotics, particularly in aquatic solutions, due to their potential to effectively remove ciprofloxacin. This study investigated the antibacterial and catalytic activity of synthesized magnetite nanoparticles (MNPs) (Fe3O4) in removing ciprofloxacin.

In this experimental research, Fe3O4 magnetic nanoparticles (MNPs) were prepared using the co-precipitation method. The nanoparticles were then examined for their physical and structural characteristics using scanning electron microscopy(SEM), X-ray powder diffraction (XRD), transmission electron microscopy (TEM), and BET technique. Fe3O4 magnetic nanoparticles (MNPs) were initially synthesized, and their properties were determined. We performed separate investigations to assess the effectiveness of various methods for removing ciprofloxacin. This included evaluating ultrasound alone (US), hydrogen peroxide alone, magnetite nanoparticles alone (MNPs), and combinations such as ultrasound with hydrogen peroxide, hydrogen peroxide with magnetite nanoparticles, and magnetite nanoparticles with ultrasound. All tests were conducted under the same conditions. The first step assessed the catalytic activity of synthesized nanoparticles for ciprofloxacin through the Fenton process. In this study, experimental parameters such as Fe3O4 catalyst dosage, initial pH of the solution, Hydrogen peroxide concentration, reaction time, and initial antibiotic concentration were investigated. In the second step, the antibacterial efficacy of synthesized nanoparticles against Escherichia coli and Staphylococcus aureus was determined via the Broth Macro dilution method.

The examination of the characteristics of synthesized nanoparticles showed that the average size of magnetite nanoparticles is approximately 20-30 nm. TEM results confirmed that the synthesized nanoparticles have a uniform size and structure. The combined process of MNPs/hydrogen peroxide/US exhibited the highest removal efficiency at 88.36%. This high efficiency can be attributed to the direct effect of the reaction between Fenton agents and ultrasonic waves, leading to the generation of numerous hydroxyl radicals. The maximum removal of ciprofloxacin was achieved in 0.5 g/L catalyst, pH=3, five mM hydrogen peroxide concentration, 550 W ultrasonic power, and 60 min reaction time. For Escherichia coli and Staphylococcus aureus, the Minimum Inhibitory and Minimum bactericidal concentrations were 3.125, 6.25, and 1.56, 3.125 μg/mL, respectively.

Synthesized iron magnetite nanoparticles have high antibacterial properties against bacterial strains and many catalytic properties in the Sono Fenton process to remove ciprofloxacin, so this process can be an effective method for eliminating hospital and pharmaceutical wastewater.

Nosocomial infections are a global problem that has become a challenge in hospitals around the world since the 80s. One of the main sources of hospital infections is personnel. In this regard, the present study aimed to investigate the frequency, colonization rate, antibiotic resistance, and molecular types of Staphylococcus aureus in the personnel of key hospital departments, including emergency, infectious, Coronary Care Unit, and Intensive Care Unit Departments.

Nasal swab samples were collected from the personnel of the Emergency, Infectious, Coronary Care Unit, and Intensive Care Units Departments in the fall of 2021 and subsequently cultured. Confirmation of S. aureus strains was performed by biochemical tests, disk diffusion method, and agar screen test. Moreover, polymerase chain reaction for the evaluation of resistance genes was performed. Determination of agr group, determination of SCCmec type, and checking the presence of pvl, tst, and etc genes were also performed.

In total, 75 out of 214 staff nasal swab samples contained S. aureus. Prevalence of methicillin-resistant S. aureus was 65.3% confirmed by PCR test results. Based on the study of SCCmec types in MRSA strains, the most common type was SCCmecIII. Among the agr groups, type I was the most common, and in terms of the abundance of pvl, tsst, and etc genes, a relatively high prevalence was observed.

Due to the increased level of personal and environmental health in hospitals, s. aureus colonizing the noses of personnel are more pathogenic and resistant due to the natural selection of strains. Therefore, they can cause more severe diseases following transmission to the patients.

Due to the continuous existence of crises and dangers and the increasing and damages caused by them on cities, in the present era, the concept of urban resilience has become a global consensus to achieve sustainable urban development. In this regard, in order to plan and realize a resilient city, the first step is to identify the dimensions and components of this approach in different urban spaces and textures. Due to the importance of the subject, the purpose of this study is to identify the factors explaining resilience and to investigate the desirability of its various dimensions in the new and old texture of Tabriz metropolis. Therefore, the research method in the present study is applied in terms of purpose and in terms of exploratory-comparative nature that structural equation modeling in Amos software has been used for data analysis. The statistical population of the study also includes citizens of the new and old context of the city of Tabriz, which has been determined as a sample size based on the Cochran's formula of 384 people. Findings indicate that the most important factors explaining resilience in the old texture of Tabriz are individual, social and managerial-institutional factors with a value of 0.63, 0.61 and 0.54, respectively, and in the new texture of the city physical-environmental and economic factors and managerial-institutional with a value of 0.77, 0.72 and 0.69, respectively. The results also show that the new urban texture is in a better position in terms of structural and physical strength, while the old texture has more appropriate human and social capital. This issue is due to the ruling management system, ie technocrats, which has had different effects on the old and new textures of the city.

A dog is an animal that is usually kept as a pet and is often allowed to live indoors. However, the issue of the uncleanliness of dogs is an important matter of jurisprudence, and it is necessary to understand the ruling on their uncleanliness. Some people argue that considering dogs unclean is against their rights. The respectful treatment of such issues, especially for those who are not qualified to comment on religious issues, has raised doubts and uncertainties about the nature of certain religious tenets. On the other hand, the hadiths (traditions) of the infallibles clearly mention the uncleanliness of dogs. In the field of medical parasitology, dogs play an important role in the transmission of parasitic diseases such as hydatid cysts and toxocara.

This descriptive-analytical study aims to investigate the views of religious jurists on the uncleanliness of dogs and the effects of dogs on human health from a medical -parasitological and Islamic perspective.

According to the sciences of medical parasitology and Islam, the dog has a great impact on the pathogenesis of human diseases mediated by contact with the feces and urine of this animal.

In accordance with religious traditions about dogs, their impurity is indisputable. Many parasitic diseases in humans, such as hydatid cysts, toxocara, etc., can be transmitted to humans through the feces of dogs. Therefore, the uncleanliness of dogs is also important in terms of health and Islamic rules.

For the optimal management of high blood pressure in children in 2017, a new guideline was replaced by the 2004 guideline by the American Academy of Pediatrics. This study was conducted with the aim of comparing the prevalence of high blood pressure in children in Kashmir based on the 2004 and 2017 guidelines of the American Academy of Pediatrics.

In this descriptive-analytical and cross-sectional study in 2022, 1287 students aged 7 to 12 years were randomly selected from 49 girls' and boys' elementary schools by cluster sampling. Children's personal information questionnaire was completed and their height, weight, body mass index, and blood pressure variables were measured according to the standard method. The obtained data were compared based on two instructions. Analysis of variance test with a significance level of less than 0.05 was used to investigate the factors affecting blood pressure.

According to the guidelines of 2017, normal blood pressure has decreased by 6.9 percent compared to the guidelines of 2004, the prevalence of prehypertension has increased from 4.2 to 4.8 percent, and hypertension has increased from 6.3 to 12.7 percent. It was found that 19.8% of children who were placed in the high blood pressure category based on the 2017 guidelines were overweight and obese, according to the results of the analysis of variance, body mass index factors, height, and weight had an effect on blood pressure. At the age of 7, height and body mass index and at the age of 11, height had no effect on diastolic blood pressure, gender factor had an effect on blood pressure at all ages.

The prevalence of prehypertension and hypertension has increased based on the 2017 guideline, so by applying it, more cases of hypertension can be diagnosed on time and preventive measures can be taken.

 In the COVID-19 era, co-infections can lead to an increase in morbidity and mortality. Normal flora bacteria can transfer to the pulmonary tract and create bacterial co-infections. The nasal cavity is one of the main areas housing normal flora in the human body.

 In this study, we evaluated the prevalence and antibiotic resistance of gram-positive cocci in the pre– and post–COVID-19 eras among health care workers.

 We assessed 376 nasal swabs from the pre–COVID-19 era and 376 from the post–COVID-19 era. Conventional and molecular methods were used to identify bacterial types and evaluate antimicrobial resistance.

 The most common gram-positive cocci in the pre–COVID-19 samples were Staphylococcus aureus, S. epidermidis, S. capitis, S. hominis, S. haemolyticus, Streptococcus pneumoniae, and Enterococcus faecalis. In the post–COVID-19 samples, the most common gram-positive cocci were S. aureus, S. epidermidis, S. warneri, S. hominis, and E. faecalis. We observed higher resistance rates in post–COVID-19 samples, as well as resistance to linezolid and vancomycin in S. aureus, S. epidermidis, and S. hominis. Additionally, our isolates showed a high resistance rate to antiseptics.

 It seems that after the beginning of the COVID-19 pandemic, due to the change in the protective procedures in hospitals, the prevalence and variety of bacteria have decreased, but instead, they have been replaced by more pathogenic bacteria with higher antibiotic resistance.

The aim of this study was to investigate the effect of "human and financial resources" on the operational planning process in teaching hospitals of Mashhad University of Medical Sciences. 176 planning experts participated in this applicable research, which was performed using review, comparative, and quantitative methods. To collect the data, a researcher-made questionnaire was used, which was designed based on review and comparative studies of various operational planning models. Its validity was confirmed by consulting experts, and its reliability was confirmed by pilot studies and Cronbach's alpha calculation of 0.96. After data collection, exploratory and confirmatory factor analysis was performed using Spss22 and Amos22 software. There has been the highest score of an average of 4.35 in the results of the variable "Supply of specialized manpower for the development and implementation of programs" in the survey of experts opinion, and the most importance has been in the analysis of variable "Accurate calculation of program costs" by varimax rotation method with a factor load of 0.772. Also the effect of "human and financial resources" factor in operational planning in teaching hospitals based on the calculation of the regression coefficient of factor analysis was estimated to be 0.829. Therefore, providing "financial and human resources" affects the quality of medical and educational services of Mashhad University of Medical Sciences hospitals, and the optimal use of these resources can improve the performance of operational planning in hospitals.

Not having a suitable planning model is one of the most important barriers to strategic planning in hospitals of Iran. This study aims to design a strategic planning model for hospitals affiliated to Islamic Azad University in Iran.

In this applied study, the review, comparative, quantitative and qualitative methods were used. First, different strategic planning models were collected and, based on them, a conceptual model was designed. Then, a researcher-made questionnaire was designed based on the different dimensions of the model and validated according to a panel of experts. The questionnaire was completed by 30 experts and the results were analyzed using one-way analysis of variance, and the model was finalized by applying the Delphi method.

Regarding the steps of strategic planning, the factors “formation of planning team” (5±0), and “creating the culture and scientific ability for planning in managers and employees” (4.87±0.34) obtained the highest scores. Regarding the implementation steps of the plan, the factors “receiving and implementing the approved plan” (4.87±0.34) and “monitoring of approved plans and their continuous evaluation” (4.87±0.34) had the highest scores. Regarding the strategic planning team members, “hospital manager” (5±0), and “one expert in planning” (4.87±0.46) obtained the highest scores.

The use of the presented strategic planning model based on its implementation steps by a team with the suggested members can improve the stages of developing and implementing plans in hospitals affiliated to Islamic Azad University.

nowadays, there is a growing demand for the use of fog computing in applications such as e-health, agriculture, industry, and intelligent transportation management. In fog computing, optimal offloading is of crucial importance due to the limited energy of mobile devices. In this regard, using machine learning methods has recently attracted much attention. This paper presents a reinforcement learning-based approach to motivate users to offload their tasks. We propose a self-organizing algorithm for offloading based on Q-learning theory. Performance evaluation of the proposed method against traditional and state-of-the-art methods shows that it consumes less energy. It also reduces the execution time of tasks and results in less consumption of network resources.

Background & Aims:

 Early diagnosis of liver diseases has a significant effect on the prevention of its complications as well as control and treatment of the disease. “Machine learning” is one of the branches of artificial intelligence that has many applications in the field of medical diagnosis. This study aimed to provide a model with high accuracy and reliability for diagnosing liver diseases using machine learning methods that can help physicians in the early diagnosis and control of liver diseases.

Materials & Methods:

 This applied-developmental study used the dataset of 583 liver patients. In order to more accurately diagnose of the people with liver diseases, the results of the three classifiers including: Random Forest, Support Vector Machine, and Artificial Neural Network were combined using Dempster-Shafer theory. Weka data mining tool and Python programming language were used to implement the model. The k-fold cross-validation method was applied to evaluate efficiency of the model.

The results showed that accuracy, sensitivity, and specificity in the proposed model were 91.47%, 89.52%, and 93.03%, respectively, which had a better performance than similar studies.

The proposed model in the studied statistical population has a better performance in diagnosing liver diseases, and can help physicians in early diagnosis of the disease and appropriate treatment of it in the early stages of it and thus prevent development of the disease.

The prevalence of hypertension in children is increasing, and this complication is considered the most important risk factor for cardiovascular diseases in older age. Early detection and control of hypertension can prevent its progress and reduce its consequences. Machine learning methods can help predict this complication promptly and reduce cost and time. This study aimed to provide a model based on ensemble machine learning methods to more accurately predict the hypertension of primary school children.

This is an applied developmental study that was conducted using the information of 1287 primary school children aged 7-13 years in Kashmar city. After data preprocessing, to achieve a more accurate diagnosis of hypertension in children, the output results of five common machine learning methods in disease diagnosis including decision tree, naive Bayesian, nearest neighbors, artificial neural network, and support vector machine using weighted majority voting method were combined.

The results showed that the accuracy, sensitivity, and specificity of the proposed model were 90.31%, 80.65%, and 93.54%, respectively, and compared to similar studies it performed better.

The proposed model can better predict and diagnose hypertension in children and improve accuracy and reduce the error rate. This model can be a useful and early tool in the diagnosis of hypertension in children, reducing the consequences and costs of this complication and being a big step in the fight against hypertension.

Changes in blood pressure are of special importance in ensuring children's health. Various factors affect blood pressure in them. The aim of this study was to determine the factors affecting blood pressure in children and adolescents.

In this descriptive cross-sectional study, 1282 students aged 7 to 12 years were studied by cluster and random sampling methods from 49 schools in Kashmar city, Iran. After measuring blood pressure, weight, pulse rate, height, and BMI and collecting demographic and medical information of the research samples, the obtained data were evaluated in SPSS software ver. 21 using analysis of variance test.

Five hundred thirty-six boys and 746 girls participated in this study. Gender had an effect on diastolic and systolic blood pressure at all ages from 7 to 12 years (p=0.0001). The height, pulse rate, weight and BMI had an effect on blood pressure; although there was no significant relationship between height and systolic and diastolic blood pressure at the age of 7 years (p=0.379) and no significant relationship between height and systolic blood pressure at the age of 12 (p=0.239). Family history of high blood pressure had an effect on diastolic blood pressure only at the age of 8 (p=0.028).

Factors such as gender, weight, pulse rate, height, BMI and family history of hypertension were effective on blood pressure of children and adolescents. Considering the differences between the results of this research and other studies, their use in the field of regional prevention of high blood pressure is recommended.

Urban resilience is the ability of a city and its subsystems to cope with a variety of hazards, adapt to critical situations, and self-recover and recover quickly. In order to achieve a resilient city, it is inevitable to study the impact and effectiveness of various components as well as the future resulting from the effects of these components. In this regard, the purpose of the present study is to analyze the effects (effectiveness/effectiveness) of the components explaining resilience and its future research in the old texture of Tabriz metropolis. Therefore, the research method is applied in terms of purpose and in terms of the nature of futurism with emphasis on analytical and exploratory approach. Also, the data analysis method was based on purposeful Delphi method (15 elites and managers in the field of crisis management) and the application of cross-impact analysis technique in Micmac software. Findings of the research by analyzing the 5 main components (economic, social, individual, managerial-institutional and physical-environmental) and 24 sub-components indicate that the most effective among the studied components on other components in order to develop resilience of the old texture of Tabriz the components of emphasis on the governance and participatory approach, the existence of interaction and cooperation between institutions and cultural context between institutions and social strata, and the most effective are related to the components of positive thinking about issues and sense of social responsibility in the face of crisis. The results also show that due to the current situation of old texture resilience and the lack of key and strategic components affecting the development of the system, the future of old Tabriz texture will be unstable in terms of resilience.

The aim of this study was to investigate the factors affecting job motivation of employees of Islamic Azad University, Kashmar Branch based on Herzberg hygiene-motivational factors theory.In this descriptive-Survey study, 90 out of 100 Official and contract employees of the Islamic Azad University of Kashmar in 1398 participated in the study by counting method. To investigate the factors affecting employees' job motivation, a researcher-made questionnaire based on Herzberg theory was used and after confirming its validity and reliability, the research data were used using SPSS-21 software in the form of frequency distribution and analysis of variance and correlation. The results showed that the most important factors affecting job motivation of employees in the field of hygiene factors were "job security and stability" and "salary" and in the field of motivational factors were "nature of work" and "growth and development" and the impact of Hygiene factors. There are more motivational factors in creating job motivation. Therefore, in order to prevent dissatisfaction of university employees and motivate them, it seems necessary to pay attention to hygiene and motivational factors with the priority of hygiene factors.

Recognizing the factors affecting the job satisfaction of nursing teachers will not only improve the education of students, but also the level of health services provided in the community. In this regard, the present study aims to investigate the factors affecting the satisfaction of nursing teachers in Islamic Azad University, Kashmar Branch.

In this descriptive-analytical study, 30 nursing teachers, who constituted the entire research community, participated in the study. To evaluate the factors affecting the job satisfaction of faculty members, a questionnaire based on Herzberg’s theory was used. The research data were analyzed using SPSS software in the form of frequency distribution, regression analysis, variance, and Pearson correlation.

The results showed that according to nursing teachers, contextual factors (0.874 ± 0.04) are more important than content factors (0.871± 0.06). The results of Pearson correlation test showed that there is a positive and significant correlation between age and content and contextual factors. The results of analysis of variance also showed a significant difference between the type of cooperation in content factors and gender characteristics and level of education in content and contextual factors.

Based on the findings, in order to increase the job satisfaction of nursing teachers, both content and contextual factors should be considered with the priority of contextual factors. Job security factors, wages, and salaries are more important than other factors.

 Streptococcus pneumoniae is one of the common bacterial pathogens in pediatrics. In this study, we performed antimicrobial susceptibility testing, serotyping, and molecular typing of blood-isolated strains of pneumococci in Bojnurd.

 In the current study, blood-isolated, penicillin-nonsusceptible S. pneumoniae strains were subjected to antimicrobial susceptibility testing and typing of capsular polysaccharides using the quelling reaction and PCR method, as well as genotyping using the Multi Locus Sequence Typing (MLST) method.

 In this study, 51 S. pneumoniae strains were isolated from blood samples of children less than five-years-old in 2014 - 2018. Antibiogram was performed using the Kirby-Bauer method. All of the isolates were serotyped by the Quelling reaction and PCR. The MLST method was applied to determine the molecular types.

 Our study revealed that the most common serotypes of blood-isolated pneumococci were 19A, 6A/B, 1, 23F, 19F, 14, 15B/C, and 15A, and the common serotypes in Penicillin-nonsusceptible pneumococci (PNSP) isolates were 19F, 19A, 23F, 14, and finally 15A, 6A/B, 1, and 15B/C. The MLST analysis of PNSP isolates revealed that three highly resistant isolates with MIC ≥ 16 belonged to Sweden15A-25-19A (ST63), Taiwan19F-14-1 (ST236), and Taiwan19F-14 (ST236) clones.

 Regarding the common serotypes in this study, it seems that PCV-13 is a suitable choice for vaccination in this area. We also observed a high prevalence of PNSP and multi-drug resistant (MDR) strains between 2014 and 2018. It seems that the Taiwan19F-14 clone and its related STs played an essential role in the diffusion of antibiotic-resistant S. pneumoniae isolates in Bojnurd.

Increased risk of infections in surgeries suggests the importance of hand hygiene by the operating room staff. This study was conducted to compare surgical scrubchr('39')s effects with alcohol-based solutions and povidone-iodine on the growth of the bacterial contamination of hands over time.

The present study is an experimental study with a crossover design. The participants of the study were 30 undergraduate students who were eligible to participate in the study. They were divided into two groups of 15; one group scrubbed their hands with povidone-iodine, and the other hand rub with Decocept alcohol-based soluble. After a week, the groups changed the scrubbing procedures. Samples were taken from inside the gloves before scrubbing and 10 and 30 minutes after scrubbing. The models were cultured in blood agar and EMB agar media.

Staphylococcus epidermidis had the highest colony growth, followed by Streptococcus pyogenes, Diphtheroid, and Staphylococcus in descending order. Comparing the results of cultures for the two groups of Povidone-iodine and Alcohol-based soluble did not show any significant difference (P = 0/243).

Alcohol-based soluble has similar effects with Povidone-iodine on the growth of bacteria. Given that Alcohol-based solutions like Decosept have fewer side effects and are more effective, Decosept is recommended to be used as an alternative to 7.5% Povidone-iodine.

Chlamydial infection is a common infection. This bacterium can cause complications such as: pelvic inflammatory infection (PID), ectopic pregnancy, infertility and abortion. This study was performed with aim to evaluate the prevalence of Chlamydia trachomatis infection in women with a history of abortion referred to Bental-Hoda Hospital in Bojnurd.

This descriptive study was performed on 90 women with a history of abortion who had referred to the Bental-Hoda Hospital in 2019. The research tool was the questionnaire and the study's sample was blood which was transferred to microbiology laboratory for ELISA test. Patient's demographic information and medical history including age, number of pregnancies, number of abortions, place of residence and number of successful deliveries were collected. Data were analyzed using SPSS software (version 19) and Chi-square and Fisher's exact tests. P<0.05 was considered statistically significant.

The prevalence of Chlamydial infection was 12.2% (n = 11). There was no significant relationship between the test's result (Chlamydial infection) and patients' age (p=0.92). The mean age was 27.7± 7.8 years in patients with chlamydia positive infection and 27.9±7.6 years in patients with negative infection. Also, no significant relationship was found between gestational age, number of pregnancies, place of residence, number of abortions and number of successful deliveries with test's result (chlamydial infection) (p<0.05).

Since in this study, the prevalence of Chlamydia infection was 12.2% in women with a history of abortion, in order to reduce the burden of disease in the community and prevent its complications, screening for Chlamydia by ELISA method can be considered as a part of routine care programs before and during pregnancy in all health centers.

Due to the resistance of microorganisms against antibiotics, the use of medicinal herbs as alternative medicines has become commonplace. The purpose of this study was to explore the antimicrobial effects of aqueous, ethanolic and acetonic extracts of Rosa damascenon on E. coli as one of the most common pathogenic bacteria.

Extraction was carried out using soaking method. To determine the antimicrobial effect of different extracts of Rosa damascenon, Agar diffusion and minimum inhibitory concentration (MIC) methods were employed.

The results showed that ethanolic extract has better antimicrobial effect than other extracts. The halo size and the minimum inhibitory concentration for the ethanolic extract of Rosa damascenon were 21mm and M=25μg / ml respectively. The aqueous extract of Rosa damascenon was free of any antimicrobial effect against E.coli.

Because of the antimicrobial activity of ethanolic extract of Rosa damascenon, clinical studies can be conducted to illuminate the effectiveness of ethanolic extract of Rosa damascenon in treating infections.

 There is a relationship between diseases and the quality of life. Epilepsy is a disease that is unpredictable and uncontrollable and its actions are limited to scattered and brief education. Therefore, this study aimed to investigate the effect of family-centered empowerment program on the quality of life of mothers with epileptic children.

This clinical trial was undertaken on 60 mothers with epileptic children. Thirty mothers with epileptic children participated in family-centered empowerment sessions and 30 mothers with epileptic children served as the control group. Personal information form and quality of life questionnaire were administered at baseline and 75 days after intervention. In order to analyze data, chi-square test, independent t-test, paired t-test, and covariance were used accordingly.

The quality of life between the two groups was not significantly different at the beginning of the study, but it was significantly different 75 days after the onset of the empowerment program. In other words, the family-centered empowerment program had a significantly positive impact on the quality of life of mothers with epileptic children (P = 0.03).

According to the results of this study, the family-centered empowerment program can be considered as a potent alternative in health care system to enhance the quality of life of families with epileptic children.