فهرست مطالب shahrokh yousefzadeh

An accident is an unforeseen occurrence that happens in all organs, including medical centers, due to unsafe conditions and practices which cause damage and sometimes irreparable injuries. Establishing safety system in the medical center seek to prevent harm to both patients and health care professionals.

The aim of this study was to assess safety status in a medical center before and after implementing standard safety system.

 This case-study was carried out among the staff of a hospital in Guilan province, Iran in 2018-2019. The information was collected through observation and interview with staff and checking the observance of instructions and safety tips. Then, the possibility of needle stick injury was identified by calculating accident indices. human errors were assessed using risk assessment using Systematic human error reduction and prediction approach (SHERPA).

 A total of 9 departments of a selected hospital were studied and the accident and human errors were identified. The recurrence rate of the accident in 2019 compared to 2018 had a decreasing rate from 11.36 to 4.09 (safe_T_score=-3.14). Risk assessment using SHERPA method in the gynecology ward revealed 4 important types of errors in this department.

 There was considerable reduction in frequency and severity of needle stick injuries after establishment of safety system in the hospital. The SHERPA method, detailed the task errors and specific remedial measure to correct the task. The results of this study can be helpful for medical staff, managers, employers, and safety experts in identifying and preventing the causes of the accident.

Hospital Supply Chain Management (SCM) agility requires finding the main and effective dimensions, prioritizing, communicating between them and analyzing these dimensions in relation to each other.

The purpose of this study was to identify different dimensions of the hospital SCM agility, proposing a model of the hospital SCM agility and determining the relationships between dimensions of agility, and prioritizing, analyzing, and interpreting dimensions of the hospital SCM agility.

This cross-sectional study was performed on the physicians, nurses and staff working at public hospitals affiliated to Guilan University of Medical Sciences. Delphi technique was used to determine the dimensions of agility, interpretive-structural modeling approach was used for analysis. Network analysis was used to prioritize the dimensions of agility.

In the literature review 16 dimensions of agility were identified. The final model of agile supply chain management has 8 levels; cost reduction placed at the highest level and organizational leadership commitment was at the lowest level. Cost reduction dimensions were the highest priority and organizational culture was the lowest priority in the final network analysis.

Agile supply chain management has very important and complex elements. Neglecting to monitor their changes can cause irreparable and profound damage to the medical sector. Interpretive-structural approach and network analysis create a constructive and effective method to model, analyze, and prioritize the dimensions of agile supply chain management.

The overall goal of the medical department is to develop and manage an efficient and effective supply chain. Intrinsic instability and unpredictability of treatment needs to require a flexible supply chain. Agility reflects the hospitalchr('39')s response to environmental changes, and agile hospitals are able to provide appropriate services to the patients. Hospital supply chain management agility needs to find the main aspects affecting the relationship and communication between them and to analyze the dimensions together. The purpose of this study was interpretive-structural modeling and analysis of dimensions of agile hospital supply chain management.

The research design combined descriptive - survey exploratory approach to the future. The population study were doctors, nurses and staff at the University of Medical Sciences. The Delphi technique was used to determine the dimensions of agility and the interpretive-structural modeling approach was used for analysis and modeling. Mick Mac software was used to analyze the dimensions of agility.

The final model of agile hospital supply chain management with 16 dimensions had 8 levels, which was at the highest level of cost reduction and at the lowest level of organizational leadership commitment. The results indicate that leadership commitment is the foundation of supply chain agility in the hospital. Knowledge management variable had low impact and effectiveness and was known as a secondary leverage variable. The results showed that most agile supply chain management aspects of the main causes of complex communication and interaction, and the importance of agility in the hospital of the show. 

The analysis and interpretation of functional from the aspect of Impact and Influence of agility dimensions in hospital environment Showed that, Dimensions of strategic planning, human resource development and staff skills training, human resource management and employee satisfaction, process management, process integration and organizational transformation, flexibility, organizational communication development and information management integration, service quality management and continuous improvement, acceptance of new technology and new ideas, speed of service, patient  understand and satisfaction, monitor, find best responds demand and market sensitivity in the strategic area are located and They cause model instability and With high impact and high influence, They play an important role in the agility of hospital supply chain management.

 Road traffic crashes and its deaths and injuries are one of the main public health problems in all over the world especially in Low and Middle Income Countries (LMICs). Road traffic crashes resulting in deaths, physical and psychological problems, and economic costs which have damages on families and communities. The number of road traffic deaths was exceeded from 1.3 million in 2016. Most of the road traffic injuries are belong to low and middle-income countries of the world. Road traffic injury is the eight leading causes of deaths for all ages, while it is largely neglected. 
There are several effective factors in road traffic crashes. The socio-economic status is known as important factors related to health status, although its influence is not fully understood on different aspects of health. People who live in low socioeconomic status suffer from the disease and injuries two times more than others. The results of the studies show that fatal and non-fatal injuries have an inverse relationship with socio-economic status. The socio-economic status is known as important factors related to health status. People who live in low socioeconomic status suffer from the disease and injuries two times more than others. The results of the studies show that fatal and non-fatal injuries have an inverse relationship with SES. However, there is a lack of enough information about the effects of socioeconomic status on road traffic crashes and its related outcomes. 
The incidence rate of road traffic injuries and its related deaths have a relationship with socio-economic status. In the international level, these incidences vary between the High-income countries and Low and Middle-income countries. Moreover, the incidences of road traffic injuries and deaths vary between the different socio-economic groups in each country.
The socio-economic status is known as the main predictor factor in different aspects of health. The importance of socio-economic status will increase in regarding this point which the outcomes of road traffic crashes are sometimes irreversible. However, the effect of socioeconomic status on the many aspects of health is not fully understood. Identifying the socio-economic status factors related to the outcomes of road traffic crashes can provide a good opportunity for policy makers and managers to use preventive interventions in high-risk groups.  This study used an analytical cross-sectional design. The studied sample was people who injured because of road traffic crashes and referred to Pour-Sina hospital in the city of Rasht. Rasht is the central city of Guilan province. Guilan province is located in the north of Iran and the rate of road traffic crashes is high in this province. The collection of data has been done by two researchers. The data collection questioner trained in order to meet the quality assurance and prevention the information bias. The using questionnaires consisted of two parts. The first part was a checklist to collecting the demographic information including the; age, gender, a marital status which obtained from hospital records. Moreover, collecting the crash information such as; the location of the injury, the type of injury, the severity of injury (based on Injury Severity Score), the clinical outcome of the patient which were extracted from hospital records. The second part of the instrument was related to socio-economic issues. For this purpose, the standardized questionnaire was used which the validity and reliability of that were confirmed in the previous study. In the cases that the injured people had died or were unable to interview due to the severity of the injuries, the interview was conducted with one of the close relatives (father, mother, brother or sister) and after obtaining informed consent.
In order to determine the socio-economic status factors (that are a combination of variables), the principal components analysis was used. Principal component analysis simplifies the data and reduces the number of variables. To extracted the factor/factors from the variables, the Varimax rotation method was used. The Varimax rotation is used if factors are assumed to be uncorrelated which is known as orthogonal rotation. In this study, the Eigenvalue greater than 1 was chosen. After determining the factor, the variables that were present in each factor were identified.
To obtain the main socio-economic status factors the method of principal component analysis was used. To assess the interest of the implementation of the principal component analysis on a data, Bartlett’s sphericity test and the KMO index were used. The main SES factors were determined and in order to assess the relationship between these factors and death and severity of injuries related to road traffic crashes, the logistic regression with the Backward-LR method was used. The analysis was adjusted on the variable of age and sex of patients. For the severity of the injury, the ISS scale was grouped (ISS> 15, ISS = <15) and it is considered as the dependent variable in the Logistic Regression model. The ISS scale above 15 is considered to be a severe injury All analyses were performed using the SPSS software version 20. The significance level of the tests in this study was considered 0.05.  In this study, 300 traumatic patients were recruited. From all, 234 patients (78%) were male. The mean age of injured patients was 34.25 years old (19.07). The ISS scale was grouped (ISS> 15, ISS = <15). the ISS scale above 15 is considered to be a severe injury. The severe injury (ISS > 15) was observed among 245 (81.7%) patients. 
Bartlett’s sphericity test and the KMO index showed that there is a good correlation between the studied variables and the using of principal component analysis is feasible. The p-value for the Bartlett test is significant and the KMO index is more than 0.5. Some socio-economic status factors had a relationship with the outcomes of death and the severity of the injury of patients. There were three factors which affect the outcome of road traffic crashes. The first factor includes the following variables; household cost, the education level of an injured person, and the education level of the mother. The second factor includes the variables of; job, owning the mobile and motorcyclist. The third factor includes the variables of; income and fathers job. The results of logistic regression analysis showed that factor 3 (family income and father's job) had a significant relationship with the outcome of traumatic death. For this factor, the odds ratios of 0.45 (CI 95%; 0.042- 0.83) for deaths and 0.65 (CI 95%; 0.45- 0.90) for the severity of injuries was obtained. The highest SES had the lowest deaths and injuries. 
There was a relationship between economic factors and the severity of the trauma, the economic-social third factor including variables; family income and father's occupation were identified as an effective factor in the severity of trauma. The odds ratio for the third factor (household income and father's occupation) was 0.68 (95% confidence interval: 0.452-0.908).  The results of this study showed that social economic factors affect both the deaths and the severity of injuries. The results of this study showed that the third factor (family income and father's job) had a significant relationship with traumatic death. In other words, the mortality rate of road traffic crashes is high among families with a low level of socio-economic status. Considering the high rates of deaths and severe injuries caused by traffic accidents in Iran compared to other countries, it is necessary economic and social factors will be considered as effective factors on deaths and injuries in road traffic policy-making and planning.

Anxiety in psychiatric patients is more prevalent than the general population. Non-pharmacological methods for the treatment of anxiety are beneficial to the health of the patient, but it is not clear which of these approaches are more appropriate. The aim of this study is comparison of the effects religious teachings and muscle relaxation on reducing anxiety in patients hospitalized to psychiatric hospital. This is a quasi-experipsychiatric study with pre and post-test with control group that was performed on patients hospitalized to the ward of psychiatric hospital during the period from March to June, 2016. Out of 100 patients under the Spielberger anxiety screening, 60 anxious patients were diagnosed and 45 subjects who entered the study were randomly assigned to three groups of 15. Univariate analysis of Variance was used to analyze the data. There was a significant difference between the post-training scores in the three groups (P=0.0001 and F=19.11). According to the Bonferroni test, there was a significant difference between the mean scores after the training in both groups of religious teachings (P=0.001 and MD=8.03, and relaxation with control group (P=0.0001 and MD=12.48). However, there is no statistically significant difference between the mean scores after training in the groups of religious teachings with relaxation (P=0.094 and MD=4.45). The use of the religious teaching module reduces of anxiety in psychiatric  patients; religious teachings and relaxation techniques are equally effective in alleviating the anxiety of psychiatric patients. Therefore, it is suggested that these complementary and low cost methods be used to reduce anxiety instead.

Ischemic stroke as the major cause of mortality and morbidity worldwide has different risk factors. One of its modifiable risk factors is opium addiction whose role is not clear yet. This study aimed at assessing the hemodynamic parameters in ischemic stroke patients addicted to opium using transcranial Doppler (TCD) ultrasonography and comparing them with non-addicted patients. This comparative cross-sectional study was conducted in an academic hospital in the north of Iran in 2016. All the patients diagnosed as ischemic stroke underwent cerebrovascular ultrasound in the first 4 days of symptoms onset. Frequency of hemodynamic abnormalities confirmed by pulsatility index (PI) and mean flow velocity (MFV) were determined and compared between the two groups. The data were analyzed by chi-square test, t-test, and multiple logistic regression models using SPSS software. A total of 353 patients with ischemic stroke (92 addicted and 261 non-addicted patients) were enrolled in the study. Univariate analysis indicated that the PI and MFV differences were statistically significant between two groups of addicted and non-addicted patients (P = 0.0001). By multivariate logistic regression model, the age [odds ratio (OR) = 1.143], diabetes mellitus (DM) (OR = 3.875), hypertension (HTN) (OR = 2.557), and opium usage (OR = 9.615) had influence on PI and only opium usage (OR = 3.246) had influence on MFV. Opium usage affects the cerebral hemodynamic parameters and increases the chance of having abnormal PI as ten-fold and abnormal MFV as three-fold.

Epidemiological knowledge of traumatic spinal fractures and spinal cord injuries (SCIs) is essential for preventive planning and health policy-making. The present study was conducted to investigate the epidemiological features of traumatic spinal fractures and SCIs in Guilan province, Iran. The present cross-sectional study was performed on all 15-80 years old patients with trauma admitted to Poursina Hospital from January 2015 to December 2017. The individual characteristics, time, place and mechanism of trauma and diagnostic characteristics of spinal trauma were gathered using trauma registry system. The incidence and epidemiological distribution of spinal fractures among traumatic patients were then estimated. The incidence of traumatic spinal fractures was found to be 0.6% in 2015, 0.3% in 2016 and 0.2% in 2017. The men to women ratio was 2.33:1. Motor Vehicle Accident (MVA) and falls were respectively the most common mechanisms of trauma and their incidence were higher in rural communities than in urban communities. There was significant relationships between mechanism of trauma and the site of vertebral fracture (P-value = 0.02). Lumbar vertebrae mostly caused by falls while cervical vertebrae caused by MVA. The incidence of SCI in all the patients with spinal fractures was 18.23% in 2015-17. SCIs were found to be more prevalent in 15-45 year olds compared to other age groups. Quadriplegia (54.83%) and paraplegia (38.7%) were the most prevalent SCI-induced types of paralysis. The incidence of SCI was significantly associated with the site of spinal fractures, although it was not associated with mechanism of trauma. This study revealed that the incidence of spinal fractures were decreased in recent years and MVA is the major cause of spinal fractures. Preventive programs are recommended to focus on traffic engineering and the training of drivers and pedestrians, especially in high-risk populations.

Anxiety and depression are among the most common psychological symptoms in patients with life-threatening illnesses, and have a close relationship with hospitalization in specialized care units. This study aimed at evaluating anxiety and depression and their related factors in patients admitted to Intensive Care Units (ICUs). This is an analytical cross-sectional study conducted on 135 patients hospitalized in ICUs (neuro ICU and general ICU) of Poursina Medical Education Center in Rasht City, Iran. The patients were selected by convenience sampling method. The study data were collected using a checklist surveying demographic, clinical and psychosocial characteristics of the patients, and Hospital Anxiety and Depression Scale (HADS). Then, the obtained data were analyzed by Mann-Whitney U and Kruskal-Wallis tests in SPSS V. 18. The Mean±SD anxiety and depression scores of the study patients were 6.12±9.3 and 7.10±2.3, respectively. There was a significant relationship between short-term hospitalization and anxiety (P=0.03), and a high score of depression was observed in those with middle-school education (P=0.03) and non-invasive ventilation (P=0.01). Moreover, administration of sedatives (P=0.001) and tracheostomy ventilation (P=0.04), showed a significant correlation with depression. Anxiety and depression (symptoms of mood disorders) among ICU patients were relatively high and the duration of hospitalization was significantly associated with anxiety. Moreover, the administration of sedative drugs had significant correlation with depression. In addition, the type of received mechanical ventilation was associated with both disorders. Routine screening of anxiety and depression by nurses in ICUs is useful for early treatment, and can prevent long-term complications of these disorders.

Traumatic brain injury (TBI) in all degrees of injury severity mainly induces   deviant cognitive, emotional and behavioral alterations that lead to their respective disorders. This brief overview strives to define the variables that determine the risk of occurrence of these disorders and to describe the common patterns of these disorders and their relevant neuropathogenetic mechanism(s).  In addition, post-traumatic deficits can interact  and exacerbate the probability, , persistence and severity of each variable relative to  one another. Since, neural substrates and pathways further complicate these TBI sequels, identifying the neuropathogenetic basis of these deficits using human brain mapping techniques has been a milestone in the investigations of the TBI field.    It has been found that TBI-induced functional disturbance of one or more specific neural networks may cause a distinct disorder. However, this matter is a topic of discussion in TBI research. Evidently, prevalent, unpleasant TBI consequences such as motivational deficits, antisocial behaviors, aggression, disability of inhibitory control and executive function are mostly associated with the disruption of neural circuits originated from separate parts of the prefrontal cortex connected to thalamic nuclei and basal ganglia. Evidence strictly emphasizes the abnormality of the default mode network (DMN) either within the network or between it and other neural networks for a majority of cognitive, emotional and sleep disorders after TBI. Therefore, imbalanced neural circuits due to TBI may serve as diagnostic and prognostic biomarkers for post-traumatic neuropsychological and neuropsychiatric disorders as well as a guide for circuit-based neurotherapy.

We aimed to determine the prognostic imaging and clinical markers of chronic Post-Traumatic Sleep-Wake Disorders (PTSWDs) with a special focus on the early cognitive and executive dysfunctions following Traumatic Brain Injury (TBI). The prevalence rate of Post-Traumatic Psychiatric Disorders (PTPDs) in various sleep disorders was also investigated.  Methods and Materials/Patients: In the present longitudinal study, 165 qualified patients with closed TBI were studied. Demographic, imaging and clinical characteristics of the subjects were recorded. The presence of acute post-traumatic cognitive deficits, anxiety, depression, and headache were measured by standard scales at discharge. Executive functioning was scored by the verbal fluency test. Several subjective questionnaires were applied to screen the chronic PTSWDs at 6 months after the onset of TBI. All variables were compared between the patients as well as those with and without PTSWDs using appropriate statistical tests.  Of 146 patients remaining in the follow-up study, 35% manifested PTSWDs, with insomnia and Excessive Daytime Sleepiness (EDS) as the most prevalent types. A poor executive functioning was observed in all PTSWDs patients, compared to those without PTSWDs, with only insomnia and hypersomnia patients demonstrating acute depression. Hypersomnia was also significantly related to bilateral brain contusion. The insomnia mostly comorbid with fatigue was predicted by mild injury, cortical lesions in the frontal lobe and acute severe headache. However, the patients who experienced the brain stem and diffusion lesions of right hemisphere were prone to EDS that was mainly accompanied by aggression.  The predictive role of acute executive dysfunction has been clarified in this study. It is suggested that early neurorehabilitative interventions targeting the impaired neural circuits of executive functioning and mood processing may accelerate and facilitate the optimal neurofunctional recovery leading to minimizing the persistent sleep disturbances.

There is no consensus over the relationship between lipid profiles and atherosclerosis risk factors with lumbar disc degeneration. This study aims to investigate the lipid profile and some risk factors of cardiovascular diseases in patients undergoing surgery for lumbar disc degeneration. Methods and Materials/Patients: A correlational cross-sectional study was carried out on all candidates for lumbar disc degenerative diseases surgery at Poursina Hospital in Rasht City, Iran from July to December 2017 (130 adult patients aged 20-77 years). The obtained data were collected from the patients’ medical file or asking them after obtaining written informed consent. The collected data were analyzed in SPSS V. 16 by performing the Chi-square and Fisher’s exact tests to examine the relationship between the study variables. The significance level was set at P≤0.05 for all tests. 60.8% of subjects had comorbid diseases, mostly hyperlipidemia, and hypertension. Their mean low-density lipoprotein and triglyceride levels were higher than normal and their mean total cholesterol was at borderline. Also, 74.6% and 84.6% of the patients had Body Mass Index and abdominal circumference higher than the normal range. Physical activity in 88.5% of subjects was below the desired level and 79.2% of the patients did not report a history of smoking. Inferential findings indicated a significant relationship between dyslipidemia and various types of lumbar disc degenerative diseases (P<0.05). The study showed dyslipidemia and some other risk factors of cardiovascular diseases, including obesity and inactivity in patients with lumbar disc degenerative disease. More research is needed to assess other atherosclerosis risk factors and types of lipids with respect to disc degenerative diseases.

Lumbar disc degeneration is one of the most frequent causes of pain in the lower back, and lack of physical activity, overweight and obesity have been regarded as the most significant factors in its occurrence. The present study was conducted with the aim of evaluation of body mass index, abdominal obesity and physical activity level in patients registered for elective lumbar disc degeneration surgery. Methods and Materials/Patients: This descriptive-analytical study was conducted on adult patients (20 to 77 years old) candidates for surgery admitted to the Poursina Hospital in Rasht City, Iran in 2016 due to degenerative lumbar vertebrae diseases. After obtaining the patients' consent, their abdominal circumference, weight, and height were measured by the researcher. The Rapid Assessment of Physical Activity (RAPA) questionnaire was used to assess the level of physical activity of the subjects and questions about professional sports were asked by the researchers. SPSS 16 was used to analyze the study findings. The Chi-square test and Fisher exact test were applied to examine the relationship between qualitative data. The mean±SD BMI values in males and females were 26.63±4.47 and 28.96±4.45 kg/m2, respectively. Also, the mean±SD values of abdominal circumference in men and women were 99.8±13.35 cm and 107.44±17.58 cm, respectively. The majority of the people (88.5%), including 71.7% of men and 97.6% of women had suboptimal physical activity, and a small percentage of samples (10.8%) reported previous professional exercises The present study results indicate the lack of activity level, high BMI and abdominal fat in our patients. Further study is required to investigate the significant relationship between BMI and degenerative disease types

Background and Importance: A 60-year-old diabetic man with simultaneous diffuse idiopathic hyperostosis, massive ossification of the posterior longitudinal ligament and cervical and higher part of thoracic ligamentum flavum is reported in this article. Such comorbidity rarely occurs. The patient’s chief complaint was sensation abnormalities without gait disturbance or severe cord compression symptoms despite the advanced stage of the disease. Computed tomography scan and magnetic resonance imaging confirmed multi-level involvement of cervicothoracic spine. After surgical treatment, his symptoms resolved completely with no complication.

Road traffic accident (RTA) is one of the main causes of trauma and known as a growing public health concern worldwide, especially in developing countries. Assessing the trend of fatalities in the past years and forecasting it enables us to make the appropriate planning for prevention and control..
This study aimed to assess the trend of RTAs and forecast it in the next years by using time series modeling..
In this historical analytical study, the RTA mortalities in Zanjan Province, Iran, were evaluated during 2007 - 2013. The time series analyses including Box-Jenkins models were used to assess the trend of accident fatalities in previous years and forecast it for the next 4 years..
The mean age of the victims was 37.22 years (SD = 20.01). From a total of 2571 deaths, 77.5% (n = 1992) were males and 22.5% (n = 579) were females. The study models showed a descending trend of fatalities in the study years. The SARIMA (1, 1, 3) (0, 1, 0) 12 model was recognized as a best fit model in forecasting the trend of fatalities. Forecasting model also showed a descending trend of traffic accident mortalities in the next 4 years..
There was a decreasing trend in the study and the future years. It seems that implementation of some interventions in the recent decade has had a positive effect on the decline of RTA fatalities. Nevertheless, there is still a need to pay more attention in order to prevent the occurrence and the mortalities related to traffic accidents..

Spinal cord injury (SCI) is one of the worst kinds of traumatic injuries with remarkable social and economic effects on communities.
Methods & Materials/Patients: In this prospective randomized clinical trial, 122 patients with traumatic spinal cord injury were admitted to Poursina hospital within 48 h of injury to compare G-CSF and high-dose methylprednisolone as neuroprotective therapy.
In this study, 122 patients were studied out of which 62 patients were included in the granulociote colony-stimulating factor (G-CSF) group with a mean age of 40.4, and 60 patients in the methylprednisolone group with an average age of 40.10 years. 55 patients (45%) out of 122 patients were completely paralyzed (Grade AIS: A) and 67 (55%) were with incomplete spinal injury (Grade AIS: B, C, D). The average ASIA sensory scores in the two groups were similarly compared in the same time intervals, and p values were 0.7, 0.3, 0.2, and 0.1, respectively . They were not statistically significant.
According to the results, the G-CSF was shown to be beneficial in average ASIA motor and sensory scores in the two groups of male patients at six months of onset of G-CSF treatment (p value=0.04) and average ASIA motor scores improvement in the falls subgroup patients also differed significantly within six months of onset of G-CSF treatment (p value=0.03). A multicentre prospective randomized clinical trial to compare the placebo effect with G-CSF protocol's treatment, and also assessment of the cost benefits of the common medical treatment versus G-CSF are n eeded.

Multiple sclerosis (MS) is a chronic debilitating disease known as one of the most common neurological dysfunctions in young adults. Recent studies suggest that infections with herpesviruses play a critical role in the pathogenesis of MS.
The present investigation aimed to detect the presence of cytomegalovirus (CMV) in patients with MS using polymerase chain reaction (PCR) and enzyme-linked immunosorbent assay (ELISA) methods.
Patients and Plasma and peripheral blood mononuclear cells (PBMCs) were collected from MS patients (n = 82) and from blood donors as control group (n = 89). They were tested for the presence of CMV antibodies and DNA by ELISA and PCR, respectively.
Anti-CMV was positive in 65 (79.3%) and 69 (77.5%) of the MS patients and healthy subjects, respectively (P= 0.853). Similarly, 23 (28%) and 2 (2.2%) patients were positive for CMV DNA among the MS and control groups, respectively. Statistical analysis showed that the frequency of CMV DNA in the MS patients was significantly higher than in the healthy controls (P The results of this study showed a possible association between CMV infection and MS. Further experimental and epidemiological studies using case-control approaches are needed to confirm this association.

Multiple sclerosis (MS) is a debilitating autoimmune and inflammatory disease of the central nervous system associated with both infectious and non-infectious underlying factors. Many recent studies suggest that infection with herpesviruses has a contributing role in the pathogenesis of MS..
The current case-control study aimed to evaluate the prevalence of herpes simplex virus (HSV) in peripheral blood mononuclear cells (PBMCs) of patients with MS compared to those of the healthy controls..
Patients and PBMC samples of 82 relapsing-remitting patients with MS (23 males, 59 females; mean age 36.9 ± 9.30 years) and 89 subjects in the healthy control group (34 males, 55 females; mean age 34.32 ± 10.56 years), from the North of Iran (2013 - 2014) were enrolled in a case-control study. The enzyme-linked immunosorbent assay (ELISA) and polymerase chain reaction (PCR) were applied to investigate the frequency of HSV in the participants..
Totally, 63 (76.8%) patients with MS showed a history of HSV exposure by anti-HSV testing compared to 70 (78.7%) subjects in the healthy group (P value = 0.855). The HSV-DNA test was positive in 37 (45.1%) and 3 (3.4%) patients with MS and healthy subjects, respectively (P value Herpes simplex virus was present in more patients with MS than healthy cases. HSV may be directly or indirectly associated with MS development. Further comprehensive molecular studies are needed to confirm the etiopathologic association between HSV and MS disease..

Spinal cord injury (SCI) is one of the worst kinds of traumatic injuries with remarkable social and economic effects on communities.
Methods & Materials/Patients: In this prospective randomized clinical trial, 122 patients with traumatic spinal cord injury were admitted to Poursina hospital within 48 h of injury to compare G-CSF and high-dose methylprednisolone as neuroprotective therapy.
In this study, 122 patients were studied out of which 62 patients were included in the granulociote colony-stimulating factor (G-CSF) group with a mean age of 40.4, and 60 patients in the methylprednisolone group with an average age of 40.10 years. 55 patients (45%) out of 122 patients were completely paralyzed (Grade AIS: A) and 67 (55%) were with incomplete spinal injury (Grade AIS: B, C, D). The average ASIA sensory scores in the two groups were similarly compared in the same time intervals, and p values were 0.7, 0.3, 0.2, and 0.1, respectively . They were not statistically significant.
According to the results, the G-CSF was shown to be beneficial in average ASIA motor and sensory scores in the two groups of male patients at six months of onset of G-CSF treatment (p value=0.04) and average ASIA motor scores improvement in the falls subgroup patients also differed significantly within six months of onset of G-CSF treatment (p value=0.03). A multicentre prospective randomized clinical trial to compare the placebo effect with G-CSF protocol's treatment, and also assessment of the cost benefits of the common medical treatment versus G-CSF are n eeded.

Background & Importance: Hydatid disease of the spine is rare but constitutes approximately 50% of bone involvement cases in human hydatidosis. It is a severe condition associated with a high rate of morbidity, disability and mortality.
In the present paper, we report an intriguing case of cervical spinal hydatid disease mimicking traumatic burst fracture.
A high degree of suspicion combined with good-quality neuroimaging is important for early and correct diagnosis. Because of the location and the potential for progression, spinal hydatid disease surgical treatment is the mainstay of treatment.

Glioblastoma multiforme (GBM), the highest grade glioma (grade IV), is the most malignant form of astrocytoma in adults. This study aimed at evaluating the relationship between demographic, clinical and medical factors with GBM outcome.
Methods & Materials/Patients: Through a cross-sectional design, 58 patients with newly diagnosed GBM were studied from 1999 to 2015 in Guilan province (North of Iran). Demographic, clinical and medical data including age, gender, score of Karnofsky Performance Scale (KPS), status at discharge, extent of resection (EOR) and administration of post operative radio-chemotherapy were recorded in an individual questionnaire. The data were analyzed using chi-square and fisher exact tests.
Of all patients, 35 (60.3%) cases were men and 23 (39.7%) were women. Age range (at the time of diagnosis of GBM) was 18-82 years (54.86±16.34). The most common side and location of tumor were left hemisphere and frontal lobe, respectively. 41 patients (70.7%) received total surgical resection. Half of patients were treated with simultaneous post operative radiation therapy and chemotherapy.11 (19%) of all cases died. About 41 (70.6%) of patients demonstrated KPS 50-70.
GBM is a frequent malignant brain tumor with male predominance and high occurrence in age range of ≥50 years. The number of dead patients increases with decreased KPS. Total surgical resection followed by concomitant radiation therapy and chemotherapy were common standard therapeutic regimens.

We described the presentation, management and subsequent treatment outcomes of children and adolescents diagnosed with a pituitary adenoma in a joint neuroendocrine setting followed up by a single service as well as assessing long-term outcomes in terms of endocrine status and neurology symptoms.
Methods & Materials/Patients: A total of 21 participants with histologically verified pituitary adenoma between January 2011 and June 2014 were studied. Patient's data from clinical, radiological and pathological records were analyzed using SPSS (Version 16).
All these children and adolescents with pituitary adenomas were managed with microscopic transsphenoidal surgery. The most common symptom was Cushing (47.6%, n=10). The functional type 76.2%, n=16) was more than the non-functional. The post-operative control MRI of most of them was clear (90.5%, n=19). The lab control of most of them was normal (76.2%, n=16). Apoplexy was seen in 5 patients (33.8%). Gross total resection (GTR; 100% tumor removal as judged by early post-operative imaging) was achieved in 19 cases. Only one of these patients showed evidence of radiologic recurrence.
In our study, all patients underwent microscopic transsphenoidal surgery due to limitation of endoscopic approach in pediatric and avoided wide anatomical deficit. Doing a comparative study between these two approaches will bring about promising results.

Breast cancer is the most common cancer in women in most areas of the world. In Iran and Guilan province, frequency of this type of cancer has shown an increasing rate according to statistics of health centers of province in recent years. Despite of efforts on early diagnosis and treatment, this type of cancer is still the second leading cause of deaths due to cancer in women. This study aimed at obtaining protein biomarkers that may be useful in diagnosis and treatment of breast cancer. Patients and In this experimental study, 10 patients with proved breast cancer and 10 patients with healthy breast, healthy and cancerous tissue samples were obtained to perform proteomics. All tissue proteins were purified using standard separation methods and proteins were separated using two-dimensional electrophoresis. Healthy and tumorous tissue proteomes were compared and the extent of protein expression was analyzed. Four hundred fifty four proteins were recognized, 138 of which were identified with changes in protein expression while cancerous. The expression of 61 proteins in tumorous group was suppressed. Three proteins showed increased expression while cancerous and 74 proteins showed decreased expression in cancerous tissue. It seems that in this disease, the expression of a large number of proteins in cancerous tissues changed, most of them decreased or not expressed at all. These changed proteins can be effective as biomarker in diagnosis and treatment of this disease.

Today, stem cell transplantation is a hot topic in scientific circles as a novel therapeutic approach to repair the structure and function of central nervous system. The safe and neuroprotective effects of cell therapy in models and traumatic brain injury patients were evaluated in many experimental and clinical studies in recent decade and somewhat promising results were provided to the scientific community. Nevertheless, there are still obstacles in translating experimental studies in the laboratory into clinical practice that should not be overlooked. In this review study, a brief explanation is provided about biological events and endogenic neurogenesis and angiogenesis after TBI; the performance of transplanted cells in restoration of damaged neurons; the role and potential use of mesenchymal stem cells as adult stem cells preferred in cell transplantation and clinical trials ever conducted in this area; features of cell transplant candidates who will most benefit from transplantation, the type of and proper time for cell transplantation, optimal method for conducting transplant to deliver cells to the brain, and the best dose for effectiveness of transplantation. Finally, the various neuroimaging techniques are discussed, which are used to track and evaluate the survival and implantation of transplanted cells.

Although most patients experience severe pain after major spinal fixation surgery, little attention has been paid to control it with a multi-modal approach. The aim of this study is to select appropriate method of pain management after spinal surgery.Methods & Materials: Patients: This study was a randomized clinically controlled trial in candidates of spondylolisthesis and spinal fixation surgery under general anesthesia. 90 patients were divided into three groups, as follows: 1) Intervention group of epidural fentanyl (F): patient-controlled analgesia (PCA) pump infused 100 µg of fentanyl and 98cc of normal saline at the rate of 3-5 ml/h in the epidural space via an epidural catheter placed by surgeon 2) Intervention group of epidural fentanyl-bupivacaine (FB): PCA pump infused 100 µg of fentanyl and bupivacaine 0.125% at the rate of 3-5 ml/h in the epidural space. 3) IV morphine group (M): No medication was received epidurally. In case of visual analog scale (VAS) score more than four, one mg of IV morphine bolus was administered to patient. The blood pressure, heart rate, respiratory rate and pain severity were recorded at the moment of patient’s transfer from recovery room to the ward and compared in three groups every six hours for 24 hours. The results of this study were analyzed by statistical tests including repeated measures ANOVA, Kruskal-Wallis, Fisher’s exact test and SPSS software 16. P values less than 0.05 were considered statistically significant. The results of the study showed that VAS score in fentanyl-bupivacaine group was significantly lower than that in the two other groups during the first 18 hours. However, VAS score in all groups decreased at 24th hour postoperatively (less than three) suggesting that there was no statistically significant difference between the three groups. In this study, no serious and severe complications were observed except for a few cases of nausea in the control group. Epidural analgesia with fentanyl-bupivacaine is a safe and effective way to postoperative pain management in listhesis and spinal surgeries.

Patients with spinal cord injury (SCI) impose a heavy burden on health care system. Awareness on prevalence and incidence of SCI is important because this would show the necessity of prevention. This study aimed to investigate the epidemiology and types of traumatic spinal cord injuries in a trauma referral center in Guilan. Methods & Materials: Patients: This is a descriptive study which was conducted on patients with spinal cord trauma using a questionnaire during one year. The questionnaire included demographic information, injured spinal cord area, mechanism of injury, and type of neural damage based on ASIA scale. The data were analyzed using SPSS18 and descriptive statistics. Out of 76 study patients, 68 (88.2%) were men with mean age of 35.2 ± 1.45 years. The most common cause of SCI was motor vehicle accidents (MVA) (48.7%). 34 patients (44.7%) had cervical spine injury and in 23 patients (30.3%), thoraco-lumbar injuries caused SCI. 29.7% of patients suffered from paraplegia and 10.8% quadriplegia. 25 patients (38.5%) had complete SCI. 7 patients with SCI (9.2%) died during hospitalization. In this study, increased age was identified as a risk factor for death. In 4 of these patients (57.1%) cervical SCI was the underlying cause of death. Young men were the group at highest risk and the most mechanism leading to SCI was motor vehicle accidents. Many of these accidents are preventable; thus, more attention should be devoted to safety policies based on needs of the vulnerable groups. Besides, comprehensive education program with clear and practical goals should be developed.