فصلنامه یافته
سال بیست و دوم شماره 4 (پیاپی 86، زمستان 1399)

Since the emergency department is considered as a vital and important department of any hospital, so the study of service delivery processes in the emergency department has a significant role in patient satisfaction. The purpose of this study is to identify the factors affecting the performance of the emergency department and determine the existing bottlenecks and provide appropriate strategies to improve performance and reduce patient waiting time using a simulation approach.

This research is descriptive-analytical. The statistical population of this study was all patients referred to the emergency department of Khorramabad Nomadic Martyrs Educational and Medical Center in a period of three months, which was performed cross-sectionally on 200 patients. First, the processes of the emergency department were identified and then the time of patientschr('39') arrival and the time of providing services of the emergency department processes in a quarterly interval were randomly measured in three shifts of morning, evening and night. Then the current situation was designed and simulated using Arena software. By implementing the simulated model, bottlenecks in the emergency department were identified and 6 scenarios were designed and implemented to clear the bottlenecks, improve emergency performance and reduce patient waiting time, and the results were compared and analyzed.

Based on the output of the simulated model, laboratory processes, patient discharge and ultrasound-radiology processes with an average of 174, 71 and 27 minutes of waiting queue were identified as the main bottlenecks. Based on this, 6 scenarios were designed and implemented in the simulation model. According to the simulation results, scenario F with an average decrease of 1.8 hours had the highest decrease in average waiting time and scenario C with a decrease in waiting time of 0.6 hours had the lowest decrease in average patient waiting time compared to other scenarios. Also, Scenario B had the lowest and Scenario F had the highest patient output compared to other scenarios. However, scenario C, which had the least decrease in patient waiting time, has an increase of 11.67% in patient output compared to the current situation.

Scenario F, E and A have better results than other scenarios, respectively, and due to resource and cost constraints in scenarios F and E, the implementation of Scenario A (adding 2 laboratory experts) leads to a reduction in the average waiting time of patients for 1.43 hours compared to the current situation, is recommended.

Tuberculosis is one of the infectious diseases that have long threat human health. The purpose of this study was to evaluate the circulation of Mycobacterium tuberculosis in Delfan city to achieve better care of the disease.

This is a descriptive-analytical study conducted in Delfan. The study data were collected from the records of all patients referred to health centers of Delfan from 2011 to 2020 using census method. SPSS 23 software was used for data collection. Frequency tables and Chi-square tests were used to analyze the data.

The mean age of the patients was 47.56 ± 22.34. from a total of 125 cases present, 76 were positive pulmonary smear tuberculosis, 18 were negative smear and 31 were extra-pulmonary tuberculosis. Eighty percent of patients have illiteracy and primary education. On average, the interval between the onset of symptoms and the diagnosis of the disease in all forms of tuberculosis was approximately 97 days. Also, a statistical relationship was observed between the type of tuberculosis and the place of residence (p≤. / 006), age (p≤. / 004) and delay in diagnosis (p≤ / 022).

In the present study, most of the patients were illiterate, so training and preventive measures to control tuberculosis are recommended for this group. Also, due to the large distance between the disease and the diagnosis, it is necessary to follow the tuberculosis care program in this city more seriously in order to shorten this distance

Patients with diabetes mellitus are at high risk of antioxidants and in long-term vascular lesions. Therefore, the aim of the present study was to evaluate the effect of one course of aerobic exercise on the gene expression of angiopoietin-1 (ANGPT-1) and cardiac tissue oxidative status (TOS) in diabetic rats.

30 male Wistar rats were divided into 3 groups (n= 10) diabetic training, diabetic control and healthy control groups. Animals in diabetic groups were diabetic by intraperitoneal injection of streptozotocin. The exercise program consisted of 6 weeks of treadmill training. 24 hours after the last training session to evaluate the effect of exercise, cardiac tissue samples were extracted to measure gene expression  of ANGPT-1 and total oxidative status. One-way ANOVA with statistical level (P<0.05) was used to compare the differences between groups.

The results showed that gene expression of ANGPT-1 and TOS were significantly increased in the diabetic training group compared to the diabetic control group (P= 0.001) but only in the ANGPT-1 there were no significant differences (P= 0.001) between two groups of diabetic control and healthy control (P>0.05).

It seems that endurance training has a positive effect on the expression of ANGPT-1 gene and improves the overall antioxidant status of the heart tissue of diabetic rats and improve the diabetic heart.

The high prevalence of Helicobacter pylori (H.pylori) infection worldwide, especially in developing countries, and its role in gastric malignancies and the emergence of antibiotic resistance have led to proposing the different treatment and prevention methods against infection. HP associated GlmM gene is coding for Phosphoglucosamine mutase that considered for molecular detection of HP.

In this case-control study, blood and stool samples were obtained from studied population and the titers of IgG & IgA were measured by ELISA kits. DNA was extracted from stool samples and PCR was used to detect glmM gene. The results were analyzed by SPSS software.

In initial study regarding of antibodies level in the blood serum, 86% of the subjects in the group showed antimicrobial IgA and IgG at the same time, while in the control group this amount was 59.9%. The results of PCR showed that in the case group, 20 out of 42 cases had glmM gene and in the control group there was no positive sample for this gene.

In this attempt, we tried to find a linkage between HP-associated virulence glmM gene and antibodies concentration through which probability of developing acute and severe state of disease in infected patients. The PCR and Ab titers associated results showed no significant relation between glmM gene of HP originated stool sample and serum concentration of IgG and IgA in patients who suffered from HP infection.

The aim of this study was to evaluate the effectiveness of dialectical behavior  therapy in reducing psychological symptoms in patients with mitral valve prolapse syndrome.   

The present study is a quasi-experimental with a pretest-posttest design with a control group. The statistical population included all female patients with mitral valve prolapse syndrome in Mashhad who referred to Ferdowsi University Clinical Psychology Clinic, Imam Reza and Ghaem Hospitals in Mashhad. Among the volunteers, 16 were They were selected from interview and initial screening by purposive sampling method and randomly assigned to experimental and control groups. The research instruments included the Albanian Panic Questionnaire, Krupp Fatigue and Generalized Anxiety Inventory (GAD-7) and the data were analyzed by SPSS software version 21 and one-way analysis of covariance.

The results showed that dialectical behavior therapy was effective in reducing psychological symptoms (P <0.01).

This approach has paved the way for improving the psychological health of these patients.

The most common iodine deficiency disorders (IDD) are; Hypothyroidism, simple goiter, psychomotor problems, hearing-neurological disorders and cretinism. This study was carried out to evaluation of urinary iodine in 8-10 years old students in lorestan province in 2019.

In this analytical descriptive study, 236 students of both sexes aged 8-10 years from urban and rural areas were selected randomly by cluster sampling and urinary iodine measured based on acid digestion. The results were analyzed using Statistical Package for the Social Sciences  (SPSS; version 20).

In this cross-sectional descriptive study the urinary iodine excretion median was 6 mg/dl and in 21.2% was more than 10 mg/dl and in 78.8% was less than 10 mg/dl. urinary iodine excretion median difference was significant for urban and rural students (p = 0.021).There was no significant relationship between gender and age variables with the median urinary iodine excretion in students.

The results of this study showed that urinary iodine excretion in Lorestan school students is not at the desired level of the World Health Organization; Therefore, it is necessary that the measures taken by the provincial committee for the control of iodine deficiency disorders be evaluated.

The purpose of this study was to determine effectiveness of emotion regulation on psychological capital and conflict resolution techniques in mothers with a physicaly disabled child in Isfahan.

This study was a quasi-experimental study with pre-test, post-test and one-month follow-up with a control group. The statistical population in this study included all mothers with adolescents with physical-motor problems of Sepehr Isfahan Welfare Center in 1397-1397, from which 30 mothers of adolescents with physical-motor problems were selected by Multi-stage random sampling and were randomly divided into control and experimental groups. In this study, the psychological capital questionnaires of Lutans et al. (2007) and Rahimchr('39')s conflict management styles (1997) were used. The data were analyzed using covariance analysis.

The results showed that emotion regulation training increased psychological capital and the use of conflict resolution techniques (in mothers with adolescents with physical and motor problems) and this effect has been preserved during the follow-up period.

Holding special courses to promote psychological capital and conflict resolution techniques in mothers with adolescents with physical disabilities is necessary and improves relations in these families.

The use of medicinal smokes is common in more than 50 countries and accepted in traditional medicine and among people.
In Iranian culture, according to ancient physicians such as Avicenna and Zakaria al-Razi, the use of smoke such as Spand (Peganum harmala) and female donkey dung (Anbarnasara) is common as a medicinal combination to treat Sinusitis and Vaginitis also wound infection, eyes and anal infections. This study aims to investigate the opinions of ancient physicians about the effect of Anbarnasara smoke on bacteria isolated from the wound, eye, and sinuses infections.

Smoke from burning Anbarnasara was collected in 50% methanol. The antibacterial effects of various concentrations (3.2-100 mg/ml) of the collected smoke were investigated by the disk diffusion method on 6 standard bacteria and 8 bacteria isolated from patients.

The largest zone of inhibition was observed in 100 mg/ml with 12 mm in Micrococcus luteus a Gram-positive standard strain and 18 mm in Klebsiella pneumoniae. a Gram-negative standard strain. In the same concentration, among gram-positive bacteria isolated from patients, the highest zone of inhibition with 21 mm was observed in S. epidermidis and among gram-negative bacteria isolated from patients, the largest zone of inhibition with 17 mm was observed in Proteus mirabilis.

Due to the observed antibacterial effects of smoke from burning Anbarnasara in the bacterial strains, which often causes infection in wound, eyes, and sinuses infections, according to the opinions of ancient physicians, this combination can be used to eliminate these infections.

Due to the increasing prevalence of preeclampsia and eclampsia syndrome and itchr('39')s multifactorial nature and the relationship between zinc and this syndrome, this study was designed to compare serum zinc level in pregnant women with preeclampsia or eclampsia and healthy in Ali Ibn Abitaleb Hospital in Zahedan.

In a case-control study, 50 pregnant women with pre-eclampsia or eclampsia and 50 healthy pregnant women were selected based on inclusion and exclusion criteria by convenient sampling method, 2019. After recording demographic and clinical characteristics in each questionnaire in two groups, 3 ml of blood was taken from each person. Serum zinc was determined by atomic absorption, spectrophotometry. Quantitative and qualitative data were described and analyzed as independent t-test by SPSS software: 16

The results showed that the mean serum zinc level was not significantly different between the case and control groups, but the frequency of serum zinc deficiency in the case group was higher than the control (P< 0.01). In pregnant women with a gestational age of 34 weeks and more, the serum zinc in the case group was lower than control (P=0.04). In addition, hypertension in healthy pregnant women is associated with serum zinc levels. Complications such as pre-hypertension, proteinuria, and abortion were more common in case group (P< 0.05).

Findings indicate that although the mean serum zinc in the two groups was not significantly different, but the frequency of serum zinc deficiency was higher in the case group. Nevertheless, screening for serum zinc deficiency and its treatment along with other diagnostic and clinical methods can be effective in ensuring health and preventing preeclampsia or eclampsia in pregnancy.

Needle sticking is one of the problems faced by the staff of health centers, especially nurses. Due to the importance of this issue, the aim of this study was to investigate the frequency and causes of needle head injury among nurses.

This study was a cross-sectional-analytical study and the study population consisted of all nurses working in teaching hospitals in Khorramabad in 1399 of this study.The data collection tool of the questionnaire is two main parts. The first part is about demographic characteristics and the second part includes specialized questions about Needle Stick. Data were analyzed using SPSS software version 15 and logistic regression test.

In this study, 380 nurses were randomly selected from all educational hospitals in Khorramabad.out of 380 samples,204 nurses(53.7%) were needled and 176(46.3%) were not needled, 301 (79.2%) were female and 79 (20.8%) were male. They were. Of these,194 (52%) were between 20-30 years old, 142 (38.1%) were between 30-40 years old and 37 (9.9%) were over 40 years old. Statistically, the results showed that there is a significant correlation between shift work and needle sticking (P=0.003), statistically the results showed that there is a significant correlation between work experience and needle sticking (P = 0.027),in terms of The results showed that there was a significant correlation between the workplace and needle sticking (P=0.015). the results showed that there was no significant correlation between gender, age, hospital, education and needle sticking.

Considering that in our country, for various reasons, the use of new injection tools and methods is not common; Therefore,efforts to Changing nurseschr('39') job behavior should be done with more emphasis.

Today, participation in regular sports programs is an undeniable need for prevention of diseases and improving the quality of life of the elderly. Therefore, the aim of this study was to investigate the effect of a selected combined training course on immunoglobulin G concentration and liver injury index in elderly men.

In this quasi-experimental study, 20 elderly men in the age group of 65-55 years were randomly divided into two groups of combined exercise and control. Combined exercises, including aerobic activity with an intensity of 60 to 74% of the stored heart rate and strength exercises with 50 to 75% of 1RM were performed during 8 weeks and three sessions per week.  Blood samples were collected 24 hours before and 48 hours after the last training session to measure serum AST, ALT and IgG levels. To analyze the data from ANKOVA test and to compare intra-group differences, paired t-test was performed at a significant level of P <0.05.

The results showed that there was a significant difference between the combination and control groups in serum concentrations of AST (P =0.003), ALT (P=0.004) and IgG (P=0.041). Paired t-test results showed a significant decrease in post-test compared to pre-test ALT (P=0.048), AST (P=0.007) and IgG (P=0.02).

The results of the present study showed that combined activities are an effective factor in preventing liver damage and strengthening the immune system of the elderly. Combined training can be a good exercise protocol to maintain health in these people.

The aim of this study was to compare Acceptance and Commitment Therapy with Compassion focused Therapy on Romantic, Family and Social loneliness in patients with Multiple Sclerosis.

In a quasi-experimental design, with pre-test and post-test and a control group, 45 patients with Multiple Sclerosis were selected among the patients referred to the MS clinic in Tehran province in 1398 and devided randomized in two experimental groups Acceptance and Commitment Therapy , Compassion focused Therapy and one contro; group. All three groups completed the Adult Socio-Emotional Feeling Questionnaire (SELSA-S) in two stages before and after the intervention. The experimental groups participated in eight sessions of Acceptance and Commitment Therapy, the second experimental group participated in ten sessions of Compassion Focused Therapy, the experimental group did not receive any intervention, and the post-test sessions were performed at the end of the sessions. In order to test the research hypothesis, the results were analyzed by multivariate analysis of variance (MANCOVA) and SPSS21.

The results showed that Compassion Focused Therapy and Acceptance and Commitment Therapy were effective on the feeling of loneliness in patients with Multiple Sclerosis and with 95% confidence it can be said that Acceptance and Commitment therapy is more effective.

According to the obtained results, these interventions can be used along with drug treatment for Multiple Sclerosis patients as a useful and complementary treatment method.

The aim of the present study was to investigate the effect of exercise pre-conditioning with intense intermittent exercise on MDA, SOD and GPx enzymes of myocardial infarction following acute myocardial infarction in male rats.

Based on this goal, 20 8-week-old male Wistar rats (mean weight 224.41 ± 5.1 g) were divided into 4 groups: control, training, stroke and stroke-training. The training groups performed two weeks of intense intermittent training in four sections. The first part of three days of training, two sessions per day and each session consisting of 4 intense two-minute intervals at a speed of 35 to 40 meters per minute . In the second part, two training days, two training sessions each day containing 4 cycles of intense activity of 2 minutes and 3 cycles of active rest of 2 minutes. The third part, in three training days, included 5 intense cycles and 4 active rest cycles. The fourth part consisted of two training days with the same intensity as the third part but with an increase in the frequency of activity and active rest in each session.

One-way analysis of variance test showed that two weeks of intense intermittent training, although reducing the heart attack area of rats, however, it did not cause significant changes in MDA, SOD and GPx enzymes following acute myocardial infarction between stroke-exercise and stroke groups.

Intense intermittent exercise reduces heart damage in myocardial infarction, and this reduction occurs independently of changes in oxidative and antioxidant factors.

The hurler syndrome is the most common form of lysosomal storage diseases (LSDs). In the present experiment, we intended to generate an IDUA targeting CRISPR-Cas system and deactivate the target gene using it.

IUDA targeting sgRNA pair were cloned into the px335 plasmid and resulted plasmid identity was confirmed using restriction mapping. Recombinant plasmid was transfected into the human epithelial cell line, HEK-293. Mutated clones were screened by melting analysis and their mutation was characterized by Sanger sequencing.

Analytical digestion and Sanger sequencing confirmed indel mutation induction in two clones in heterozygote and one clone in homozygote state.

In this study, we produced an IDUA knockout cell model using CRISPR-nCas9 system. This model can be used in the therapeutic approaches of this disease.