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  Background & objectives: Today, the concept of q uality of services is particularly important in health care and customer satisfaction can be defined by comparing the expectations of the services with perception of provided services. The aim of this study was to evaluate the quality of services provided for outpatients in clinic of Ardebil city based on the SERVQUAL model.

  Methods: This descriptive study was conducted on 650 patients referred to outpatient clinic since July to September 201 3 using a standardized SERVQUAL questionnaire (1988 ) with confirmed reliability and validity. The paired t-test and Friedman test were used for analysis of data by SPSS software.

  Results: 56.1 % of respondents were male and 43.9 % of them were female . The mean age of patients was 33 ± 11.91 , 68.9 % of patients were in Ardabil and 27.3 % of them had bachelor's or higher. The results showed that there is a significant difference between perceptions and expectations of the patients about five dimensions of the service quality (tangibility, reliability, assurance, responsiveness, and empathy) in the studied clinic (P< 0.001). The highest mean gap and minimum gap were related to empathy and assurance, respectively.

  Conclusion: Regarding to observed differences in quality , the managers and also planners have to evaluate their performance more accurately in order to have better planning for future actions. In fact, any efforts to reduce the gap between expectation and perception of patients result in greater satisfaction, loyalty and further visits to organizations.

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  Background &objectives: Glutamine has antioxidant properties and can be used to treat some diseases. This study was conducted to assess the effect of one-week glutamine supplementation on oxidative stress indices in young healthy men.

  Methods: Nineteen active healthy men volunteered for this study. This study was conducted in biochemistry lab of Ardabil branch of Islamic Azad University in Spring 2014. Participants were randomized in a double-blind placebo-controlled method into two groups: Glutamine (n = 9) and placebo group (n = 10). The participants took supplement (0.15 g/kg glutamine + 15g sweetener + 250ml water) or placebo (15g sweetener + 250ml water) daily for 7 days before main trial.Fasting blood samples were taken before and after supplementation. Total antioxidant capacity (TAC) of plasma, reduced glutathione (GHS) level of serum, and malondialdehyde (MDA) of plasma were measured.

  Results: GHS significantly increased after treatment compared with pre-treatment in Glutamine group (p<0.05). There were no other within and between group significant differences in any indices (p>0.05).

  Conclusions: These results showed that one-week daily oral supplementation of glutamine has been able to increase GHS probably because of greater glutamine availability .

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  Background & objectives: Dental caries is one of the most chronic diseases in children. Various factors were effective in incidence andprevalence of dental caries. The aim of this study was to determine the dental caries prevalence among 6-12 yearsold school children in Ardabil city.

  Methods : In this descriptive–cross sectional study a total of 847 school children (444 girls and 403 boys) were randomly selected from public and private schools in all over of Ardabil city.Clinical examination of children have been done for dental caries according to world health organization (WHO) criteria including determination of DMFT, dmft, DMFS and dental caries prevalence. Data were analysedin SPSS.16 by statistical methods.

  Results: Total prevalence of dental caries was 79.7% in children with 71.1 % in permanent and 88.3 % in primary dentition. The mean of dmft, DMFT, DMFS indexes were 2.74± 0.09, 1.6±0.1, and 3.5± 0.1, repectively.Results showed that there was a significant relation between DMFT, dmft and DMFS and age group.

  Conclusion : Results showed that the dental caries prevalence among 6-12 years-old school children in Ardabil city was higher than the world standard. Therefore, improving the existing dental services, programing and performing education, prevention and treatment programs for oral health between school children seems tobe necessary in the future.

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  Background & objectives: Trichomonas vaginalis is a protozoan parasite lives and also causes symptoms in urogenital system of human. Trichomoniasis is the widest spread infection which is transmitted through sexual contact and more than 170 million people are a ffected with Trichomonas vaginalis in the world. Trichomonas vaginalis in women causes pelvic inflammatory disease, increase in the risk of fallopian tube dependent infertility, ectopic pregnancy, preterm labor, the birth of low weight infants and the increase in the possibility of HIV transmission. Considering the importance of Trichomonas vaginalis infection in pregnant women and lack of data from Ardabil city, this study was performed to identify this infection in pregnant women referred to health and medical centers of Ardabil city.

  Methods: Vaginal discharge from 500 pregnant women was collected with sterile swap and disposable speculum and examined for Trichomonas vaginalis by direct microscopic examination and cultured in Diamond specific medium. A testimonial and questionnaire were completed for each case and the results analyzed using chi-square test by SPSS statistical software version 19.

  Results: In this study, the culture of samples displayed 12 positive cases (2.4%). Furthermore, Trichomonas vaginalis trophozoites were observed in five cases (1%) with direct microscopic examination. Among 12 positive cases, five respondents (41.7%) were in age range of 16-25 years and seven (58.3%) in 26-35 years old. Among different clinical manifestations there was a significant relation between discharge and the infection.

  Conclusion: The present survey confirmed the presence of Trichomonas vaginalis infection in pregnant women of Ardabil city. Therefore, an effective healthcare program by health authorities for prevention of infection in this group seems to be needed.

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Background & objectives: Myocardial infarction (MI) isone of the most commonly heart diseases in all countries with the mortality rate of about 30%. Reperfusion of blocked coronary arteries plays an important role in reducing mortality and enhancing the quality of life of patients after acute MI. 

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Alzheimer's disease (AD) is a common cause of dementia in elderly people that is accompanied by progressive cognitive decline and memory loss. The pathologic hallmarks of AD are synaptic and neuronal degeneration together with extracellular senile plaques containing amyloid-beta (Aβ) and the intracellular neurofibrillary tangles (NFTs) in the hippocampus and other cortical regions. Amyloid-beta peptide is believed to have a pivotal role in the pathogenesis of AD as a major component of the senile plaques. It acts as a trigger key of AD and is considered as the principal toxic factor in the pathogenesis of the disease. Accumulation of amyloid β protein (Aβ), a main component of the senile plaques, in the brain initiates a cascade of events that ultimately lead to neuronal dysfunction and cognitive deficits. Other proposed mechanisms for AD include impairment in cholinergic function, oxidative stress, inflammatory agents and glutamate-mediated excitotoxicity. AD is characterized neuropathologically by impaired cholinergic function, increased oxidative stress, neuroinflammation, neuronal cell death, synapses loss, cortical atrophy, deficiencies in steroid hormones and appearance of glutamate-mediated excitotoxicity.

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Background & objectives: Therapeutic abortion in the second trimester of pregnancy can be done by a number of medical or mechanical methods. The aim of this study was to compare the efficacy of vaginal misoprostol with and without letrozole and combination of misoprostol and laminaria in preoperative cervical ripening among women with under second-trimester abortion.
Methods: In this interventional study, 120 pregnant women with the gestational age of 20 weeks, who were candidates for therapeutic abortion, were selected and randomly divided into three groups (n=40). Proper counseling was done and a written informed consent was obtained before starting the treatment regimen. The first group received vaginal misoprostol alone and the second group received misoprostol in combination with laminaria and oral placebo. In the third group, in addition to cervical placebo on the first and second days, letrozole was prescribed, and on the third day, the patients were hospitalized and received vaginal misoprostol and third dose of letrozole. The patients were regularly examined every 4 hours, and in the absence of abortion, vaginal misoprostol was repeated after 4 hours.
Results: The results showed that termination of pregnancy was caused by embryo anomaly in 23 cases and fetal death in 97 cases. In this study, response to treatment was 90% in the group receiving laminaria and misoprostol 85% in the group receiving letrozole and misoprostol and 67% in the group receiving misoprostol. Regarding the duration and amount of bleeding, the groups receiving laminaria and misoprostol had the lowest duration and severity of bleeding, but this difference was not statistically significant. Combination of misoprostol and laminaria caused a significantly shorter time interval from the initiation of intervention to abortion, and pain relief was also higher than the other two groups.
Conclusion: Based on the obtained results, a combination of misoprostol and laminaria is recommended for induction of second-trimester therapeutic abortion.

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Background & objectives: Due to the widespread use of zinc oxide nanoparticles (ZnO-NPs) and their possible unwanted effects in biological environments, we made an attempt to investigate the effect of ZnO-NPs on the blood lipid profile.
Methods: In this study, 24 male Wistar rats were used. The rats were randomly divided into three groups: control group, the group receiving ZnO-NPs at 25 mg/kg (ZnO-NPs 25 mg/kg) and the group receiving ZnO-NPs at 50 mg/kg (ZnO-NPs 50 mg/kg). The duration of the test was two weeks. The blood samples were taken and the serums were separated. Serum levels of triglyceride, cholesterol, VLDL, LDL and HDL were determined using standard kits and methods.
Results: Based on the findings of this study, serum levels of triglyceride and VLDL in both ZnO-NPs receiving groups were significantly increased in comparison with the control group (p<0.05). Also,  the serum levels of HDL , LDL and LDL/HDL ratio decreased significantly in both ZnO-NPs receiving groups compared to the control group (p<0.05), while the  serum cholesterol levels did not change compared with the control group.
Conclusion: Our results showed that 25 and 50 mg/kg doses of ZnO-NPs had both harmful (increase triglyceride and VLDL and reduction of HDL) and beneficial (reduction of LDL and LDL/HDL ratio) effects on the blood lipid profile.

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Background & objectives: 10 year survival rates for thyroid cancer is about 90%, but papillary thyroid cancer often spread to regional lymph nodes resulting in survival rate falls below 90%. In patients with thyroid cancer, cervical lymph node metastasis risk is about 20 to 50 percent. The aim of this study was to evaluate the association between ultrasound results and the involvement of lymph nodes before thyroidectomy and compare it with the pathologic response after thyroidectomy in patients with non-medullary thyroid cancer.
Methods: 60 patients with thyroid cancer were randomly selected and entered into the study. Ultrasonographic examination of cervical lymph nodes was performed by two radiologists using an ultrasound machine in all patients diagnosed with thyroid cancer. Patients underwent total thyroidectomy and neck lymph node dissection by surgeon.
Results: In papillary thyroid cancer, there was a significant relationship between ultrasonographic results and pathologic outcomes in determining the presence of cervical lymph node metastasis before thyroidectomy. And also, there was a significant relationship between the results of ultrasonography and pathologic findings in determining the location of affected lymph nodes.
Conclusion: Compared to histological examination, ultrasonography can be a useful tool in determining the location of affected cervical lymph node in thyroid cancers before surgery.

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Introduction & objectives: Vaginismus is an uncontrolled contraction of the outer third muscle of the vagina that prevents intercourse. Based on the DSM-V-TR system, this disorder is associated with dyspareunia and "Genito-pelvic pain/penetration disorder". The purpose of this overview was to summarize population-based studies that reported the prevalence of vaginismus in the general population and to discover the discrepancies between studies.
Methods: This systematic review study was conducted on published articles on the prevalence of vaginismus in the world and in English. In selecting the articles, the keywords including Vaginismus, Prevalence, Incidence, Sexual Dysfunction, Genito-Pelvic Pain, Penetration Disorder with all possible combinations were systematically searched in the google scholar, science direct, PubMed, Cochrane databases. No search time limit was set to retrieve all relevant articles published by September 21, 2018.
Results: Of the 10 studies, 4 articles reported prevalence of vaginismus in the general population. In selected studies, the incidence of vaginismus in the general population of women was reported 0.4% to 8%.
Conclusion: Different prevalence rates have been reported in different studies for vaginismus. In this review study, it was not possible to Meta-analyze and determines the overall prevalence due to the heterogeneity of the prevalence reports and different study methods.
 

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Background & objectives: Gastric cancer has a very wide geographic distribution. Identification of the genetic factors involved in the cancer predisposition is very important. IL-1β as a pro inflammatory cytokine is involved in gastric acid secretion in the H. pylori infected individuals. This study was aimed to evaluate the role of IL-1β-511 polymorphism on the susceptibility to gastric cancer in residents of Ardabil province.
Methods: One-hundred patients affected with gastric cancer and 100 normal individuals were selected as case and control groups, respectively. After DNA extraction from peripheral blood samples, the presence of the polymorphism IL-1β-511 was determined via PCR-RFLP assay. The results were evaluated by agarose gel electrophoresis.
Results: Among cases, CC, CT, and TT genotypes were observed in 19%, 60%, and 21% of individuals, respectively. Also, the distribution of genotypes among the participated individuals in control group was 4%, 67%, and 29%, respectively. There was a significant difference (p<0.05) between case and control groups.
Conclusion: According to this study, there was a significant relationship between IL-1β 511C allele polymorphism and gastric cancer in patients with gastric cancer in Ardabil province. It is indicated that some of the polymorphisms in IL-1β cytokine are associated with gastric cancer, and this finding would be used as a predictive value.

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Background & objectives: Over the last couple of decades, research has focused on attempting to understand the genetic influence on sports performance. Whole exome sequencing (WES) has great potential to explore all possible genetic variants associated with physical performance. However, this new technique has not been used in sports genetics research. Therefore the aim of this case study was to report new variants in genes involved in skeletal muscles strength (ACE, NOS3, IGF1R, IL-6) in an elite weightlifter using WES.
Methods: After obtaining a written testimony from a 32-year-old man, who is a member of the Iranian national weightlifting team, 5 cc of blood was taken and then DNA was extracted. DNA samples were analyzed using the whole exome sequencing method.
Results: Whole exome sequencing analysis revealed a missense variant (99454613G>A) in IGF1R, 22771156C>T polymorphism in IL-6, 150695726T>C and 150704250C>G polymorphisms in NOS3 and 61573761T>C and 61564052A>G in ACE genes.
Conclusion: Results of whole exome sequencing analysis revealed a missense variant and polymorphism in muscle strength and hypertrophy related genes in this elite weightlifter. However, other studies with larger sample sizes are needed to investigate the relationship between these variants and power athlete status. 

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Background & objectives: Cyclin-dependent kinase 2 (CDK-2) is a serine/threonine protein kinase with regulatory activity in the cell cycle. Inhibitors of this protein are the treatment of choice for a variety of cancers by stopping the cell cycle. In this in silico study, the effects of docking and molecular dynamics of Abemaciclib, Hymenialdisine, and Indirubin on the inhibition of CDK-2 as one of the most important factors in the cell cycle have been investigated.
Methods: PDB file of CDK-2 protein as well as three-dimensional structures of Abemaciclib, Hymenialdisine, and Indirubin were obtained from the protein database (http://www.rcsb.org) and pubchem server, respectively. After simulating CDK-2 in Gromacs software, molecular docking of compounds on CDK-2 was performed by AutoDock 4.2 software. Finally, the most important molecular dynamics factors such as RMSD,the radius of gyration and total energy in the pre-docking state were analyzed and compared to these factors in the post-docking stage.
Results: Abemaciclib has the highest affinity for binding to amino acids at the CDK-2 binding site by releasing binding energy equivalent to 8.23 kJ/mol. The binding of Abemaciclib, Hymenialdisine, and Indirubin to CDK-2, resulted in significant reductions in some molecular dynamics factors such as mean total energy, the radius of gyration, RMSD, and changes in CDK-2 secondary structure.
Conclusion: Abemaciclib, Hymenialdisine, and Indirubin have a high tendency to interact with CDK-2, and this binding can induce significant dynamic molecular changes in the structure of CDK-2 molecule.  Based on the results of molecular dynamics simulation, the secondary structure of CDK-2 changes after each ligand binds to it and makes the complex of ligand and protein more stable. 

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Background & objectives: Coronary heart disease (CHD) is an important medical disorder and one of the most common heart diseases worldwide, which causes disability and economic burden. The medical and research community is increasingly interested in computer-aided coronary heart disease diagnosis through the use of machine learning methods. This study aimed to diagnose coronary heart disease using a discriminant analysis algorithm in active elderly men.
Methods: This analytical study was conducted on 351 patients of Ayatollah Kashani Hospital in Tehran. This work used discriminant analysis algorithm to diagnose coronary artery disease. Python software was used for data analysis.
Results: The results showed that by using 14 characteristics as risk factors related to the subjects' laboratory, personal and lifestyle information. The discriminant analysis algorithm could distinguish healthy and sick people with 94.4% accuracy and 88.9% precision.
Conclusion: The results of the present study showed that this system can probably be used as an effective and intelligent method along with other diagnostic methods by cardiologists to predict coronary artery disease. Also, new data mining methods can be effective in reducing invasive risks.
 

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Background & objectives: Designing knee osteoarthritis (KOA) prevention programs requires recognizing modifiable risk factors. This study aimed  to determine the frequency of osteoarthritis in patients with knee pain referred to Imam Khomeini Hospital in Ardabil city.
Methods: In this cross-sectional descriptive study, 850 patients with knee pain who were referred to the clinic of rheumatology in Imam Khomeini Hospital in Ardabil city were studied. Demographic and personal characteristics and medical history of OA were collected from the participants by a checklist. Osteoarthritis was diagnosed based on clinical and radiographic evidence by a rheumatologist.
Results: Of all patients, 310 (36.5%) were diagnosed with knee osteoarthritis. The most of patients (33.5%) were in the  age group of 50-59 years old, women (80.6%) and housewives (29%). 39.9% of all patiens had obesity and most of them (43.2%) have  not exercised at any time. A family history of knee osteoarthritis was reported in 45.2% of patients, while a family history of joint replacement was reported in 6.1%. 15.8% of patients reported a history of previous knee trauma. The type of used toilet was traditional in 90.3%.
Conclusion: The frequency of knee OA in our study similar to other studies was at a moderate level and due to regional risk factors, it is suggested to reduce the incidence of KOA by presenting necessary training programs and changing the nutritional patterns of society people.

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Background & objectives: Parkinson’s disease is a disorder that causes progressive degeneration of neurons, and oxidative stress is increasingly implicated as a factor that contributes to its pathophysiology. Carnosic acid, a compound found in rosemary, can scavenge free radicals in the brain and decrease the risk of neurodegenerative diseases such as Alzheimer’s. Thus, this study explored the effect of this plant on the improvement of Parkinson’s disease.
Methods: The study used 35 male mice that were randomly divided into five groups (n=7 mice each). A control group, a Parkinson's group induced by MPTP toxin, and three groups that received aqueous extracts of rosemary at doses of 100, 150 and 200 mg/kg were included in the study. Measurements were made of lipid peroxidation, superoxide dismutase activity, muscle rigidity, and grip strength. Scores were calculated based on rotational behavior tests and scoring systems.
Results: Rosemary treatment at doses of 150 and 200 mg/kg significantly changed the level of superoxide dismutase activity, muscle rigidity test and rotational behavior of animals relative to the MPTP group. Moreover, the dose of 200 mg/kg of rosemary significantly modified lipid peroxidation relative to the MPTP group, although lipid peroxidation was still significantly higher than the control group.
Conclusion: This study demonstrated that the aqueous extract of Rosemary at a dose of 200 mg/kg can alleviate the signs of Parkinson’s disease and manage the disease.