Background: Type 1 DM (T1DM) is caused by an autoimmune destruction of pancreatic ß cells. We proposed a novel stimulation using a low-level laser therapy (LLLT) through acupuncture points to stimuli the stem cells to be adult pancreatic ß cells. This study aimed to identify an optimal dose of low-level laser therapy (LLLT) for treatment of type 1 diabetes mellitus (T1DM).

Methods: An experimental study was performed with a pretest-posttest control groups design. The intervention was tested in rats (Rattus novergicus, Wistar strain). The rats were made diabetic by injection of streptozotocin (STZ). Rats were treated with different doses of LLLT in 4 groups. The tested laser doses were 0.2 joules (group L1), 0.3 joules (group L2), 0.4 joules (group L3), and 0.5 joules (group L4). The therapy was performed by perpendicularly attaching laser probe to the animal body, at the acupuncture point pishu (BL-20) on respective sides.

Results: Rats in the L2 group were performing better compared to others. The highest decrease of blood glucose level was found in group L2. Two rats in the L2 group achieved normal blood glucose level upon laser therapy. The dose of laser therapy in the L2 group of 0.3 joules was found to be the optimum dose.

Conclusion: Clinical and statistical analyses indicated that 0.3 joule was the optimal dose for LLLT in our animal model. Further investigation of LLLT in human is warranted and validation of the identified dose in future studies should be pursued.

Background: It is very important when teaching ethics to nurse students to select an educational method and materials that are relevant to their future career as clinical nurses. The aim was to determine the effect of implementing nursing ethics codes as a combined plan in North Khorasan’s University of Medical Sciences.

Methods: This research was an action research conducted in School of Nursing and Clinical setting at Bojnurd, North Khorasan Province, Iran, from September 2013 until September 2015. Data was collected through checklists and interviews with small groups and then analyzed. First, the researchers explored the difficulties in imposing nursing ethics codes. Then a combined plan was considered to solve the ethical codes’ problem. To perform this combined plan, a combination of interferences from three different levels of scope, which are students, college, and clinic, was considered. Permission from the Bojnourd’s Nursing and Midwifery College Educational Council was obtained for this study.

Results: The results of this study showed that 65.5% of students had given the right answers to ethical codes. More than half of the students remarked that respecting the rights of patients and nurses was the most important code. More than half believed that there was a system to supervise the implementation of ethical codes. The results from the ethical rounds with students showed that disobedience to ethical codes occurred in the three fields which are clinical staff, educator, and student administrators. This study offered a practical model for implementing professional ethics code based on Iran’s sociocultural background. Along, this study was done to satisfy the need for ethical education and conduct according to these professional ethics code in the college and the clinical setting.

Conclusion: It is recommended that a suitable evaluation system should be considered to get the feedback from the implementation of this combined plan of teaching professional ethics codes.

Background  In the history of Persian literature, Rumi is a unique figure in terms of the extent of information and ideas, excitement, outpouring, diversity of themes, full awareness of the human psyche, and the knowledge of pain, understanding the causes of diseases and their treatment.

Methods: This is a qualitative study using analytical deduction method. Resources related to the subject matter, the meaning, and implication of cognitive-behavioral concepts, symbols, emblems, and parables in Masnavi and other works of Rumi were studied.

Results: The results indicate Rumi believes that psychological disorders such as depression do not belong to individuals with a history of childhood psychological trauma but it is common in all humans, and it can result from repeated vain thoughts and personal cognitive distortions. From the perspective of Rumi, a seeker prevents the penetration of negative automatic thoughts into psyche (inherent self) by mastering the subjective identity (self). On the contrary, disability and succumbing to the influx of mental automatic and dysfunctional thoughts are the main causes of mental illness; their repetition and continuity end in the dissociation from his inherent self.

 Conclusion: For Rumi, staying away from primordial nature and separation from essence brings the drought and coldness of December that makes human life and existence cold, dry, and barren. Continuation of this condition causes the emergence of mental illness such as depression.

Background: Rhinosinusitis is one of the most concerning illness due to high medical cost and its negative effect on the respiratory tract. The etiology of chronic rhinosinusitis remains unknown. The main cause of chronic rhinosinusitis with or without nasal polyp is bacterial infections; thus antibiotics remain a main therapeutic intervention. Prescription of broad spectrum antibiotics and the inappropriate combination of antibiotics are the main factors of antibiotic resistance. This study aims to obtain the pattern of aerobic and anaerobic bacteria in chronic rhinosinusitis patient (with or without nasal polyp) and its sensitivity pattern, in Medan, Indonesia. Methods: This is a case series. Samples were patient with chronic rhinosinusitis who had undergone functional endoscopic sinus surgery (FESS). Results: The most common aerobic bacteria found is Klebsiella oxytoca (21.7%), and it is sensitive to ceftriaxone, cefotaxime, levofloxacin, and meropenem. While for the anaerobic bacteria, one patient was positive for Peptostreptococcus and it is sensitive to chloramphenicol. Conclusion: The most common bacteria in the maxilla in patients with chronic Rhinosinusitis with and without polyps in Medan are the aerobic bacteria Klebsiella oxytoca and anaerobic bacteria Peptostreptococcus. It is suggested that the antibiotic prescribed should be based on microbiology examination.

Background: Maternal mortality rate (MMR) in Indonesia is still high, including in East Java Province. Although the successful decline in MMR has been achieved, more action still needed to maintain and accelerate the process. Several factors that affect the maternal mortality, especially referral factor, and districts maternal health services quality, need to analyze. This study was conducted to analyze the correlation between maternal mortality with labour referral and maternal health service quality in 10 regencies/cities in East Java Province, Indonesia. 

Methods: The case-control study among 2 groups of 5 regencies/cities with the highest and lowest MMR in East Java Province in 2015. The indicators used, were maternal referral relay in maternal mortality report, frequencies of antenatal care, labor by health care provider, puerperal health care, obstetric complication management, detection of high-risk pregnancy by community and healthcare personnel, and family planning program.

Results: Total number of maternal mortality in East Java province in 2015 was 531, with MMR were 89,6/100.000 living birth. From the comparative study, we found a significant difference in indicators of high-risk pregnancy detection by healthcare personnel (p=0,035) and obstetrics complications management (p=0,006). There were no significant differences in frequencies of antenatal care, labor by health care provider, puerperal health care, detection of high-risk pregnancy by the community, and family planning program in 10 regencies/cities in East Java Province, Indonesia. 

Conclusion: High-risk pregnancy detection by healthcare personnel and obstetrics complications management were related with MMR in 10 districts in East Java province, Indonesia.

Background: Infection and inflammation will stimulate the acute phase response (APR) activation which will cause the changes in lipid metabolism. In rodents, the infection will induce an increase in cholesterol, including LDL, whereas in the primates and humans, LDL levels will decrease or normal. As lipopolysaccharides (LPS) and cytokines will lower the total cholesterol level in primates, while in mice will increase due to the stimulation of infection enhance the cholesterol synthesis de novo, reducing the lipoprotein clearance, and lowering the cholesterol conversion into bile acid.

Aim: This study aims to determine the influence of the bacterial sepsis severity to the value of Low-Density Lipoprotein (LDL)

Methods: It was a case-control observational study which conducted from January-March 2017 to the 30 sepsis patients and 30 non-sepsis patients at Haji Adam Malik General Hospital, Medan. Data were collected by measuring LDL and PCT levels in both sepsis and non-sepsis patients on days 0, 3, and 5 of study then was analyzed by using Mann-Whitney test to assess the relationship between them. 

Results :  The result showed that LDL value in sepsis group on pretreatment was 77,70 ± 33,42 mg / dl and increased on day 3 and 5 treatment to 83,50 ± 38,68 mg / dl. In the non-sepsis group, the mean value of LDL at baseline was 102.23 ± 45.90 mg/dl and increased on day 3 and 5 of treatment to 114 ± 38.58 mg/dl. Statistically, there were significant differences in LDL levels between sepsis and non-sepsis groups on the first day of treatment, day 3 and day 5 of care (p <0.05). Spearman correlation test results obtained a significant negative correlation between LDL levels with sepsis degree with correlation strength is moderate (r = -0.318).

Conclusion: There was a significant relationship between the severity of sepsis and the LDL value in patients with sepsis.

Background: Sepsis is the second leading cause of death in intensive care unit and one of the top 10 cause of deaths worldwide. In sepsis, an inflammation response occurs that leads to the tissue destruction. According to the Survival Sepsis Campaign in 2012, early management in septic patients with 30 ml/kg of crystalloid fluids will have better outcomes. Objective: This study aimed to determine the optimal crystalloid fluid in the resuscitation of septic patients. Method: This double-blinded study was held from March 2017- May 2017 in Haji Adam Malik General Hospital. A total of 40 patients who passed the inclusion and exclusion criteria were assessed for interleukin-6 changes before and after treatment with ringer acetate malate and ringer lactate. Results and Discussion: From 40 Patients who passed the criteria, we compared the administration of Ringer's acetate and Ringer's lactate malate in septic patients. The mean systolic and diastolic blood pressure were increased in both study groups (p <0.05) and a significant decrease in pulse rate was also present in both groups (p <0.001). In both groups, there was a significant decrease in interleukin-6 levels (p <0.001). Administration of ringer acetate malate leads to a stronger decrease of interleukin-6 compared to ringer lactate administration (p <0.001). Conclusion: Ringer's acetate malate in EGDT of septic patients is superior in decreasing interleukin-6 Compared with Ringer lactate.  

Background: Cancer has become an increasingly important issue for health expenditure and in the public sector. Therefore, identification of socioeconomic patterns is essential for developing novel methods of cancer prevention. A cancer risk prediction system is proposed here, which is easy and cost-effective, also saves time.

Methods: Initial data were collected from surveys with a digital audio recorder on 2014 cancer dependent and independent smokers. Patterns were found using a decision tree model. As socioeconomic patterns are neglected altogether, this study will pave the way for public health policies.

Results: This study shows that a death rate in cancers by smoking around 24.3%. According to them, the type of cancers attributed to smoking was oral cavity (8.2%) and bladder (8.2%) cancer. Some risk factors related to smoking and cancers were included male patients (66%), age <35 years old group (56.3%), employee (86.3%), married (86.2%), as well as have very good public insurance (96.5%). In addition, 98% cancer patients were known have public insurance.

Education levels have been shown most of the patients with cigarette smoking had less than a college education and in the absence of police, they use fewer safety belts.

Those with risk factors for failing to wear a seat belt under a doctor to quit smoking. Although

The health situation in cancers attributed to smoking vs. non-smoking attributed to worse evaluated.

The age factor is effective in counseling for the doctor to quit smoking, and people aged 35-65 are the most advised to quit smoking.

Conclusion: Smoking-related costs in Iran are high. The cost methodology presented is useful for policy making. Cost estimates can be used to evaluate the level of cigarette taxes and other policies related to smoking.

Background: One of geroprotectors for mammals are still polyvitaminic preparations, one of which is Lipovitam-beta. Purpose of research: to estimate Lipovitam-beta impact on the indices of hemostasis and blood rheology systems of aging rats.

Methods: We examined 193 healthy outbred male-rats at the age of 24 months being kept in conditions of vivarium and having traditional ration. In experimental group (98 rats) we investigated the impact of Lipovitam-beta feeding on the basis of 5.5 mg on 100 gr of body mass once in 5 days during 6 months on relevant indices. Control group was composed of 95 healthy male-rats. We estimated the basic indices of hemostasis, blood viscosity, aggregation and deformability of erythrocytes at the beginning and in 6 months of investigation.

Results: Lipovitam-beta application has led in case of rats from experimental group to reliable lowering of spontaneous and stimulated platelets' aggregation and activity weakening of plasma hemostasis. On the background of Lipovitam-beta feeding to rats we found lowering of blood viscosity and erythrocytes' aggregation index what was accompanied by increase of erythrocytes' deformability index.

Conclusion: Application of Lipovitam-beta to aging rats led to activity lowering of plasma hemostasis and platelets, improving rheological features what can positively influence microcirculation, the level of vital activity and forthcoming life duration.

Background: Malignant ovarian tumor is one of the most common types of cancer in women worldwide, and most patients come with advanced stage. Until now, a pre-operative diagnostic method to determine malignant ovarian tumor was considered unsatisfying. Neutrophil gelatinase-associated lipocalin (NGAL) allegedly plays a role in proliferation and metastasis of the cancer cells, so it is important to explore the difference of serum NGAL levels between benign and malignant epithelial ovarian tumor.

Aim: to determine the characteristics of patients with benign and malignant epithelial ovarian tumor, histologic types, and serum NGAL levels difference in benign and malignant epithelial ovarian tumor.

Method: This was a comparative analytic study with a cross-sectional design. Forty patients were chosen with consecutive sampling; each group consists of 20 female patients who will undergo primary surgery for suspicious of benign and malignant epithelial ovarian tumor. A blood sample was collected one day prior to the surgery and confirmed with histopathologic examination after surgery.

Results: most of the patients aged 20-50 years old, had ≥1 child and the most common histopathology type of malignant epithelial ovarian tumor was mucinous adenocarcinoma while the majority of the benign epithelial ovarian tumor was endometriotic cyst. The median rate of NGAL in the malignant epithelial ovarian tumor was 219.5 ng/ml, higher than median rate of NGAL in benign epithelial ovarian tumor with 132.5 ng/ml, the difference was statistically significant (p < 0.001). The median rate of NGAL in malignant epithelial ovarian tumor according to the stage of disease showed no significant difference.

Conclusion: A new diagnostic criteria of epithelial ovarian tumor needs to be considered which include NGAL as one of the screening components.

Background and Aim: Constipation is a common digestive problem in elderly people, which has a negative effect on their quality of life. There are many methods in complementary and alternative medicine to treat this problem in the elderly. The aim of this study was to determine the effect of prune as a complementary and alternative medicine on the severity of constipation in elderly women living at Zabol Elderly House.

Materials and Methods: This study was an experimental study on 60 elderly women who are qualified residents living at Zabol Elderly House with constipation based on the Rom III diagnostic criteria. The samples were randomly assigned to intervention group and control group, consisting of 30 samples each. The[A1]  tools used in this study were a demographic questionnaire and a constipation scale. Data were analyzed by SPSS Software Version 20 and Mann-Whitney Test.

Results: According to the findings, the difference in the mean of constipation severity in the two groups was not significant before intervention (P = 0.61). However, at the end of the first week until the end of the third week after the intervention, there was a significant difference in the mean of constipation severity (P <0.05). This result showed that the effect of the intervention started from the first week and prune was effective in lowering the severity of constipation in the elderly women.

Conclusion: This study indicated that prune could be an effective complementary and non-pharmacological method to reduce the severity of constipation in elderly women. Therefore, nurses can use this simple, inexpensive and uncomplicated method as a complementary method to care for the elderly with constipation.

Aim: Esophageal multi channel intraluminal impedance-PH (MII-PH) monitoring is a new technique used for detecting the flow of fluids and gas through the esophagus, using the differences in electrical impedance between the mucosal surface, fluids, and gas that surround the catheter. The aim of this study was to determine the frequency of functional heartburn in Iranian patients with non-erosive gastroesophageal reflux disease (NERD).

Methods: In this study, 940 patients aged 11-84 years, with the chief complaint of heartburn were selected. The MII-PH monitoring was done in 215 of the patients who did not have esophageal injuries (NERD).

Results: Of the participants who filled the questionnaire, 29.4% experienced heartburn at least once a week, 24.1% had it twice daily, and 21.3% had it after each meal. The mean age of the patients with heartburn was 36.97 ± 10.8 (Range: 21- 57) years. Of the patients, 51.2% were female. MII-PH monitoring was done in 215 participants, with non-erosive esophagitis.

Esophageal acid exposure of time (EAET) was negative in 42.8% and positive in 57.2% of the NERD patients. Of the patients, 39.1% and 18.1% had functional heartburn (FH) and hypersensitive esophagus (HE), respectively

Conclusion: Functional heartburn and non-erosive gastroesophageal reflux disease are prevalent in the Iranian population. Esophageal multi channel intraluminal impedance-PH (MII-PH) monitoring is essential for discriminating functional heartburn from other types of non-erosive gastroesophageal reflux diseases.

Background: Prematurity is one of the most important problems of recent years, and the number of premature infants is increasing every year. Babies who are born prematurely due to defects in the coordination of swallowing, sucking and breathing require mouth tube or nasogastric intubation feeding. Because bolus gavage feeding is more appropriate physiologically and improves the secretion of gastric hormones is more common in neonatal intensive care units. Objective: The primary objective of the study is a comparison of two alternate gavage ways with force gravity and injection with syringe in premature infants and find existence difference and compared with the results of the research have been performed yet. Methods: In this study, gastric residual volume indicators collecting method are used. The study used a questionnaire to collect data to measure indicators of the following tools. Results: Results showed that both alternate gravity and injection (push) ways, complications of gavage (vomiting, aspiration, abdominal distention and necrotizing enterocolitis) had not been seen. Conclusions:  Based on the results of both currently study of methods in preterm infants feeding have same effectiveness and safety.

Abstract
Introduction
Pre- hospital emergency health care plays an important role in saving people’s lives. Proper performances of various parts of this system result in rapid and timely deployment of ambulance in patient’s place and prevention of death and disability. Thus, the present study was done in order to Compiling of performance evaluation indicators for pre-hospital emergency Centers in 2017.
Methods
The present study is a qualitative- quantitative research which was conducted in 2017. In order to compiling the indexes for evaluating the performance of pre-hospital emergency centers, the study was done in two phases. In phase one of the study, primary items and their fields were identified in accordance with the present literature. In the second phase, Delphi technic in three rounds was used to finalize the items and the fields. In the first round of Delphi technic, the identified items and fields were given to experts in forms of check list. The items and fields with average of >4 and standard deviation of <1 were confirmed, items with average of <2 and standard deviation of <1 were removed, and other items were randomly passed into round two. In the second round, all the items with average of >4 and standard deviation of <1 were confirmed, items with average of <3 and standard deviation of <1 were removed, and other items were randomly passed into round three. In round three, only items with average of >4 and standard deviation of <1 were confirmed and other items were removed.
Results
The results of the study showed that 9 items in field of facilities and physical space, 10 items in field of communication, 10 items in field of ambulance, 8 items in field of human resources, 9 items in field of regulations and protocols, 3 items in field of storing equipment in the center, and 3 items in field of training were identified.
Conclusion
Considering the identification of seven effective factors in improving quantitative and qualitative level of pre-hospital emergency services, it is highly important for authorized managers and decision-makers to plan and enhance all necessary factors.

Background: Idiopathic intracranial hypertension (IIH) is a nervous disease characterized by increased intracranial pressure around the brain. It is induced by increased production or decreased reuptake of cerebrospinal fluid (CSF). The standard treatment of IIH includes medicines to reduce CSF production. Acetazolamide is the most commonly used drug in treating IIH and is also considered as the first-line treatment. Topiramate is used to treat obesity. Since obesity is a risk factor of IIH, topiramate is used to treat IIH. We investigated the effect of topiramate as an adjunct drug along with acetazolamide in patients with IIH who presented to Shahid Sadoughi Hospital in Yazd, central Iran.

Methods: This study was a double-blind clinical trial. Forty-eight IIH patients presenting to Shahid Sadoughi Hospital participated in the study, divided into two groups. The acetazolamide group received acetazolamide 750-1000 mg qd and the Acetazolamide+topiramate group received acetazolamide 750-1000 mg qd and topiramate 25-50 mg qd. CSF pressure, body mass index (BMI), and visual field were assessed at the beginning of treatment and 6 months after intervention. The gleaned data were analyzed with SPSS20 using statistical tests.

Results: Our findings showed significant differences in CSF pressure in acetazolamide group and CSF pressure, BMI, and visual field in acetazolamide+topiramate group at baseline and 6 months after treatment. There were also statistically significant differences between the mean score of retinal examination in IIH patients in both groups at second, fourth, fifth, and sixth months (P-value <0.05).

Conclusion: Topiramate can be used as an adjunct to acetazolamide to increase the effect of treatment in IIH patients. 

Background: Transforming Growth Factor β (TGF-β) is a cytokine regulator of inflammation that important in inhibited parasite growth and preventing inflammation. Andrographis paniculata was empirically used as traditional medicine in Indonesia to cure malaria by activating TGF-β. Preliminary studies showed that AS201-01 tablets containing the ethyl acetate fraction of A. paniculata had been shown to inhibit the growth of Plasmodium berghei.

Aims: This study aims to determine the effect of the AS201-01 tablet on parasite inhibition and TGF-β expression in P.berghei infected mice placenta.

Methods: About 24 pregnant mice were divided into 4 groups: healthy pregnant mice (normal) (G1), untreated infected pregnant mice (negative control) (G2), infected pregnant mice treated by AS201-01 tablets (G3), and infected pregnant mice treated with Dihydroartemisinine-piperaquine (positive control) (G4). About 1x10⁶ parasitemia were infected on the 9^th day of pregnancy, while therapy was administered on the 11^th day of pregnancy. The placenta was collected at the 15^th day of pregnancy. The parasite inhibition and TGF-β expression were evaluated using Hematoxylin-Eosin (HE)  and immunohistochemistry assay.

Results: The results showed that the parasite still found in the placenta of G2, G3, and G4 still, but parasite of placental in G2 was higher than G3 and G4. There was a significant difference in the parasite inhibition between G2 with G3 and G4 (p<0.05). In addition, the immunohistochemistry assay found that there was a significant difference in TGF-β expression between G2 with G3, G4, and G1 (p<0.05).

Conclusion: Administration of the AS201-01 tablets inhibit parasite P. berghei and increase TGF-β expression on the placenta of infected mice.

Introduction: Overnutrition has become an emergent health problem worldwide and could signifcantly alter the normal human physiology. It still unknown how overnutrition could affect the
outcome of pediatric patient with dengue infection. This study aimed to unveil how overnutrition affects the risk of dengue shock syndrome (DSS) in dengue pediatric patient by evaluating the adiponectin which has immune-modulatory property and the inflammation
marker sVCAM-1.

Methods: An analytic observational nested case-control study was conducted in Paediatric Division Sanglah General Hospital, Bali, Indonesia from January 2015 to October 2016. Initially, patient’s anthropometric parameters were measured and the diagnosis of the
dengue infection was established according to the medical record and blood plasma was isolated to determine the level of adiponectin and sVCAM-1.

Result: The study showed that overnutrition increased the risk of DSS as much as 2.67 times greater than normal but it was not statistically signifcant (95%CI: 0.72 - 9.95). The mean level of sVCAM-1 was observed to be higher in overnutrition patients in almost all categories
of dengue infection, but none is statistically signifcant. However, its level appears to be lower in over nutritious DSS patients compared to their non-DSS counterparts (4638.64 (±934.99) vs. 5680.80 (±601.77); P = 0.013). The adiponectin level was found to be consistently lower
in patients with overnutrition regardless the category of dengue infection, but signifcant differences only observed in over nutritious DHF and overnutritious non-DSS comparisons.

Conclusion: It can be concluded that overnutrition increase the risk of DSS in pediatric patient with dengue infection whether it was not statistically signifcant. The lower level of adiponectin and elevated expression of sVCAM-1 could be the explanation of this phenomenon.

Background: The infiltration of neutrophil increased in the Erythema Nodusum Leprosum (ENL) which is thought to have a role in releasing the free radicals and TNFα which causes dermal nerve damage. ENL occurs in leprosy type LL and BL which has lipid droplets as a synthesis site of Prostaglandin E2 which plays a role in suppressing nerve inflammation. This study investigates neutrophil distributions that express TNFα and iNOS as well as PGE2 expressions of the S100b distributions on ENL patient’s Schwann cells.

Methods: The cross sectional study used 23 samples of biopsy skin pedis of patients with MB leprosy type (10 ENL samples and 13 as control samples), from the Skin Polyclinic Sanglah Hospital, Denpasar, Indonesia. Punch biopsy of 4 mm in diameter is performed. Slides are conducted with Hematoxylin-Eosin standard staining as a structural confirmation, type of leprosy and distribution of neutrophil cells. Observation of TNFα, iNOS, PGE2, and s100b are conducted with immunohistochemistry techniques. Expression analysis is performed with immune ratio software (freeware). The PGE2, s100b, TNFα and iNOS expression percentage are put on a list, T-test is performed and IBM-SPSS 21 for Windows is used in the relationships between groups test.

Results: In the present study, it was found that the distributions of neutrophil increased in the ENL compared to the ones in the control. The increased neutrophils appeared in the dermis area around the blood vessels. INOS and TNFα distributions on neutrophil cells increased significantly in the ENL. And in line with that, the s100b expressions on the ENL were significantly lower.

Conclusions: The significant increase of the iNOS and TNFα neutrophil cells in the ENL may play a role in the dermal nerve damage. This study digs into the possibility of the role of Prostaglandin E2 in maintaining the peripheral nervous system on leprosy with ENL. Hence the understanding of PGE2 as the main mediator in the inflammatory process especially in the Schwann cell damage is very important.

Objective: The aim of the current study is designing a model for patient satisfaction and defining priority factors that impact patient satisfaction of healthcare services. Method: The preliminary literature search was undertaken in December 2014. A subsequent search was carried out in October 2015, which covered a majority of databases including PubMed, Scopus, ProQuest, and Magiran. Studies related to inpatients in hospitals included and related to specific area were excluded. No time bound was applied.   Two of the authors independently appraised the quality of studies and subsequently, the grouping of the variables was done using MAXqda 12 software and the analysis was done through vote – counting method. Result: Out of 1315 articles, 85 articles were chosen for final consideration. Most of which have been carried out in developed countries. The main factors affecting consumer satisfaction in hospitals were grouped into two categories. 1- Patient attribute factors: that involved expectations, health status, demographic and socio-economic. 2- Health system factors: that involved service quality, hospital features, staff satisfaction and insurance. Conclusion: In this study the risk of bias for each study not researched. It has been contended that the construct of consumer satisfaction is a multidimensional and subjective one. The finding of the current study suggests that all these variables be considered when evaluating patient satisfaction. The evaluation process should be performed cautiously as service providers have little direct influence over patient attribute factors. 

Background: The health system reform in many countries has been focused on the structural changes, cost reduction, market mechanisms and service consumers, and despite the importance of human resource management, these issue have been discussed less or even neglected altogether in HSR reforms. This study seeks to sensitize decision-makers and policymakers to the role of human resource policies in advancing the goals of health system reforms through systematic review of the studies on human resource challenges in implementing health system reforms.

Materials and Methods: This study is a systematic review based on PRISMA. The selected time period for data collection is the interval of 2000-2017. Different database search methods and manual search was used to find the related articles. Results of the manually reviewed articles were analyzed using thematic analysis by two members of the research team and conflicts were referred to the third person.

Results: According to the considered inclusion and exclusion criteria in this study finally 13 Article were selected to determine the human resource challenges in implementing the health system reforms. Selected studies were analyzed in three general themes; context and dynamics of the reform process, Capacities needed to implement the reform and negative impact of Reform on HR.

Conclusion: Achievement of the health goals is completely dependent on provision of the adequate high quality effective human resources in appropriate positions and available in all geographical regions. The lack of clear human resources policies simultaneous and consistent with the goals of health reforms is one of the main reasons for the failure of these reforms to achieve the intended goals. Therefore, determining human resource problems and development of the related HR policies should be the start point for planning any kind of health system reform.

 

Background: The diagnosis of Burkitt Lymphoma is made based on a medical history, physical examination, complete blood count (CBC), blood smear and bone marrow examination. Many other diseases with similar symptoms must be excluded. Typically, the higher white blood cell count, the worse prognosis. A bone marrow aspiration provides conclusive proof of the cases. Blast cells were seen on blood smear in the majority of the cases. Case Presentation: A six-year-old male was admitted to Sanglah General Hospital with vomiting for few days and found hepatomegaly. After several days of being treated, patients showed deterioration with decreased awareness and convulsions. Burkitt Lymphoma enforced by peripheral blood smear and bone marrow examination. Bone Marrow smear showed lymphoblastic infiltrations about 20% lymphoblasts with heterogeneous morphology. Moreover, there were some lymphoblasts with many vacuoles on the cytoplasm, and from all of the features, it concluded as Acute Lymphoblastic Leukemia (L3) or Burkitt type.The disease had metastasized to the kidney and central nervous system (CNS) showing a decrease in consciousness and the presence of convulsions. Conclusion:The patient may have a CNS leukemia leading to a bad prognosis.

Background: Maple syrup urine disease (MSUD) is a rare genetic disease of metabolic disorder inherited as an autosomal recessive trait. The disease is caused by branched-chain alpha-keto acid dehydrogenase (BCKD) deficiency. It results in the accumulation of branched-chain amino acids (BCAA) which are toxic to the nervous system. 

Case Presentation: A one-week-old infant was brought to Siloam Hospital because she suddenly became lethargic, had a poor feeding, and an intermittent muscle spasm. She was the fourth child in her family. At her admission, she was diagnosed with neonatal sepsis. On advanced clinical and laboratory examination, we found ketoacidosis, hypoglycemia, and the typical odor of maple syrup in the urine. Plasma amino acids analysis showed a marked elevation of BCAA (leucine, isoleucine, and valine), confirming the diagnosis of MSUD. The patient was treated with intravenous glucose infusions and dietary support, including formulas free of BCAA. She was monitored for blood sugar and urine ketones. 

Conclusion: Metabolic disease should be considered in an infant who suddenly suffered a critical illness several days following a normal delivery.