Background: Diabetes mellitus is a common and dangerous disease. Current methods in our country are not effective in the management of diabetes mellitus. The main object of our study is to design and test an effective model in the management of diabetes mellitus.

Materials and methods : Grounded theory research used for designing the heory, 30 adults patients with their families, physicians, nurses, and dietitians were interviewed. The data were analyzed according to the Straus and Corbin method. The effect of designed theory on glycemic control was assessed during a randomized clinical trial on 104 diabetics referring to the Iranian Diabetes Association in 1382.

Results : In qualitative part, 395 open codes were clustered in 27 subcategories and 9 main categories. Later on, the model shaped with defining the process and relationships between the categories. Personal system cure, care, and support system as well as social system are the main 3 systems that their interaction will determine the outcomes like glycemic control which is the most important indicator of diabetics. 3 months followed by model-based interventions, the mean of HbA1c was reduced form 8.22±2 to 6.7±1.6 in the intervention group. (p<0.02)

Conclusion : Outcome based management revealed to control effectively the blood glucose level.

Background: With respect to prevalence of unwanted pregnancy and lack of information on its risk factors in rural population at risk, the current study was carried out on rural women of Najafabad to determine prevalence of unwanted pregnancy and its risk factors in 1997.

Materials and Methods: In this cross-sectional study, 788 pregnant women of studied area enrolled. Samples were randomly selected. Unwanted pregnancy, age, method of contraception, tendency to abortion, history of unwanted pregnancy and other relevant factors were asked. Data were analyzed using descriptive statistics.

Results: Of 788 studied women, 42% had unwanted pregnancy. Place of receiving family planning services, method of contraception and taking OCP played main role in unwanted pregnancy.

Conclusion: Prevalence of unwanted pregnancy is dangerously high. More studies on the causes, as well as interventional studies in order to control them, are recommended.

Background: The first outbreak of Influenza A (H1N1), the first pandemic influenza in the present century,  in Kashan was in July 2009. This study was carried out to describe the stages of spread and also the outcome of influenza A (H1N1) in terms of incidence and death in Kashan, Aran and Bidgol cities during 2009-10.

Materials and Methods: In this case series-study of confirmed influenza A (H1N1), clinical and demographic data of all confirmed cases were recorded using SPSS software and were analyzed by Mann-Whitney test.

Results: The total number of confirmed cases (mean and median of age were 29.8±18.7 and 26 years, respectively) was 86 with a male/female ratio of 1:1. Among the 7 cases who died (mortality rate: 8.1%) the mean age for death was 46.9±27.9 years, though greater than that of the recovered cases (30.01±18.1 years), but non-significant statistically.

Conclusion: Beginning of new educational year for schools was identified as the most important factor in spread of the disease. Considering the mortality rate and other related variables, no significant difference was seen between Kashan, Aran and Bidgol cities compared to other countries. However, comparing the present findings with the findings of other domestic medical universities can disclose the reasons for disparities. Moreover, a 10 week time interval between the first outbreak and the peak for pandemy highlights the presence of an efficient surveillance system for disease control.

Background: Considering that the Digoxin's therapeutic level is very close to its toxic level, it is important to determine the digoxin dose. Digoxin serum level is affected by multiple pharmacokinetic factors. Therefore, this study aimed to evaluate the serum digoxin level and its relation with the initial dose and other related factors in patients referred to Kashan cardiovascular clinic.

Materials and Methods: This cross-sectional study was carried out on 125 patients for whom digoxin was prescribed for at least one month. The patients were excluded in the case of having simultaneous history of thyroid disease and other antiarrhythmic drugs. Serum digoxin, creatinine and potassium level and also the demographic characteristics of the patients for the first time were checked out.

Results: The mean age of patients was 63.7±13.42 years. Sixty-six (52.8%) cases were male. The most common reason for drug implication was systolic dysfunction (63.2%) and the most common cause of systolic dysfunction the coronary artery disease (56.61%). Most patients (70.4%) had a glomerular filtration rate (GFR) between 30-90 ml/min. Moreover, Fifty-nine patients (47.2%) with the highest frequency in treatment group were treated with 3.5 tablets per week. Serum digoxin level was significantly associated with the age and GFR (P=0.001 and P=0.008, respectively), but not with gender, potassium level and the reason for drug use and left ventricular ejection fraction.

Conclusion: The main factor in determining the digoxin dose is the patient’s GFR that includes all pharmacokinetic variables of drug plasma level.

Background: Fibrinolytic therapy of myocardial infarction (MI) should be started as soon as possible after the onset of symptoms. Since efforts to reduce pre-hospital delay have shown limited success in treatment, substantial emphasis should be placed on reducing in-hospital delay. This study aimed to evaluate the in-hospital delay for fibrinolytic therapy in Kashan Shahid-Beheshti hospital during 2007-2010.

Materials and Methods: This cross-sectional study was performed on 300 patients with ST-elevated myocardial infarction. Exclusion criteria were the previous MIs, incomplete data regarding the time of hospital admission or fibrinolysis and patients who were referred to the hospital by physicians outside the hospital. Demographic data, the time of symptom onset, admission time and fibrinolysis were collected and then analyzed.

Results: Two hundred and twenty-five (75.3%) out of 300 patients were male. Most patients (63.7%) were in the age range of greater than 55 years. The mean of in-hospital delay was 57 minutes. Sixty-three percent of patients experienced an unacceptable delay of greater than 30 minutes and only 37% of the patients experienced an acceptable delay of equal or less than 30 minutes. The mean of pre-hospital delay was 136 minutes. Half (53.7%) of the patients had a total delay of less than 3 hours. There was no association between the in-hospital mortality and total or in-hospital delay.

Conclusion: The majority of patients (63%) had an undesirable in-hospital delay and the mean door-to-needle time was about two times more than the optimal. Furthermore, identifying and modifying of the contributing factors in triage and emergency wards seem to be effective for decreasing in-hospital delay in reperfusion therapy.

Background: Ischemic heart disease (IHD) is predicted to be the most common cause of death worldwide by 2020. Cardiac rehabilitation (CR) as a secondary preventive measure can reduce the cardiac risk factors, mortality and morbidity, and improve the quality of life in such patients. This study aimed to investigate the effect of an 8-week CR program on clinical and paraclinical findings of patients with IHD.

Materials and Methods: This clinical trial was performed on IHD patients referred to Kashan Shahid Beheshti hospital. Patients were allocated the two groups (rehabilitation and control). The rehabilitation group received an 8-week rehabilitation program the clinical and paraclinical evaluations were performed before and after the program.

Results: This study showed that body weight, BMI, HDL, TG, FBS, resting heart rate and the systolic and diastolic blood pressure, quality of life, exercise capacity, maximal oxygen uptake during exercise and the numbers of recurrent hospitalization were significantly improved in the rehabilitation group (P<0.001). The rehabilitation program had no effect on the platelet count, frequency and duration of chest pain, total cholesterol, and LDL.

Conclusion: Using an 8-week cardiac rehabilitation program can be beneficial in the management of IHD patients and ultimately can reduce the risk factors of the heart diseases, improve the quality of life and reduce the risk of disease exacerbation.

Background: Homocysteine​​ is an amino acid that is produced during the metabolism of the methionine cycle. In previous studies, a causal role of homocysteine in coronary artery disease (CAD) has been investigated; however, the homocysteine ​​level in diabetic and non-diabetic patients with CAD has not been compared. This study aimed to investigate this issue.

Materials and Methods: This cross-sectional study was conducted on 200 patients with CAD in Kashan Shahid Beheshti Hospital during 2014-2015. Coronary artery disease was confirmed by angiography. Homocysteine levels, blood urea nitrogen, creatinine, hemoglobin A1C and mean blood pressure were measured. Data were analyzed using t-test with SPSS version 16.

Results: In this study, one hundred and eight of patients (54%) were men. The mean concentrations of hemoglobin A1C in diabetic and non-diabetic patients were 6.69±1.44 and 5.74±0.92, respectively (P<0.001). Moreover, the mean homocysteine serum ​​levels in diabetic and non-diabetic patients were 19.89±6.86 &mu;mol/L and 24.35±9.93 &mu;mol/L, respectively (P<0.001).

Conclusion: Results of the current study showed that the homocysteine serum level ​​in patients with CAD was higher than the normal level and in patients without diabetes was significantly higher than patients with diabetes.​​ Also, in diabetic patients with CAD, the serum creatinine and urine protein levels were higher than those in non-diabetics patients.