فصلنامه کومش
سال چهاردهم شماره 3 (پیاپی 47، بهار 1392)

One of the most important subjects in the study of suicide is the methods of suicide. There is not accurate information relating to employed poisoning methods for suicide in Iran. Studies conducted in different provinces provided different results. This study aimed to estimate the prevalence of poisoning methods used in attempted suicides in Iran.

Domestic scientific databases, PubMed, Science direct/ISI and Scopus searched without any time limitation. Searching was updated by March 20, 2012. Initially, 1398 articles were retrieved. After review of titles, 34 studies included for review of full text. Finally, 19 articles entered in meta-analysis. Random effects model of Mantel-Haenzel employed for estimation of pooled prevalence. Meta-regression and Subgroup analyses were employed to assess the cause of heterogeneity among the selected studies.

This meta-analysis included 8494 males and 13503 females. Heterogeneity measure for drug poisoning and agricultural poisoning was 99.3% and 98.1%, respectively. The prevalence of drug poisoning was 75% (CI 95%: 68 to 82%) and the prevalence of agricultural poisoning was 13% (CI 95%: 10 to 16%). The lowest prevalence of drug poisoning and agricultural poisoning was in Ilam and Khorasan Razavi provinces and highest in Golestan and Ilam provinces, respectively.

Drug poisoning was the most prevalent method for suicide. Therefore, training for no storage of drugs at home and impose more strict instructions for medications prescription are recommended

The use of steroids especially for a long time is universally used for the treatment of polymyalgia rheumatica (PMR). Because the adverse effects of long-term steroid therapy are common and deleterious, steroids-sparing combination therapy has been found a vital role for treating PMR. The current study came to address comparing the efficacy and safety of prednisolone plus methotrexate as a steroids-sparing combination therapy and prednisolone alone in patients with PMR. Fifty eight untreated patients with newly diagnosed PMR were consecutively entered and randomly assigned to receive prednisolone plus methotrexate or prednisolone alone. A single dose of methotrexate (10 mg per week, orally) was administered for the case group. The both groups were administered oral prednisolone (15 mg/day for 4 weeks) and supplement of calcium-vitamin D (1000 mg/day). Subjects continued their active treatment with gradual tapering of the steroid dosage. The remission rate at a total of 44 weeks follow-up, and other measures of disease activity, i.e. erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) were the main outcome measures. Fifty eight patients entered (29 cases and 29 controls) and 47 patients completed the trial (24 cases and 23 controls). On follow-up over the full 44 weeks, mean ESR level was significantly more decreased in the case compared to control group within the full 44 weeks (52.44 versus 39.38 mm/1st h, P=0.002). There was no difference in the decrease of mean CRP (75.86 versus 51.75 mm/1st h, P=0.312) and also last to first measures (79.39 versus 57.75 mm/1st h, P=0.356) between the case and control groups. Subsequent analyses at week 44 of follow-up showed a significant higher remission rate in the case compared to the control groups (43.5% versus 8.3%, P=0.006). However, the relapse rate was similar in both groups (34.8% versus 33.3%, P=0.917). Significant differences in cumulative steroid dosage per patient was also revealed in the two treatment groups at week 44 that the mean prednisolone equivalent in the case and control groups was 3225.00 ± 162.66 mg and 3715.85 ± 136.14 mg (P=0.026). Higher remission as well as reduced disease activity seems to be more achieved with steroids-sparing combination therapy (prednisolone plus methotrexate) compared with prednisolone alone in patients with PMR

Pain during insertion of vascular needles is the most stressful part of the hemodialysis treatment. Repeated painful interventions have adverse effects on the body and the spirit of these patients. Due to central role of nurses in care, they have important role in reducing the pain of these patients. This study was conducted to determine the effect of lidocaine spray on the pain intensity when the needles are inserted into vascular access for hemodialysis. A semi-experimental and double blind study was performed on 30 patients in hemodialysis ward of Semnan Fatemieh hospital. In this study, pain intensity during the insertion of hemodialysis vascular needles was measured by numerical pain scale in a one group by using Lidocaine spray and Lidocaine spray placebo. Pair T test was used to determine pain intensity mean difference between two conditions. Overall, the results showed that the mean pain intensity was 2.3±1.91 and 3.96±2.14 in two conditions using lidocaine spray and lidocaine spray placebo, respectively. However, a significant difference was found between the mean pain intensity in two conditions statistically by using paired t- test (P<0.001). Results showed that lidocaine spray is effective in reducing pain when the needles are inserted into vascular access. Therefore, based on the results of the study, it is recommended to use lidocaine spray in order to reduce pain in these patients before insertion of hemodialysis vascular needles

Hypospadias surgery is a challenge for a surgeon because of its complications is higher than other reconstructive surgeries. Although several surgical techniques have been presented, but their outcomes are very different and are associated with high incidence of complications. In this study, post-operative complications in the patients who were underwent hypospadias surgery were evaluated to determine effective factors in creation of post-operative outcomes.

49 children who were underwent hypospadias repair surgery from 2006 to 2011 in Semnan (Iran) Amir-Al-Momenin hospitals followed for the outcomes of surgery and early and late post-operative complications

The mean age of patients was 5.1 year. Desired cosmetic were obtained in 92% of the patients. Fistula and early metal stenosis were seen in 8.2 % and 26.5% of the patients, respectively. Survival without stricture was 54% after 60 months follow-up. Primary failure of suvrgical repair was observed in 4.1% of patients.

The long-term outcome of hypospadias surgery was cosmetically and functionally acceptable without considering the age of patient at the time of surgery. The severity of hypospadias and surgical technique (using the second layer) were the most important factors in the development of post-operative complications.

Reduction of post-operative nausea and vomiting (PONV)) promotes discharge of patients and reduces healthcare costs, hospital re–admission and duration of stay of patients in hospital, and finally satisfies patients. In this study, the effects of three opioids that are used routinely in general anesthesia (alfentanil, sufentanil and fentanyl) were assessed on the incidence of PONV. In this double-blind clinical trial, one hundred eighty patients (ASA I and II), aged 18-35 year, were randomly allocated into three groups. All three groups were firstly received 1mg midazolam 2minutes before anesthesia and then each group received 2cc of one of following opioid drugs: Alfentanil, fentanyl and sufentail (the general anesthesia method was similar in three groups). PONV was assessed 2hrs and 2-24hrs in post-operative period in these three groups. Incidence of postoperative nausea was respectively 13.33 %, 35% and 41.6% in alfentanil, fentanyl and sufentailgroup in the first 24hrs of post-operative period. Incidence of nausea was significantly lower in alfentanil group in the first 2hrs (p<0.001) and 0-24hrs (p<0.01) in post-operative period. No significant difference was observed in the incidence of vomiting between three groups in 24hrs of post-operative period. Overall, in the first 24hrs post-operative period, there was no difference between the effects of alfentanil, fentanyl and sufentanil on postoperative vomiting, while alfentanil can be consider with lower effects in nausea incidence for post-operative periods

Lack of balance during sport activities may results in the possibility of sports injuries. Recently, it has been shown that using of warm-up exercise may enhance sensitivity of mechanoreceptors, namely muscle spindle, and so preventing of injury during sport activities. This study was designed to find out the acute effect of warm-up training on the static and dynamic balance indices in athletic and non-athletic subjects. 64 university athletic students (16 male and 16 female) and university non-athletic students (16 male and 16 female) participated in a cross over study and were randomly assigned in one of the two experimental groups: warm-up group (5 minutes running on treadmill) and control group (no intervention), so that all participants attended in both warm-up and control groups in two assessing sessions with 2 weeks interval. Falling risk index, dynamic (bilateral standing) and static (single leg standing) overall, anterior-posterior and medial-lateral indices were assessed by measuring centre of pressure displacement during both eye-open and closed-eye condition before and after the intervention. The comparison of mean changes before and after intervention in both groups showed no significant difference in static balance indices in eye-open condition between groups (p>0.05), while static balance indices in closed-eye condition and dynamic balance indices in both, eyes-open and eyes-closed conditions were significantly improved after warm-up, compared to the control group (p<0.05). After warm-up intervention, falling risk index was reduced significantly (p<0.05) in both athletic and non-athletic participants. No significant difference was found between athletic and non-athletic subjects, in term of static and dynamic balance indices. These results showed that general warm-up training may improve static and dynamic balance control and falling risk in both athletic and non-athletic groups. From these findings may conclude that performing general warm-up training prior to sport activity may prevent of sport injuries by enhancing balance control.

Dysmenorrhea is one of the most common gynecologic complications in young women. Given the widespread use of ibuprofen in the treatment of dysmenorrhea, the purpose of present study was to determine the analgesic effect of ibuprofen by alprazolam in treatment of dysmenorrhea. The study was designed as a double blind clinical trial and cross-over study. 40 young female students with dysmenorrhea were randomly divided into two groups of 20. In the first month, the first 20 persons were received ibuprofen (400mg) every 8 hours and received placebo nightly from the time of menarche and the second group were received ibuprofen (400mg) every 8 hours and a single dose of alprazolam (0.5mg) every night for a period of 3 days. Then for the second month, the medicine regime was swiped between two groups. Data were collected using Cox menstrual symptom scale questionnaires. The mean scores of abdominal pain for the day 2 and 4 after treatment in ibuprofen-alprazolam group were lower than those one were observed for ibuprofen- placebo group (both, P=0.000). Also, the mean scores of low back pain in both day 2 and 4 after treatment with ibuprofen-alprazolam group were significantly lower than those one were observed in the group, which was given ibuprofen- placebo (P=0.000, P=0.005, respectively). According to these findings, it might be proposed ibuprofen-alprazolam compound for relief of dysmenorrheal symptoms, which results in minimum adverse effects of pain on daily living activities as well as pain relief.

Episiotomy is one of the common surgeries in the world with few complication and perineal pain. Since the olive oil has antiseptic and healing effects, this study was performed to evaluate the effects of olive oil sitz bath on improvement of perineal injury after delivery. This double blind clinical trial was carried out on 60 selected eligible women who they had mediolateral episiotomy or perineal tear grade 1 and 2. Following repairing episiotomy, the subjects were randomly allocated into two groups: the Study group was undergone care by olive oil sitz bath and the control group by distilled water sitz bath for 10 days. Data were collected through demographic data, REEDA scale and visual analog scale of pain. There was a significant difference between the study and control group with regards to pain severity after 5 and 10 days (p<0.05), wound redness after 5days (p<0.0001) and redness (p<0.000), edema (p<0.05) 10 days after delivery. Any case of ecchymosis, discharge and approximation (distance between the wound edges) was not observed in the olive group but those signs were observed in the control group. However, this difference was not statistically significant. This study suggests that olive oil to be added to routine water sitz bath for post-episiotomy care.

Substance abuse is one of the most common disorders that exert a high impact on the life of patients and their families. There are many treatment methods for Addiction. The purpose of the present study was to determine the effects of narcotics anonymous (NA) program on personality characters in substance abuse patients.

This quasi experimental design was performed on 100 patients with substance abuse disorders that they had been randomly selected from those patients who were referred to psychiatric clinics and counseling centers in Esfehan in 2008. Then, the subjects were equally divided into two groups; experimental and control. All the patients carried out Eysenk test prior to any intervention and also a demographic questionnaire were filled out by all the subjects. Then, Eysenk test was performed on all the patients following the intervention. Changing in personality character in the experimental group (before and after the intervention) was compared with those of the control group.

The findings showed that narcotic program has significant effects on personality characters of experimental group to substance abuse in post test, but these effects are not significant in control group.

According to the findings of this work, we suggest the effectiveness of NA program in changing personality characters of the patients with substance abuse

Researchers are extensively using biomarkers to detect diseases. Commonly, a cut-off point is selected for separating sick and healthy people. Sometimes it is necessary to obtain more than one cut-off points, by classifying subjects into more than two groups. As such, in the present paper, generalized Youden index has been used to classify subjects into three groups. The main intention of this study was to determine the optimal cut-off points for the hemoglobin levels in the first trimester of pregnancy in order to predict preeclampsia.

We used data of the hemoglobin levels in the first trimester of pregnancy and preeclampsia from 620 pregnant women who were referred to Tehran's Milad Hospital in 2009-2010. The optimal cut-off points for prediction of preeclampsia in the first trimester were obtained by using generalized Youden index and volume under the receiving operating characteristics (ROC) surface (VUS). Statistical analysis was performed using by R software version 2-15-1 and DiagTest3Grp package.

The estimated cut-off points, using by Youden index, were 13.18 and 14.5 with correct classification proportions of 70%, 35% and 15%, respectively. The estimated cut-off points, using by ROC surface were 12.4 and 13.1 and correct classification proportions were 42%, 35% and 55%, in order. The volume under the ROC surface was 0.25.

The generalized Youden index, as a complementary index for VUS, can be adopted to achieve greeter diagnostic accuracy; it can also be used to achieve a three group classification of subjects

The aim of this study was to determine the frequency of distal symmetric polyneuropathy (DSP) and the role of physical examination for neuropathy diagnosis in subjects with type 2 diabetes mellitus.

A cross-sectional study was carried out from 2009 to 2010. A total of 107 patients with type 2 diabetes were evaluated using the Michigan Neuropathy Screening Instrument (MNSI). MNSI consists of two parts: History and physical assessment. History was focused on positive (burning, tingling) and negative (numbness) sensory symptoms, cramps and muscle weakness, foots ulcers or cracks, and prior diagnoses of diabetic neuropathy by a physician. Physical assessment was determined from foot appearance, ulceration, ankle reflexes, vibratory perception and monofilament testing.

A total of 72 women and 35 men were participated in this study. The frequency of neuropathy diagnosed based on physical assessment was 78.5%. The mean age was 57.6 (± 10.2) and the mean duration of diabetes was 10.2 (± 7.3) years. Ankle reflexes were not observed in both both foot in 67% of patients. Vibration perception was absent in 25% of patients. Monofilament testing was normal in 86% of patients in both feet.

The results showed a key role of physical examination in diagnosis of DSP in diabetic patients. The high frequency of DSP among diabetic patients demonstrated the importance of annual screening, further evaluations, planning and management of patients in diabetic foot clinics. However, considering the results of this study, the sensitivity of monofilament test in screening of DSP is questionable.

Job satisfaction is one of the important variables in the evaluation of work health. Job satisfaction survey developed by Paul Spector to measure this variable in job settings. The aim of this study was to examine the psychometric properties of Spector’s Job Satisfaction (JSS) Survey in Iran. In this study, Spector’s questionnaire was translated in Persian languge. A sample of 415 employees in Kerman (Iran) hospitals participated in this study and filled out the questionnaires. Cronbach’s alpha reliability analysis showed appropriate item-total correlations for subscales and a good total scale internal consistency. An exploratory factor analysis (EFA) identified 6 factors in participants’ reponses which could explain 65.44 percent of the total variance altogether. EFA identified dimensions of pay, promotion, supervision, coworkers, nature of work, and communication. These findings showed that JSS has a good construct validity and internal consistency. Persian translation of JSS is a reliable and valid measure to assess job satisfaction in Iran

Weight bearing asymmetry is one of the basic causes of disturbance in maintaining balance of hemiparesis patients that could complicate standing and participation in activities of daily living in these patients. The purpose of this study was to investigate the immediate effects of constraint induced movement therapy technique using wedge on symmetry index as well as the short-term effects of this technique on functional balance of chronic hemiparesis patients.

In this quasi-experimental study, twenty-one hemiparesis patients by mean age of 54.28 (±10.06) and the mean passed duration of injury 50.14 (±36.48) months were selected by simple non-probability method. The symmetry index was measured in three conditions: non-wedge, wedge 5ºand wedge 7.5º. Also, functional balance of patients was measured with Functional Reach (FR) and Timed Up and Go (TUG) tests before and after using of short-term constraint induced movement therapy technique.

According to the results of this study, symmetry index difference was significant in both wedge 5º and wedge 7.5º conditions compared with no-wedge condition (p<0.001), while it was not significant between wedge 5º and wedge 7.5º conditions. The mean scores of FR (P=0.012) and TUG (P=0.006) showed significant changes after using the constraint induced movement therapy technique

Constraint induced movement therapy technique caused immediate improvement of weight bearing symmetry and improvement of functional balance in short-term interval.

The aim of the present research was to study the expression of activated-leukocyte cell adhesion molecule (ALCAM) in oral squamus cell carcinoma (OSCC) and its association with histopathological and prognostic parameters. In a cross-sectional study, samples of OSCC tumors from tongue and oral mucosa available in Institute of Cancer of Imam Hospital in Tehran were simultaneously studied in term of tumor size, lymph node metastasis, and differentiation and ALCAM expression. Analysis was performed using multiple logistic regression models. 39 samples of tongue and 19 samples of oral medusa belonged to 35 men and 23 women with mean (Standard deviation) of age 58(15.69) years of old were studied. More than half of lesions had good differentiation and lymph node metastasis. From all, 42 (72.4%) of samples were positive of ALCAM. Odds of ALCAM total expression in tumors with size of at least 20 mm was more (OR=3.9, p=0.001). Odds ratios for membranous and cytoplasmic expression of ALCAM in positive samples of lymph node metastasis (OR=0.4, p=0.03) and in patients with age 40 and more (OR=2.7, p=0.002) were respectively significant. The study confirmed positive relationship between ALCAM expression and tumor size as while as ambiguity of ALCAM role as a "Paradox" indicator. Next researches may make the role of ALCAM in different phases of tumor developing clearer

Tumor necrosis factor α (TNF-α) is a potent cytokine that exerts pleiotropic functions in inflammatory symptoms. With regarding to the important role of TNFα in hyperalgesia and edema induction via intra-cellular signaling pathways, we aimed to investigate the role of increasing serum TNF-α on hyperalgesia and edema and spinal mu opioid receptor (mOR) expression variation during different stages of Complete Freound Adjuvant- induced arthritis in male rats.

Mono-arthritis was induced by CFA and then inflammatory symptoms (hyperalgesia and edema) were assessed on day 0, 3,7th, 14 and 21 following CFAinduction. In addition, anti-TNF-α was daily administered for 21 days for all different experimental groups. Spinal mOR expression were detected by western blotting.

Our results showed that anti-TNFα administration in AA group resulted in decrease of paw volume and hyperalgesia until day 14, whereas, those symptoms were increased on day 21 following CFAinduction. Our study stated that anti- TNFα antibody administration causes a significant decreasing in spinal mOR protein expression on days 14 and 21 of the study.

This study confirmed the time-dependent and bi-directional effects of serum TNF-α levsel on CFA-induced hyperalgesia, which it can say, a portion of these effects might be mediated via spinal mOR expression variation.

Stress interferes with the different physiological performance systems and causing in some behavioral responses that including food intake. Considering the effects of peppermint in traditional medicine as an effective drug on some disorders in this study its effect on food intake and body weight following immobilization stress were studied. Male mice were divided randomly into the three groups; the first group as a control group, second group as a stress group and third group as stress plus peppermint oil group with ten mice in each. The second group as a stress group received immobilization stress four hours for three days. Third group as stress plus peppermint oil group received stress in addition to administration of 27 mg/kg peppermint oil intraperitoneally before stress. After three days of treatment, food intake and body weight were measured. Based on food intake, there were statistical differences between control and stress groups (P=0.001), stress and stress plus peppermint oil (P=0.001), control and stress plus peppermint oil (P=0.025). Based on body weight, there were statistical differences in stress and stress+ peppermint oil groups before and after experiment (P<05). This study showed that the level of food intake and body weight in stress group after three days compared to the control group was decreased. Administration of peppermint oil, improved food intake and weight gain after chronic stress immobilization.

Carcinoembryonic antigen (CEA), a glycophosphatidyl inositol (GPI) anchored glycoprotein, is over-expressed in various cancers, including colorectal carcinomas. Inhibition of cell differentiation can cause cancer. Previous studies show transfection and over-expression of CEA gene in myoblasts or colonocytes leads to inhibition of cell differentiation. We investigated whether soluble CEA has a role in inhibition of cell differentiation.

Monolayer cultures of L6, C2C12, Caco-2 and CHO cell lines were grown in dulbecco's modification of eagle's medium (DMEM) containing 10% fetal bovine serum (FBS). For differentiation induction C2C12 and L6 cell lines media, was changed to DMEM containing 2% horse serum. CEA concentration was measured in harvested media by ELISA assay. H&E staining, CK assay and RT-PCR for myogenin gene were used for C2C12 differentiation experiments.

The results showed although commercial pure CEA and LS-180 conditioned media (contain high level of CEA) have inhibitory effects on Caco-2 differentiation, but it can also inhibit differentiation of control groups. We observed the effect of high concentration of CEA (5μg/ml) on L6 differentiation is identical with the effect of BSA as control. C2C12 differentiation was inhibited in response to LS-180 conditioned media at morphological level and myogenin expression. CK activity was significantly lower in LS-180 conditioned media (P= 0.0012) and CHO (P= 0.0002) conditioned media groups in comparison to control group.

Our finding shows soluble CEA antigen did not have a significant effect on cell differentiation.