Iranian Red Crescent Medical Journal
Volume:19 Issue: 2, Feb 2017

Nowadays quality of life (QOL) is an important part of health and measuring health-related QOL after surgery is necessary for decision-making by patients and surgeons. To assess post cholecystectomy QOL, documentation of high quality care has been subjected to extended discussions, and the use of patient-reported outcome satisfaction for quality improvement has been advocated for several years.
The aim of this study was to compare quality of life after surgery in candidates of laparoscopic and open cholecystectomy.
Patients and This study was an optional part of a longitudinal study for comparison of quality of life in candidates of laparoscopic (LC) and open cholecystectomy (OC). One hundred consecutive cases of hospitalized patients, aged 20 to 65 years, at two hospitals of Karaj, Iran (Imam Khomeini and Alborz), were recruited in the study from May to December 2011. Patients were divided to two groups based on the order of admission and the surgeons’ and patients’ preference. Patients were evaluated with the medical outcomes study 36-item short-form health survey (SF-36). Quality of life was measured at three points of time (the baseline was two and four weeks after surgery) using this health questionnaire. Differences between baseline time periods of two and four weeks were compared by independent-samples t-test and within groups the time periods were compared by the paired-sample t-test.
Two weeks after the operation, in the LC group, the QOL scores decreased significantly in physical functioning, physical status, body pain and emotional status (for all of them P ≤ 0.01), whereas, in the OC group all the aspect of QOL decreased (for all of them P Quality of life is an important factor affecting medical and surgical treatment, as well as decision-making. Improvement of short-term quality of life after laparoscopic cholecystectomy in comparison to open cholecystectomy proves the obvious superiority of LC over OC.

Traumatic brain injury (TBI) is an important public health problem throughout the world.
The aim of this study was to assess repeated glasgow coma scale (GCS) scores in predicting the severity of TBI and patients’ survival.
Patients and In this longitudinal study used a total sample of 239 patients, all of whom were hospitalized with traumatic brain injuries. Subjects were selected by simple random sampling in intensive care unit (ICU) wards of the Shahid Beheshti hospital in Kashan, Iran between September 2008 and September 2010. The patients’ level of consciousness was evaluated using GCS at admission, six hours after admission to the ICU, and at the time of discharge from the hospital. A Glasgow outcome score (GOS) is used to classify the global outcomes in TBI survivors. A joint modeling approach was utilized for data analysis using R software.
The results showed that female patients had the risk of occurrence, slightly more than men, but this was not significant (HR =1.095 P = 0.757). The mortality risk was significantly higher in older patients (HR = 1.010, P = 0.010). In addition, the results indicated a significant increasing linear trend in GCS values over time (HR=1.78, P=0.003). Higher age was also associated with lower GCS values over time (P By jointly modeling longitudinal data with time-to-event outcomes, our findings supported the use of the GCS scores in predicting the severity of TBI.

A consistent and comparative description of the burden of diseases, injuries and risk factors that cause them is an important input to health decision-making and planning processes.
The aim of this cross-sectional study was to compare the extent and pattern of variation in generic utility measures with respect to capturing the clinical nature of acute poisonings from the moment of onset until restoration of health after treatment.
Patients and We measured the health status of patients admitted to the emergency medical toxicology ward of our teaching hospital, Mashhad, Iran. We measured their EuroQol both at admission and pre-discharge, and they were asked for time they traded-off for their current illness.
The study enrolled 82 patients (34 males, 48 females) admitted to the emergency medical toxicology department. A questionnaire was completed for all patients at the two time intervals. The results varied from 22222 to 33333 at initial management; at the time of discharge, this rating varied from 11111 to 11122. These significant changes occurred over just a few days.
This study attempted to compare the course of acute poisonings with some other diseases to show how self-induced poisoning affects one’s health perception, and how this change takes place over a short time.

Cervical cancer is one of the most common cancers observed in women worldwide, and its development is related to E6 and E7 two viral oncoproteins of high-risk human papillomavirus (HPV) types. Aberrant expression of E-cadherin, which is associated with epithelial-to-mesenchymal transition (EMT), is frequently observed in cervical cancer.
The mechanisms underlying E-cadherin suppression in cervical cancer are not clear; therefore, this experimental study from Iran was designed to elucidate the relationship of DNA methyltransferase expression and E-cadherin promoter methylation with E-cadherin expression in HPV-16 E6- and E7-expressing cells.
Real-time PCR and western blot were used to determine the effects of HPV-16 E6 and E7 on E-cadherin, DNMT1, DNMT3a, and DNMT3b expression in HCT-116 cell line. We also analyzed E-cadherin promoter methylation in cells expressing HPV-16 E6 and E7 oncoproteins by bisulfite sequencing.
HPV-16 E6 and E7 proteins reduced E-cadherin expression 3.7 and 2.2 times when compared with control cells (P = 0.0221 and P = 0.0461, respectively). This reduction was greater in HPV-16 E6-expressing cells than in HPV-16 E7-expressing cells. Although HPV-16 E6 and E7 increased DNA methyltransferase 1 expression 2.6 and 3.4 times, respectively (P = 0.0133 and P = 0.0113) when compared with control cells, they was no E-cadherin promoter methylation.
Unlike other cancer-associated viruses (HBV, HCV, and EBV), reduction in E-cadherin expression in HPV-16 E6- and E7-expressing cells is not due to hypermethylation of the E-cadherin promoter.

Coincided familial hypophosphatemic rickets (FHR) and Hypopituitarism is a rare condition. Growth hormone deficiency (GHD) evaluation has been advocated for refractory FHR cases, considering the possible masking effect of FHR on the former. Moreover, there has been controversial use of growth hormone as an adjunct therapy in FHR.
A 19-month-old girl was presented with severe growth failure, refractory to 6 months of vitamin D therapy for assumed nutritional rickets. Following detection of low serum phosphate, insulin-like growth factor-1 (IGF-1) and insulin-like growth factor-binding protein 3 (IGFBP3), phosphaturia and positive FHR family history, she was diagnosed with concomitant FHR and hypopituitarism.
This case highlights the fact that FHR and GHD may coexist, with possible masking effect of one on the other, thereby misleading the approach, posing large impacts on therapy, which has historically been a difficult challenge in FHR patients.

Resistance to antibiotics is a growing worldwide problem. The inappropriate use of antibiotics has rendered some strains of bacteria resistant to antimicrobial drugs, making the treatment of infections much more difficult. However, many herbs and their derivatives are effective against drug resistant microbes.
The aim of this research was to evaluate the effects of an Aloe vera extract on the morphological and physiological properties of Escherichia coli.
Patients and A clinical isolate of E. coli was obtained from a patient harboring a urinary tract infection (UTI), and was identified using biochemical and microbiological methods. Aqueous extracts of Aloe vera were prepared, and the minimum inhibitory concentration (MIC) of the extract was determined for E. coli via the microdilution method. The bacterium, at a concentration of 1.5 × 108 cells/mL, was exposed to the MIC of the extract. Then, the morphology of the cells was studied using optical microscopy, and the physiological properties were studied using biochemical testing and differential culture media.
The MIC of the Aloe vera extract was 2.23 mg/mL, and was able to prevent the growth of E. coli. The morphological examination of the bacteria exposed to the extract at the MIC revealed that the cells were shrunken, the concentration was reduced, the number of coccobacilli was increased, and the staining property of this bacteria changed (P This study showed that Aloe vera has antibacterial effects against E. coli, and can result in structural and physiological changes in this bacterium.

Mothers are vulnerable to mental disorders, such as depression and anxiety, in the 6-week postpartum period after delivery.
This study was performed to determine the potential effect of orange peel essential oil on postpartum depression and anxiety.
Patients and This double-blind randomized controlled clinical trial consisted of 96 postpartum women. Qualified samples were assigned to intervention and control groups using randomized blocking. The intervention group drank a glass of water containing 10 drops of orange peel essential oil, and the control group drank a glass a water containing 10 drops of placebo, 3 times a day, after each meal for 8 weeks. The subjects completed depression and anxiety questionnaires before and after the intervention. A general linear model was used to analyze the data.
There was no statistically significant difference between the groups in terms of sociodemographic characteristics and depression and anxiety scores before and after the intervention (P > 0.05). At the end of the 8th week, the mean depression score (standard deviation [SD]) was 6.7 (4.7) in the orange peel essential oil group and 6.7 (4.9) in the placebo group (P = 0.956). The mean state anxiety score was 47.6 (3.8) in the orange peel essential oil group and 48.4 (4.1) in the placebo group (P = 0.197). The mean trait anxiety score was 45.6 (3.5) in the orange peel essential oil group and 45.9 (3.8) in the placebo group (P = 0.726).
Orange peel essential oil did not reduce postpartum depression and anxiety.

Paracoccidioidomycosis (PCM) is a type of mycosis most often found in the lung. The authors present a case of pulmonary PCM.
A 72-year-old man had a four-year history of dyspnea, dry cough, and weakness and a recent weight loss of more than 10 kg. First, he was treated with glucocorticoid, but he did not continue this treatment. Core needle biopsy was done. Pathology reported paracoccidioidomycosis. The patient was treated with itraconazole.
PCM has not been reported in Iran until now, but it should be considered as a differential diagnosis when risk factors or symptoms of PCM are detected.

Although there are studies that suggest a vast expansion of medicalization of pregnancy and birth in Iran, data about the rate of intervention applications caused by the medicalization in low-risk pregnancies and birth is limited. Moreover, there is limited information on the effectiveness of these interventions for different modes of childbirth.
This study aimed to determine the rate of application of maternal medicalized care in low-risk pregnancies and births and to identify the factors that are associated with type of delivery.
Patients and This cross-sectional study was performed by stratified-cluster sampling on 320 postpartum women from four public and private hospitals in Mashhad, Iran. The data collection instrument was a designed and standardized tool for assessment of medicalized pregnancy and childbirth. Also, descriptive tests and logistic regression were used. A value of P In this study, the rates of natural vaginal and caesarean birth were 34.7% and 65.3%, respectively. Preconception and prenatal care received from an obstetrician were 72.8% and 51.6%, respectively. The median number of prenatal visits, laboratory examinations and sonography procedures was 12, 3 and 4, respectively. In 49.4% of the cases, the women were hospitalized before the onset of labor. Early admission (OR = 2.40; 95% CI = 1.93 - 2.97; P = 0.001) and performing electronic fetal heart monitoring during admission (OR = 2.47; 95% CI = 1.28 - 4.73; P = 0.006) were the interventions that the regression logistic analysis identified as associated with a higher rate of caesarean delivery.
It seems that obstetric interventions are widely applied in low-risk pregnancies and births. Some of these interventions have the effect of increasing the rate of caesarean delivery. According to the provided information, it seems that it is necessary to adjust health policy to provide appropriate care for low-risk pregnancies and births.

Aminophylline expedites the recovery from total intravenous and inhalation anesthesia.
The aim of this study was to evaluate low and high doses of aminophylline on extubation time, time to discharge from recovery, and the bispectral index score (BIS) in patients who received isoflurane anesthesia.
Patients and After ethical approval and informed consent were obtained, this prospective, randomized, blinded clinical study was conducted in Sina hospital in Iran. Seventy-five patients who were scheduled for elective laparatomy surgery under isoflurane anesthesia were randomly allocated to receive either saline or 1 or 5 mg/kg of aminophylline (n = 25 for each) at the end of their anesthesia. The time to tracheal extubation and BIS after the administration of the study drug and the total time required until discharge from the post anesthesia care unit (PACU) were recorded.
Seventy-five patients completed the study. Compared to saline, patients who received 1 and 5 mg/kg of aminophylline demonstrated decreased extubation times (mean ± SD) (12.26 ± 7.33 vs. 11.15 ± 8.62 and 10.4 ± 4.78 min, respectively, P = 0.001) with higher BIS values (P = 0.001). However, the recovery and discharge times from the PACU were no different between the aminophylline and saline groups.
The administration of high doses of aminophylline after laparatomy procedures with isoflurane anesthesia expedited the extubation time with no effects on discharge from the PACU.

Functional dyspepsia (FD) is a common gastrointestinal disease that has various treatments, including medicinal plants.
The current study aimed to investigate the effect of Mentha longifolia on relieving the symptoms and improving the quality of life (QOL) in patients with functional dyspepsia from the subgroup of postprandial distress syndrome (PDS).
Patients and This randomized, double-blind, placebo-controlled trial was conducted in a gastroenterology clinic affiliated with Isfahan University of Medical Sciences. One hundred patients diagnosed with PDS according to the ROME III criteria were assigned to two groups: the M. longifolia capsules (three times daily for four weeks) group and the placebo group. Tools for gathering data were the FD severity scale and QOL (Persian version of the SF-36 questionnaire). Assessments of FD symptoms were obtained at baseline and also at the end of weeks 2, 4, and 12. QOL was evaluated at baseline and at the end of week 12.
At the end of treatment period, the M. longifolia group reported a more significant improvement in the mean severity scales of FD symptoms than the placebo group (P This study showed the efficacy of M. longifolia in relieving PDS symptoms and improving the QOL of patients with PDS.

Schizophrenia (SCZ) is a complex neuropsychiatric disorder characterized by pronounced genetic heterogeneity. Much of the genetic architecture of the disorder has not yet been clearly elucidated.
In the present experimental genetic analysis study, we used the whole-exome sequencing (WES) approach to identify the SCZ-related genetic variants in consanguineous multi-affected families.
Patients and The current study was conducted between 2013 and 2015. The patients were recruited from two mental hospitals, including Razi hospital (Tehran, Iran) and Mirza Koochak Khan hospital (Rasht, Iran). All patients were diagnosed based on the DSM-IV-TR diagnostic criteria for SCZ. DNA samples from one proband for each of the three consanguineous Iranian families with twelve affected patients were subjected to WES. Then, a multi-step analysis strategy was employed to identify the genetic variants that may have potentially contributed to SCZ.
After variant filtering, WES data revealed two previously known pathogenic mutations (rs450046 in PRODH and rs1800497 in ANKK1 genes) and five novel variants in five genes (NOS1, ANKK1, ARVCF, GRID1, and ANK3), all of which were predicted to be causing damage by SIFT, Polyphen-2, and MutationTaster tools. Two of these novel variants (c.562C > T in ANKK1 and c.7649G > T in ANK3) showed complete segregation in the families, which makes them good candidates for further case-control studies.
By applying WES, both novel and known SCZ pathogenic variants with complete or incomplete segregation in the families with multiple cases of schizophrenic patients were identified.

Puberty and changes resulting from it are one of the most important events of everybody’s life. Mothers play a central role in raising the level of knowledge, managing family health and improving hygienic behaviors of their daughters.
The current study aimed to compare the effects of educating mothers and their daughters on the knowledge and practices toward puberty hygiene in adolescent girls in Tabriz, Iran, 2014.
Patients and This randomized controlled trial was conducted on 364 adolescent students of 12 randomly selected high schools who had experienced menstruation. The students were first matched by the practice scores they received in the pretest and then divided randomly and equally into three groups: educating the mothers, educating the girls, and the non-intervention group. The questionnaires regarding knowledge and practices in the pre- and post-intervention stages (with an interval of two months between them) were completed. The general linear model, in which the baseline values were controlled, was employed to compare the scores of the three groups after the intervention.
There were no significant differences between the three groups concerning the scores received on knowledge and practice prior to the intervention (P > 0.05). After the intervention, by controlling the scores received before the intervention, the mean score on knowledge in the two groups of educating the mothers (adjusted difference: 0.7; confidence interval (CI) 95%: 0.0 - 1.3) and educating the girls (0.8; 0.2 - 1.5) were significantly higher compared to those of the control group. With respect to improvement in the scores received on practice, no significant differences were found between the three groups.
Results of the current study indicate that it is possible to use the method of educating the mothers and transferring knowledge from them to their daughters as a substitute for direct education of the girls in order to raise the level of their knowledge on puberty hygiene.

Adolescents are involved in a variety of health risk behaviors like inactivity and unhealthy diet. Furthermore, behaviors learned by adolescents will continue to adulthood.
The current study aimed to determine the effects of lifestyle intervention on the anthropometric measurements by the health belief model (HBM) among obese adolescents in Iran.
In this parallel randomized controlled educational trial, 90 obese adolescents 12 - 18 years were selected (44 in control and 46 in the test group). The participants in the present study were selected by simple random sampling method among adolescents with obesity referred to the Isfahan cardiovascular research center, Iran. Education based on health belief model was conducted. The main components of the program were on nutrition and physical activity as two major factors in the weight control of people with obesity. Subjects in the control and intervention groups completed questionnaires at baseline (T0), end of three months of intervention (T1) and three months after the end of intervention (T2).
The multivariate test results showed significant effects of interaction of time and group for knowledge scores (F = 101.19; P Results of this study showed that the 12-week educational intervention program using the HBM was effective to increase knowledge, perceived susceptibility and self-efficacy of the participants.

Primary non-Hodgkin’s lymphoma of the bone (PLB) represents about 3% - 5% of all extranodal non-Hodgkin’s lymphoma (NHL) cases and 7% of primary bone tumors. It may occur at any age. The peak incidence for PLB is in the fifth and sixth decades of life, and it has a slight male predominance. The most commonly affected sites are the long bones. A palpable mass due to soft tissue extension of the bony disease is seen in almost half of all cases.
We report the case of an NHL (diffuse large B-cell lymphoma) in the talus bone of a 17-year-old boy who was referred to our center in 2011 - 2012, which had an odd presentation. The patient’s first diagnosis was a simple ankle sprain, and he underwent conservative treatment. Given the patient’s deteriorating symptoms, further paraclinical evaluations were conducted, and fracture of the talus was diagnosed, which was thought to be a cause of further osteonecrosis. Finally, because of lack of pain relief and due to MRI images, the suspicion of malignancy was raised. Open biopsy of the talus showed NHL (diffuse large B-cell lymphoma).
The present case is interesting because it expresses how such lesions can be met with diagnostic confusion.

Nutritional therapy in the forms of parenteral or enteral nutrition is an important factor of care and appears to positively impact the clinical outcomes of critically ill patients.
This study aimed to compare the effects of acupuncture and prokinetic drugs on delayed gastric emptying (DGE) in intensive care unit patients.
In a prospective, block-randomized, single-blinded, parallel group trial, 60 fully sedated, mechanically ventilated surgical patients were enrolled in two groups with 30 patients in each group in Besat hospital in Hamadan, Iran from February 2011 to October 2012. Patients in the drug treatment group received 10 mg of IV metoclopramide every eight hours. For patients with whom persistent DGE was seen, 500 mg of IV erythromycin every 24 hours was added. Patients in the acupuncture group received bilateral prolonged intermittent transcutaneous electrical acupoint stimulation of acupuncture point Neiguan. The intervention was performed for six consecutive days or until the cessation of gradual residual volume.
A demographic analysis of the participants revealed no significant differences between groups (P > 0.05). Although the results of the RANOVA model for DGE did not show a significant time trend (P > 0.05) in both acupuncture and drug groups, comparing means of the both acupuncture and drug groups in all the time points after the intervention were significant (P = 0.024): 711.83 ± 193.28 vs. 755.00 ± 166.79 (P = 0.358), 564.17 ± 672.35 vs. 628.50 ± 176.77 (P = 0.614), 324.00 ± 146.49 vs. 472.00 ± 188.47 (P Although neither acupuncture nor the drug interventions had significant effects on the improvement and obviation of DGE, the acupuncture had greater effects than prokinetic drugs on the reduction of DGE.

The standard treatment for symptomatic primary hyperparathyroidism due to parathyroid adenoma is surgery, but in patients who are not good candidates for surgery, other treatment modalities including ethanol ablation, laser ablation, ultrasound wave ablation, and radiofrequency ablation are used. We describe a patient with multiple medical problems and a parathyroid adenoma who was treated with radiofrequency ablation.
A 47-year-old patient was referred to our hospital (Namazi hospital, Shiraz, Iran) in April, 2015 with intracranial hemorrhage, as well as high serum calcium and PTH (parathyroid hormone) levels (12.1 mg/dL and 1062 pg/mL, respectively), who had a parathyroid adenoma. Radiofrequency ablation was performed for the patient after he was stabilized, and three days later, his serum calcium and PTH levels decreased to 8.9 mg/dL and 38 pg/mL, respectively, and there was abnormal uptake according to the post-ablation parathyroid scan. The patient was followed for 12 months in our endocrine clinic, during which time he was in good general condition, with normal serum calcium, phosphate, and parathyroid hormone levels.
Radiofrequency ablation may be used successfully in the treatment of parathyroid adenoma when a patient cannot tolerate surgery.

Ionizing radiation has become an essential part of modern medicine. However, applying the effective dose of ionizing radiation is compromised by its inevitable radiation-induced damage to normal tissues. Natural products with free radical scavenging, antioxidant activities, and immune stimulatory effects offer suitable radio-protective effects.
This study was designed to evaluate the in vivo radio-protective activity of lycopene, a naturally dietary carotenoid, against whole-body gamma-irradiation-induced mortality and sickness in mice.
In this animal experimental study, lycopene was extracted from tomato paste, characterized, and then administered to mice. Consecutively, 80 healthy adult male mice were recruited and irradiated individually, and then monitored for irradiation sickness and survival parameters.
Pretreatment with 7 mg/kg dose of lycopene 7 days before irradiation was found to reduce the severity of symptoms of radiation sickness in a 30-day post-radiation monitoring. Lycopene treatment increased the survival rate. At the radiation dosage of 8 and 9 Gy, the difference between the survival rates of control and sample groups became significant after day 15 and 25. Lycopene was also shown to have a protective effect on white blood cell count against 8 and 9 Gy gamma radiations.
Natural and exhibiting whole-body radio-protective activity, lycopene can be proposed as an effective radio-protector in healthy people who are exposed to radiation, such as radiographers, nuclear pharmacists, and radiologists.

Augmentation therapy involves the addition of a second drug, such as mood stabilizers, antipsychotics, and nutritional supplements, to a primary antidepressant treatment. Studies on adding folic acid to a preexisting antidepressive regimen as a form of augmentation therapy have had different and even controversial results.
This study aimed to determine the effects that adding folic acid to a pharmaceutical diet with citalopram has on the treatment of depression.
This double-blind randomized clinical trial was conducted in Kashan, Iran on 90 patients who suffered from depression. Patients were allocated to study groups using random permuted blocks. One group (n = 45) received a dosage of 20 mg citalopram in combination with 2.5 mg folic acid on a daily basis, and the other group (n = 45) received the same daily dose of citalopram with a placebo for eight weeks. To measure the severity of each patient’s depression, the Beck depression inventory II (BDI-II) questionnaire was used prior to starting the antidepressant therapy and was repeated four, six, and eight weeks after beginning the treatment. A reduction from the original BDI-II scores that was greater than 50% was considered to be a response to treatment.
The average depression scores before treatment were 30.11 ± 10.41 in the intervention group and 31.24 ± 10.26 in the control group (P = 0.6). At the end of the study, the depression scores in the intervention and the control groups were 13.31 ± 6.57 and 19.11 ± 8.59, respectively (P Folic acid, when used as a complementary therapy, can improve a patient’s response to antidepressants used for the treatment of major depression.

Approximately 80% of nosocomial infections are caused by strains of Klebsiella pneumoniae. Resistance to β-lactam antibiotics is a result of expression of extended-spectrum β-lactamase (ESBL) genes. Recently, phage therapy has gained increasing attention due to its many advantages over chemotherapy.
The aim of this study was to isolate ESBL-positive Klebsiella pneumoniae strains from different types of wounds, and a lytic bacteriophage against them.
During a two-year period from January 2013 to February 2015, in a cross-sectional study, 41 K. pneumoniae strains were isolated from 193 categories of infected wounds at three hospitals in Isfahan, Iran. Phenotypic and genotypic methods were used to detect the ESBL-positive strains. A lytic phage against K. pneumoniae was isolated, and its host range, morphology, thermal and pH stability, saline stress, and estimated genome size were determined.
Of the 41 K. pneumoniae isolates, 18 were ESBL-producing and 36 carried antibiotic-resistance genes. A total of 36 out of 41 isolated samples carried one or more resistance genes. The results showed that the differences between phenotypic and genotypic identification methods were significant (P = 0.0001). The SHV, CTX-M, and TEM genes were detected in 29, 10, and 9 isolates of the tested bacteria, respectively. No bacteria contained both the SHV and the CTX-M genes. The frequency of the SHV gene was significantly higher than that of the other genes (P = 0.0001). The phage’s morphology features placed it in the Myoviridae family. Only 38 out of 41 clinical isolates were susceptible to the phage. Phage titers were completely preserved after one hour of incubation at 30°C and 40°C, and they were stable at different pH values. The phage’s survival decreased when the salt concentration was increased.
The high rate of isolation of antibiotic-resistant strains of K. pneumoniae was consistent with other studies. As the phage was virulent and specific for K. pneumoniae, and was stable and active at different pH values, salt concentrations, and temperatures, its application in phage therapy of infected wounds is suggested.

The origins and spatio-temporal dynamics of the HIV-1 subtype B and CRF01_AE clades are largely unknown in Iran.
This study investigates the origins and spatio-temporal dynamics of HIV-1 subtype B and CRF01_AE clades in Iran using the most recent phylogeographic methods.
This Bayesian phylogeographic study examined HIV-1 sequence data available in the Los Alamos HIV databases. For the purposes of this study, we retrieved all the eligible time-stamped and geo-referenced HIV-1 subtype B (pol p66 and p51 RT) and CRF01_AE (gp160) sequences from Iran. The majority of these data were obtained from studies using convenience and snowball sampling. Evolutionary and phylogeographic parameters were jointly estimated for each clade using BEAST software v.1.8.1. A Bayesian stochastic search variable selection method, with a threshold of 3.0 for the Bayes factors test, was used to obtain significant migration rates of the virus.
Our results suggest that the subtype B epidemic was introduced to Iran from Southern China, Germany and the USA. Although the migration rate from the USA to Iran was found to be statistically insignificant, the results suggested that the USA was the earliest exporter of the subtype B to Iran (i.e. since 1974, 95% Highest Posterior Density (HPD): 1966-1974). Moreover, based on our findings, the CRF01_AE clade was first introduced to Iran from Thailand (1988, 95% HPD: 1986 - 1990). Among the factors contributing to the transmission of subtype B to Iran from Germany is the transit of goods and long-distance truck driving. However, the factors behind the transmission of this clade from the USA and Southern China remain unknown. Similar to many countries, the introduction of CRF01_AE from Thailand might be attributed to sex tourism.
There is evidence to suggest that subtype B and CRF01_AE were introduced to Iran through multiple pathways and origins, including Germany, Southern China, the USA, and Thailand. Factors such as international trade, the transit of goods, and tourism are among the most likely methods for transmission of these clades. However, the existing preventive strategies in Iran have been mostly focused on other risk groups, including sex workers and intravenous drug users. The findings of our study highlight the need for the further development of targeted preventive strategies, such as educational interventions, aimed at tourists, truck drivers, and people involved in international trade and transactions in order to prevent the onward transmission of disease.

While the application of anti-pruritus medications may be useful for hemodialysis (HD) patients, they are at risk of drug toxicity because of their renal inability to eliminate drug metabolites.
To examine the effect of the topical application of sweet almond oil on reducing uremic pruritus in HD patients.
This study is a randomized clinical trial research. The study population consisted of patients referred in 2013 to the HD ward of Shahid Beheshti hospital, which is affiliated with Yasuj University of Medical Sciences, Iran. From a total of 60 patients, 42 that met the inclusion criteria were selected using a nonrandom sampling method; they were allocated to two groups through a random-allocation method. Sweet almond oil (with a traditional medicine certification and a registration number for the production license) was topically applied on the pruritus location(s) in the intervention group once daily over two weeks. The data were collected using a pruritic score questionnaire at one week and two weeks post-intervention. The data were analyzed using descriptive statistics, such as central tendency and dispersion indices, as well as statistical tests, including repeated measures ANOVA with a P-value significantly less than 0.05 and a confidence interval of 95%.
Pre-intervention, there was no significant difference in the mean scores for the severity of pruritus between the test and control groups, but significant differences were observed between the two groups (P In this study, topical application of sweet almond oil, which was not followed by any specific complications, was able to significantly reduce the uremic pruritus in hemodialysis patients; however, these findings require further studies.

Many factors affect physicians’ dispersion across various locations in Iran. Identifying these factors can be effective in planning for a fair distribution of physicians throughout geographical areas.
This study aims to identify the key factors affecting newly graduated general practitioners’ (GPs’) choice of service delivery in Iran in regard to location.
This was a mixed-method, applied study using a descriptive survey. A questionnaire was designed based on key variables extracted from relevant literature and analyzed from interviews with experts in the field. We used expert opinions to assess the questionnaire’s validity, and Cronbach’s coefficient alpha was calculated (0.925) to confirm its reliability. The questionnaire was randomly distributed among 400 participants (GPs) applying for their mandatory service in Iran during four periods in 2015 (100 participants were surveyed in each period). The data was analyzed using the 8th edition of SPSS and AMOS, and both exploratory and confirmatory factor analysis methods were applied.
Forty key factors were identified loading on five main factors during EFA, which explained 77.90% of the total variance. We used the following designations for the five factors: 1) socioeconomic developmental status, 2) geographical conditions, 3) personal reasons, 4) district health services, and 5) demographics. In CFA, the third factor has the highest weight with 0.97, and the first factor has the lowest weight with 0.89. But the slight differences among factor load show the importance of all factors. The highest weighted factor relates to a number of health center variables, such as the type of roads in the district, social development and liberation, physician efficiency in the region, and distance from the provincial capital.
To resolve the unequal geographic distribution of physicians, it is necessary to consider the key factors affecting the attractiveness of a district for GPs and the existing demand for health services. Attempting to resolve the developmental inequalities among different districts, as well as implementing motivational policies to encourage physicians to work in less developed districts, is recommended.

Renomedullary interstitial cell tumor (RICT), or medullary fibroma, is a small tumor that is usually asymptomatic unless it attains a significant size; in rare cases, the tumor may be large and symptomatic. These benign tumors have a specific histology. Although they are usually incidental findings, it is necessary to be able to discriminate this lesion from other malignancies of the kidney, especially since its management represents a challenge during pregnancy. Numerous patients undergo an unnecessary radical nephrectomy to diagnose renal masses, which is considered hazardous for pregnant women. Ultrasound is the imaging procedure of choice followed by the magnetic resonance imaging (MRI) for assessing the urinary system in pregnant women. Histopathological examination is considered mandatory for the diagnosis of RICT to preclude an unnecessary nephrectomy.
In November 2015, a 31-year-old pregnant woman at gestational week 12 of her second pregnancy was referred to our private clinic in Rasht, Iran. She had microscopic hematuria; a mass measuring 39 × 33 mm in the upper portion of her right kidney was was detected by ultrasonography.
A percutaneous renal mass biopsy was used, instead of nephrectomy, to diagnose the mass; immunohistochemical reports showed that the morphologic features were not compatible with an epithelial neoplasm and the paucicellular spindle cell tumor was compatible with renomedullary interstitial cell tumor. Patients with RICT can be successfully managed using a percutaneous renal mass biopsy and avoiding unnecessary nephrectomy.

Manual handling of patients without using proper devices built for this purpose is the most important risk factor causing musculoskeletal disorders (MSDs) among nursing staff.
The aim of the present study was to determine the prevalence of MSDs, assess the risk of manual handling of patients, and identify the risk factors related to the development of such disorders among nursing staff.
This cross-sectional study was conducted in 2015 and included 220 nurses from 24 wards who were working in Baqiyatallah hospital, Tehran, Iran; their duties mainly involved patient handling. The participants were selected based on the random stratified sampling method. In this study, the Nordic musculoskeletal questionnaire, demographic questionnaire, movimentazione and assistenza di pazienti ospedalizzati (MAPO), and patient transfer assessment instrument (PTAI) methods were applied as data collection tools. In addition, Spearman correlation coefficients and binary and multiple logistic regressions were used to determine the possible relationships between the variables.
The prevalence of MSDs among the participants over the past 12 months was found to be 79.5%. The results for the risk factors showed that the lower back, neck, shoulders, and upper back were the most affected areas of the body. According to the MAPO and PTAI, 60% and 40% of the wards, respectively, are at risk of MSDs. A significant relationship between MAPO and PTAI was found, with a coefficient correlation of 0.252. Based on the statistical analysis, positively significant relationships were found between body mass index, gender, nurse-to-bed ratio, final PTAI and MAPO indices, and MSDs.
The prevalence of MSDs among the nurses was high, and the occurrence of such disorders was found to be related to the scores of MAPO and PTAI indices. Based on the results, these two indices can be used as appropriate tools to assess the risk of MSDs in patient handling by nursing staff. The risk of developing MSDs can be lowered through interventional programs, such as providing and equipping hospitals with the tools required for patient handling and educating staff on how to properly use such devices. In addition, increasing the nurse-to-bed ratio will lower the burden for the nurses in patient handling.

Pelvic floor reconstruction can result in obstruction of the ureters. In order to confirm ureteral patency, an intraoperative diagnostic cystoscopy is indicated.
This case describes a 48-year-old multiparous patient with history of end stage renal failure requiring hemodialysis. She was presented with recurrent cystocele and mix urinary incontinence to City of Hope medical center in Duarte, California, United States in February 2016. The patient underwent transverse cystocele repair for pelvic organ prolapse. When intraoperative cystoscopy was non-diagnostic, retrograde intubation of the ureteral orifices confirmed patency.
This case raises awareness on the lack of visualization of ureteral flux during conventional cystoscopic evaluation in patients with renal failure undergoing pelvic organ prolapse repair, while also emphasizing the importance of confirming ureteral patency via retrograde ureteral intubation when cystoscopy is non-diagnostic.

Retinal ischemia reperfusion (RIR) injury is a common pathological process that can result in visual impairment in many ophthalmic diseases. Inflammation and apoptosis play an important role in RIR injury.
This experimental study was designed to explore the ability of a new cytokine, IL-33, to attenuate RIR injury via an apoptosis-inhibitory mechanism.
From June, 2015 to October, 2015, 40 Sprague-Dawley (SD) rats from Wuhan university in China were divided into the following four groups: normal control group (NCG), RIR injury model group (MG), IL-33 pretreatment group (IL-33), and PBS group (PBS) according to random number tables. Rats in the IL-33 and PBS groups received an intravitreous injection of 2 μg of recombinant IL-33 (rIL-33) or PBS one hour before the induction of ischemia. Histological evaluation, inflammatory cell infiltration, and apoptosis of retinal cells were examined. The expressions of apoptotic-related proteins (Bcl-2 and Bax) were quantified by immunohistochemistry and western blotting. The presence of NF-κB p65 in the retina was assessed by western blotting.
Our data revealed that IL-33 pretreatment maintained a better retinal structure, inhibited leukocyte infiltration (IL-33 vs. MG with P IL-33 may be a potential new agent to attenuate RIR injury by reducing inflammatory cell infiltration and preventing apoptosis.

Methylene blue was first described for the treatment of methemoglobinemia but practical usage of the compound for surgical purpose is common. The aim of this report is to describe a case of hemolysis in neonatal period as a potential hazard of methylene blue toxicity without presence of G6PD deficiency.
In October 2015, a 36-week GA female infant with 2.05 kg weight was delivered by cesarean section with APGAR score of 9/9 from a healthy mother, with common type esophageal atresia. She underwent surgical repair with drainage tube placement on second day of life in our subspecialty referral center, Tehran, Iran. Her blood group type was A and her mother was AB with no family history of hematologic disease. On fifth day postoperative, 2 mL of methylene blue solution that was prepared by dissolving its powder in the hospital laboratory were fed per oral for confirmation of the integrity of esophagus after repair. 8 days after methylene blue ingestion, we met suddenly the occurrence of severe anemia and hyperbilirubinemia with Hb: 6 gr/dL (post-operative Hb: 15 gr/dL) , retic count: 4.8%, total bill/direct: 20/ 0.3, indirect coombs negative ,G6PD: sufficient, ALT: 30 U/L, and AST: 66U/L. At follow-up 2 months after the initial operation, barium meal showed moderate stricture at the site of anastomosis.
We considered two main reasons for hemolysis in our patient. The first explanation is that our patient received 20 mg/kg MB as solution which was nearly 5 - 10 times more concentrated than the recommended dose. The second is that the absorption of MB from mediastinal/plural space could be more than expected. Our justification for this event is the anastomosis site stricture at follow-up that was suggestive of Methylene blue leak to mediastinal/plural space on first day after repair. Therefore, paying attention to the preparation of methylene blue solution from its powder is essential. Determination of G6PD status as a risk factor for development of methylene blue toxicity is recommended. However, G6PD with two rechecks was sufficient for our patient.

Absence of cranial bones is a rare condition that is incompatible with life. Parietal bone agenesis has rarely been reported in the literature. We performed a search for bilateral parietal bone agenesis associated with hydrocephalus and found that this was one of the few cases in the literature.
Case Report: We presented a case with metopic and sagitta suture cranioschisis mimicking bilateral parietal bone agenesis (University of Izmir of Medicine, Turkey, 05.01.2016). There is a large defective area in our case similar to parietal bone agenesis, however, it has not anencephaly. Due to all of these aspects, our case is secondary cranioschisis. We have planned three stages of treatment for this case: 1) treatment of hydrocephalus, 2) tension bands to close the cranial bones and 3) cranioplasty.
In the determination via 3D cranial tomography the presence of the parietal bones is important because, in case of agenesis the tension band does not benefit and on the contrary it creates extra stress on cerebral tissue.

We present a case report of a healthy man who ingested a large number of well-manufactured cocaine packages to smuggle them across international borders.
A 36-year-old man ingested cocaine packages worth approximately US $900,000 to transport it from Dubai to Madrid. He was arrested by police at Istanbul Ataturk Airport for suspected body packing of drugs. On arrival to the emergency department of our tertiary-care university hospital in Istanbul, Turkey, he confessed that he had attempted to smuggle 76 packages of cocaine in his gastrointestinal tract. The patient complained of nausea, but did not have abdominal pain. The physical examination was unremarkable. Radiological screening showed many small packages in the abdomen. There were no signs of intestinal obstruction. In this case, repeat computed tomography of the abdomen confirmed complete evacuation. The patient was discharged into police custody six hours later, after passing the number of packets that he had reported to have swallowed.
Abdominal radiography and computed tomography are useful tools for in the evaluation of suspected body packers. Improved packaging material used by smugglers and a more conservative treatment approach have reduced the mortality and morbidity.