Iranian Red Crescent Medical Journal
Volume:19 Issue: 7, Jul 2017

Context: The relationship between dairy products consumption and the incidence of diabetes is investigated in various studies leading to contradictory results; therefore, the current meta-analytical study aimed at shedding light on the matter and estimating the potentiality of diabetes resulting from consuming dairy products.
Evidence Acquisition: The study used some reliable electronic databases such as Web of Science, Scopus, Science Direct, and PubMed revised to March 2016. All original articles from prospective cohort and case-cohort studies examining the relationship between dairy products consumption and the risk of diabetes were considered without any restrictions on age, gender, language, race, and publication year. To assess the quality of the study, the STROBE (strengthening the reporting of observational studies in epidemiology) checklist was employed. The indices of relative risk and rate ratio were reported using the random effect model.
Out of 1391 articles, 14 studies (covering 458,082 subjects) were included in the current meta-analysis. The findings showed that consuming dairy products prevents diabetes: total dairy decreases the risk of diabetes by 8% to 12% (relative risk = 0.88 (95%CI: 0.80, 0.96), rate ratio = 0.92 (95%CI: 0.88, 0.97)). The decrease adds up from 11% to 19% in the case of consuming low-fat dairy (relative risk = 0.81 (95%CI: 0.68, 0.96); rate ratio = 0.89 (95%CI: 0.85, 0.93)). In spite of the fact that high-fat dairy diminishes the risk of diabetes, the relationship is not statistically significant (relative risk = 0.98 (95%CI: 0.78, 1.24); rate ratio = 1.01 (95%CI: 0.96, 1.06)).
The current study indicated that the consumption of total dairy and low-fat dairy had a preventive impact on the incidence of diabetes; therefore, it seems that drawing up some plans in this regard decreases the risk of the disease.

Diabetes is a cosmopolitan health problem worldwide, especially in Asia. It is a metabolic disorder originating from insulin secretion deficiency, insulin performance or both. When both factors are involved, abnormal complications may result. Exercise training plays an important role in controlling diabetic parameters, including biomechanical variables.
This study aimed at assessing the effectiveness of exercise on biochemical parameters in patients with diabetes.
This study was a randomized control trial. A total of 30 volunteers met the inclusion criteria and were randomly divided to 2 groups, aerobic and control, by block randomization method. This study was performed during May to October 2016 in Iran. The intervention protocol included 24 sessions (8 weeks) of aerobic exercise on the treadmill with zero slope, 3 days per week for 30 minutes per session. Intensity of training protocol was 50% to 70% maximum heart rate. Measurements of biochemical parameters were done before and after the 24 sessions
There were no significant differences in anthropometric, gender, age, diabetic history, cardiac ejection fraction, and biochemical variables (P > 0.05). After 8 weeks, results were as follows: fasting blood glucose (FBS) (130.92 (45.43) Mg/dL), glycosylated hemoglobin (HbA1c) (6.62 (1.52) percent), cholesterol (150.62 (24.07) Mg/dL), triglyceride (119.62 (39.18) Mg/dL), Low density lipoprotein (LDL) (77.23 (26.73) Mg/dL), and very low density of lipoprotein (VLDL) (23.92 (7.90) Mg/dL); these were significantly reduced in the training group (P Eight weeks of aerobic exercise was shown to be effective in controlling biochemical parameters. However, longer training duration is needed in order to modify CRP.

The prevention of ventilator-associated pneumonia (VAP) can decrease the duration of mechanical ventilation, length of hospital stay, mortality, and healthcare costs.
The aim of this study was to compare the effect of the elevation of head of bed (HOB) to 30 and 45 degreess on the incidence of VAP.
This study was a 3 group controlled randomized clinical trial. It consisted of 120 patients who were under mechanical ventilation and hospitalized in the intensive care unit (ICU) from February to July 2016 in the selected governmental hospitals of Iran University of Medical Sciences. The patients were allocated into 3 groups. The patients of intervention groups received interventions consisting of HOB elevation to 30 and 45 degreess for 3 consecutive days. The patients in the control group were in the routine position in the bed for 3 consecutive days. The HOB elevation was measured using the goniometer and recorded by nurses in perticular forms. At the end of the third day, VAP and pressure ulcers were evaluated using the clinical pulmonary infection score (CPIS) as well as Braden scales. The data were analyzed using descriptive and inferential statistics.
Statistically significant differences were reported in terms of VAP between the groups of the HOB evelation to 30 degrees (32.50%) and 45 degrees (20.00%) and control groups (52.50%) (P = 0.01). However, the mean scores of pressure ulcer showed no statistically significant differences between the groups (P = 0.625). The greatest change in position was performed by the staff nurses for nursing care in the group of 45 degrees elevation that reported as 6.125 ± 3.13 hours.
The HOB elevation to 45 degrees helped with the prevention of VAP compared with the HOB elevation to 30 degrees as well as bed routine. Therefore, it is suggested that nurses elevate HOB to 45 degrees (more than 30 degrees) among mechanically-ventilated patients admitted to the ICU.

Metabolic Syndrome (MetS) is rapidly growing in today''s world as an important predictor for type 2 diabetes and cardiovascular disease.

The present study aimed at assessing the incidence of MetS and the most powerful components as predictors of MetS in a cohort study in central Iran.

This cohort study was a follow-up of participants (n = 2000 and aged 20 to 74 years), who were selected using multistage random cluster sampling method from urban areas of Yazd, Iran, during year 2005 and repeated in 2015. Metabolic Syndrome was defined using a modified version of National cholesterol education program adult treatment panel III (NCEP III) definition. To assess hazard ratio of components of MetS for crude and adjusted values in two models, Cox proportional hazard regression was used.

Prevalence of MetS was 44.8% (n = 887) at baseline. Therefore, we followed subjects without MetS (n = 809) in 2015. After about 10 years, MetS was developed in 56.1% (n = 454) of subjects. Incidence of MetS in males and females was 56.1/1000 person-years and 58.7/1000 person-years, respectively. The analysis revealed that incidence of MetS significantly increased with age and higher level of socio-economic status and decreased with high level of education. In females and males the most powerful component for incidence of MetS was high fasting blood glucose (HR = 16.6, 95% CI: 1.91 - 22.82) and hypertriglyceridemia (HR = 1.64, 95% CI: 1.02 - 2.6), respectively.

The current study showed a high incidence of MetS in males and females residing in central Iran. Furthermore, community-based interventions that reduce MetS in the population are needed.

Shivering is a common unpleasant problem in parturients undergoing cesarean section under spinal anesthesia. Therefore, attempts for solving this problem are rational.
To evaluate and compare the effect of intrathecal meperidine with morphine on the incidence and intensity of shivering and other side-effects during delivery under spinal anesthesia.
In a double blind randomized controlled trial, 90 parturient women who were scheduled for elective cesarean delivery under spinal anesthesia were selected conveniently and randomly divided in 3 groups at the Besat hospital, which is a tertiary referral hospital in Sanandaj, Iran, from March to October 2013. Spinal anesthesia was applied using 12.5 mg of hyperbaric bupivacaine 0.5% combined with 10 mg meperidine in group P (n = 30), 12.5 mg of hyperbaric bupivacaine 0.5% combined with 0.2 mg morphine in group M (n = 30), and 12.5 mg of hyperbaric bupivacaine 0.5% combined with 0.5 mL saline in group S (n = 30).
Incidence of shivering in the meperidine group (6.7%) was significantly lower than the morphine (40%) and control groups (67.7%, P = 0.0001). The intensity of shivering in the meperidine group (0.13) was significantly lower than the morphine (0.73) and control groups (1.43, P = 0.001). There was no clinically significant difference in anesthesia’s side effects between the 3 groups.
According to the study results, adding either meperidine or morphine to hyperbaric bupivacaine during spinal anesthesia for cesarean section decreases the incidence and severity of shivering without increasing the side effects. However, intrathechal meperidine is superior for this purpose.

Socioeconomic status (SES) is one of the main determinants of health-related quality of life (HRQoL), where people with lower SES experience more health problems, have a lower quality of life, and are exposed to have a greater number of health-related risk factors.
This study aimed to examine the relationships between HRQoL, SES, and several demographic factors among the residents of the city of Ilam (located at the West of Iran).
This cross sectional study was conducted on 400 households from 3 districts of the city of Ilam in 2015. The participants were selected on the basis of the multistage sampling method. The second version of the 12-item Short-Form Health Survey (SF-12v2) questionnaire and the Wealth Index were used to measure HRQoL and SES, respectively.
The mean scores of the physical component summary (PCS) and the mental component summary (MCS) were 46.32 ± 9.69 and 42.12 ± 9.11, respectively. The findings indicated that PCS (P = 0.01) and MCS (P = 0.01) were significantly related to SES (wealth index). The demographic variables of age, gender, education level, marital status, job status, and home ownership (P HRQoL is directly related to SES, in that HRQoL is higher in families with higher SES. Similarly, HRQL is higher in younger people, men, and those with a university degree. A decrease in socio-economic inequalities and the gap between the rich and the poor can enhance the individuals’ health status and HRQoL within a community.

Breast cancer (BC) is the most leading cause of cancer and the second most common cause of cancer-related death among females worldwide. The survival time of the disease and its risk factors are important for physicians.
The current study aimed at applying the Cox, cure, and frailty models to identify the risk factors related to the survival of patients with BC.
The current historical cohort study investigated 499 patients with a confirmed diagnosis of BC, from March 2010 to March 2014, and followed-up to March 2015 in Besaat hospital in Tehran, Iran. The Cox regression, cure, and frailty models were used for the survival analysis (SA) of the patients. Data analysis was carried out by R3.2.2 software.
The mean (± SD) age of the patients was 50.39 (± 11.13) years and the mean survival time was 53.44 months (95% CI: 51.41 - 55.48). In addition, the 1-year overall survival rate was 0.92 (95% CI: 0.89 - 0.94). Age at diagnosis, tumor size, and metastasis covariates were significant in all models (P The cure and frailty models were better than the Cox model to estimate the parameters. When some patients have a long-term survival, cure models can be an interesting method to study survival and also describe the short-term and long-term effects.

Adherence to regular physical activity (PA) remains a challenge for hypertensive (HTN) patients. The present study was aimed at assessing the effectiveness of theory-based training intervention on PA and blood pressure in HTN patients.
The randomized control trial conducted at the healthy heart house in Shiraz, Iran, from January 2015 to January 2016 on 78 HTN patients (39 experimental group (EG) and 39 control group (CG). The exercise program for the EG included 30 minutes of fast walking at 40% to 60% of maximum heart rate reserve 5 days a week for 3 months. The study outcomes included PA stages of change, exercise self-efficacy (ESE), decisional balance, PA and 24-hour ambulatory blood pressure (ABP) and were measured at the onset and at three months post-intervention.
Between baseline and three months post-intervention, a greater increase in PA was observed in the EG than in the CG, giving a mean difference of 872.50 metabolic equivalent (MET), p = 0.004. The mean change from baseline to three months post-intervention in 24-hour systolic and diastolic ABP were significant between the EG and CG (mean difference -9.48 mmHg, P = 0.007 and -4.51 mmHg, P = 0.010 respectively). In the EG, 35 subjects (89.7%) and in the CG, 8 subjects (20.5%) entered the stage of action. The mean change from baseline to three month post intervention in ESE and decisional balance was significant between the EG than the CG (mean difference = 20.20, P = 0.001 and 0.50, P = 0.024 respectively).
Among HTN patients, a three-month Theory-based training intervention used was effective in increasing PA and reducing 24 hour ABP.

Gastroesophageal reflux disease (GERD) is one of the most prevalent digestive diseases. Long-term treatment and recurrence of symptoms after discontinuation of medication are amongst its problems.
The aim of this study is to investigate the impact of myrtle fruit syrup on the recurrence of symptoms in reflux patients after the discontinuance of using a PPI.
This research is a double-blind, randomized clinical study. With regard to withdrawal rate, 45 patients were selected for each group. The trial was conducted at the traditional medicine clinic at tehran university of Medical Sciences, Tehran- Iran, between November 2014 and March 2016. Diagnosis was conducted on the basis of the Mayo clinic standardized questionnaire. Every individual with heartburn or regurgitation symptoms with frequency of at least once a week was diagnosed as suffering from reflux. Omeprazole 20 mg with fasting as well as myrtle or placebo syrup 5 mL after meal were prescribed. Treatment duration was 6 weeks, after which the medicine was discontinued and patients were evaluated for 2 weeks. The cases in which recurrence of symptoms up to 14 days did not occur were considered as being non-recurrence.
Eighty nine people with symptoms of reflux were studied. The recurrence of symptoms was 22 people in treatment group and 27 people in control group with no significant difference (P value = 0.179). Time delay in the onset of symptoms was 9.57 days in treatment group and 6.27 days in control group which had significant difference (P value = 0.027).
Although the recurrence of symptoms was lower in the treatment group than in the control group, there was no significant difference. However, treatment significantly delayed the onset of symptoms in quantitative terms. The findings show that further research should be implemented.

Among core competencies introduced by the Accreditation council for graduate medical education (ACGME), practice-based learning and improvement (PBLI) monitors the improvement and quality of physicians’ performance during their professional practice. Understanding and knowledge of the viewpoints of medical professionals, planners, and graduates about the concept of PBLI and investigating its current status are required for proposing appropriate policies and plans in this area.
This qualitative study was performed through thematic content analysis. In-depth semi-structured interviews were conducted to gather data in Tehran, Iran from June 2016 to January 2017. Purposeful sampling was applied, and the participants included experts, planners, and medical graduates. While considering the trustworthiness criteria during the study, interviews were performed, transcribed, and coded. We used ATLAS.ti version 6 for coding and categorization.
The study sample consisted of 11 participants, including 4 executive officials, 4 experts of medical education, and 3 general practitioners (4 females and 7 males). The average age of the participants was 48 ± 8.47 years. The analyses introduced 9 categories, 56 subcategories, and 224 initial codes. The main categories included: PBLI attributes, components of PBLI, shortcomings of the academic educational system, shortcomings of the health system, strategies for academic education reform, strategies for health system reform, activators of PBLI, solutions for gaps in PBLI, and need for PBLI.
PBLI is a professional necessity for all physicians. Feasibly, excellence in clinical care can be achieved with this competency. Implementation of PBLI requires a competency-based curriculum, academic education, and a proper infrastructure for its implementation in clinical service delivery environments. Health system stewardship plays a great role in overcoming the challenges and developing coordinated national systems.

Women are exposed to different stressors in life. Physical, emotional, and economic stressors of pregnancy might negatively affect couples’ emotional and sexual intimacy.
The present study was designed to perform a path analysis of the correlation of sexual dysfunction with prenatal stress and quality of life.
In this descriptive, correlational study, 300 pregnant Iranian women were recruited via convenience sampling, based on the inclusion criteria from 4 governmental referral hospitals in 2016. Data were collected using female sexual function index, 26-item world health organization quality of life questionnaire, prenatal anxiety questionnaire, and a demographic questionnaire.
The goodness of fit indices (GFI) in the model indicated the suitability and reasonability of relationships among variables (root mean square error of approximation, 0.023; GFI, 0.99). Quality of life and age directly affected sexual dysfunction, while prenatal anxiety and income were indirectly correlated with sexual dysfunction through quality of life (P Anxiety can decrease sexual function in women during pregnancy. Poor quality of life can also cause sexual dysfunction in pregnant women. Therefore, it is an undeniable necessity to take measures to reduce prenatal anxiety and promote sexual activity during pregnancy for ensuring marital satisfaction. In addition, through such measures, we can maintain/improve the general and sexual health of couples, increase the quality of life in pregnant women, and eventually strengthen family bonds.

Spiritual leadership has recently become the focus of attention for policy makers and top managers in Iran, especially in the health system. Due to the lack of culturally and academically accepted scales in Iran for measuring spiritual leadership, localization of a foreign scale in this field is necessary.
This study aimed at investigating the validity and reliability of the Persian version of Fry’s spiritual leadership questionnaire (SLQ) among Iranian nurses.
The present cross sectional methodological research was conducted during year 2016. Participants were 400 nurses working in teaching hospitals affiliated to 3 universities of medical sciences in Tehran, Iran, who were selected using stratified sampling. A standard forward-backward translation procedure according to Wild et al. (2005) was used to translate the English version of the SLQ to Persian. The psychometric evaluation processes were achieved by face, content, and construct validity (confirmatory factor analysis). Reliability was examined using test-retest and Cronbach’s alpha for internal consistency reliability.
The SLQ showed good content validity (CVI = 0.94) ranging from 0.79 to 0.94 for each of the items. Construct validity evaluation by confirmatory factor analysis (CFA) led to extraction of 8 factors from data was confirmed with acceptable values (factor-loading values ranged from 0.32 to 0.95). The original model was presented and incorporated in the CFA, indicating an acceptable fit for the model (root mean square error of approximation (RMSEA) = 0.08; comparative fit index (CFI) = 0.91; normed fit index (NFI) = 0.90; and incremental fit index (IFI) = 0.95). Cronbach’s alpha coefficient for the total scale was 0.94 and for each component ranged from 0.71 to 0.86, indicating good internal consistency, and the intraclass correlation coefficients (ICC = 0.92) showed good test-retest reliability.
The Persian version of Fry’s spiritual leadership questionnaire has acceptable psychometric properties for measuring spiritual leadership style of Iranian nurse managers and helps detect and predict the extent and scope of the application of this new type of leadership to improve organizational outcomes.

Cancer is the third cause of death in Iran. Oncologists play a key role in declining the mortality rate of cancer.
This study aims to accurately estimate oncologists’ active supply by using 3 sources of capture-recapture (CRC) in Iran.
This was a cross-sectional study in 2015 targeting all oncologists in Iran registered in 3 independent sources, a hospitals national survey (213), database of Iran ministry of health and medical education (180), and the database of continuing medical education (173) were used to identify number of oncologists that were active. Duplicate records between the 3 sources were identified and removed using the Microsoft Office Access software. Medical council codes, names, surnames, as well as national ID codes were used for data linkage between the 3 sources.
After removing the duplicate records, a total of 314 oncologists were identified. Based on the selected model, it was estimated that the total number of oncologists were 533 in 2015. They included 325 adult hematologist-oncologists, followed by 88 pediatric oncologists, 47 surgical oncologists, 20 gynecologic oncologists, and 18 urologic oncologists. The estimated ratios for oncologist to population and oncologist to patients suffering from cancer were 0.67 and 1.34 per 100,000, respectively. Completeness of data for all 3 data sources after removing duplicates was 59.13%.
This study highlighted the shortage of oncologists in Iran and showed that the quality of Iran specialists’ registration databases needs improvement.

No specific model has been developed so far to determine the number of clinical faculty members required for medical schools as the most important and most costly workforce.
Since any action in this regard needs to understand the current status, this study aimed to identify the factors and variables involved in staffing of medical schools in Iran.
This was an analytical descriptive study conducted with qualitative approach in early 2016. Participants included 15 educational deputies of Medical Sciences Universities in Iran who were selected through purposeful intensity sampling. Data were collected using in-depth interviews and analyzed using inductive qualitative content analysis via seven-stage framework analysis.
Five categories of factors were identified to affect the number of clinical faculties in Medical Sciences Universities of Iran, namely “faculties’ functions and range of work”, “characteristics of faculty members”, “features of the faculties’ service delivery location”, “department/major properties”, and “dominating objectives and policies”.
A variety of subjective and inaccurate factors are considered for estimating the required number of clinical faculties in Iran among which only a few are the same as criteria for other faculties. The prerequisites that organize the factors and components in the form of a system are: clearly determining the responsibility of clinical education space and then, defining relatively identical financial incentives for various functions of faculty members.

Triploidy is the most frequent chromosome abnormality in the gestational age. According to the study, survival of more than 2 months in triploid patients is very rare. A 7-year-old girl with mild mental retardation with dysmorphism was referred for genetic counseling and clinical evaluation to Sarem medical genetics department (Tehran, Iran, 2013). Clinical features of the child were mental retardation, prominent upper lip, microgenitalia, prominent forehead, foot fingers syndactyly, and short hypoplastic 5th finger. G banding technique, skin biopsy, and Fluorescence in situ hybridization (FISH) testing were performed. Brain Imaging was evaluated. The karyotype of patient showed triploid (69, XXX) chromosome complement in all the metaphase spreads. However, two cell lines were found in metaphase of cultured cutaneous biopsy. The majority of the cells the body were triploid (69, XXX) and 16% of cells were diploid (46, XX). Findings of the FISH testing using X and Y Satellite enumeration probes in all studied peripheral blood lymphocyte (PBL) cells, included 3 signals and none signal respectively indicating X and Y chromosomes. Also, cultured of cutaneous biopsy finding showed 66% of cells had three signals (triploid) and 34 percent of cells had two signals (diploid) and mosaicism was confirmed. Karyotypes of parents and the brain imaging were normal. This study presents a rare case of triploidy with long survival with normal karyotypes of PBL and mosaicism in skin biopsy and interphase FISH.

Tuberculous meningitis (TBM) is the most fatal form of tuberculosis. Despite adequate treatment, its mortality and morbidity is high. Clinical, laboratory, and radiologic findings help in diagnosis of TBM, although analysis of cerebrospinal fluid (CFS) might sometimes delay and mislead the rapid diagnosis.
We present a 14- year- old Afghan immigrant male, with uncommon laboratory results of advanced TBM, who referred to Baharloo hospial in Tehran, Iran, in September 2016. He experienced headache and anxiety one month prior to referring to the hospital; he had fever, severe headache, vomiting and showed bizarre behavior 7 days before admission. Suspecting meningoencephalitis, the physician advised empirical treatment. The first CSF revealed polymorphonuclear (PMN) predominance with low glucose, which was repeated in the second and third CSF analysis. This pattern indicates early phase of TB meningitis. In day 4, antituberculous treatment with corticosteroid was administered empirically. Unfortunately, he succumbed to disease in day 36. Polymerase chain reaction (PCR) for mycobacterium tuberculosis (MTB) in CSF was positive. The patient’s presentation (lethargic to coma) and brain computed tomography (CT) scan indicated advanced stage of disease.
All physicians should consider TB meningitis in any patient with low glucose even with serial PMN predominance in CSF.