فهرست مطالب

  • Volume:34 Issue: 1, 2020
  • تاریخ انتشار: 1398/11/12
  • تعداد عناوین: 111
|
  • Hojat Dehghanbanadaki, Marzieh Khademsharif, Hossein Aazami*, Ali Azimi Page 1
    Background

    Of scientometric goals are to explore scientific productivity and trend, elicit scientific collaborations and inter/intra and cross disciplinary relations within a realm of study. This is a descriptive scientometric analysis of Medical Journal of the Islamic Republic of Iran (MJIRI) from 1987 to 2018.

    Methods

    The data were collected from 1987 to 2018 including the MJIRI annual publication number, annual growth rate (AGR), annual citation indicators, annual degree of collaboration (DC), the most active universities, and the most co-occurred keywords being used in MJIRI articles.

    Results

    MJIRI has published 2166 articles in the field of health and medicine between 1987 and 2018, over a third of which have been published during the last five years (2014-2018). The highest and lowest AGR were recorded in 2014 (AGR=276.190%) and 2001(AGR=-28.75%), respectively. The journal CiteScore has increased from 0.26 in 2013 to 0.94 in 2018; the SCImago Journal Rank has promoted from 0.123 in 2013 to 0.320 in 2018. The Source Normalized Impact per Paper has enhanced from 0.398 in 2013 to 0.552 in 2018. The overall degree of collaboration of MJIRI articles was 0.89. Also, the most co-occurred keywords pertaining to the specific field of medicine were “Breast cancer”, “Pregnancy”, “Tuberculosis”, and “Hypertension”.

    Conclusion

    The current quantitative evaluation of MJIRI provides a holistic landscape of journal performance for 32 years.

    Keywords: Scientometrics, Bibliometrics, Medical Journal of the Islamic Republic of Iran, Productivity
  • Seyyed Mostafa Kouhestan, Reza Hashempour*, Behzad Raei, Dariush Chivaee, Hossein Safari Page 2
    Background

    A huge portion of health expenditure is attributed to hospital services. Thus, it is important to use the resources appropriately. Many studies have measured inappropriate admissions and hospitalizations. The aim of this study was to review them systematically and determine the pooled quantity as well as the reasons behind such admissions and hospitalizations.

    Methods

    PubMed, Scopus, Web of Science, Google scholar, and internal databases such as Sid, Magiran, and Barkat were searched in January 2018. Moreover, the grey literature was also performed. All studies which had assessed the appropriateness and inappropriateness of services were included. Newcastle-Ottawa scale was used for quality appraisal. I2 test, subgroup analysis, meta-regression, and sensitivity analysis were performed. STATA was used for analysis. There was neither time limitation nor language limitation. The registration number in PROSPERO is CRD42019123401.

    Results

    Of 1576 studies, 15 met the inclusion criteria. The number of medical files ranged from 198 to 1815. Most of the studies (14) were performed in teaching hospitals. AEP was the most frequent tool for assessing inappropriateness of the services. The pooled inappropriate admission and hospitalization were 11% (95% CI= 8% - 14%)) and 13 % (95% CI= 10%-16%)), respectively. The most important determinants for inappropriate hospitalizations were attributed to physicians.

    Conclusion

    A huge portion of health care services is inappropriate. Thus, it is highly recommended to monitor physicians more than before, as the more they are monitored, the less inappropriate the delivered services will be.

    Keywords: Inappropriateness of services, Admission, Hospitalization, Iran
  • Simin Siamigorji, Isa Jorjani, Alireza Tahamtan, Abdolvahab Moradi* Page 3

    MicroRNAs (miRNAs) are known as a new class of small RNAs (18-25 nucleotides) that regulate gene expression at multiple levels from transcription to translation. Considering the important role of miRNAs in cell proliferation, differentiation, and apoptosis, any variations in their expression can contribute to various anomalies, such as tumorigenesis. Single-nucleotide polymorphisms (SNPs) have received much attention as potential genetic markers for diseases due to their advantage of being present at a high frequency in the human genome. SNPs can occur in different parts of the miRNA genes (primary, precursor, and mature) which result in pathological conditions. In this study, recent findings related to the effects of SNPs in miRNAs on their biogenesis and functions and their role in cancer development and progression are discussed. This review was performed using PubMed to search for related reports. The identified effects may be useful for clinical decision-making and providing important new information about the pathophysiology of miRNAs.

    Keywords: MicroRNAs, Noncoding RNAs, Single nucleotide polymorphisms, Mutation, Cancer
  • Monireh Kamali, Shirin Manshouri, Yasser Bagheri, Masoumeh Rostami, Mahdi Karkhaneh Mahmoudi, Pardis Moradnezhad, Farhad Seif* Page 4
    Background

    Acinetobacter baumannii is an opportunistic, aerobic, nonfermentative, Gram-negative bacterium that can cause major nosocomial infections, especially in patients hospitalized in intensive care units (ICU). Recently, A. baumannii strains have been resistant to a variety of antibiotics. Thus, it was aimed to evaluate the prevalence of A. baumannii and their resistance to the antibiotics in the patients hospitalized in postcardiac surgery ICU.

    Methods

    This retrospective cross sectional study was performed in Rajaei hospital between March 2014 and February 2016. A. baumannii strains were isolated from blood cultures, catheter cultures, sputum cultures, and wound smear cultures. Then, isolates were characterized using standard morphological, cultural, and biochemical properties according to CLSI 2016. The frequency of A. baumannii species were reported as percent.

    Results

    Among 27 167 patients were admitted to the ICU, 113 individuals, including 55 males and 58 females, were identified as A. baumannii-infected and the prevalence rate was 0.42%. The highest rates of antibiotic sensitivity were related to Meropenem 20 (17.7%) and Colistin 16 (14.1%). The shortest length of stay (LOS) for patients with A. baumannii in the ICU was 3 days, while the longest LOS was 98 days.

    Conclusion

    The findings indicated that A. baumannii strains isolated from postcardiac surgery ICUs had a high prevalence and were sensitive to Meropenem and Colistin. However, new molecular-based techniques are needed to monitor nosocomial infections. Therefore, the treatment of the patients may be feasible by appropriate antibiotic therapy, and infection control policies will be improved by adopting precise disinfection strategies.

    Keywords: Acinetobacter baumannii, Nosocomial infection, Antibiotic, Resistance
  • Haamid Bashir, Showkat Ahmad Bhat, Sabhiya Majid*, Rabia Hamid, Rakesh Koul, Muneeb U Rehman, Isha Din, Javaid Ahmad Bhat, Jasiya Qadir, Akbar Masood Page 5
    Background

    Type II Diabetes mellitus (T2DM) is a multifactorial disease and a leading cause of premature deaths. Inflammatory cytokines are reported that they have potential to enhance insulin resistance and hence T2DM. Assessment of immunological profile in T2DM patients of Kashmir valley is unclear. So, detection of cytokines is relevant to determine the extent and direction of immune responses. The current research was taken to study the role of inflammatory mediators in T2DM along with insulin sensitivity, biochemical and hematological parameters in mountainous valley of Kashmiri population.

    Methods

    A total of 340 subjects were selected in this study among them 160 were T2DM cases and 180 were healthy controls. Serum expression of  inflammatory mediators  (TNF-α and IL-6 ) were quantified by ELISA technique, WBC count was measured on Sysmax (Germany) hematology analyzer, biochemical and Immunoassay parameters were done on Abbott c4000 (USA) and Abbott C1000 (USA) fully automatic analyzer. Data was analyzed using statistical ‘software SPSS 16.1’ (Chicago, IL). For all assessments, p<0.05 were considered statistically significant.

    Results

    The expressions of candidate cytokines (TNF-α, IL-6, CRP, and WBC) were highly significant (p<0.001) in T2DM. Among inflammatory mediators, TNF-α shows a positive correlation (p<0.001) with glycemic profile and insulin sensitivity in T2DM cases in comparison with healthy normal. Biochemical (fasting sugar, HbA1c, insulin resistance, lipid profile) and anthropometric (BMI) parameters were highly significant (p<0.001) in T2DM cases as compared to non-diabetic normal.

    Conclusion

    Low grade inflammation and up regulation of inflammatory mediators has been purported to play a significant role in pathogenesis of T2DM. Our findings confirm that positive correlation of TNF-α and IL-6 with T2DM and insulin sensitivity. These can act as early prediction biomarkers of T2DM. Further studies on wider range of pro and anti- inflammatory cytokines i.e. mediators, in association with other biochemical, immunoassay and hematological parameters are needed to help clinicians manage and treat T2DM effectively.

    Keywords: Inflammation, Biomarkers, Cytokines, Kashmir, Mediators, Adult onset type 2 diabetes mellitus, SMHS
  • Ruhollah Seddigh, Somayeh Azarnik, Nadereh Memaryan, Fatemeh Hadi* Page 6
    Background

    This study aimed to investigate the state of spirituality in the general medicine curricula in Iran.

    Methods

    Reference books for general medicine were reviewed and data were analyzed according to the qualitative content analysis method.

    Results

    After reviewing references, it was found that only 35 paragraphs of the educational reference pages dealt with this subject. Related topics to spirituality had 2 major themes: (a) spirituality and care (assessment, treatment, palliative care, and bereavement); (b) spirituality and professionalism (considering culture and medical ethics).

    Conclusion

    This study showed that despite the importance of the subject and much evidence on spirituality and medicine, medical references have limitations. The authors suggested some strategies to develop a specific course and integrate all educational references with the objectives of the general medical education course in Iran.

    Keywords: Spiritual needs, Spiritual health, Medical curriculum, Sociocultural determinant of health, Iran
  • Farshid Rahimibashar, Reza Norouzzadeh, Amir Vahedian Azimi* Page 7
    Background

    Regarding the widespread prevalence of chronic diseases, nurses need to understand the choices, priorities, and abilities of patients in reality, their communication, and the social context in order to play their professional role and responsibility. This review study was conducted with two

    purposes

    determining the effect of partnership-care-model (PCM) on the outcomes of chronic diseases, and describing and assessing the quality of methodology of published papers in the field.

    Methods

    The systematic review was conducted from inception to the year 2019. A systematic search was conducted using PRISMA guidelines to retrieve all national and international PCM studies. To assess the quality of the methodology of studies, four instruments were used, including JADAD, Consort, New Castle-Ottawa, and Cochrane.

    Results

    In the initial search, 11509 papers were retrieved, which according to the PRISMA guidelines, 23 relevant papers remained. The results of the reviewed papers indicated the effectiveness of the PCM. Describing and assessing the quality of the methodology of published papers of PCM was at an acceptable level. The final papers were classified and reviewed according to the authors, year, sampling characteristics, data collection methods, and final PCM conclusion. 

    Conclusion

    According to the review of the studies and their effectiveness in the different outcomes, also, the acceptable quality of the methodology of published papers, it can be concluded that the PCM is an effective, context-based, simple, efficient, and reliable model and has the ability to be used in promoting and improving the various dimensions of chronic diseases.

    Keywords: Chronic disease, Cochrane, Consort, Methodology of paper, New-castle-Ottawa, Partnership Care Model, Review study
  • Aziz Shamsi*, Hamid Peyravi Page 8
    Background

    Nursing shortage is an important and multifaceted challenge in the health systems and has reached a warning threshold. The factors associated with nursing shortage vary from country to country. Therefore, this study compared the causes of nursing shortage and suggested strategies to help resolve this concern both in Iran and in the world.

    Methods

    To conduct this systematic review, search was done in English and Persian databases from 2000 to 2016. In the preliminary review, 537 articles were included in the study. After reviewing the titles, abstracts, objectives, and results of articles, 32 studies were finalized.

    Results

    The important causes of nursing shortage in the world included aging of the nursing workforce, inadequate admission and training of nurses, aging population, and job abandonment. However, the leading causes in Iran were unwillingness and lack of desire to enter and remain in the nursing field, job abandonment, inadequate salaries, low social status, and negative perception of nursing. Proposed strategies in the world are increasing the salaries, redesigning the work environment, improving the public’s perspective, retaining the existing nursing workforce, and flexible work schedules. In Iran, these strategies include increasing salaries and recruitment, enhancing the public’s perception of nursing, and supporting nursing organizations.

    Conclusion

    Nursing shortage is a multifaceted concept with varying magnitudes in different countries. Therefore, the strategies to resolve nursing shortage should be based on the unique conditions of each country. The most important strategies to overcome nursing shortage in Iran are focused on the improving the retention of existing nursing workforce.

    Keywords: Medically underserved area, Shortage, Iran, Nursing
  • Somayeh Delavari, Alireza Monajemi, HamidReza Baradaran, Phyo Kyaw Myint, Minoo Yaghmae, Seyed Kamran Soltani Arabshahi* Page 9
    Background

    Although theory explains the development of illness script, it does not provide answers how medical students develop scripts in their learning. To fill the knowledge gap of developing illness script in medical students and interns, this study aimed to investigate the impact of educational strategies inspired by theory in the development of illness scripts.

    Methods

    A total of 15 medical students and 12 interns participated in an educational intervention that included theory-driven strategies. To evaluate the impact of this intervention, clinical reasoning problem (CRP) and key features (KF) tests were used for before and after the intervention. In addition to descriptive statistics, the differences in participants’ pretest and posttest variables were tested using Wilcoxon. Significance level was set at p≤0.05 for all tests. 

    Results

    Interns significantly recognized more KF in the posttest. However, no significant difference was found between the pretest and posttest scores in total diagnostic accuracy (5.41±1.16 vs 4.91±1.44; p=0.111) and total correct discriminating score (0.41±0.66 vs 1.41±2.06; p=0.146). Medical students produced less total key features in the posttest, indicating that they became less elaborate in their case processing. However, no significant difference was observed in common KF score (0.4 [0.25-0.78] vs 0.9 [0.6-1]; p=0.791) and discriminative key features score (0.33 [0.16-0.33] vs 0.22 [0.11-0.44]; p=0.972) in the posttest compared to the pretest.

    Conclusion

    This study showed that theory-driven educational strategies have an impact on illness script development specifically in interns. It is recommended that this intervention would be tested on those in higher levels of expertise (ie, residents).

    Keywords: Illness script, Clinical reasoning, Clinical decision-making, Medical education, Medical student, Education, Undergraduate
  • Leily Sokoty, Majid Kermani, Leila Janani, Mohsen Dowlati, Babak Hassanlouei, Shahnaza Rimaz* Page 10
    Background

    Quantification of the attributed effects of air pollution determines the impact of air pollutants on the community and shows the critical condition of air quality.
    This study aimed to quantify and estimate the cardiovascular and respiratory diseases attributed to PM10 in Urmia during 2011-2016.

    Methods

    In this descriptive-analytic study, at first, hourly data of pollutant PM10 concentrations were received from air pollutants station located in the Department of Environmental Protection. The data were evaluated using AirQ2.2.3 software after primary and secondary processes and filtering.

    Results

    The results showed that the mean annual concentration of PM10 during 2011-2016 was 88.66, 92.45, 81.22, 78.38, 113.78, and 92.67 μg /m3, respectively. The number of hospitalized cases due to respiratory diseases attributed to PM10 in this period was 486, 525, 459, 453, 684, and 552, respectively, and the number of cases due to cardiovascular diseases was 188, 203, 177, 175, 263, and 213, respectively.

    Conclusion

    Considering the attributed health effects of PM10, the necessary measures should be taken to identify the causative agents and to understand the mechanisms of these processes and correct them.

    Keywords: Air Q model, PM10 particles, Cardiorespiratory diseases, Urmia
  • Alireza Pournajafian, HamidReza Faiz, MohammadAli Motazedi Ghajar, Zahra Sadat Koleini, Masood Mohseni* Page 11
    Background

    Electroconvulsive therapy (ECT) is an effective treatment in major depressive disorder (MDD). Earlier studies suggest that ketamine has antidepressive effects and prolongs seizure duration in favor of therapeutic efficacy of ECT. A great concern with the use of ketamine is its possible adverse hemodynamic effects during ECT. This study was conducted to compare the hemodynamic effect and seizure duration between ketamine and sodium thiopental, a common anesthetic in ECT.

    Methods

    In a cross-over clinical trial, 26 patients of either sex with MDD who were candidates for ECT therapy in a university hospital were enrolled. A total of 13 patients received induction with ketamine in the first session and thiopental for the second. The sequence of treatments was vice versa in the other group. The followings were measured in all patients: blood pressure, heart rate, and oxygen saturation before induction, immediately after induction, at 1, 2, 4, and 10 minutes postinduction, and after recovery from anesthesia. Also, seizure duration, recovery time, and complications of treatments were measured. Chi square test and student t test were used for categorical data and numerical data, respectively. P values < 0.05 were considered statistically significant. Analyses were performed with SPSS software version 21.0.

    Results

    Heart rate, systolic and diastolic blood pressure, oxygen saturation, and recovery time were comparable between groups. Mean duration of convulsion in patients who received ketamine was significantly more than those who received STP (36±11 vs 28±9 s, p=0.001). Myalgia was less common in patients who received ketamine rather than sodium thiopental (11.5 vs 46.2%, p=0.014).

    Conclusion

    Ketamine prolongs seizure duration with no deleterious effects on hemodynamic parameters. Considering the antidepressant effects of ketamine, it may be a better choice, compared to thiopental sodium, for MDD patients.

    Keywords: Major depressive disorder, Electroconvulsive therapy, Ketamine, Thiopental Sodium, Anesthesia, Hemodynamic
  • Bahareh Nazemi Salman, Samira Basir Shabestari, Mahsa Shaboyi Jam, Sarira Alizadeh Tari, Iman Shirinbak Page 12
    Background

    Periodontal disease and diabetes mellitus are 2 most common encountered chronic diseases. The occurrence, appearance, and severity of the periodontium tissue conditions vary during adolescence. Also, there is controversy about the relationship between diabetes mellitus and increased periodontal disease breakdown during puberty. This study aimed to assess the periodontal parameters and oral hygiene in diabetic and nondiabetic adolescents in city of Zanjan.

    Methods

    In this case and controls study, 140 diabetic (case) and 140 nondiabetic (control) adolescents were compared. The participants were matched by age, sex, and socioeconomic status using the group matching method. Clinical attachment loss, periodontal pocket depth, gingival index, periodontal index, and bleeding on probing were measured for the 6 Ramfjord index teeth. Data were analysed using descriptive statistics, chi-square test, t test, and one-way ANOVA using SPSS version 18.

    Results

    The mean age of the diabetic and nondiabetic group was 16.7±1.6 and 17.1±0.30 years, respectively. Duration of diabetes was 2.15 ±0.86 years. Mean clinical attachment loss, periodontal pocket depth, gingival index, and bleeding on probing in the patient group were 7.4, 1.68, 12.9, and 97.7%, respectively. All these indices in diabetic adolescents were significantly greater than in nondiabetics. Only the PI was poor in both groups and no significant difference was noted in this respect between the 2 groups.

    Conclusion

    Both diabetic and nondiabetic adolescents had equally poor oral hygiene. Gingivitis and periodontitis indices were significantly poorer in diabetic patients.

    Keywords: Diabetes Mellitus, Oral hygiene, Periodontal diseases, Health
  • Seyyed Hashem Sezavar, Morteza Hassanzadeh*, Davood Akhlagh Moayed, Mahmood Tabandeh, Massoud Ghasemi, Seifollah Abdi, Iraj Firoozi, Pejman Golbidi, Marzieh Pourjafari, Negin Taslimi, AliAsghar Akhlaghi, Mahmoud Hashemian Page 13
    Background

    Frequent Percutaneous Coronary Intervention (PCI) procedures are being performed on a daily basis in Iran. However, no study has been reported on the current PCI practice in patients with acute coronary syndrome (ACS) in Iran. We aimed to describe the clinical characteristics and treatment patterns in Iranian ACS patients treated with PCI.

    Methods

    Between February 2017 and July 2017, ACS patients presented to 5 referral hospitals in two major cities of Iran (Tehran and Shiraz) were included in this observational study if aged > 18 years and underwent PCI for ACS during hospitalization; and their clinical and procedural characteristics were collected. All data were entered into SPSS v.21 and descriptive statistics were performed.

    Results

    Of a total of 314 patients, 228 (73%) were males, 162 (52%) were diagnosed with ST-elevation myocardial infarction and 152 (48%) with Unstable angina/ Non-ST elevation myocardial infarction. Trans-femoral approach was more often (64%) used for PCI procedures. Stent placement was the most frequent (98%) treatment strategy on PCI, with drug-eluting stent selected in the majority of subjects (98%). The overall rate of PCI success was 95%, with 4.1% PCI-related complications, and 1.6% post-PCI bleeding events. The vast majority of the study patients (99%) were discharged with dual anti-platelet therapy.

    Conclusion

    In this study, we observed a high level of adherence to the currently accepted guidelines in the current PCI practice on ACS patients in Iran. Also we found our practice is highly in line with the global reduction trend in the PCI-related complications.

    Keywords: Percutaneous coronary intervention, Acute coronary syndrome, Iran
  • Aeen Mohammadi, Rita Mojtahedzadeh, Shadi Asadzandi*, Hamed Rashidi Page 14
    Background

    Promoting ethics is one of the goals of education, but the free flow of communication and divulging unethical behaviors in e-learning make the urgent need to clarify ethical values. Therefore, the aim of this study was to prepare ethical codes to develop and deliver e-contents.

    Methods

    A draft of e-content ethical codes was prepared based on the literature review. Then, it was further revised by e-learning, medical education, ethics, and e-content experts. Finally, the draft was finalized through a 2-round Delphi process among related experts all over the country  .

    Results

    The final document of e-content ethical codes, including introduction, definitions, and 7 ethical code statements, was devised.

    Conclusion

    Considering the difference between e-content and other kinds of publications, this set of ethical codes can be used straightforwardly to assess ethical aspects of e-contents.

    Keywords: Ethical codes, E-content, E-learning, Delphi method
  • Zainab Malmoon, Sogand Tourani*, Mohamadreza Maleki, Mehdi Jafari Page 15
    Background

    This was a systematic review presenting the future competencies for hospital managers. 

    Methods

    Participants, interventions, comparisons and outcomes (PICO) strategy with MeSH terms were used for searching. Databases used were Web of Science, PsycINFO and Medline, EBSCO, ScienceDirect, Emerald, ProQuest, Social Sciences Research Network, Embase, and some Iranian database such as IRANDOC and SID. All publications were accepted if they had been published in English or Persian language and fulltexts were accessible. The study was carried out using a systematic literature search published between January 1995 and December 2018. The Endnote v.17 software was used to facilitate reference management. Quality assessment of publications were carried out independently by two reviewers using the Critical Appraisal Skills Programme (CASP) and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. A descriptive summary with data tables produced to summarize the literature. Data extraction was conducted by two researchers. 

    Results

    Forty seven studies were analyzed to identify the future competencies required for hospital managers. In all, 3190 publications were retrieved. 1934 citations were excluded because of irrelevant (n=2600), duplicates (n=316), and unavailable full text (n=18). After studying the 256 remaining publications, 33 citations were extracted and presented. After extracting the future competencies of hospital managers, competencies were classified into four main categories based on the qualitative meta-synthesis process.

    Conclusion

    The most important competencies in the future are global knowledge, Key Eligibility Criteria, wide attitude and core skills that must be addressed in the face of ambiguity.

    Keywords: Competency, Hospital manager, Future
  • Maryam Shahabi, Nooredin Mohammadi, Jalil Koohpayehzadeh, Seyed Kamran Soltani Arabshahi* Page 16
    Background

    Medical professional identity is how an individual perceives him/herself as a doctor. Formation of professional identity includes development, advancement, and socialization through social learning of specific knowledge, skills obtained while performing professional roles, practicing, and new attitudes and values. A qualitative study was performed to examine live experience of undergraduate medical science students with regards to obtaining professional identity.

    Methods

    This qualitative study was performed using a conventional content analysis method. Participants were students who were studying medicine at Iran University of Medical Sciences. Sampling was done based on a purposeful sampling method. A total of 23 students took part in semi-structured interviews until data saturation was reached. The interviews were transcribed verbatim. Also, to develop themes, data were analysed using conventional content analysis.  Moreover, data management was done using MAXQDA software.

    Results

    Based on data analysis, 2 main themes were as follow: meaningful medical practice” and “professional medical practice”. The first theme had 3 categories: (i) self-insight; (ii) manner; and (iii) values and beliefs. The second theme had 2 categories: (i) professionalism; and (ii) holistic view of medicine.

    Conclusion

    Certain individual characteristics and personality type were factors that affected participants’ choice of their field of study. The participants’ understanding of their profession was formed, not only by studying in the university through learning relevant knowledge, skills, and practice, but also by perceived attitude, views, and values in their profession.

    Keywords: Qualitative study, Professional identity, Physician, Medical education
  • Mahta Salehi, Maryam Salehi, Soodabeh Shahidsales, Golboo Goshayeshi, Maryam Emadzadeh, Mehdi Seilanian Toosi, Seyed Amir Aledavood, Seyede Samaneh Hoseini, Pardis Shojaei* Page 17
    Background

    Lung cancer (LC) is a global public health priority. In this study, the epidemiology and current trends of primary LCs were investigated in northeast of Iran.

    Methods

    Demographic and pathologic records of primary LCs during 1985-2012 in Mashhad (capital of northeast of Iran) were reviewed. Data were obtained from archives of the largest referral oncologic hospital and the only private outpatient radiation-oncologic clinic in the region. To investigate trends, study duration was classified into 3 periods: 1985-1995, 1995-2005, and 2005-2012. Patients were placed in one of these 3 groups, based on the date of their pathologic diagnosis. Data were analyzed by SPSS 16 software. T test, chi-squared, and ANOVA tests were used for data analysis, and statistical significant level was set at < 0.05.

    Results

    Among 939 cases with pathologic diagnosis of primary LC, male-to-female ratio was 2.36. Mean±SD age at diagnosis was 61.47±12.01 years in males and 58.45±12.75 in females (p=0.001). Squamous cell carcinoma (SCC) was the most frequent pathologic subtype. Mean age at diagnosis and rate of smokers were unchanged during the study (p= 0.978 and 0.153, respectively). Relative frequency of leading pathologic subtypes changed in 3 intervals (p<0.001): it was increasing in adenocarcinoma and large cell carcinoma and decreasing in SCC and small cell lung cancer (SCLC). There were statistically significant differences in the mean age at diagnosis (p<0.001), rate of smokers (p<0.001), and male-to-female ratio (p=0.011) between leading pathologic subtypes.

    Conclusion

    Similar to universal picture, rate of adenocarcinoma in northeast of Iran was rising during recent decades, especially among younger patients, women, and nonsmokers. These trends are indicative of changes in exposures and smoking habits and reveal the need for regional studies in these contexts.

    Keywords: Epidemiology, Lung cancer, Pathology, Smoking, Trend
  • Nahid Zerafati-Shoae, Ensiyeh Jamshidi*, Leili Salehi, Farzaneh Asgari Taee Page 18
    Background

    Food environment plays a major role in health outcomes. A growing interest in community-based participatory research (CBPR) has led to its application in the improvement of the food environment. This scoping review aims to compile and map the literature and identify key strategies used for increasing community participation capacity in the food environment policymaking process.

    Methods

    The scoping review of peer-reviewed articles on community participation and food environment policymaking followed the framework suggested by Arksey and O'Malley (2005). Scopus, PubMed, and Web of Science were searched. A charting table was developed to extract the key information of each identified study. A directed content analysis approach was used to assign retrieved codes into categories proposed by Foster-Fishman.

    Results

    A total of 28 studies were included in this review. Most studies used the CBPR approach to involve the community at least in the problem identification step of the policymaking process (n=12) and 7 studies reported their involvement in all the steps of policymaking. In 15 out of 28 studies, the level of community participation was at “involvement” and in 8 studies it was at “empowerment”. Strategies for increasing relational capacity, member capacity, programmatic capacity, and organizational capacity of community participation were reviewed.

    Conclusion

    To improve food environment using the community-participation approach, identifying different strategies and adjusting them based on the social and political context of each society is of high importance.

    Keywords: Community-based participatory research, Food environment, Policymaking, Participation, Capacity building
  • Afsun Nodehi Moghadam*, Elham Sarabadani Tafreshi, Shima Abdollahi, Enayatolah Bakhshi Page 19
    Background

    Altered scapular kinematics in individuals with rounded shoulder posture (RSP) may affect acromiohumeral distance (AHD). The purpose of this study was to compare AHD and scapular dyskinesis prevalence in individuals with and without RSP.

    Methods

    A total of 44 women (RSP, n=21; control, n=23) participated in the study. RSP was assessed by measuring acromion to table distance (ATD) in supine position and forward shoulder angle (FSA) using a camera and the AutoCAD software from the lateral side. According to these measurements, ATD more than 2.6 cm and FSA equal or more than 52° were considered as RSP. AHD was measured via ultrasonography with the arm at rest and 90 º of active elevation in scapular plane (scaption). Also, scapular dyskinesis was assessed by Uhl yes/no rating system. Independent and paired t tests were used to compare AHD between and within groups’ comparisons, respectively. Chi-square test was used to compare the scapular dyskinesis prevalence in individuals with or without RSP. The data were analyzed using the SPSS statistical software version 17. Significance level was set at 0.05

    Results

    There were no statistically significant differences in participants’ AHD in rest position (dominant side, p=0.187, nondominant side, p=0.144) and 90° scaption (dominant side, p=0.144, nondominant side, p=0.182) in each side between the 2 groups. Also,  the results of chi-square test showed that there were not any significant differences  in the prevalence of scapular dyskinesis during  shoulder flexion (dominant side, p=0.653, nondominant side, p=0.541)  and shoulder abduction (dominant side, p=0.141, nondominant side, p=0.277) in individuals with and without rounded shoulder postures.

    Conclusion

    According to our results, RSD cannot lead to reduced AHD and higher prevalence of scapular dyskinesis.

    Keywords: Rounded shoulder posture, Acromiohumeral distance, Subacromial space, Scapular dyskinesis
  • Simintaj Sharififar, Katayoun Jahangiri*, Armin Zareiyan, Amir Khoshvaghti Page 20
    Background

    The fatal pandemics of infectious diseases and the possibility of using microorganisms as biological weapons are both rising worldwide. Hospitals are vital organizations in response to biological disasters and have a crucial role in the treatment of patients. Despite the advances in studies about hospital planning and performance during crises, there are no internationally accepted standards for hospital preparedness and disaster response. Thus, this study was designed to explain the effective factors in hospital performance during biological disasters.

    Methods

    Qualitative content analysis with conventional approach was used in the present study. The setting was Ministry of Health and related hospitals, and other relevant ministries responsible at the time of biologic events in Islamic Republic of Iran (IR of Iran) in 2018. Participants were experts, experienced individuals providing service in the field of biological disaster planning and response, policymakers in the Ministry of Health, and other related organizations and authorities responsible for the accreditation of hospitals in IR of Iran. Data were collected using 12 semi-structured interviews in Persian language. Analysis was performed according to Graneheim method.

    Results

    After analyzing 12 interviews, extraction resulted in 76 common codes, 28 subcategories, and 8 categories, which are as follow: detection; treatment and infection control; coordination, Resources; training and exercises; communication and information system; construction; and planning and assessment.

    Conclusion

    Hospital management in outbreaks of infectious diseases (intentional or unintentional) is complex and requires different actions than during natural disasters. In such disasters, readiness to respond and appropriate action is a multifaceted operation. In IR of Iran, there have been few researches in the field of hospital preparation in biologic events, and the possibility of standardized assessment has be reduced due to lack of key skills in confronting biological events. It is hoped that the aggregated factors in the 8 groups of this study can evaluate hospital performance more coherently.

    Keywords: Key capabilities, Biological disasters, Assessment, Performance, Preparedness, Hospital
  • Yousef Alimohamadi, Seyed Mohsen Zahraei, Manoochehr Karami, Mehdi Yaseri, Mojtaba Lotfizad, Kourosh Holakouie Naieni* Page 21
    Background

    In spite of existing vaccination programs in many countries, outbreaks of pertussis are still reported. In Iran, the suspected and confirmed cases of pertussis are reported annually. Due to the lack of similar studies, the purpose of the current study was to determine the Spatio-temporal distribution of Pertussis using Geographic Information System (GIS) to identify high-risk areas in Iran during 2012-2018.

    Methods

    In the current cross-sectional study, registered data in the department of vaccine-preventable diseases in the Iranian ministry of health were used. To assess the temporal trend, the Cochran–Armitage test was used. To show the spatial distribution and to identify hotspot areas, Choropleth map and Getis-Ord Gi statistics were used. All analyses performed by Arc.map10.5, Stata 15 and Excel 2010 

    Results

    The incidence of suspect pertussis cases had an increasing trend but did not have a linear trend (p=0.06). Most of the cases happened in under 1 year infants (62.66%).  The incidence of reported cases in northern areas was higher than in the Southern areas. The Zanjan had the most reported cases during the understudied period with a median of 7.63 reported cases per 100,000.  The clustering of infection and hotspots were identified in northern areas of Iran including Qazvin, Qom, Markazi, and Hamadan.

    Conclusion

    Our results showed that the cumulative incidence of reported cases is increasing. The northern ‎ provinces had the highest incidence of Pertussis. Therefore, the causes of this spatio-temporal pattern of pertussis should be determined. Also, supervision on vaccination programs in high-risk areas is recommended.

    Keywords: Spatio-temporal, Bordetella pertussis, Iran
  • Behzad Damari*, Hamid Sarami, Siamak Alikhani, Hossein Mirzaei Page 22
    Background

    Recent evidence shows that the prevalence of substance abuse is 2.1% in Iranians aged 15-64 years, while reported rates are higher in studies that target industrial workplaces. Our study intends to provide a national picture of substance use among industrial workers in Iran.

    Methods

    This survey was designed to collect data through interviews and dipstick urine tests. Using a multi-stage sampling approach, we recruited our study subjects from a representative sample of industrial workers from all provinces in 2015. Data were weighted to estimate the prevalence rate of substance use. Odds ratios were calculated through adapting logistic regression to test the strength of association between substance use (based on self-report and urine test) and sociodemographic factors including sex, age group, education level, marital status and worker’s professional training status. All statistical analyses were conducted using SPSS Version 22. P <0.05 was considered significant.

    Results

    We analyzed the data collected from 13,128 participants; both self-reported use and urine test results. Majority of the respondents were male (n=12077, 92%), aged 21-40 years old (n=9491, 72.3%), had finished middle/secondary school (n=8353, 63.6%) and were married (n=11012, 83.9%). Opium was the most popular abused substance (n=352, 2.7%) followed by alcohol (304, 2.3%), based on self-reports. Urine tests showed that 23.8% (n=3105) of the participants had a positive result for the use of opiates/opioids, crystal meth and/or cannabis. The highest rate of substance use reported from a province was 60.50%; the lowest provincial rate was 9.0%. 

    Conclusion

    Nearly a one-fourth of Iranian industrial employees are engaged in use of substances with significant geographical distribution. Urine test is the recommended method to assess the prevalence of drug use among industrial workers in Iran.

    Keywords: Survey, Substance Use, Industrial Workers, Iran
  • Alireza Mazdaki, Hamed Zandian, Aein Zarrin, Telma Zahirian Moghadam* Page 23
    Background

    Developing countries, such as Iran, have been struggling with high rates of insurance deduction. As part of the Health Transformation Plan (HTP) in Iran, a new reference book was introduced to update the medical tariffs. This study aimed to compare the rates and extent of insurance deductions before and after HTP in Iran’s public hospitals. 

    Methods

    This was a quasi-experimental study. Overall, 400 medical bills were selected from Iran’s national Health Information System using multilevel random sampling before and after HTP implementation (2014 and 2017). Insurance deductions were divided into 5 groups: (1) diagnostic procedures, (2) medication and medical appliances, (3) accommodation and human capital provision, (4) surgery, and (5) other services. Using STATA Version 14.0, independent t test and Fisher’s exact test were used for data analysis. Significance level was set at 0.5.

    Results

    There was a significant decrease in insurance deductions among Iran’s Health Insurance (HI) and Social Security Insurance (SSI). Accordingly, before HTP, the average amount of insurance deductions was 58.9% and 71.3% in HI and SSI, respectively. Moreover, there was a significant decline in all 5 groups between the pre- and postimplementation of HTP (p<0.05). Based on the results, hospitalization time (OR=2.31, 95% CI=1.9-3.2), patients in general hospitals (OR=1.49, 95% CI=1.4-2.7), coverage by SSI (OR=2.54, 95% CI=1.8-5.6), and having surgery (OR=3.5, 95% CI=2.0-7.3) increase the chance of insurance deduction significantly (p<0.05).

    Conclusion

    Findings of this study showed that after HTP, insurance deductions were decreased significantly. The causes of this decline may be due to the range of services covered by public insurances, increase in insurance coverage, and improvement in health providers-insurance companies communication.

    Keywords: Insurance deduction, Relative value unit, Health transformation plan, Hospitals
  • Behnam Sobouti, Maryam Mirshekar, Shahrzad Fallah, Aram Tabaei, Jalil Fallah Mehrabadi, Atieh Darbandi* Page 24
    Background

    Nosocomial infection caused by Acinetobacter baumannii has emerged as a world-wide serious problem in the emergence of multidrug-resistant (MDR). Infections caused by antibiotic-resistant strains of A. baumannii cannot be completely eliminated among the infected patients. This study aimed to monitor antibiotic resistance among A. baumannii strains isolated from burnt children.

    Methods

    After performing biochemical identification tests on 115 isolates, 62 were detected as A. baumannii. Minimum inhibitory concentration (MIC) was used to test susceptibility to colistin, and disk agar diffusion was used for the susceptibility of the isolates to the antibiotics Ciprofloxacin, Amikacin, Gentamicin, Cefepime, Meropenem, Imipenem, Ceftazidime, Levofloxacin and Piperacillin/Tazobactam. Bacterial species were isolated and identified as multidrug-resistant (MDR), extensively drug-resistant (XDR) and pan drug-resistant (PDR), based on the susceptibility patterns to elected antibiotics, deputing different classes of antimicrobial.

    Results

    The antibiotic susceptibility pattern out of a total of 62 bacterial strains used in this study. Thirty-six (58%) strains were categorized as MDR, 17 (27.5%) as XDR, and nine (14.5%) as PDR.

    Conclusion

    To reduce the threat of antimicrobial resistance, MDR, XDR and PDR A. baumannii strains must be evaluated by all clinical microbiology laboratories.

    Keywords: PDR, Acinetobacter baumannii, Burnt Children
  • Sahar Golabi, Jalal Zaringhalam*, Homa Manaheji Page 25
    Background and objectives

    Apoptosis disruptions play substantial roles in pathogenesis of arthritis and its symptoms. Cytokines and their intra-cellular signaling have pivotal roles in arthritis pathophysiology. The present study aimed to investigate the relation between synovial Interleukin- 6 (IL-6), Nuclear Factor Kappa- B (NF-ĸB) and Fractalkine (Fkn) in the changes of edema and apoptosis during Adjuvant-induced knee arthritis.

    Methods

    240 male Wistar rats were divided into different groups. Arthritis was evoked and the knee edema changes were evaluated by Vernier caliper. Synovial IL-6 was assayed by rat standard ELISA kit. Synovial NF-ĸB, Fkn, and markers of apoptosis were measured by western blot experiment.

    Results

    The injection of Complete Freund's Adjuvant (CFA) caused intense knee edema reduced by implementing Anti-IL-6, Anti-Fkn and Inh-NF-ĸB. The results indicated elevated levels of apoptotic markers during the acute phase, along with an increase in IL-6, NF-ĸB and Fkn. Although IL-6, NF-ĸB and Fkn levels elevation continued during chronic phase, the apoptosis markers decreased in this phase. The findings revealed that Anti-IL-6 treatment during different phases of study can change the synovial NF-ĸB and Fkn.

    Conclusion

    It seems that time-dependent variations in apoptotic markers level may be involved in pathogenesis of Adjuvant-induced knee arthritis. In conclusion, synovial IL-6 through NF-ĸB- Fkn pathway can play an important role in this process.
    Keywords: Apoptosis, Adjuvant, Fractalkine, IL-6, Inflammation, NF-ĸB

    Keywords: Apoptosis, Adjuvant, Fractalkine, IL-6, Inflammation, NF-ĸB
  • Ghobad Moradi, Bakhtiar Piroozi*, Amjad Mohamadi Bolbanabad, Hossein Safari, Azad Shokri, Ramyar Rahimi Page 26
    Background

    The new Coronavirus disease (COVID-19) was first identified in China in 2019. Case fatality rate (CFR) indicator of the disease is one of the most important indices noticed by experts, policymakers, and managers, based on which daily evaluations and many judgments are made. CFR can change during epidemics. This study aimed to estimate the actual number of COVID-19 cases in Iran and to calculate the early CFR for the disease based on official statistics.

    Methods

    This was a descriptive study whose data were obtained from the website of the Ministry of Health and Medical Education of Iran from February 20, 2020 until March 26, 2020. CFR has been obtained by dividing the total number of deaths by the total number of confirmed cases at one point in time. In this study, the actual number of COVID-19 cases in Iran was estimated based on the mortality model in 4 scenarios. Excel 2013 software was used to analyze the data.

    Results

    According to the findings of this study, In Iran, until March 26, 2020, a total of 27 017 people have been infected by COVID-19 and 2077 died of it. However, CFR indicator had a descending trend in Iran: 100%, 18.6%, 8.8%, 3.3%, 6.9%, and 7.7% on days 1, 5, 10, 20, 30, and 35, respectively. The actual number of COVID-19 cases in Iran was estimated to be 4 789 454, 2 873 673, 1 436 836, and 718418 as of March 26, 2020 according to the 4 scenarios, respectively.

    Conclusion

    In emerging epidemics, CFR indicator must not be used as a basis to judge the performance of a health system unless that epidemic condition has been clarified. Moreover, it is suggested that in the outbreak of an epidemic, specifically emerging diseases, CFR must not be the base of judgment. Making judgments, specifically in the outbreak of emerging epidemics, based on fatality rate can lead to information bias. It is also possible to estimate the total number of patients based on the CFR in circumstances where little information is available on the disease.

    Keywords: Coronavirus, COVID-19, Case fatality rates, Pandemic, Mortality estimated model, Iran
  • Ali Ahmadi*, Yassin Fadai, Majid Shirani, Fereydoon Rahmani Page 27
    Background

    COVID-19 is a new disease and precise data are not available about this illness in Iran and in the world. Thus, this study aimed to determine the epidemic trend and prediction of COVID-19 in Iran.

    Methods

    This was a secondary data analysis and modeling study. The daily reports of definitive COVID-19 patients released by Iran Ministry of Health and Medical Education were used in this study. Epidemic projection models of Gompertz, von Bertalanffy, and least squared error (LSE) with percentage error were used to predict the number of hospitalization cases from April 3, 2020 until May 13, 2020.

    Results

    The prediction of the number of patients on April 3, 2020 by von Bertalanffy, Gompertz, and LSE, with 95% confidence interval (CI), were estimated at 44 200 (39 208-53 809), 47 500 (38 907-52 640), and 48 000 (40 000-57 560), respectively. The number of deceased COVID-19 patients was also estimated to be 3100 (2633-3717) individuals by the von Bertalanffy model, 3700 (2900-4310) by Gompertz's model, and 3850 (3200-4580) by LSE. Making predictions about the flat epidemic curve and number of patients based on Gompertz model, will project 67 000 (61 500-87 000) cases. Based on Gompertz and von models, 7900 (6200- 9300) and 4620 (3930- 5550) deaths will occur from May 13 to June 1, 2020, respectively, and then the curve will flatten.

    Conclusion

    In this study, estimations were made based on severely ill patients who were in need of hospitalization. If enforcement and public behavior interventions continue with current trends, the COVID-19 epidemic will be flat from May 13 until July, 2020 in Iran.

    Keywords: COVID-19, Coronavirus, Prediction, Modeling, Epidemiology
  • Seyed Mohsen Aghaei Zarch*, Masoud Dehghan Tezerjani, Mehrdad Talebi, Mohammad Yahya Vahidi Mehrjardi Page 28
    Background

    Diabetes mellitus (DM) is a growing epidemic metabolic syndrome, which affects near 5.6% of the world’s population. Almost 12% of health expenditure is dedicated to this disorder. Discovering and developing biomarkers as a practical guideline with high specificity and sensitivity for the diagnosis, prognosis, and clinical management of DM is one of the subjects of great interest among DM researchers due to the long-lasting asymptomatic clinical manifestation of DM. In this study, we described a recently identified molecular biomarker involved in DM.

    Methods

    This review study was done at the Diabetes Research Center affiliated to Shahid Sadoughi University of Medical Sciences.  PubMed, Scopus, Google Scholar, and Web of Science were searched using the following keywords: “diabetes mellitus”, “biomarker”, “microRNA”, “diagnostic tool” and “clinical manifestation.”

    Results

    A total of 107 studies were finally included in this review. After evaluating numerous articles, including original, meta-analysis, and review studies, we focused on molecular biomarkers involved in DM diagnosis and management.

    Conclusion

    Increasing interest in biomarkers associated with DM goes back to its role in decreasing diabetes-related morbidity and mortality. This review focused on major molecular biomarkers such as proteomic and microRNA (miRNAs) as novel and interesting DM biomarkers that can help achieve timely diagnosis of DM.

    Keywords: Diabetes Mellitus, Biomarkers, MicroRNAs
  • Azadeh Tavoli, Ali Montazeri* Page 29
    Background

    The Brief Fear of Negative Evaluation Scale-Straightforward Item (BFNE-S) is an internationally recognized tool for measuring fear of negative evaluation. The current investigation was designed to assess the reliability and validity of the Persian version of BFNE-S in a non-clinical sample in Iran. 

    Methods

    A cross-sectional study was conducted on a sample of university students. They completed the Iranian version of the BFNE-S and the Social Phobia Inventory (SPIN). Internal consistency was assessed using the Cronbach's alpha coefficient. Validity was examined using known groups comparison to test how well the questionnaire differentiates between subgroups of the study sample that differed in gender. In addition convergent validity was performed to examine the correlation between the BFNE-S and scores derived from the SPIN. Furthermore, the structural validity of the questionnaire was examined by performing confirmatory factor analysis using the LISREL 8.8 software.

    Results

    A total of 150 university students participated in the study. The results obtained from reliability analysis indicated that the Iranian version of the BFNE-S had desirable internal consistency. The Cronbach's alpha coefficient was 0.89. Satisfactory discriminant and convergent validity of the questionnaire also were established. The BFNE-S score was significantly higher in female respondents compared to male respondents as hypothesized (P = 0.008). The BFNE-S was correlated to the Iranian version of the Social Phobia Inventory (SPIN) in the expected direction (r = 0.58, P <0.001). The confirmatory factor analysis indicated a good fit to data lending support to its original one-dimensional structure.

    Conclusion

    The findings indicated that the Iranian version of the BFNE-S was a valid measure of fear of negative evaluation. Since the scale showed a unitary factor structure, the theoretical basis for the BFNE-S is confirmed.

    Keywords: Psychometrics, Surveys, questionnaires, Factor analysis, Fear, Iran
  • Majid Ghanbari Birgani, Reza Reiazi*, Mahdieh Afkhami Ardekani, Hamed Ghaffari, Ali Shakeri Zadeh, Bahram Mofid Page 30
    Background

    Use of hair samples to analyze the trace element concentrations is one of the interesting fields among many researchers. X-ray fluorescence (XRF) is considered as one of the most common methods in studying the concentration of elements in tissues and also crystalline materials, using low energy X-ray. In the present study, we aimed to evaluate the concentration of the trace elements in the scalp hair sample through XRF spectroscopy using signal processing techniques as a screening tool for prostate cancer.

    Methods

    Hair samples of 22 men (including 11 healthy and 11 patients) were analyzed. All the sample donors were Iranian men. EDXRF method was used for the measurements.  Signals were analyzed, and signal features such as mean, root-mean-square (RMS), variance, and standard deviation, skewness, and energy were investigated. The Man-Whitney U test was used to compare the trace element concentrations. The analysis of variance (ANOVA) test was used to identify which extracted feature could help to identify healthy and patient people. P values ≤ 0.05 were considered statistically significant. Statistical analysis was performed using SPSS 16.0 software.

    Results

    The mean±SD age was 67.8±8.7 years in the patient group and 61.4±6.9 years in the healthy group. There were statistically significant differences in the aluminum (Al, P<0.001), silicon (Si, P=0.006), and phosphorus (P, P=0.028) levels between healthy and patient groups. Skewness and variance were found to be relevant in identifying people with cancer, as signal features.

    Conclusion

    The use of EDXRF is a feasible method to study the concentration of elements in the hair sample, and this technique may be effective in prostate cancer screening. Further study with a large sample size will be required to elucidate the efficacy of the present method in prostate cancer screening.

    Keywords: Prostate cancer, Hair sample, XRF, Prostate screening, Signal processing
  • Alireza Amanollahi, Maziar Moradi Lakeh, Farhad Shokraneh, Yousef Bashiri, Leily Mahmudi* Page 31
    Background

    Meta-analyses, like all other studies, may be poorly designed and implemented. This study was designed to determine the quality of meta-analyses in systematic reviews in the field of pharmaceutical research in Iran.

    Methods

    Web of Science Core Collection, EMBASE, Ovid Medline, CINAHL, Scopus, and PubMed were systematically searched on June 4, 2017. The search was limited to the researches in the field of pharmaceutical studies. Based on inclusion criteria, 104 systematic reviews with meta-analysis (SRMA) were selected and assessed using quality assessment tools introduced by Higgins.

    Results

    Participants, experimental interventions, and outcomes were reported in all the articles. Comparator intervention and study design were correctly reported in 103 (99.04%) and 101 (97.12%) articles, respectively. The comprehensive search strategy was available only in 48 articles (46.16%), and there was no evidence of a comprehensive search in 56 articles (53.84%). Risk of bias was investigated in 78 articles (75%). Also, funnel plots were the most commonly used method for reporting the bias in 64 articles (46.42%).

    Conclusion

    In many of the meta-analyses, several items of the tool that represented a high-quality meta-analysis were absent. According to the findings, the comprehensive search and quality assessment were not at an appropriate level. Thus, the importance of reproducibility of information and quality assessment of included studies should be emphasized.

    Keywords: Meta-analysis, Pharmaceutical research, Bias, Research design
  • Seyed HamidReza Faiz, Taghi Riahi, Poupak Rahimzadeh, Nasim Nikoubakht* Page 32
  • Soheila Aminimoghaddam*, Saeedeh Barzn Tond, Alireza Mahmoudi Nahavandi, Ahmadreza Mahmoudzadeh, Sepideh Barzin Tond Page 33
    Background

    This study investigates the possibility of predicting preterm labor by utilizing serum Magnesium level, BMI, and muscular cramp.

    Methods

    In this case-control study, 75 preterm and 75 term labor women are included. Different factors such as serum magnesium level, mother’s age, infant’s sex, mother’s Body Mass Index (BMI), infant’s weight, gravid, and muscular cramp experience are measured. Preterm labor is predicted by developing a linear discriminant model using Matlab, and the prediction accuracy is also computed.

    Results

    The results show that each of the studied variables has a significant correlation with preterm labor. The p-value between BMI and preterm labor is 0.005, and by including the muscular cramp, it becomes less than 0.001. The correlation between serum magnesium level and the preterm labor is less than 0.0001. Using these three significant variables, a linear discriminant function is developed, which improves the accuracy of predicting preterm labor.

    Conclusion

    The prediction error of preterm labor decreases from 31% (using only serum magnesium level) to 24% using the new proposed discriminant function. Based on this, it is suggested to use the optimized linear discriminant function to enhance the prediction of preterm labor, since the serum magnesium level cannot predict the preterm labor accurately.

    Keywords: Premature labor, Prenatal diagnosis, Biomarkers, Optimized linear classifier, Magnesium level
  • Marzieh Pashmdarfard, Akram Azad* Page 34
    Background

    Given the increasing population of older adults in different societies, it is important to take into account the needs of them. In this regard, the most important things that are closely related to their quality of life are their ability in evaluating Activity of Daily Living (ADL) and Instrumental Activity of Daily Living (IADL) performances. The aims of the present study were to identify the outcome measures specific to the ADL and IADL for older adults and to investigate the psychometric properties of these measures.

    Methods

    This is a systematic review done on the articles published between June 2019 and February 2019. Articles in English language from these database included: Medline, PubMed, Google Scholar, CINAHL, OVID Medline, Cochrane, ProQuest, Up to Date, Web of Science, OT search, OT direct, Pedro, SID, Magiran, Iran Medex, MEDLIB and Iran doc. English keywords included: “Activity of Daily Living (ADL)”, “Instrumental Activity of Daily Living (IADL)”, “assessment”, “evaluation”, “aging”, “ageing”, “older adults”, “elders”, “Basic Activity of Daily Living (BADL)”, “Advanced Activity of Daily Living (AADL)”, “basic functions”, “self-care”, “mobility”, “independency”, “dependency”, “occupational therapy”, “physical therapy”, “rehabilitation”. The Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) checklist were employed to investigate the psychometric properties of the studies.

    Results

    Of the initial 482 studies considered, 13 studies met the inclusion criteria that assess the ADL and IADL performance of older adults. In this regard, 8 outcome measures were found especially for ADL assessment and 5 for IADL assessment. 

    Conclusion

    Most of the assessment tools are performance-based and have been developed in especial contexts and especial groups of older adults. Some have been used frequently in different contexts but some were used less than others. None of these measures has been developed in Iran. So, for better assessment and having better intervention plans for older adults in Iran, it is suggested to develop an instrument that is especially designed for Iranian context.

    Keywords: Elderly, Evaluative, Everyday life, Review
  • Yousef Moradi, Babak Eshrati* Page 35
    Background

    Estimating the net reproductive number of COVID-19 virus can reveal the rate and severity of the disease transmission in the Iranian society to health researchers and practitioners. Also, it signifies the importance of the disease to the community. Thus, the aim of this study was to determine the net reproductive number of COVID-19 in Iran and its different provinces.

    Methods

    This study was conducted on the data of COVID-19 patients in Iran from February 21 to March 8, 2020. To determine the net reproductive number of COVID-19 in Iran, the serial interval and β value were first determined using linear regression analysis. Then, the net reproductive number values were calculated for Iran and its different provinces.

    Results

    The results of this study showed that the net reproductive number of COVID-19 in Iran was 1.31. Using the available data up to March 15, 2020, the highest net reproductive number was in Mazandaran, Yazd, Isfahan, Qazvin, and Zanjan provinces, with values of 2.07, 1.86, 1.84, and 1.76, respectively. The net reproductive number also showed an increasing trend in Kohgiluyeh and Boyer-Ahmad province.

    Conclusion

    It seems that although the net reproductive number of the virus had a decreasing trend in the provinces, it is still high. Therefore, sanitary measures in these provinces should be pursued more seriously. On the other hand, social distancing is a topic that should be taken into consideration, that is, social gatherings and contacts should be avoided as much as possible and strategies and facilities for this action should be developed by the government and health policymakers.

    Keywords: COVID 19, Net reproductive number, Iran
  • Sakineh Narouee, Mohsen Shati, Mahnaz Didevar, Mahshid Nasehi* Page 36
    Background

    The network scale-up method is an indirect method of estimating the size of hidden and hard-to-reach populations. An important prerequisite in this method is to estimate the size of an active social network, as considered in the present study. 

    Methods

    In 2015, the social network size was calculated using the known subpopulation approach and maximum likelihood estimation in the central, Bampur, and Bazman districts of Iranshahr province. Individuals older than 18 years took part in a street-based survey. The relationship between the demographic variables and social network size estimation was analyzed (p< 0.05). Linear regression was used to investigate the relationship of each known subpopulation with underlying variables. Data were analyzed in Excel 2010 and SPSS 19.

    Results

    From among 1000 participants, 50.2% lived in rural areas. The social network size of the residents of Iranshahr was estimated to be 308.35 with 12 remaining subgroups. The Pearson’s correlation coefficient between the real and estimated values in known subpopulations was equal to 0.92 (p= 0.001). Men aged 25-39 years, those with high education levels, employees, and those residing in villages had a wider social network. The estimated social network size had a significant relationship with gender, education level, and place of residence (p< 0.001).

    Conclusion

    The estimated social network size in Iranshahr was smaller than the value reported by a nationwide study (the ratio-based method).

    Keywords: Network scale-up, Population size estimation, Social network size, Hidden population
  • Azam Zolfi Kashani, Hadi Ranjbar, Maryam Rasoulian, Amir Shabani, Mohammad Ghadiri, Homa Mohammad Sadeghi* Page 37
    Background

    Disclosure of the diagnosis is an essential part of the treatment process and an important part of patient rights. However, it can be a very stressful experience, especially in mental health disorders. Patients with bipolar disorder have a unique experience of receiving and managing their diagnosis. The objective of the current study was to explore the experience of patients with bipolar disorder of diagnosis disclosure.

    Methods

    This was a qualitative study. Participants were recruited from patients who knew their disorder’s name using purposive sampling method. The inclusion criteria were being diagnosed by a psychiatrist as having bipolar disorder and the disclosure was conducted by a psychiatrist. Sixteen semi-structured, in-depth interviews were conducted with twelve patients. Data were analyzed using thematic content analysis.

    Results

    Patients received their diagnosis name in three steps including Wandering in Unknowns, Limited Brightness and Reaching to a Relative Insight. Patients believed that disclosure of the diagnosis was not accompanied by enough information.

    Conclusion

    The disclosure of diagnosis in patients with bipolar disorder without providing enough information is stressful and is not helpful in empowering these patients. Based on our results, disclosure of diagnosis to patients with bipolar disorder was not conducted with enough information and patients had problems for understanding their symptoms and treatments.

    Keywords: Disclosure, Bipolar disorder, Mental health, Medical ethics, Patient rights
  • Vahid Alipour, Zahra Meshkani*, Aziz Rezapour, Ali Aboutorabi, Rafat Bagherzadeh, Naser Saber Page 38
    Background

    In the coming years and near future, Iran will experience a main demographic transition resulting in an aging phenomenon and increased number of people over 65 years. Aging leads to increased medical expenditures associated with chronic diseases such as osteoporosis. This study aimed to investigate the patient-specific hospitalization costs of osteoporosis treatment in elderly patients.

    Methods

    A retrospective cost analysis of hospitalization arising from osteoporosis conducted on all the elderly patients (adults aged 65 years and above) in a teaching hospital in Tehran through examining hospital admissions during 2017. The elderly patients consisted of 295 with a length of stay ≥ 24 hours. Cost analysis was performed using a bottom-up micro-costing approach and payer perspective (patient and insurer); and the result was statistically significant (p≤0.05). Nonparametric tests, including Mann–Whitney and Kruskal–Wallis tests, were used to investigate the relationship between affecting variables. Hospital training was considered as a control variable. The data were analyzed using SPSS 11 software

    Results

    The mean age of the patients was 71.3 years; of the patients, 79% were female and 21% male. The overall crude prevalence of osteoporosis was 80% among people ≥ 65 years and 85% among patients who experienced relevant surgeries. The average cost of hospitalization was $3794.13. Also, 3 main areas of hospital costs were identified: consumables (57.70%), hoteling (17.24%), and surgical services (15.76%). The prevalence of osteoporosis was 4 times higher in women compared with men. Moreover, there were significant differences between the variables affecting hospital costs, such as gender, length of stay, diagnosis, intensive care unit services, and surgery (p<0.05).

    Conclusion

    Age-associated diseases such as osteoporosis increase the health care costs. The dominant cost drivers in this study were the consumables, hoteling, and surgical services, respectively. Policymakers and health care planners should consider such variables as gender, previous surgeries in the patients’ records, length of stay, and intensive care unit services as driving factors and determinants of hospital costs for older seniors with osteoporosis.

    Keywords: Osteoporosis, Elderly, Hospital costs, Fractures
  • Narjes Khalili, Mohammad Heidarzadeh, Abbas Habibelahi, Batool Tayefi, Mozhdeh Ramezani, Zahra Rampisheh, Arash Tehrani Banihashemi, Fariba Mirbaha, Farima Raji, Ebrahim Babaee, Rahim Taghizadeh Asl, Maziar Moradi Lakeh*, Mohsen Naghavi, Ali H. Mokdad Page 39
    Background

    Under Every Newborn Action Plan (ENAP), stillbirth rate in every country should be reduced by 12 or fewer per 1000 total births by 2030. The aims of this study were to determine stillbirth rate at national and subnational levels and to investigate its associated risk factors in Iran.

    Methods

    Using all data from Iranian Maternal and Neonatal Network (IMaN), we calculated stillbirth rate of Iran from 2014-2016. This network registers information of almost all births across the country. The logistic regression was used to estimate the adjusted odds ratio (aOR) with 95% confidence intervals (CIs) for stillbirth.

    Results

    In 2014, still birth rate was 7.40 per 1000 births. In 2015 and 2016, stillbirth rates were 7.22 per 1000 births and 7.63 per 1000 births, respectively. The most important related factors of stillbirth were preterm birth (aOR= 62.53, 95% CI; 60.77-64.34), sexual ambiguity (aOR= 14.51, 95% CI; 12.76-16.50), and post term birth (aOR= 3.31, 95% CI; 2.66-4.13).

    Conclusion

    Under Every Newborn Action Plan (ENAP), stillbirth rate in every country should be reduced by 12 or fewer per 1000 total births by 2030. Iran has achieved stillbirth target of ENAP at national level. It is important for the health care system to establish and improve specific and focused policies, interventions, and programs for achieving this target even in the most deprived areas.

    Keywords: Prevalence, Stillbirth, Risk factor, Iran
  • Abbas Eshraghi, Mohsen Esfandbod*, Seyed Reza Safaeinodehi, Farhad Shahi, Azhar Eshraghi Page 40
  • Abdoulreza Esteghamati, Mohammadamin Joulani, Shirin Sayyahfar*, Sarvenaz Salahi, Mahla Babaie, AhmadReza Shamshiri, Alireza Fahimzad Page 41
    Background

    The aim of this study was to determine the baseline statistics of intussusception in the under-five- year age group in Iran to facilitate the monitoring of potential side effects after administration of rotavirus vaccine.

    Methods

    This hospital-based historical cohort study reviewed children under 60 months of age with the final diagnosis of intussusception, ICD-10 code K56.1, using census in all hospitals of Tehran, Iran from March 2010-2015. Demographic (sex, age, hospital stay duration), clinical manifestations (such as currant jelly stool, abdominal pain, vomiting, and fever),diagnostic and treatment methods (contrast enema, ultrasonography, laparotomy, and laparoscopy), and outcome data of patients aged less than 5 years with the diagnosis of intussusception were collected and analyzed using SPSS Version 16.0 (SPSS Inc., Chicago, IL, USA)

    Results

    In this study, 759 patients were diagnosed with intussusception; 309 (40.7%) cases were less than 12 months old. The annual incidence of intussusception was 66.54 cases per 100.000 in children less than one-year-old and 31.61 cases per 100.000 in children less than five years old. The most common symptoms and signs were abdominal pain/irritability (94.2%) and tenderness (24.2%), respectively. The diagnostic method was ultrasound in 75.9% of cases. The most frequent anatomic location was the ileocolic region (87.87%) and the most common treatment method was barium enema.

    Conclusion

    This research has provided a baseline statistic for childhood intussusception in Tehran prior to the administration of the rotavirus vaccine to provide a better comparison with post-introduction data.

    Keywords: Incidence, Intussusception, Invagination, Pediatrics, Rotavirus vaccine
  • Aziz Rezapour, Saeide Alidoost*, Asra Asgharzadeh, Zeynab Farhadi, Najme Khodadadi, Roghayeh Mohammadi Bakhsh, Razieh Sepehrian, Morteza Salemi, Masood Taheri Mirghaed, Masoud Behzadifar, Rahim Sohrabi Page 42
    Background

    In recent years, increased longevity, poor dietary habits, and the rising prevalence of metabolic syndrome and hypertension have increased the prevalence of gout. Gout significantly increases direct and indirect costs and reduces the quality of life. Allopurinol and febuxostat are the most commonly used drugs for reducing uric acid levels and controlling this disease with different cost-effectiveness. The present systematic review compares the cost-effectiveness of these drugs.

    Methods

    This was a systematic review of economic evaluations. Cochrane CENTRAL, Web of Science, PubMed, Embase, and the Cost-Effectiveness Analysis (CEA) Registry were searched up to April 30, 2018, based on the specific search strategy of each database. Keywords used in the search include gout, cost-effectiveness, allopurinol, and febuxostat in MeSH and free-text forms. Screening of identified studies, data extraction, and quality assessment were done independently by 2 reviewers. The quality of studies was assessed based on Drummond Checklist. Finally, a qualitative analysis was done to analyze the results.

    Results

    A total of 94 studies were identified through database search and the review of references. After screening the titles, abstracts, and full-texts, 6 economic evaluations were included in the review. The majority of the studies had been conducted in the US using the Markov model, within a 5-year horizon, and from the payer’s perspective, with the quality of life as a measure of effectiveness. In most studies, the incremental cost-effectiveness ratios (ICERs) of febuxostat per quality-adjusted life year (QALY) were below the threshold (10 000$/QALY and 30 000€/QALY).

    Conclusion

    Febuxostat has been shown to be more cost-effective than allopurinol in all treatment sequences in studies that have used uric acid levels as the measure of effectiveness. Furthermore, in studies with the quality of life as the measure of effectiveness, febuxostat has been shown to be very cost-effective as the second-line treatment.

    Keywords: Gout, Economic evaluation, Cost-Effectiveness, Allopurinol, Febuxostat, Systematic review
  • Mohammad M. Mojahedian, Aeen Mohammadi, Mohammad Abdollahi, Abbas Kebriaeezadeh, Mohammad Sharifzadeh, Shadi Asadzandi, Shekoufeh Nikfar* Page 43
    Background

    Increasing the number of students in universities, simultaneously limiting allocation of funds to them, and maintaining the highest efficiency level in education and research are of paramount importance. There are several methods to assess the efficiency of universities, and one of the most widely used of which is data envelopment analysis (DEA). The aim of this study was to determine the input and output criteria to evaluate the efficiency of universities of medical sciences through review-related articles using the DEA method.

    Methods

    The time limit for retrieving articles was considered from the beginning of the publication of the first paper in this field until the end of 2017. The data were retrieved from Web of Science, Scopus, Ovid, ProQuest, Science Direct, and PubMed using advanced searches. Inclusion criteria were as follow: relevancy of the articles to the purpose of the research, availability of the articles’ full-text, articles published to the end of 2017, and articles published in English

    Results

    The most inputs used in the literature to determine university efficiency were number of academic staffs, budget and costs, number of students, number of nonacademic staffs, spaces, and equipment and student's entrance scores. Also, the most outputs used in the literature to determine university efficiency were number of graduates, publications, incomes, number of students, and student's scores.

    Conclusion

    This study showed that a large number of researchers have focused on measuring and comparing the efficiency of universities to improve efficiency, reduce costs, and manage the resources. Efficiency analysis by DEA allows the policymakers to define and develop policies and guidelines to improve their performances.

    Keywords: Education, Efficiency, Data envelopment analysis, Inputs, Outputs
  • Pouria Khani, Siamak Farokh Forghani, Zohreh Ataei Kachoei, Ali Zekri*, Farideh Ghazi Page 44
    Background

    Epidermolysis bullosa simplex is a hereditary skin disorder caused by mutations in several genes such as KRT5 and KRT14. Skin fragility in basal keratinocytes presence regions led to the cytolysis of epidermis and blistering. Aim of this study was to detect the molecular defects in KRT5 and KRT14 genes hot spots in patients with clinical suspicion of EBS and investigation of their probable genotype-phenotype correlations.

    Methods

    Exons 1 and 6-7 of KRT 5 and exons 1 and 4-7 of KRT 14 amplification and mutation detection were performed by polymerase chain reaction and Sanger sequencing, respectively. Novel variants pathogenicity evaluated by bioinformatics tools.

    Results

    Nine important variants detected in seven different patients within 6 Iranian families affected by Epidermolysis bullosa simplex, of which four variants were novel. Three patients had a mottled pigmentation phenotype [G96D (p.Gly96Asp) and F97I (p.Phe97Ile) in KRT5]. One of them showed a Dowling–Meara phenotype [A417P (p.Ala417Pro) and E477D (p.Glu477Asp) in KRT5] and another had a Koebner type phenotype [R397I (p.Arg397Ile) and Q444* (p.Gln444Ter) in KRT5]. A novel variant [G92E (p.Gly92Glu) in KRT5] in a double heterozygous state with a challenging variant [A413T (p.Ala413Thr) in KRT14] identified in one patient with Koebner type phenotype. Also, a previously reported mutation [I377T (p.Ile377Thr) in KRT14 gene] identified in this study.

    Conclusion

    The results of molecular data analysis showed that the most severe phenotypes were associated with mutations in highly conserved regions. In some cases, different inheritance modes were observed.

    Keywords: Epidermolysis bullosa simplex, Skin fragility, Keratin
  • Samaneh Mansouri, Iraj Kazemi, AhmadReza Baghestani*, Farid Zayeri, Zahra Ghorbanifar Page 45
    Background

    Coriandrum sativum (coriander) is prescribed as a treatment for headache in traditional Persian medicine. Several investigations have been carried out to find the medicinal properties of this plant. However, no study has evaluated the effectiveness of this plant on becoming migraine-free.

    Methods

    Sixty-eight migraineurs were randomly allocated to two equal groups of intervention and control. Each received 500 mg of sodium valproate in addition to 15 mL of coriander or placebo syrup three times a day. We followed subjects and recorded their migraine duration in the 1st, 2nd, 3rd, and 4th weeks. We applied an appropriate statistical model so as to consider special features of the data, which led to more accurate results using SAS 9.4

    Results

    Our findings showed that the probability of being migraine-free was not only considerably higher in final weeks of the study (p<0.001) in all patients of the intervention group than placebo group, but it was also significantly higher in patients less than 30 years of age compared to patients older than 30 years old. Migraine duration in migraineurs using coriander syrup reduced considerably during the study (p<0.001).

    Conclusion

    The finding of this study revealed that coriander has a significant effect both on the probability of being migraine free and the duration of migraine attacks. Its effects were more significant during the final weeks of study.

    Keywords: Migraine headache, Coriandrum sativum, Herbal drug, Clinical trial, Mixture model
  • Azam Nabavi, Abbas Allami*, Reza Qasemibarqi Page 46
    Background

    Lipid profiles are infrequently measured in clinical management of sepsis patients. Sepsis leads to significant alterations in the metabolism of lipids. The aim of the present study was to determine whether changes in plasma lipid concentrations during sepsis treatment were associated with clinical outcome.

    Methods

    In this study, 74 adult septic patients were included in this prospective observational study from January to December 2017. Patients taking lipid lowering agents were excluded. A detailed medical history was obtained and clinical examination was performed. Serum total cholesterol (STC) and its fractions [low-and high-density lipoprotein] and triglyceride levels were measured in the morning of the first day after admission and then once weekly. The primary outcomes of the study were in-hospital mortality, and hospital stay and hypocholesterolemia were defined as STC levels < 50 mg/dL. Manne-Whitney U and chi-squared tests were used for data analysis, and significance level was set at p<0.05.

    Results

    In this study, 78.4% (CI 95%: 67.3-87.1) of patients had hypocholesterolemia. During the study period, 21.6% (CI 95%: 12.9- 32.7) of patients died. All lipid (except TG) concentrations continuously decreased in deceased sepsis patients but increased in recovering patient (p value for STC (p=0.004), LDL (p=0.006), HDL (p=0.010), and TG (p=0.052)). The serum lipids concentration was not associated with length of hospital stay (p value for STC (p=0.524), LDL (p=0.813), HDL (p=0.799) and TG (p=0.581)).

    Conclusion

    In this study it was found that the additional decline of lipid profile was significantly associated with increased mortality rate of sepsis patients. Thus, the clinically termed 'the lipaemia of sepsis' is not true in all situations.

    Keywords: Cholesterol, Lipoprotein, LDL, HDL, Triglyceride, Sepsis, Emergency service, Hospital
  • Somaye Yosaee, Reyhane Basirat, Abdolhamid Hamidi, Alireza Esteghamati, Mahmoud Khodadost, Farzad Shidfar, Vida Bitarafan, Kurosh Djafarian* Page 47
    Background

    Metabolically healthy obese (MHO) individuals appear to be protected or more resistant to the progression of obesity-related metabolic disorders. Hormonal regulation associated with adipose or muscular tissues such as irisin and leptin may facilitate the healthy metabolic profile of MHO cases. In this case-control study, the differences between serum level of irisin was investigated in metabolically unhealthy obese (MUO) and metabolically healthy obese (MHO) individuals.

    Methods

    The study participants included obese individuals with metabolic syndrome (MetS) (n=51) and 2 control groups that included weight matched cases without MetS (n=51) and normal weight cases without MetS (n=51). Diagnosis of MetS was made based on the Adult Treatment Panel III (ATPIII) criteria. Serum levels of leptin and irisin were determined by enzyme-linked immune-sorbent assay (ELISA) kit. Receiver Operator Characteristic (ROC) curve, multiple linear regression, and one-way ANOVA analysis were used in SPSS 16 software. Significant level was set at 0.05.

    Results

    Based on the statistical analysis, serum levels of irisin were 2.91±1.6, 3.14±1.4, and 4.47±3.23 (ng/mL) in MUO, MHO, and nonobese metabolically healthy participants, respectively (P = 0.001). Also, serum levels of leptin were 14.06±12.4, 11.2±9.3, and 7.09±7.1 (ng/mL) in MUO, MHO, and nonobese metabolically healthy cases, respectively (p=0.002). After adjusting for demographic variables, a significant association was found between irisin and study groups (β = 0.77, P = 0.001), weight (β=-0.03, p=0.014), BMI (β=-0.11, p=0.006), TG (β=-0.003, p=0.025), fat mass (β=-0.04, p=0.046), and fat free mass (β=0.08, p=0.014).

    Conclusion

    Obese patients with/without MetS had lower level of irisin than normal weight participants.

    Keywords: Irisin, Obesity, Metabolic syndrome, Leptin
  • Sina Mahdavifard*, Manochehr Nakhjavani Page 48
    Background

    Thiamine deficiency contributes to hyperglycemia and diabetes complications. Thus, in this study, the effect of thiamine pyrophosphate (TPP) on the in vivo and in vitro formation of glycation, oxidative stress, and inflammatory markers (the main contributors of vascular diabetes complications) was examined in type 2 diabetes rat model.

    Methods

    Type 2 diabetes was induced in rats with a combination of streptozotocin and nicotinamide (55+200 mg/kg). Two groups of rats, healthy and diabetic, were treated with 0.1% TPP in drinking water daily for 3 months and the 2 others received water only. The glucose, insulin, early to end glycation products, the activity of glyoxalase system, lipid profile, LDL oxidation markers, inflammatory markers, creatinine in the serum, and proteinuria in the urine of all rats were determined. Moreover, albumin and LDL were incubated with glucose in the presence and absence of TPP, and the samples were investigated for glycation and oxidation products. Different variables in all 4 groups were compared with multiple analysis of variance (MANOVA-Tukey) test using SPSS version 16.  Significance level was set at p<0.05.

    Results

    TPP decreased the formation of diverse glycation and oxidation products in both in vivo (glycated LDL= 144.50±3.48 and oxidized LDL= 54.08±2.67 μmol/l) and in vitro (glycated LDL= 107.00±2.82 and oxidized LDL= 50.83±1.22 μmol/l). In addition, the vitamin reduced fasting blood sugar (9.23±0.29), insulin resistance (9.10±0.50), tumor necrosis factor-α (285.43±15.97), interleukin-6 (257.65±13.06), and improved the lipid profile, the activity of Glo system (Glo-I= 31.65±1.06 and Glo-II= 27.01±0.90 U/mL) and renal function in the diabetic rat (p<0.001).

    Conclusion

    TPP decreased the major risk factors for diabetic complications and corrected the alternations of glucose and lipid metabolism in type 2 diabetic rats; thus, it is recommended for diabetes treatment.

    Keywords: Type 2 diabetes, Glycation, Oxidative stress, Inflammation, Streptozotocin, Diabetic vascular complications, Glyoxalase system, Proteinuria
  • Fateh Tavangar, Hassan Rafiey*, AhmadAli Noorbala, Farhad Nosrati Nejad, Gholamreza Ghaedamini Harouni, Hesam Ghiasvand, Fardin Alipour, Sina Ahmadi Page 49
    Background

    Development of tools for measuring stress has been considered by mental health researchers for many years. The purpose of this study was to develop and validate a "Stressful Events Inventory"(SEI) using exploratory and confirmatory factor analyses.

    Methods

    Using a representative sample (n=6000) from all people who reside in Tehran, the validity of the inventory was confirmed by exploratory and confirmatory factor analyses, and its reliability was also confirmed by Cronbach's alpha.

    Results

    Eleven major sets of stressful events were identified as follow: political problems (α=0.731), neighborhood’s problems  (α=0.739), livelihood problems (α=0.609), fear of the future (α=0.663), educational events (α=0.635), educational changes (α=0.704), individual changes (α=0.463), occupational difficulties (α=0.64), housing problems (α=0.69), problems related to occupational relations (α=0.46), and family problems (α=0.69). The value of correlation between the factors was equal to 0.82 and the value of variance determined by these factors was 0.49 (r^2=0.49). In the confirmatory factor analysis, these factors also had an appropriate fitness (RMSEA=0.02).

    Conclusion

    The developed instrument has suitable psychometric properties, which make it appropriate for future research on psychosocial stress.

    Keywords: Stress, Stressful event inventory, Exploratory factor analysis, Confirmatory factor analysis
  • MohammadMehdi Soltan Dallal*, Samaneh Motalebi, Hossein Masoumi Asl, MohammadKazem Sharifi Yazdi, Abbas Rahimi Forushani Page 50
    Background

    Foodborne diseases are caused by indigestion of contaminated food. In some cases they may result in either hospitalization or death. The Centers for Disease Control (CDC) and Prevention in 2017 stated that 10% reduction in foodborne illness would prevent nearly five million illnesses every year. Approximately one out of six Americans become ill from contaminated foods or beverages every year. Another problem is drug resistance which is responsible for approximately 2 million illnesses and around 23000 dead every year. Nearly 400,000 Americans acquire antibiotic-resistant Salmonella or Campylobacter each year. The aim of this study was to evaluate the outbreak of salmonellosis and shigellosis along with their antibiotic susceptibility patterns in different provinces of Iran.

    Methods

    Over a period of 2 years from 2015 to 2016, a total of 1055 cases in 249 outbreaks reported in 20 provinces of Iran, as a part of surveillance by the National Institute of Health (NIH). The stool samples of patients were taken and tested for Salmonella spp. and Shigella spp. by conventional standard techniques. Disk diffusion was used for the antibiotic sensitivity test.

    Results

    Of 1055 cases, 118 (11.2%) contained Shigella and 74 (7%) contained Salmonella. Antibiotic susceptibility tests showed that entirely 100% of Salmonella and Shigella isolates were susceptible to ciprofloxacin; whereas 12.2% of Salmonella and 98.2% of Shigella were resistant to cotrimoxazole.

    Conclusion

    Our results show that there is a need for more food handling practices to minimize the exposure of consumers to Salmonella and Shigella, at all points along the distribution chain.

    Keywords: Foodborne, Outbreaks, Salmonellosis, Shigellosis
  • Majid Akrami, Hamid Nasrollahi*, Mostafa Vahabi, Seyed Hassan Hamedi, Sedigheh Tahmasebi, Sareh Karbasi, Mehran Pashnesaz, Vahid Zangouri, MohammadYasin Karami, Ahmad Mosalaei, Abdolrasoul Talei Page 51
    Background

    Intraoperative radiation therapy (IORT) is the delivery of radiation at the time of surgery. Whereas the dose delivered by external beam radiation therapy (EBRT) is limited by the tolerance of the surrounding normal tissues, IORT allows exclusion of a part or all of the dose-limiting sensitive structures by operative mobilization and/or direct shielding of these structures. The aim of the present study was to report the non-breast cancer patients' outcomes after receiving IORT in Shiraz, Iran.

    Methods

    In this retrospective study, all cases who had received IORT and had non-breast malignancies were selected. Diagnosis was confirmed by biopsy. Additional imaging was done by sonography, magnetic resonance imaging (MRI) and computed tomography (CT). IORT was applied by self-shielded, LIAC 6-12 MeV Sordina mobile linear accelerator. Typically, a single dose of 10-21 Gy was given for maximally resected tumors. The statistical analyses were carried out using SPSS (version 21).

    Results

    Twenty-six patients were treated with IORT alone or combined with EBRT. Different tumors were treated, including colorectal adenocarcinoma (10 cases, 38.4 %), Soft Tissue Sarcomas (STS, 11 cases, 42.3 %), head and neck cancers (3 cases, 11.5 %), one cervix malignancy case and one paravertebral fibromatosis case. Mean ± SD overall survival was 15±14.89 (0-38) and 34.3±15.72 (14-53) months for colorectal cancer and STS, respectively.

    Conclusion

    IORT is mostly useful for pelvic and abdominal malignancies where normal bowel limits the dose that can be delivered with EBRT. However, the dose delivered in a single fraction with IORT is rarely sufficient for tumor control; therefore, IORT is usually preceded or followed by additional EBRT which should be further evaluated preferably in prospective randomized trials.

    Keywords: Intraoperative radiation therapy, External beam radiation therapy, Cancer
  • Hojat Dehghanbanadaki, Farhad Seif, Yasmin Vahidi, Farideh Razi, Ehsan Hashemi, Majid Khoshmirsafa, Hossein Aazami* Page 52
    Background

    Since the outbreak of the novel coronavirus disease from Wuhan, China, in early December 2019, many scientists focused on this infection to find a way to deal with it. Due to the dramatic scientific growth in this field, we conducted a scientometric study to gain a better understanding of the scientific literature on COVID-19.

    Methods

    We extracted all COVID-19 documents indexed in the Scopus from December 1, 2019, to April 1, 2020, without any language limitation and determined their bibliometric characteristics, including document type, open accessibility status, citation counting, H-index, top cited documents, the most productive countries, institutions and journals, international collaboration, the most frequent terms and keywords, journal bibliographic coupling and cocitations.

    Results

    A total of 923 documents on COVID-19 were retrieved, of which 418 were original articles. All documents had received 2551 citations with an average citation of 2.76 per document and an h-index of 23. China ranked first with 348 documents, followed by the United States (n = 160). The Lancet and BMJ Clinical Research Ed published the most documents (each with 74 documents) and 2 institutions (University of Hong Kong and Huazhong University of Science and Technology) ranked first in this regard. In addition, the present study analyzed the top 25 highly-cited documents (those that had received 70% of all citations).

    Conclusion

    This study highlighted the focused subjects on various aspects of COVID-19 literature such as pathogenesis, epidemiology, transmission, diagnosis, treatment, prevention, and its complications.

    Keywords: Novel Coronavirus, COVID-19, SARS-CoV-2, Scientometrics, Bibliometrics
  • Leila Janani*, Ahmad Hajebi, Hajar Nazari, Neda Esmailzadehha, Leila Molaeipour, Fatemeh Varse, Mehrdad Eftekhar, Cornelia Betsch, Seyed Abbas Motevalian Page 53
    Background

    The worldwide emergence and rapid expansion of COVID-19 emphasizes the need to assess the knowledge gap and to predict the disease-related behaviors and reactions during this epidemic.

    Methods and design

     COVID19 Population Survey of Iran (COPSIR) is a repeated cross sectional survey that will be conducted in 8 waves. In each wave, 515 Iranian adults aged 18 years or older will be randomly selected and interviewed by phone. The study waves will be performed at approximately weekly intervals. The survey tool is adapted from COSMO (COVID-19 Snapshot MOnitoring) study. This study will provide information on trends of knowledge, risk perception, preventive behaviors, psychological problems, essential needs, and public trust among Iranian adults during COVID-19 epidemic.

    Discussion

    The key findings of each wave will be immediately reported to the National Headquarters for Coronavirus Control to set better policies for disease control and prevention. Moreover, if a message is extracted from the results of this study that needs to be communicated to the public, it will be done through the mass media.

    Keywords: COVID-19, Knowledge, Risk perception, Preventive behaviors, Psychological problems, Public trust
  • Mona Omidi, Ali Maher*, Samira Etesaminia Page 54
  • Ali Montazeri* Page 55

    Although there are many important concerns related to coronavirus disease-19 (COVID-19), ethical issues should remain the top priority since the humanistic dimension of the recent pandemic is of prime importance. This short commentary highlights some ethical concerns related to (COVID-19). Political misuse, caring for older adults, and spread of harmful information are the 3 main issues that are addressed. It is hoped that those who can influence communities at large consider these issues for better public’s health.

    Keywords: Coronavirus, COVID-19, Ethics
  • Azad Shokri, Ghobad Moradi, Bakhtiar Piroozi, Sonia Darvishi, Shina Amirhosseini, Arshad Veysi, Fatemeh Manafi, Amjad Mohamadi Bolbanabad* Page 56
  • Mohammad Haghparast, Mahdieh Afkhami Ardekani*, Mahmoud Navaser, Soheila Refahi, Milad Najafzadeh, Hamed Ghaffari, Mahboubeh Masoumbeigi Page 57
    Background

    Measuring background radiation (BR) is highly important from different perspectives, especially from that of human health. This study was conducted to measure BR in the southeast of Iran.

    Methods

    BR was measured in Hormozgan and Sistan-Bluchestan provinces using portable Environmental Radiation Meter Type 6-80 detector. The average value was used to calculate the absorbed dose rate and indoor annual effective dose (AED) from BR. In addition, excess lifetime cancer risk (ELCR) was evaluated.

    Results

    The results showed that the maximum and minimum absorbed dose rates were 71.9 and 34.2 nGy.h-1 in Abomoosa and Minab in Hormozgan province and 90.0 and 47.8 nGy.h-1 in Zahedan and Chabahar in Sistan-Bluchestan province, respectively. Data indicated that these areas had a lower BR level compared with the worldwide level.  The ELCR from indoor AED was larger compared with the worldwide average of 0.29 × 10-3.

    Conclusion

    This study provided a reference for designing and developing specific regional surveys associated with the measurement of natural BR in the southeast of Iran.

    Keywords: Background radiation, Environmental radiation, Absorbed dose rate, Annual effective dose
  • Maghsoud Sarebani, MohammadBagher Shiran*, Ahmad Bitarafan Rajabi, Fereidoon Rastgoo, Zahra Ojaghi Haghighi, Ali Abbasian Ardakani Page 58
    Background

    Cardiac echocardiography and cardiac ECG-gated single-photon emission computed tomography (SPECT) are the most common modalities for left ventricle (LV) volumes and function assessment. The temporal resolution of SPECT images is limited and an ECG provides better temporal resolution. This study investigates the impact of frame numbers on images in terms of qualitative and quantitative assessments.

    Methods

    In this study, 5 patients underwent echocardiography and cardiac ECG-gated SPECT imaging, and 5 standard views of the LV were recorded to determine LV walls boundaries and volumes. Also, 2 original images with 8 frames and 16 frames per cardiac cycle were recorded simultaneously in a single gantry orbit. Using the data extracted from the LV model, 8 extra new frames were created with interpolation between existing frames of the original 8-frame image. Three series of images (8 and 16 original and 16 interpolated) were reconstructed separately. LV volumes and ejection fraction (EF) were calculated using Quantitative Gated SPECT (QGS) software.

    Results

    Compared to the original 8-frame gating, original 16-frame gated images resulted in larger end-diastole volume (EDV) (mean ± SD: 68.6 ± 27.11 mL vs 66.2±25.41 mL, p<0.001), smaller end-systole volume (ESV) (mean ± SD: 24.6±8.7 mL vs 26±7.3 mL, p<0.001), and higher EF (64% vs 60.2%, p<0.001). The results for the interpolated series were also different from the original images (closer to the original 16-frame series rather than 8-frame).

    Conclusion

    Changing the frame number from 8 to 16 in cardiac ECG-gated SPECT images caused a significant change in LV volumes and EF. Frame interpolation with sophisticated algorithms can be used to improve the temporal resolution of SPECT images.

    Keywords: SPECT, Echocardiography, Interpolation, End-diastole volume (EDV), End-systole volume (ESV), Ejection fraction (EF)
  • Katayoun Falahat, Monir Baradaran Eftekhari*, Asghar Ebadifar, Masoumeh Eltemasi, Zahra Sobhani, Elham Ghalenoee, Elham Habibi Page 59
    Background

    As the partner country of the WHO Commission on Social Determinants of Health (SDH), Iran has expanded the knowledge based on the social determinants of health- as one of commission recommendations- by establishing SDH research centers to collect evidence and design responses to the existing health equity gap. Considering the importance of the role assigned to these research centers, this study aimed to present the knowledge production of SDH research centers and determine their status in Iran’s health research system (HRS).

    Methods

    In this cross sectional study, research performance of SDH research centers was assessed based on international research indicators and compared with national medical research centers and HRS knowledge production. Then, SDH research centers were scored and ranked based on the research indicators.

    Results

    Out of 37 approved SDH research centers, the knowledge performance of 33 research centers was reviewed. The total number of academic members was 334. The number of these centers’ indexed published articles and the proportion of published articles per academic member have been doubled from 483 and 1.44 in 2015 to 984 and 2.94 in 2017. In this period, the number of citations of the past 5-year publications was 4355 according to Scopus database. The proportions of these centers’ high-quality publication (Q1) and international collaborations per published articles were 14.8 and 8.25. In ranking, the first to third ranks were occupied by SDH research centers of Kermanshah, Kurdistan, and Qazvin Universities of Medical Sciences.

    Conclusion

    Although knowledge production seems desirable in mentioned research centers, it is essential to create a virtual research network to increase intersectoral collaboration and develop strategies to solve the puzzle of gathering evidence on the social determinants affecting health inequities.

    Keywords: Health equity, Social determinants of health, Health research system, Research center, Knowledge production, Iran
  • Owais Raza, MohammadAli Mansournia, Abbas Rahimi Foroushani, Kourosh Holakouie Naieni* Page 60
    Background

    Diarrhea in children under 5 years is generally considered as an important public health problem and the major cause of childhood morbidity and mortality in Sub-Saharan Africa. The purpose of this study was to present exploratory spatial data analyses to identify spatial clusters and outliers in the prevalence of childhood diarrhea in Mozambique.

    Methods

    Using data from 2011 Mozambique Demographic and Health Survey, we calculated the prevalence of childhood diarrhea on the district level. Two exploratory spatial data analyses methods were applied, namely, global and local Moran’s I statistics, providing spatial autocorrelation and spatial clusters/outlier in the prevalence of childhood diarrhea, respectively.

    Results

    Choropleth mapping and global Moran’s I statistics showed that the prevalence of childhood diarrhea has clustered distribution across the study area. A local Moran’s I index revealed spatial clusters within the province of Tete, Gaza, Cabo Delgado, and Zambezia. However, spatial outliers were confined within Sofala province.

    Conclusion

    The exploratory spatial data analyses showed various spatial clustering and outliers present in the prevalence of childhood diarrhea, indicating interventions needed in targeted regions.

    Keywords: Diarrhea, Mozambique, Geographic information systems, Spatial analysis
  • Seyed Hamidreza Bagheri, Alimohamad Asghari, Mohammad Farhadi, AhmadReza Shamshiri, Ali Kabir, Seyed Kamran Kamrava, Maryam Jalessi, Alireza Mohebbi, Rafieh Alizadeh, AliAsghar Honarmand, Babak Ghalehbaghi*, Alireza Salimi, Fatemeh Dehghani Firouzabadi Page 61
    Background

    The occurrence of anosmia/hyposmia during novel Coronavirus disease 2019 (COVID-19) may indicate a relationship between coincidence of olfactory dysfunction and coronavirus disease 2019 (COVID-19). This study aimed to assess the frequency of self-reported anosmia/hyposmia during COVID-19 epidemic in Iran.

    Methods

    This population-based cross sectional study was performed through an online questionnaire from March 12 to 17, 2020. Cases from all provinces of Iran voluntarily participated in this study. Patients completed a 33-item patient-reported online questionnaire, including smell and taste dysfunction and their comorbidities, along with their basic characteristics and past medical histories. The inclusion criteria were self-reported anosmia/hyposmia during the past 4 weeks, from the start of COVID-19 epidemic in Iran.

    Results

    A total of 10 069 participants aged 32.5±8.6 (7-78) years took part in this study, of them 71.13% women and 81.68% nonsmokers completed the online questionnaire. The correlation between the number of olfactory disorders and reported COVID-19 patients in all provinces up to March 17, 2020 was highly significant (Spearman correlation coefficient = 0.87, P< 0.001). A sudden onset of olfactory dysfunction was reported in 76.24% of the participations and persistent anosmia in 60.90% from the start of COVID-19 epidemic. In addition, 80.38% of participants reported concomitant olfactory and gustatory dysfunctions.

    Conclusion

    An outbreak of olfactory dysfunction occurred in Iran during the COVID-19 epidemic. The exact mechanisms by which anosmia/hyposmia occurred in patients with COVID-19 call for further investigations.

    Keywords: Coronavirus, COVID, COVID-19, SARS-CoV-2, Anosmia, Smell, Hyposmia, Dysgeusia, Taste loss, Gustatory, Olfactory, Olfaction, Infection, ENT
  • Maryam Ramezanian, Ali Akbar Haghdoost*, MohammadHossein Mehrolhassani, Masoud Abolhallaje, Reza Dehnavieh, Atousa Poursheikhali Page 62
    Background

    Different factors affect Iran's health care financing system, and regardless of this impact, the future of this system will face fundamental challenges. In this environment, a health system is successful if it is able to anticipate the effects of these factors in the future of health care financing and preplan appropriate interventions towards health care financing system. The present study aims to identify these factors and trends.

    Methods

    This study compiled a round view of the experts on the subject, with a future studies approach through a qualitative method. To collect data, a deep and semi-structured interview was performed. The results of the interviews were analyzed using content analysis method, and the primary and secondary themes were extracted using the Micmac software.

    Results

    A total of 71 variables were identified in the form of 12 groups with titles of stewardship, service provision, resource gathering, purchasing and resource allocation, sociocultural, technological, environmental, economic, political, and managerial, and laws and values. Four variables, including distant-service provision, administrative bureaucracy, administrative focus and corruption, low-support decision-making, economic blockade, and sales of oil were among the influential factors and drivers.

    Conclusion

    The findings showed Iran's financing system is relatively stable but fragile and 3 areas of technology, politics, and economics have the most impact on structuring Iran’s financing system.

    Keywords: The financing system, Future studies, Key forces, Drivers, Health system functions
  • Fatemeh Kashaninasab, Reza Panahi Dashdebi, MirFarhad Ghalehbandi* Page 63

    This study attempted to diagnose and examine the treatment challenges of a 25-year-old patient with the first episode of bipolar I disorder (BD-I) who also had Coronavirus disease 2019 (COVID-19) at the same time. This patient was admitted to the general ward of the hospital, along with other COVID-19 patients, and was treated with electroconvulsive therapy (ECT). Our results showed that it is important to pay attention to the comorbidity of psychiatric disorders in patients with COVID-19 to evaluate and treat them completely and avoid drug interactions.

    Keywords: COVID-19, Bipolar disorder, Case report
  • Seyed Mohammad Hashemi Shahri, Mohammad Khammarnia, Alireza Ansari Moghaddam*, Fatemeh Setoodehzadeh, Hassan Okati Aliabad, Mostafa Peyvand Page 64
    Background

    In the 21st century, the world has become a global village and a disease outbreak in one part of the world can spread rapidly to other countries far away.

    Methods

    The emergence of the new Coronavirus (COVID-19) in China in January 2020 and its growing level of spread and severity between and within other countries as well as different continents has become a global emergency. Moreover, low health literacy results in more problems and continuation of the outbreak. Consequently, COVID-19 pandemic may produce new debates, discussions, and disturbing developments every day. In the meantime, cyberspace plays an important role in this case.

    Results

    Improving people's health literacy can lead to increased potential of patients to make informed decisions, reduce health risks, increase disease prevention, and improve quality of life.

    Conclusion

    The experience during COVID-19 pandemic has shown that health literacy plays an important role in preventing and controlling diseases and pandemic.

    Keywords: COVID-19, Health literacy, Sources of news
  • Mehdi Shirazi, Alireza Aminsharifi*, Faisal Ahmed, Alireza Makarem, Seyed Alihossein Zahraei, Naeimehossadat Asmaarian Page 65
    Background

    To evaluate the outcome of retrograde endopyelotomy as a minimally invasive option for management of failed open pyeloplasty in children and assess how the duration of post-procedural stenting may affect the endopyelotomy outcome.

    Methods

    A total of 15 patients with secondary UPJO (Ureteropelvic junction obstruction) underwent retrograde endopyelotomy.  The procedure was done using low-energy monopolar electrocautery hook under direct vision of pediatric ureteroscope and control of fluoroscopy. Double J stent was placed after the operation in all cases. Stent was removed in another session, 8 weeks (Group A, n=7) vs. 12 weeks (Group B, n=8) after endopyelotomy. Patients in both Groups were followed one, six and twelve months after the stent removal, and the anteroposterior renal pelvis diameter (APD), renal cortical thickness (CT) and degree of hydronephrosis (HDN) were recorded using the repeated measure test. P-value less than 0.05 were significant. We analyzed the data using SPSS software, version 20.

    Results

    The median interquartile range (IQR) age at time of surgery for group A and B were 24 (62) months and 12 (50) months respectively. Median (IQR) times between previous pyeloplasty and endopyelotomy were 6 (6) months and 12 (8.5) months in groups A and B, respectively. The success rate of endopyelotomy after 12 months was 57.1% in group A and 87.5% in group B. The resolution of HDN was more prominent in the 12 week stenting group compared to the 8 week group during the 12 months follow-up period (p=0.030). The APD and CT in group B compared to group A was improved during follow-up period.

    Conclusion

    A higher one-year success rate of retrograde endopyelotomy in terms of improvements in the degree of HDN, APD and CT was observed when the double j stent was remained for 12-weeks rather than 8-weeks. This observation need to be validated in a large cohort study with a long term post procedural follow up.

    Keywords: Double-J stent, Endopyelotomy, Treatment failure, Pyeloplasty, Ureteropelvic junction obstruction
  • Jude Okoye* Page 66
    Background

    In Nigeria, the policies and interventions due to the COVID-19 pandemic are majorly directed at businesses and relief. There are no clear plans to identify individuals with comorbidities associated with high morbidity and fatality rates. This paper identifies comorbidities associated with high morbidity and fatalities of COVID-19 across countries and vulnerable groups in Nigeria.

    Methods

    Peer-reviewed articles published between 2010 and 2020 retrieved from Google scholar, African Journal Online, EMBASE, Scopus, and MEDLINE/PubMed (central) were systematically reviewed.

    Results

    The pooled prevalence of hypertension is the lowest in North Central Nigeria (22.0%) and the highest in South-Eastern Nigeria (33.6%) while the pooled prevalence of diabetes mellitus (DM) is lowest in North-Western Nigeria (3.0%) and highest in South-Southern Nigeria (9.8%). Significant differences in the frequency of comorbidities (hypertension, DM, cardiovascular disease, cancer, and chronic kidney disease; CKD) and complications (cardiac injury and acute respiratory disease syndrome; ARDS) were observed between fatal and non-fatal cases of COVID-19 (p<0.0001). There were significant correlations between hypertension and ARDS (p=0.002), DM and ARDS (p=0.010), hypertension and (p<0.0001), DM and CKD (p=0.033), and hypertension and DM (p=0.001).

    Conclusion

    High prevalence of comorbidity may be predictive of high COVID-19 morbidity and mortality. Thus, to flatten the curve early intervention funds should be appropriately allocated based on the prevalence of comorbidities in the geopolitical zones. Such high-risk groups should be identified, stratified and actively monitored during treatment to prevent the development or progression of complications such as cardiac injury and ARDS.

    Keywords: COVID-19, Comorbidities, Fatality, Cardiac injury, Cancer
  • Hadi Kazemi Arpanahi, Khadijeh Moulaei, Mostafa Shanbehzadeh* Page 67
    Background

    The 2019 coronavirus (COVID-19) is a highly contagious disease associated with a high morbidity and mortality worldwide. The accumulation of data through a prospective clinical registry enables public health authorities to make informed decisions based on real evidence obtained from surveillance of COVID-19. This registry is also fundamental to providing robust infrastructure for future research surveys. The purpose of this study was to design a registry and its minimum data set (MDS), as a valid and reliable data source for reporting and benchmarking COVID-19.

    Methods

    This cross sectional and descriptive study provides a template for the required MDS to be included in COVID-19 registry. This was done by an extensive literature review and 2 round Delphi survey to validate the content, which resulted in a web-based registry created by Visual Studio 2019 and a database designed by Structured Query Language (SQL).

    Results

    The MDS of COVID-19 registry was categorized into the administrative part with 3 sections, including 30 data elements, and the clinical part with 4 sections, including 26 data elements. Furthermore, a web-based registry with modular and layered architecture was designed based on final data classes and elements.

    Conclusion

    To the best of our knowledge, COVID-19 registry is the first designed instrument from information management perspectives in Iran and can become a homogenous and reliable infrastructure for collecting data on COVID-19. We hope this approach will facilitate epidemiological surveys and support policymakers to better plan for monitoring patients with COVID-19.

    Keywords: Minimum data set, MDS, Registry system, COVID-19, Coronavirus
  • Abbas Abbasi Ghahramanloo, Esmail Moshiri, Sima Afrashteh, Ali Gholami, Saeid Safiri, Abolfazl Mohammadbeigi*, Hossein Ansari Page 68
    Background

    The prevalence of metabolic syndrome (MS) is rapidly increasing in the world. Thus, the aim of the present study was to identify the latent subgroups of  Iranian male adults based on MS components and investigate the effect of abnormal alanine aminotransferase (ALT) and aspartate aminotransferase (AST), high total cholesterol (TC), and low-density lipoprotein  (LDL) on the odds of membership in each class.

    Methods

    In the present study, we used the data of a population-based screening program conducted on 823 urban adult men aged 25 years and older in city of Qom in 2014.  Abdominal obesity, fasting blood sugar (FBS), blood pressure, and serum lipid profile were measured in participants after for at least 8 hours. MS was defined according to the Adults Treatment Panel III criteria. Latent class analysis was used to achieve the aims of study. Analyses were conducted using PROC LCA in SAS 9.2 software. In all analysis, p value < 0.05 was considered statistically significant.

    Results

    There were 3 different latent classes among participants. Latent class 1, non-MS, 55.1%; latent lass 2, at risk, 21.3%; and finally latent class 3, MS, with 23.6% of the participants. Age (OR=0.98, 95% CI: 0.98-0.99, high LDL (OR=0.27, 95% CI: 0.13-0.56), high TC (OR=8.12, 95% CI: 4.40-15.00), and abnormal ALT (OR=2.25, 95% CI 1.49-3.41) were associated with at risk class. Also, only age (OR=1.02, 95% CI: 1.01-1.04) was associated with MS class. The most prevalent components among the participants were having low HDL (34.0%) and high WC (33.9%).

    Conclusion

    Notable percent of samples fell in “at risk” and “MS” classes, which stress the necessity of designing preventive interventions for these specific stratums of population.

    Keywords: Metabolic syndrome, Latent class analysis, Subgrouping, Iran
  • Ghobad Ramezani, Azam Norouzi, Eshagh Moradi, Ghadir Pourbairamian, Maryam Aalaa, Somayeh Alizadeh, Zohreh Sohrabi* Page 69
    Background

    Evidence-based medicine is one of the most important topics in medical sciences that requires a proper teaching method. Very few studies have evaluated EBM education outcomes through peers and TBL workshops. The purpose of this study was to compare the effect of evidence-based medicine (EBM) education through peers with TBL workshop method in medical students.
      

    Methods

    This quasi-experimental study was conducted on 42 medical students of the Faculty of Medicine in Iran University of Medical Sciences (IUMS) in 2019 who were selected through convenience sampling. Students were divided into 2 experimental and control groups based on the randomized blocking method. The data collection tools were 2 questioners that evaluated EBM knowledge and satisfaction in both intervention and control groups. The knowledge of students was compared using pretest and posttest and their satisfaction was evaluated at the end of the TBL workshop and peer education. Data were analyzed by SPSS software and descriptive tests (t test and ANOVA), and significance level was set at 0.95.
      

    Results

    A significant difference was found between the level of basic knowledge (pretest) and secondary knowledge (posttest) in the EBM education through TBL workshop method compared to peer method. The average scores gained by students in TBL workshop were 3.8 more than the peer teaching method. The results of the Satisfaction Questionnaire were 74% in control group and 86% in the experimental group.
      

    Conclusion

    EBM education through TBL workshop both increased students’ knowledge and satisfaction compared to peer education. Thus, it can be concluded that providing EBM education by expert and qualified teachers through face to face teaching strategy can be effective in knowledge translation. However, peers can participate in educational sessions as facilitators.

    Keywords: evidence-based medicine, peer education, TBL workshop, Education
  • Pooneh Maziar, Sajjad Razavi*, Leila Hosseini Ghavamabad Page 70
  • Aysan Latifi, Samad Ghanizadeh Vesali, Soudabeh Hosseini, Monireh Mohsenzadegan* Page 71
    Background

    At early ages, recurrent or persistent infections are associated with increased serum C-reactive protein (CRP). Inflammatory mediators release inhibitory cells named myeloid-derived suppressor cell (MDSC) into circulating and tumor tissues. In the present study, we assayed the percentage and count of whole blood CD11b+/CD33+/HLA-DR- MDSCs or myeloid cells at early ages with infectious diseases and increased CRP.

    Methods

    In this study, the clinical significance of CD11b+/CD33+/HLA-DR- MDSCs or myeloid cells was evaluated in whole blood samples from 40 patients with infectious disease and 20 healthy controls by flow cytometry analysis. Subsequently, the Pearson correlation between the percentage and absolute count of MDSCs with clinical parameters were obtained by SPSS analysis. A p value of < 0.05 was considered statistically significant.

    Results

    We found a significantly higher level of MDSCs in infants and children with infectious diseases and increased CRP as compared to healthy controls (P=0.003). However, the results of analysis showed no correlation between MDSC percentage and count with grouped age and sex in patient groups. 

    Conclusion

    Our findings showed a significant correlation between the high level of serum CRP and peripheral blood CD11b+/CD33+/HLA-DR- MDSCs at early ages. This study could be a roadmap for future studies to use increased CRP as a potential prognostic biomarker to target MDSCs in children with recurrent or persistent infections.

    Keywords: CRP, MDSC, Infectious disease
  • Reza Ghaffari, Ali Taghizadieh, Mozhgan Behshid*, MohammadHusein Somi, Azim Mirzazadeh, HamidReza Baradaran, Mark Huntington, Seyed Hasan Emami Razavi, Flora Baghban, Fariba Salek Ranjbarzadeh Page 72
    Background

    To implement the education reform package on accountability in medical education, the Education Development Center (EDC) of Tabriz University of Medical Sciences has held the first national conference on accountability in medical education, and the present statement is the result of scientific interactions and exchanges in the conference.

    Methods

    For implementation of the accountability in medical education, there was a need to inform faculty members and other stakeholders about their responsibility in education and health care needs. The provision of such platform was provided by holding a specialized conference on accountability in medical education by Tabriz University of Medical Sciences. Steps of preparing the draft version of the Tabriz 2018 Statement were as follow: Formation the scientific committee; Division of the responsibility for drafting the statement between various workgroups; and Preparation and primary approval of the draft of Tabriz 2018 Statement.

    Results

     Steps of preparing the draft version of the Tabriz 2018 Statement were: Formation of the scientific committee, Division of the responsibility for drafting the statement between the various workgroups and Preparation and primary approval of the draft of Tabriz 2018 Statement

    Conclusion

    Establishing an educational accreditation model and reviewing accreditation standards based on social accountability can be an effective step to strengthen accountability towards community needs.

    Keywords: Accountability, Medical, Education, Implementation
  • Akram Hashemi, Fatemeh Bahmani, Saeedeh Saeedi Tehrani, Mina Forouzandeh, Jalil Koohpayehzadeh, Mortaza Ashrafi, MajidReza Khalajzadeh, Seyed Abbas Motevalian* Page 73
    Background

    Research ethics committees are comprised of policymakers, supervisors, and decision-makers and aim at increasing adherence to professional ethics standards in conducting health-related research. The existential philosophy of these committees is to preserve the patients’ health, maintain and promote public trust in health care providers, protect the rights of both patients and health care providers, and promote organizational ethics.However, this task can be complex and challenging during a public health emergency. Research ethics committees set the standard of research in the emergency situations through defining which research has the potential to promote the quality of response to a public health emergency.

    Methods

    This study aims at collecting and classifying the valuable experiences of the research ethics committee members and reviewers during the early days of the COVID-19 epidemic in Iran University of Medical Sciences, one of the major universities in Tehran. It provides a basic understanding of the key concepts and challenges in reviewing and approving research by research ethics committees and the recommendations to overcome these challenging issues.

    Results

    To accelerate the review process of COVID-19 research proposals, the scientific, methodological and ethical review panel was integrated as a large committee called ‘IUMS Corona Research Team’. The first meeting was held on March 7, two weeks after the official announcement of the first case of the disease and is continued once a week. A total of 130 projects have been discussed and evaluated in this committee, among which 83 proposals were approved after modification.

    Conclusion

    An interdisciplinary approach supports a flexible and effective scientific and ethical review of research leading to more protection of research subjects as well as promotion in the treatment and management of the pandemic ahead.

    Keywords: Research ethics committee, Pandemic, COVID-19
  • Mehrdad Pashazadeh* Page 74
    Background

    Exosomes are extracellular cells (EVs) emancipated by various cell types and are involved in cell-to-cell transmission. In cancer diseases, exosomes emerge as local and systemic cells to cell mediators of oncogenic information and play a significant role in the advancement of cancer through the horizontal transfer of various molecules, such as proteins and miRNAs.

    Methods

    In this study, 66 articles from PubMed, MEDLINE, Science Direct, Cochrane, EMBASE, and Scopus were used as English sources.

    Results

    The biological distribution of cancer cell-derived exosomes in tumor tissue is an important factor in detecting their role in tumor increase; on the other hand, a limited number of studies have examined the biodistribution of exosomes in tumor tissues. While exosomes function as cancer biomarkers and support cancer treatment, we have a long way to improve the antitumor treatment of exosomes and develop exosome-based cancer diagnostic and therapeutic strategies.

    Conclusion

    This review describes the science and significance of cancer pathogenesis and exosomes relative to cancer treatment resistance.

    Keywords: Exosome, Cancer pathogenesis, Tumor, Metastasis, Immune system
  • Vasna Joshua, Satish Sivaprakasam* Page 75
    Background

    The World Health Organization declared the outbreak of COVID-19as a public health emergency of international concern on January 30, 2020. Therefore, relevant research metrics would be an added value for understanding the virus for researchers.

    Methods

    Research outputs related to the Coronavirus were retrieved from the Web of Science database from January 1968 to March 2020 and were analyzed using MS-office, Word Cloud generator, VOS viewer, and ArcGIS software. The analysis was based on the number of research publications per year, contributing author’s clustering pattern, most preferred journals, leading publication, document type, broad research areas, commonly used keywords, the geographical distribution of publications, commonly used languages, and productive institutes.

    Results

    The search retrieved 6424 Coronavirus research publications. The number of articles found in the year 1968 was 1, but it was 275 in 2019. A total of 33 clusters of authors contributed to studies on COVID-19 across the globe. The Journal of Virology had the most productivityon Coronavirus publications (n=810). An article published by Ksiazek TG et al in the New England Journal of Medicine had the maximum citation (n=2175); 90% of the research outputs were articles, broadly classified under Infectious diseases (n=5341); and the most commonly used keyword was ‘Coronavirus’. The higher number of publications was from the USA (n=2345) and the commonly used language was English (n=5948), and the most productive institute was the University of Hong Kong (n=506).

    Conclusion

    The results of the study showed that the growth pattern was not uniform, the United States, and the University of Hong Kong have played a major role in the contribution of Coronavirus research. Even though this depicts a higher scientific growth, it is an alarming sign to the community for preparedness. Under the prevailing situation of seeking better prevention, treatment and vaccination for COVID-19, in-depth research in the above portrayed metrics would be an added knowledge for the researchers.

    Keywords: Coronavirus, Bibliometric, Public health, Novel coronavirus, Web of Science, COVID-19
  • Nazanin Hajizadeh, Nasrin Saharkhiz*, Sedigheh Hosseini, Behnam Arabzadeh Page 76
    Background

    The preterm labor has increased in multiple pregnancies over the past 2 decades. Preterm labor has led to increase in neonatal mortality rates, long-term morbidity, respiratory distress, and neonatal infections. Thus, this study aimed at investigating the effect of cerclage versus pessary on the prevention of preterm birth in twin pregnancies.

    Methods

    This prospective randomized clinical trial was performed on 50 women pregnant with twins who visited Taleghani hospital in 2016-2018. Their cervical length, which was measured by transvaginal ultrasonography (TVS), was less than 30 millimeters at week 14 of pregnancy. The participants were randomly divided into 2 groups (n=25). They separately underwent cervical pessary and cerclage. McDonald's procedure was performed in cerclage group from 14 to 27 weeks. The suture material was Mersilene Ethicon 5-0 double-armed s14 needle. Ring hodge pessary was also inserted in the vagina of the participants in the pessary group. All the patients were injected 250 mg intramuscular 17 alpha-hydroxyprogesterone caproate weekly from week 16 to week 36. All statistical analyses were performed using SPSS 18 software.

    Results

    The results of this study showed that the mean ± standard deviation (SD) for pregnancy length of the cerclage and pessary groups were 238.6±32.4 and 223.6±16.6, respectively. Also, significant differences were found between the 2 groups (p=0.048). No significant difference was found in pregnancy (p=0.565), length of pessary/cerclage use (p=0.491), and BMI before and after delivery between the cerclage and pessary groups (p>0.05).

    Conclusion

    The use of cerclage in twin pregnancies is recommended to increase the length of pregnancy.

    Keywords: Cerclage, Pessary, Twin pregnancy
  • Khalid Mahmood, Ramsha Riaz, Muhammad Salman Ul Haq*, Khizar Hamid, Hassaan Jawed Page 77
    Background

    Irritable Bowel Syndrome (IBS) is one of the most commonly diagnosed gastrointestinal disorders, and its etiology is believed to be multifactorial. The role of smoking in the pathophysiology of IBS still remains inconclusive. Hence, we aim to investigate whether or not an association exists between smoking and IBS.

    Methods

    A cross-sectional study was conducted in a tertiary care hospital of Karachi. A sample size of 200 smokers and 200 non-smokers was selected. A two-part self-reported questionnaire was administered to the participants and the diagnosis of IBS was based on the Rome III diagnostic criteria. All data were analyzed using the Statistical Package for the Social Sciences version 17. Statistical tests employed were Independent samples t-test, chi-square test, and binary logistic regression analysis to obtain Odds Ratio (OR) for various variables. A P-value <0.05 was considered statistically significant.

    Results

    Overall prevalence of IBS based on Rome III criteria was 9.5% (95% CI 9.45-9.60). Smoking was significantly found to be associated with IBS (P=0.002). Binary logistic regression analysis indicated that non-smokers were more likely to have IBS (Crude OR: 3.00, 95% CI 1.23-7.30) than smokers, and females were more likely to have IBS (Crude OR: 3.73, 95% CI 1.56-7.69) than males. Age, BMI, and food groups were not found to be significantly associated with IBS.

    Conclusion

    Our study concludes that IBS was more prevalent among non-smokers and amongst females. Further studies are required to firmly establish the role of smoking in IBS.

    Keywords: Irritable bowel syndrome, Smoking, Risk factors, Gastrointestinal diseases, Pakistan
  • Aliasghar Hayat, Naeimeh Kohoulat, Mitra Amini, Seyed AliAkbar Faghihi* Page 78
    Background

    Determining the variables influencing students’ academic performance is one of the main preoccupations in medical colleges. Therefore, this study examined the effect of the Big Five personality traits on medical students’ academic performance, considering the mediating role of self-efficacy.

    Methods

    We applied a cross sectional research design using a PLS-SEM approach.  A total of 249 medical students participated in this study. Two valid and reliable questionnaires, including Big Five Inventory (BFI-10) and New General Self Efficacy (GSE) were used. Data were analyzed using both SPSS 18 and PLS2 software.

    Results

    The validity and reliability of the questionnaires were confirmed by confirmatory factor analysis. The results revealed that openness (β= 0.16, p<0.001), conscientiousness (β=0.22, p<0.001), agreeableness (β=0.19, p<0.001), and self-efficacy (β=0.24, p<0.001) had a significant positive and direct effect on academic performance. Neuroticism (β=-0.21, p<0.001) had a significant negative and direct effect on academic performance. Also, openness (β=0.47, p<0.001) and conscientiousness (β=0.33, p<0.001) had a direct positive effect on self-efficacy. Neuroticism (β=-0.15, p<0.001) had a direct negative effect on self-efficacy. Moreover, the results showed an indirect positive effect of conscientiousness (β=0.08, p<0.001) and openness (β=0.11, p<0.001) on academic performance through self-efficacy. In addition, the results showed that neuroticism (β=-0.03, p<0.001) had an indirect negative effect on academic performance through self-efficacy. 

    Conclusion

    This study discovered the relationships between personality traits, self-efficacy, and academic performance of medical students. The results showed that individual differences in personality traits directly and indirectly play an essential role, through self-efficacy, in contributing to the students’ academic performance.

    Keywords: Personality, Self-efficacy, Performance, Medical student
  • Babak Eshrati, HamidReza Baradaran*, Saeed Erfanpoor, Arash Mohazzab, Yousef Moradi Page 79
    Background

    As hospitalized patients with COVID-19, especially those who are admitted to ICU or die afterwards, generally have comorbidities, the aim of this study was to determine the factors affecting the survival rate of COVID-19 patients in Iran using a retrospective cohort.

    Methods

    This retrospective cohort study was conducted on patients with COVID-19 who referred to medical centers under the supervision of Iran University of Medical Sciences, Tehran, Iran, from February 22 to March 25, 2020. The final date of follow-up was April 19, 2020. All consecutive inpatients with laboratory-confirmed COVID-19 were included in this study. Clinical laboratory, radiological, treatment, and demographic data were collected and analyzed. The associations among gender, immune disease, diabetes, liver disease, cardiovascular disease, kidney disease, chronic pulmonary disease, cancer, chronic nervous disease, type of treatment, and risk of death were analyzed. The Kaplan-Meier and Log-rank tests were used to estimate survival rate and compare survival rates, respectively.

    Results

    The total number of deaths or desired event in the study was 329 (10.3%).The risk of death in the age groups of 50-60 years, 60-70 years, and >70 years compared to the 30-40 age group was 2.17 (95% CI: 1.03, 4.55; p: 0.040); 3.72 (95 % CI: 1.80, 7.68; p: 0.001) and 5.09 (95 % CI: 2.49, 10.40; p: 0.001), respectively. The results showed men had 11.5% more risk of deaths than women (HR: 1.11; 95 % CI: 0.89, 1.39; p: 0.341). Kidney disease increased the risk of death by 52.3% in these patients, which was not statistically significant (HR: 1.78; 95 % CI: 1.04, 3.04; p: 0.035). Also, chronic pulmonary diseases and diabetes increased the risk of death in COVID-19 patients by 89.5% and 41.3%  compared to COVID-19 patients without chronic pulmonary diseases and diabetes [(HR: 1.89; 95 % CI: 1.17, 3.04; p: 0.008), (HR: 1.41; 95 % CI: 1.01, 1.96; p: 0.038)].

    Conclusion

    Based on the results of this study, more attention and care should be paid to COVID-19 patients with underlying diseases, such as chronic obstructive pulmonary disease, diabetes, and kidney disease to reduce the number of deaths.

    Keywords: Survival Rate, Death, Risk Factors, COVID-19, Iran
  • MohammadHossein Panahi, Mahboubeh Parsaeian, MohammadAli Mansournia, Mostafa Khoshabi, MohammadMehdi Gouya, Payman Hemmati, Akbar Fotouhi* Page 80
    Background

    Investigating the spatial aspects of the disease can help decision-makers and researchers better understand the pattern of the disease, and is also very important in the implementation of the disease control programs. Given the vast area of Iran, as well as the diverse geographical and climate conditions of the country, using the geographical information system (GIS) is a suitable method for the study of influenza. In this study, we provide a clear picture of the distribution of the influenza-like illness (ILI) in Iranian provinces through the years from 2011 to 2016 by applying a spatio-temporal analysis, using geographic information system (GIS). Disease rates by location and year are estimated, and then hot spots and cold spots are distinguished.

    Methods

    This study was conducted using the ILI incidence rate data recorded in the Iranian Influenza Surveillance System from August 2011 to August 2016. The Choropleth map method and the various equal interval and natural break classifications were used. The local Getis-Ord Gi* method was then used to identify the hot spots and regions where, for some reason, the distribution of the disease had significantly clustered spatially. Statistical analyses were done using the ArcGIS 10.2 software.

    Results

    This study indicates that the highest ILI rate belongs to the period from August 2014 to August 2015 with a rate of 180.26 (95%CI: 177.65 to 182.9) per 100,000 people. The results show that the highest 5-year mean of ILI rate belongs to Zanjan, Markazi, Lorestan, Ilam, North Khorasan, and South Khorasan provinces. Also, results from the local Getis-Ord Gi* method show that ILI has formed a hot spot between the years 2011 and 2013 on the eastern borders of Iran and afterward during the years 2014 to 2016 in the western regions of the country.

    Conclusion

    Given the importance of influenza and its huge economic burden on the society, identifying the hot spot regions can help better manage the disease. This study indicates the distribution of the disease has formed a hot spot in the western regions of the country.

    Keywords: Epidemiology, Influenza, Surveillance, Spatial analysis, Iran
  • Amir Javanmard, Kianoush Abdi*, Abbas Ebadi, Samaneh Hosseinzadeh Page 81
    Background

    Spinal cord injury (SCI) has serious impacts on the patient’s function. Therefore, their participation is important as one of the major indicators of the quality of life. This study reviews instruments that evaluate participation among people with spinal cord injury.

    Methods

    Four electronic databases (WebofScience, Scopus, MEDLINE/PubMed, SID) were searched for studies published in the English language between 2000 and 2019 in one or more peer-reviewed journals on the measurement properties (reliability, validity and/or responsiveness) in all populations including adults with SCI. Instruments assessed based on special criteria designed for disability outcome measures.

    Results

    Six instruments were included: Incontinence - Activity Participation Scale, Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-P), World Health Organization's disability assessment tool-II (WHODAS-II), ICF Measure of Participation and ACTivities Screener (IMPACT-S), Impact on Participation and Autonomy (IPA) , Participation measure for Post-Acute care (PM-PAC). Evidence related to the reliability and validity was reported for all of the instruments. Only WHODAS-II, USER-P, and IMPACT were compared with each other in recent publications. Responsiveness was not obtained for any of the instruments.

    Conclusion

    As the underlying structure of every instrument is different, the concept of the evaluated participation varies between instruments. The proper instrument for examining participation of the patients with SCI should be selected based on a thorough analysis of the individual's condition and context. Innovative models of disability should be the basis of emerging instruments for evaluation of participation, as well as empirical studies and modern measurement technologies that fill the gap between the perceived participation of the individual and the research's record.

    Keywords: Rehabilitation, Participation, Spinal cord Injury, Outcome, Measurement
  • Ahmad Tayefi, Abdolreza Pazouki, Kaveh Alavi, Razieh Salehian, Fahimeh Soheilipour, Atefeh Ghanbari Jolfaei* Page 82
    Background

    Obesity is a chronic disease that causes several medical and psychiatric complications. There are plenty of pharmacological and non-pharmacological therapies for obesity treatment. Bariatric surgery is one of the most efficient non-pharmacological treatment for morbid obesity; however, several psychological factors affect the success of bariatric surgery. This study aims to evaluate personality characteristics and eating attitude relationship with the success of bariatric surgery.

    Methods

    This study was carried out on 75 patients with obesity who were candidates of bariatric surgery in the obesity clinic of Rasoul-e-Akram Hospital in Tehran. The patients were asked to fill the TCI and EAT-26 questionnaires before and after the surgery. Statistical analyses were performed using the SPSS-23 applying T-test, Mann-Whitney tests and Pearson and Spearman's correlation coefficient. The significance level was set at 0.05.

    Results

    Seventy-five patients, including 13 men and 62 women, were assessed through this study. The
    mean of the BMI of the participants was 44.7 prior to the surgery and 30 after the operation. Personality characteristics and eating attitudes had no significant relationship with the success of bariatric surgery.

    Conclusion

    Although the eating attitude and personal characteristics of the bariatric surgery candidates before the surgery was not related to the outcome of the surgery, they should be considered in post-operational psychological assessments.

    Keywords: Temperament, Eating attitude, Personality characteristics, Success, Bariatric surgery, Obesity
  • Razieh Bidhendi Yarandi, Kazem Mohammad, Hojjat Zeraati, Fahimeh Ramezani Tehrani, MohammadAli Mansournia* Page 83
    Background

    The Bayesian methods have received more attention in medical research. It is considered as a natural paradigm for dealing with applied problems in the sciences and also an alternative to the traditional frequentist approach. However, its concept is somewhat difficult to grasp by nonexperts. This study aimed to explain the foundational ideas of the Bayesian methods through an intuitive example in medical science and to illustrate some simple examples of Bayesian data analysis and the interpretation of results delivered by Bayesian analyses. In this study, data sparsity, as a problem which could be solved by this approach, was presented through an applied example. Moreover, a common sense description of Bayesian inference was offered and some illuminating examples were provided for medical investigators and nonexperts.

    Methods

    Data augmentation prior, MCMC, and Bayes factor were introduced. Data from the Khuzestan study, a 2-phase cohort study, were applied for illustration. Also, the effect of vitamin D intervention on pregnancy outcomes was studied.

    Results

    Unbiased estimate was obtained by the introduced methods.

    Conclusion

    Bayesian and data augmentation as the advanced methods provide sufficient results and deal with most data problems such as sparsity.

    Keywords: Bayesian inference, Prior information, MCMC, Data augmentation
  • Hooman Tadbiri, Maziar Moradi Lakeh*, Mohsen Naghavi Page 84
    Background

    Iran reported its first COVID-19 deaths on February 19, 2020 and announced 1284 deaths with a laboratory-confirmed SARS-CoV-2 infection by March 19, 2020 (end of the winter 1398 SH). We estimated all-cause excess mortality, compared to the historical trends, to obtain an indirect estimate of COVID-19-related deaths.

    Methods

    We assembled time series of the seasonal number of all-cause mortalities from March 21, 2013 (spring of 1392 SH) to March 19, 2020 (winter 1398 SH) for each province of Iran and nationwide with the vital statistics data from the National Organization for Civil Registration (NOCR). We estimated the expected seasonal mortality and excess mortality (the difference between the number of registered and expected deaths). Moreover, we reviewed the provincial number of confirmed cases of COVID-19 to assess their association with excess deaths.

    Results

    The results of our analysis showed around 7507 (95% CI: 3,350 – 11,664) and 5180 (95% CI: 1,023 – 9,337) all-cause excess mortality in fall and winter, respectively. There were 3778 excess deaths occurred in Qom, Gilan, Mazandaran, and Golestan provinces in the winter, all among the COVID-19 epicenters based on the number of confirmed cases.

    Conclusion

    We think most of the excess deaths in the winter were related to COVID-19. Also, we think the influenza epidemic might have been the main reason for the excess mortality in the fall and parts of excess deaths in the winter of 1398 SH. Moreover, a review of all available clinical and paraclinical records and through analyses of the surveillance data for severe acute respiratory infections (SARI) can help to obtain a more accurate estimate of COVID-19 mortality.

    Keywords: COVID-19, SARS-CoV-2, Coronavirus, Iran, Mortality, Excess mortality, Excess deaths
  • Seyed Kazem Malakouti, Nafee Rasouli*, Mohsen Rezaean, Marzieh Nojomi, Behrooz Ghanbari, Azita Shahraki Mohammadi Page 85
    Background

    According to the expansion of suicide prevention applications in recent years, the aim of this study was to review randomized controlled trials (RCTs) and pretest-posttest studies that evaluated the effectiveness of suicide prevention applications.

    Methods

    In this systematic review, we searched online databases including Pubmed, SCOPUS, Web of Science, Chocrane Database, and Google Scholar to find randomized controlled trials and pretest-posttest studies published up to Jul 18, 2019. Randomized controlled trials and pretest-posttest of efficacy self-guided telephone applications that reported any primary and secondary outcome of suicidal thoughts and behaviors were included in the review. We evaluated the articles using the CONSORT 2010 checklist.

    Results

    After screening articles, 7 studies were included in this review. Four studies focused on the effectiveness of applications on suicide thoughts and attempt, 2 on effectiveness of applications on self-injury, 4 on depression and anxiety, 1 on impulsivity, and 2 on adaptive strategies. Overall, mobile phone applications were associated with reductions in suicidal ideation scores at post intervention, and enhancement of adaptive skills; however, no evidence of reduction was reported in impulsivity after use of applications.

    Conclusion

    Despite the differences in studies, this review showed that the use of mobile applications had an overall positive effect on reducing the risk of suicide and improving performance and health of patients.

    Keywords: Smartphone application, Effectiveness, Suicide prevention, Clinical trials
  • Hamed Ghaffari, MohammadReza Atashzar*, Hamid Abdollahi Page 86

    Cancer stem cells (CSCs) have critical roles in tumor development, progression, and recurrence. They are responsible for current cancer treatment failure and remain questionable for the design and development of new therapeutic strategies. With this issue, medical imaging provides several clues for finding biological mechanisms and strategies to treat CSCs. This review aims to summarize current molecular imaging approaches for detecting CSCs. In addition, some promising issues for CSCs finding and explaining biological mechanisms have been addressed. Among the molecular imaging approaches, modalities including Magnetic resonance imaging (MRI) and positron emission tomography (PET) have the greatest roles and several new approaches such as optical imaging are in progress.

    Keywords: Cancer stem cells, Molecular imaging, MRI, PET, Optical imaging
  • Gholamreza Masoumi, Amir Noyani, Arezoo Dehghani, Ali Afrasiabi, Nahid Kianmehr* Page 87
  • Jamshid Mehrzad*, Mahdieh Dayyani, Mohammadreza Erfanian Korasani Page 88
    Background

    Several environmental and genetic factors have contributed to the development of colorectal cancer (CRC). We aimed to investigate the independent and combined effects of some selected risk factors and Arg399Gln XRCC1 polymorphism on CRC.

    Methods

    A total of 180 patients with CRC and 160 healthy individuals who were matched for sex, age, and place of residence (Northeast of Iran) participated in this case-control study. Before collecting blood samples and filling out questionnaires, a written consent form was obtained from all participants. Genotypes were determined by RFLP-PCR. The comparison of genotype and allele frequencies was performed using p value based on the results of chi-square test. The odds ratios (OR) and 95% confidence intervals (CI) were calculated by employing a logistic regression model. All statistical calculations were performed using SPSS. Each of the 2-sided p values less than 0.05 were considered statistically significant.

    Results

    The level of literacy, physical activity, consumption of vegetables and fruits, and tea intake of the patients were significantly lower than healthy individuals, but gastrointestinal disorders, family history of cancer, BMI, and fast food consumption were significantly higher in cases than in controls. No significant difference was observed between the 2 groups regarding smoking, opioid addiction, alcohol consumption, diet, fish consumption, and liquid intake, using the kitchen hood, diabetes, and cardiovascular disease. Arg/Gln + Gln/Gln and Arg/Gln genotypes were involved in increased CRC risk (The crude OR =1.781 with a 95% CI of 1.156-2.744 and OR = 1.690 with a 95% CI of 0.787-3.630). Also, Gln/Gln genotype was more frequent in CRC group than in control group. However, none of the risk factors interacted with polymorphism, and thus did not have an effect on CRC.

    Conclusion

    Some risk factors, such as reducing the consumption of vegetables and fruits or reducing physical activity as well as polymorphism of the XRCC1 Arg399Gln alone, increase the risk of CRC, but they do not interact with each other.

    Keywords: Risk factors, Polymorphism, XRCC1, Colorectal cancer
  • Shirindokht Farhady, MohammadMehdi Sepehri*, AliAkbar Pourfathollah Page 89
    Background

    Mobile health or MHealth refers to the use of mobile phone in healthcare services to enhance the health level of people. Before using MHealth, it is necessary to study the effective factors in physicians’ adoption and acceptance of technology in the field of thalassemia.

    Methods

    This cross sectional study was conducted using the survey and correlation methods. The statistical population of the study consisted of hematologists who were selected using the convenience sampling method. In this study, 58 questionnaires along with structural equations modeling based on partial least squares were used. SPSS and SMART PLS2 were used for data analysis. P values less than 0.05 were considered as statistically significant.

    Results

    Based on the outcomes of the model from all theories, the coefficient of variation seems to be positive and the possibility of test is lower than 5%. The results indicated that all factors introduced in the proposed model are significantly effective in MHealth technology adoption.

    Conclusion

    In this study, using the inputs from hematologists in hospitals and clinics in Tehran, it was aimed to find the factors affecting the hematologists’ decision to use mobile health technology in reducing the complications of blood transfusion in patients with thalassemia who needed blood transfusion. Thus, plans were made determine to priorities and the existing conditions to implement this new system. Also, the strengths and weaknesses of each factor were measured to improve the weaker factors. UTAUT was used to determine the acceptance factors.  After reviewing the results, the use of this model is recommended to physicians.

    Keywords: Mobile Health, Unified Theory of Acceptance, Use of Technology (UTAUT), Thalassemia Patients
  • Mostafa Shanbehzadeh, Hadi Kazemi Arpanahi* Page 90
    Background

    Effective surveillance of COVID-19 highlights the importance of rapid, valid, and standardized information to crisis monitoring and prompts clinical interventions. Minimal basic data set (MBDS) is a set of metrics to be collated in a standard approach to allow aggregated use of data for clinical purposes and research. Data standardization enables accurate comparability of collected data, and accordingly, enhanced generalization of findings. The aim of this study is to establish a core set of data to characterize COVID-19 to consolidate clinical practice.

    Methods

    A 3-step sequential approach was used in this study: (1) an elementary list of data were collected from the existing information systems and data sets; (2) a systematic literature review was conducted to extract evidence supporting the development of MBDS; and (3) a 2-round Delphi survey was done for reaching consensus on data elements to include in COVID-19 MBDS and for its robust validation.

    Results

    In total, 643 studies were identified, of which 38 met the inclusion criteria, where a total of 149 items were identified in the data sources. The data elements were classified by 3 experts and validated via a 2-round Delphi procedure. Finally, 125 data elements were confirmed as the MBDS.

    Conclusion

    The development of COVID-19 MBDS could provide a basis for meaningful evaluations, reporting, and benchmarking COVID-19 disease across regions and countries. It could also provide scientific collaboration for care providers in the field, which may lead to improved quality of documentation, clinical care, and research outcomes.

    Keywords: Minimum basic data set, Minimum data set, COVID-19
  • Abbas Pourshahbaz, Mehrdad Eftekhar Ardebili, Behrouz Dolatshahi, Hadi Ranjbar, Mozhgan Taban* Page 91
    Background

    Gender role, sex-oriented attitudes, behaviors, cognitions, and emotions play an essential role in interpersonal relationships. Along with other factors, marital relationships and satisfaction can also be affected by a person’s gender role. The increased rate of divorce is related to a decrease in marital satisfaction. The aim of this study was to evaluate the predictor power of gender role conflict on marital satisfaction considering the role of demographic variables (age, income, number of children, and number of family members), marriage-related factors (duration of the marriage, family functioning), and mental health disorder.

    Methods

    This was a cross sectional study. Participants were selected from couples who were attending West of Tehran health center. A total of 123 married couples aged 18 to 60 years who did not have mental or other medical disorders were recruited.  Data gathering tools were McMaster Family Assessment Device (FAD), ENRICH Marital Satisfaction Scale, Bem Sex-Role Inventory (BSRI), a sociodemographic questionnaire, and Brief Symptom Inventory (BSI). Pearson correlation, chi-square, t test, ANOVA, Scheffe post hoc, and linear regression tests were used to analyze the data. Data were analyzed using SPSS 16, and in all statistical tests, significance level was set at p<0.05.

    Results

    No significant correlations were observed between marital satisfaction and age, number of family members, duration of the marriage, number of children, and income (p>0.05). The presence of gender role conflict was correlated with lower marital satisfaction. Family functioning, gender role conflict, and presence of psychotic problems were predictors of marital satisfaction (p<0.001, R2=0.419).

    Conclusion

    Screening couples who applied for divorce due to psychiatric problems and gender role conflict and evaluating their family functioning may have a positive effect on reduction of divorce rate.

    Keywords: Marital relationship, Satisfaction, Gender role, Psychology, Family
  • Anahita Amidi Naeini, Hadi Ranjbar, Homa Mohammadsadeghi, Kaveh Alavi, Hamidreza Ahmadkhaniha, Mayram Rasoulian* Page 92
    Background

    Diagnosis disclosure is the result of a shift in medical approaches from traditional paternalism to participatory and patient-centered decision making. Disclosure of psychiatric diagnosis remained uncommon and controversial. Giving information about psychiatric illnesses is very complicated, and it is affected by several factors. While clinical guidelines provide a clear pathway for treating patients, in practice, the treatment of patients is influenced by cultural and social factors. The aim of the current study was a qualitative assessment of psychiatrists’ approaches regarding the disclosure of psychiatric disorders to their patients.

    Methods

    The current study was conducted with a qualitative approach. The participants were purposefully selected psychiatrists from three medical universities in Tehran, Iran. The data gathered using the semi-structured interview method. Sixteen interviews with 14 psychiatrists were conducted. Data were analyzed using thematic analysis.

    Results

    Psychiatrists decide to disclose the diagnosis based on several factors. We summarized these factors in a central theme, passive situational decision making based on paternalism and displacement of responsibility. It has two subthemes, including “passive and situational decision making” and “paternalism and displacement of responsibility.” Each theme presented by detailed quotations.

    Conclusion

    The results of this study showed that psychiatrists did not actively disclose the diagnosis name to patients. Diagnosis disclosure was influenced by several factors, such as the certainty about the diagnosis and the severity of the disease. This passive approach does not respect the patient's rights. The paternalistic nature of this approach mandates psychiatrists to consider themselves as the responsible perosn for their patients’ welfare.

    Keywords: Disclosure, Diagnosis, Psychiatrists, Mental health, Medical ethics
  • Somayeh Soleymanzadeh Moghadam*, Nazanin Mohammad, Maryam Ghooshchian, Sara Fathizadeh, Zohreh Khodaii, Mahmood Faramarzi, Zeinab Fagheei Aghmiyuni, Masoud Roudbari, Abdolreza Pazouki, Tahereh Mousavi Shabestari Page 93
    Background

    Infection of burn wounds is one of the most important problems in the world. Lactobacillus plantarum is known for burn wound healing because of the immunomodulatory and anti-microbial roles. This study was performed to compare the effects of L. plantarum and imipenem – alone and in combination – on infected burn wound healing.

    Methods

    Burn wounds were experimentally induced on 50 rats in three test groups (germ and supernatant of L. plantarum) and two control groups (n=10 each) and were inoculated with Pseudomonas aeruginosa. During a 14-day period, wounds in all groups were daily treated topically. The data were analyzed using one-way analysis of variance followed by Tukey–Kramer and LSD. A p-value of < 0.05 was considered as statistically significant.

    Results

    The mean size of the wound on day 14 after the treatment in the probiotic group was significantly lower than the control and the supernatant treated groups (p<0.05).  The percentage of wound healing was significantly higher in the probiotic pellet treated group compared to the imipenem and the supernatant groups (by Anova test: 69.58%, p=0.022). The mean leukocyte count in the probiotic pellet group (12110) and supernatant group (13650) was significantly higher than the imipenem group (7670) (p=0.002 and 0.001, respectively). Wound cultures revealed that the percentage of cases where the pathogens had no growth was significantly different among the comparison groups. In all three test groups, P. aeruginosa was completely eliminated in comparison to the positive control group (p<0.05).

    Conclusion

    The results of our study showed that L. plantarum and its by-products promote wound healing and can be used as an alternative to antibiotics to treat ulcer infections caused by resistant bacteria.

    Keywords: Lactobacillus plantarum, Imipenem, Burn, Wound healing
  • Seyyedeh Sara Azimi, Fatemeh Koohi, Mohammad Aghaali, Roya Nikbakht, Maryam Mahdavi, Yaser Mokhayeri, Rasool Mohammadi, Niloufar Taherpour, Mehran Nakhaeizadeh, Davood Khalili, Hamid Sharifi, Seyed Saeed Hashemi Nazari* Page 94
    Background

    Estimation of the basic reproduction number of an infectious disease is an important issue for controlling the infection. Here, we aimed to estimate the basic reproduction number (0) of COVID-19 in Iran.

    Methods

    To estimate 0 in Iran and Tehran, the capital, we used 3 different

    methods

    exponential growth rate, maximum likelihood, and Bayesian time-dependent. Daily number of confirmed cases and serial intervals with a mean of 4.27 days and a standard deviation of 3.44 days with gamma distribution were used. Sensitivity analysis was performed to show the importance of generation time in estimating 0.

    Results

    The epidemic was in its exponential growth 11 days after the beginning of the epidemic (Feb 19, 2020) with doubling time of 1.74 (CI: 1.58-1.93) days in Iran and 1.83 (CI: 1.39-2.71) in Tehran. Nationwide, the value of 0 from February 19 to 29 using exponential growth method, maximum likelihood, and Bayesian time-dependent methods was 4.70 (95% CI: 4.23-5.23), 3.90 (95% CI: 3.47- 4.36), and 3.23 (95% CI: 2.94-3.51), respectively. In addition, in Tehran, 0 was 5.14 (95% CI: 4.15-6.37), 4.20 (95% CI: 3.38-5.14), and 3.94 (95% CI: 3.45-4.40) for exponential growth, maximum likelihood, and Bayesian time-dependent methods, respectively. Bayesian time dependent methods usually provide less biased estimates. The results of sensitivity analyses demonstrated that changes in the mean generation time affect estimates of 0.
      

    Conclusion

    The estimate of 0 for the COVID-19 ranged from 3.94 to 5.14 in Tehran and from 3.23 to 4.70 in nationwide using different methods, which were significantly larger than 1, indicating the potential of COVID-19 to cause an outbreak.

    Keywords: COVID-19, Basic reproduction number, Transmissibility, Iran
  • Hala Halbony*, Khadija Salman, Ahmad Alqassieh, Mutaz Albrezat, Ahmad Hamdan, Ali Abualhaija’A, Omar Alsaeidi, Jamal Masad Melhem, Julide Sagiroglu, Orhan Alimoglu Page 95
    Background

    Multiple risk factors contribute to the development of breast cancer, including age, positive family history, early menarche, late menopause and the strongest factor being female gender. In this study, we aimed to investigate the proportion of breast cancer patients with certain risk factors, the prevalence of each cancer type, in addition to the surgical procedures performed.

    Methods

    The medical records of patients diagnosed with breast cancer from January 2010 to November 2015 were evaluated retrospectively regarding demographics, breast cancer risk factors, comorbidities, diagnostic methods, tumor location, cancer type and stage, pathological findings, tumor markers, harvested lymph nodes and the types of surgical procedures. The collected data were statistically analyzed as number, mean, and frequency as percentages. Cases with deficient medical records were excluded from the analysis of certain parameters.

    Results

    The sample consisted of 120 patients, 118 (98.3%) of whom were women. The mean age was 56.5±12.0 years. The most common diagnostic method at presentation was self-exam in 93.3% of patients.  Invasive ductal carcinoma was the most common type of tumor (80.0%). The pathological stages could be determined for only 106 patients, and 26 patients (24.5%) were at stage 1 disease, 45 patients (42.5%) were at stage 2 whereas 34 patients (32.1%) were at stage 3. According to the results of pathological examinations, 72.6% (85 patients) of the cases were estrogen receptor positive, 61.2% (71 patients) were progesterone receptor positive while 24.8% (27 patients) were HER positive.  Modified radical mastectomy (MRM) was performed in 52 (43.3%) patients and wide local excision (WLE) was preferred in 46 (38.3%) cases.

    Conclusion

    Advanced age, positive family history, and prolonged estrogen exposure were remarkable in the majority of patients. Moreover, the most common type of breast cancer was invasive ductal carcinoma, and around half of the patients presented at stage 2 disease. Modified radical mastectomy and WLE were the most commonly performed surgical procedures.

    Keywords: Breast Cancer, Epidemiology, Jordan
  • Hesam Seyedin, Ali Mohamad Zanganeh*, Mohammadbagher Mojtabaei, Rafat Bagherzadeh, Hushyar Faghihi Page 96
    Background

    OVID-19 is a major cause of morbidity and mortality worldwide. The closure of governmental and nongovernmental centers as well as social, cultural, and economic activities are other major negative impacts of the virus. The present paper aimed to develop a model of economic and health-related factors which affect the reopening of businesses and the proper management of the effect of virus on different aspects, particularly on people’s health and economy.

    Methods

    In order to facilitate decision-making and model risk analysis of guilds and occupations, an expert panel, including eight 8 experts, was convened by the Ministry of Health in Iran to prepare a strategic framework for the national taskforce of COVID-19 management. The panel spent many hours to prepare a simple model of reopening businesses and prioritize them from low to high risks.

    Results

    The experts identified and weighed seven health and three economic-related factors. The businesses and jobs were classified into 69 categories based on their similarities; they were also graded according to a predefined five- point Likert scale and categorized into three levels of low, medium, and high risk. The policymakers recommended to reopen businesses stratified by risk levels at least two weeks’ intervals.

    Conclusion

    The relaunch strategy in Iran put health and safety first while gradually reopening businesses, resuming activities, and getting people back to work. At the same time, attempts were made to slow the spread of the virus through following public health measures, social distancing, good hygiene, and continued acting responsibly. As many countries may have to deal with the same issue, this model can help them adopt appropriate policies and strategies for disease containment.

    Keywords: COVID-19, Health policy, Public health, Disaster management, Risk analysis, Business, Job, Relaunching business, Pandemic, Model
  • Mehran Asadi Aliabadi, Arash Tehrani Banihashemi*, Maziar Moradi Lakeh Page 97

    The new coronavirus pandemic at the end of 2019 raised fear around the world. The rapid spread and relatively higher observed case fatality of this disease compared to other viral respiratory infections, have caused social reactions such as xenophobia and stigma. These negative social attitudes and acts will affect different segments of the society, such as patients and their families and health care providers. Also, this could disrupt the identification and surveillance of patients and could lead to considerable negative impacts on its control and management.

    Keywords: Social Stigma, COVID-19, Health care providers
  • Zahra Olfati, Garshasb Rigi*, Hajar Vaseghi, Zamanzadeh Zahra, Mojtaba Sohrabi, Seyed Hesamaldin Hejazi Page 98
    Background

    Several studies have proven the pattern of neurotransmitters, especially serotonin, in carcinogenesis and tumor development. Several studies have also shown that changes in serotonin receptors, especially 5HTR2A and 5HTR3A, can play an important role in incidence of cancers. This study was conducted to investigate changes in mRNA expression of 5HTR2A and 5HTR3A receptors in the breast tumor tissue compared to their marginal zone. 

    Methods

    In this study, tissue samples were obtained from 40 female patients with breast cancer. Entire RNA was obtained from the tissues and cDNA synthesis was performed. Finally, real ime PCR technique was performed to investigate the gene expression variation of both 5HTR2A and 5HTR3A. To analyze the results of real time PCR, both ΔΔCt and 2-ΔΔCt equations were used. All statistical analyses were performed using the SPSS 18 software and R-Studio 1.0.136. P values less than 0.05 (p<0.05) and 0.001 (p<0.001) were considered statistically significant.

    Results

    The results showed increased expression of 5HTR2A and 5HTR3A genes in tumoral tissues of patients with breast cancer compared to their marginal tissues, where the 5HTR2A and 5HTR3A genes expression in tumor tissue was 3.12 and 3.24 times more than that of the marginal zone, respectively.

    Conclusion

    The results indicated an increase in the mRNA expression of serotonin receptors (5HTR2A and 5HTR3A) in the tumor tissue compared to the marginal zone, which due to the mitogenic nature of these receptors, is likely to induce more proliferation of cancer cells.

    Keywords: 5HTR2A, 5HTR3A, Gene expression, Tumor, Breast cancer
  • Khosrow Keshavarz, Mojtaba Jafari, Farhad Lotfi, Peivand Bastani, Mahmood Salesi, Farshid Gheisari, Mohsen Rezaei Hemami* Page 99
    Background

    Positron Emission Mammography (PEM) is an imaging technique which is increasing focuses on imaging the chest instead of imaging the whole body. The aim of this study was to conduct a systematic review of the clinical efficacy and cost-effectiveness of PEM technology, as compared with PET, as a diagnostic method used for breast cancer patients.

    Methods

    The present study was a Health Technology Assessment (HTA), which was conducted via a systematic review of clinical efficacy and cost-effectiveness of the methods based on domestic evidence. To evaluate the efficacy of the PEM diagnostic method, as compared with PET, we used efficacy indices, including Sensitivity, Specificity, Accuracy, PPV, and NPV. The required data were collected through a meta-analysis of studies published in electronic databases from 1990 to 2016. In addition, direct costs in both methods were estimated and finally, a cost-effectiveness analysis was performed using the results of the study. Also, a one-way sensitivity analysis was performed to examine the effects of parameters’ uncertainty in the model. In this study, we used STATA software to integrate the results of studies with similar parameters.

    Results

    A total of 722 cases (N) were obtained from the five final studies. The results of the meta-analysis performed on the collected data showed that the two methods were identical in terms of the Specificity and PPV parameters. However, as to Sensitivity, NPV, and Accuracy parameters, the PEM method was superior to the PET for diagnosis of primary breast cancer. The total cost of using PEM and PET was $1737385.7 and $1940903.5, respectively, and the cost of a one-time scan (cost per unit) using PEM and PET devices was $86.82 and $157.63, respectively. As compared with the PET method, the use of the PEM diagnostic method for diagnosis of breast cancer was cost-effective in terms of all the five studied parameters (it was definitely cost-effective for four parameters and was also considered as cost-effective for another index, since ICER was below the threshold).

    Conclusion

    The results showed that the use of PEM technology for the diagnosis of primary breast cancer is more cost-effective than PET technology; thus, due to the wide range of PET technology in different fields, it is recommended that this method should be used in other areas of priority.

    Keywords: Meta-analysis, Breast cancer, PEM, PET, HTA
  • Tahereh Changiz*, Alireza Yousefy, Mohammad Fakhari Page 100
    Background

    Research utilization plays an important role in evidence-based practice. Health professions education is a research-based discipline. Conclusive research knowledge is ranked as high level of evidence in evidence-based practice. This study was conducted to develop a model to reach conclusive research knowledge in health professions education.

    Methods

    This study was conducted in 2 phases. In the first phase, a qualitative content analysis of the literature was performed, which provided research utilization concepts to design a model. In the second phase, a group of 5 consultants of health professions education designed a preliminary model and revised it to develop an appropriate model for research utilization in health professions education.

    Results

    The indicators mentioned in 24 documents were extracted and later categorized into 25 items. Then, 8 concepts emerged, including problem identification, research design and implementation, research reports, research publication, presentation, research access, adoption, and research use. These concepts were arranged to design a model for research utilization in health professions education.

    Conclusion

    This study illustrated a cyclical, spiral, and developmental model to reach conclusive research knowledge. This model emphasizes both primary and secondary research projects to reach conclusive research knowledge.  Also, it distinguishes between aligned transfer and cooperative presentation in research knowledge dissemination.  This model reveals the importance of the process use in health profession education. Also, it distinguishes between use and misuse of research findings.

    Keywords: Medical education, Utilization, Translational medical research, Diffusion of innovation
  • Fateme Mojallal, Mehrnaz Nikooieh, Majid Hajimaghsoudi, Mehdi Baqherabadi*, Mohammadali Jafari, Alireza Esmaeili, Naser Mohammad Karimi, Ehsan Zarepur Page 101
    Background

    Head trauma is one of the common reasons for patient attendance in the emergency ward. This study investigated the effect of tranexamic acid as a cheap, easily available antifibrinolytic drug on reducing the progress of cerebral hemorrhage compared to placebo.

    Methods

    This double-blind controlled clinical trial was performed on 120 traumatized patients presenting to the emergency room of Shahid Rahnemoon hospital during 2014-2015, Yazd, Iran. Those patients who met the inclusion criteria were randomly allocated into 2 groups. Group A received tranexamic acid, while group B received placebo parenterally. Finally, 56 patients in Group A and 44 in Group B were analyzed. The patients underwent brain CT scan and were followed up for ICU stay in days. Also, the number of patients who died during the first 7 days of hospitalization was recorded. The data were analyzed with SPSS20 using independent samples t test and chi-square test.

    Results

    The mean age of the patients was 41±20.27 years. Also, 20 patients (20%) were female and 80 were male (80%). There was no significant difference between the drug group and placebo group in the rate of hemorrhage volume progress (p=0.824). Regarding patients’ ICU stay, the ICU stay of the tranexamic acid group decreased significantly compared to the placebo group (p=0.001). No significant difference was found between the intervention group and placebo group in the mortality rate of patients during the first 7 days of hospitalization (p=0.236).

    Conclusion

    Tranexamic acid has no effect on reducing cerebral hemorrhage volume in patients. Although this drug was not effective in reducing mortality rate in patients, it decreased their ICU stay.

    Keywords: Trauma, Cerebral, Hemorrhage, Tranexamic acid, Clinical Trial
  • Matine Gharavi*, Mostafa Esmaeili Page 102
    Background

    Hepatitis B is a common infectious disease with serious complications. Health care workers (HCWs) are among the susceptible groups for Hepatitis B Virus (HBV) infection. Hepatitis B Virus is usually diagnosed through serological tests, which are invasive and expensive. Having in mind that saliva can be seen in many cases as an indicator of serological changes, in this study we aimed to assess the specificity and sensitivity of salivary HBs-Ag and anti-HBc, as the 2 diagnostic markers of HBV infection, compared to serological results of these markers.

    Methods

    Samples were obtained from 39 individuals diagnosed with hepatitis B and 20 healthy individuals. In this study serum HBs-Ag and anti-HBc of all the patients were evaluated by their physicians in the previous week. Unstimulated whole saliva was collected and sent to laboratory for evaluating salivary HBs-Ag and anti-HBc. Specificity and sensitivity were evaluated through data analysis by SPSS software.

    Results

    Serum was considered as a reference test and saliva as an index test. Sensitivity and specificity for oral fluid assay were measured: Sensitivity and specificity of salivary HBs-Ag were 86% and 95%, respectively, and they were 71% and 95%, respectively, for anti-HBc.

    Conclusion

    Our results suggest that salivary tests of HBs-Ag and anti-HBc marker could have the potential to replace serological tests for these markers.

    Keywords: Hepatitis B, Saliva, Serum, HBs-Ag, Anti-HBc
  • Farid Khorrami, Mehraban Shahi, Nasrin Davaridolatabadi, Nader Alishan Karami, Mehdi Hasaniazad, Fereshteh Jafarian, Abbas Sheikhtaheri* Page 103
    Background

    The rapid outbreak of COVID-19 has resulted in a global pandemic in 2020. Information sources such as disease registries through accessing quality, valid, accurate, and timely data empower researchers and health authorities to study and develop appropriate actions. Our study describes the protocol for implementation of regional COVID-19 registry in Hormozgan province (RCovidRH).

    Methods

    We followed approved phases for the development of RCovidRH to cover the population in Hormozgan. Missioned to develop and implement the protocol, the registry’s steering committee was made up of 10 members from subject fields of the registry at the core and 5 subgroups. The main purpose of the registry is to provide a comprehensive information profile of demographic, clinical, laboratory, imaging, and treatment data of confirmed and probable COVID-19 patients in Hormozgan. The data is retrospectively and prospectively collected. Case report form (CRF) was mainly based on International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC) CRF. A web-based, 2-language software was also developed to facilitate data collection and storage. Data analysis is to be conducted with collaboration of clinical physicians, data-mining specialists, and epidemiologists after reaching appropriate sample size.

    Results

    We included data related to demographic and identification, onset and admission, signs and symptoms at hospital admission, admission signs and symptoms, comorbidities, pathogen testing, assessment, laboratory, imaging, complications, treatment and medication, and outcomes. We found this registry was limited by incomplete clinical data for small fraction of outpatients, incomplete or inaccurate address by referred people due to fear of social rejection, delay in data entry at the facilities due to workload.

    Conclusion

    This registry via organizing clinical and epidemiological COVID-19 data increases the potentiality of joint studies. Recognition and coordination of a registry is highly important to solve its limitations to collect data. Other universities and provinces can apply our model to develop COVID-19 registries or data sets for this disease.

    Keywords: COVID-19, Hormozgan, Iran, Registries, SARS-CoV-2, Study Protocol, COVID-19 registry, Data elements
  • Marzieh Pashmdarfard, Kamran Soltani Arabshahi, Narges Shafaroodi*, Afsoon Hassani Mehraban, Soroor Parvizi, Kirsti Haracz Page 104
    Background

    Clinical education is a vital part of occupational therapy education process. High clinical education quality in fieldwork settings leads to higher clinical competency and occupational proficiency. One of the most effective clinical education methods in equalizing the conditions of clinical education to students is the correct use of educational models related to each field of medical sciences. In the field of clinical education, various models have been designed with a specific subject. However, limited research has been done on the introduction of the usability of these models in occupational therapy settings. This study was conducted to determine which models have the potential to be used as clinical education models in occupational therapy.

    Methods

    A scoping review was conducted and studies published in English between 2000 and 2018 that examined clinical education models were selected.

    Results

    A total of 8 articles were entered in the review, and a central theme of implementing clinical education models in occupational therapy was determined by thematic analysis. This central theme consisted of 3 categories: (1) evaluative models, (2) acting models, and (3) evaluative/acting models.

    Conclusion

    Occupational therapists, especially who work as educators should be aware of the different types of clinical education models and try to use these models in clinical education process and minimize the variation of teaching methods in fieldwork settings to promote the clinical education quality.  However, more research should be done to improve evidence-based occupational therapy practice in clinical education.

    Keywords: Models, Occupational therapy, Education, Clinical practice
  • Parisa Arzani*, Minoo Khalkhali Zavieh, Khosro Khademi Kalantari, Alireza Akbarzadeh Baghban Page 105

    Dyspnea, shortness of breath, and inability to perform activities of daily living are the main complaints in patients with COVID-19 and physiotherapy has a vital role in managing such symptoms. We present a case treated with pulmonary and neurological physiotherapy, which improved symptoms and quality of life. In this case report, the importance and potential effect of concise physiotherapy on patients with COVID-19 is presented.

    Keywords: Dyspnea, Pulmonary Rehabilitation, Exercise therapy, Coronavirus, Iran
  • Samira Alihosseini, Aidin Aryankhesal, Asma Sabermahani* Page 106
    Background

    Colorectal cancer counts as the third prevalent type of cancer and the fourth cause of death worldwide. The second-generation colon capsule endoscopy (CCE-2) is a new technology for the diagnosis of colon cancer. The aim of this review was to provide information on the diagnostic accuracy (diagnostic effectiveness) of the second-generation colon capsule endoscopy compared to colonoscopy for the diagnosis of colon cancer and disorders.

    Methods

    A systematic review of literature in PubMed, Scopus, Science Direct, and Cochrane Library and Iranian databases, such as MagIran, SID, Irandoc, the grey literature (via Google Scholar) was conducted on February 30, 2018. QUADAS-2 was used to assess the quality of the studies.  MetaDiSc 2.0 software was used for the meta-analysis.

    Results

    In this review, 480 records were identified. Eight prospective cohort articles were included among which 7 included in the meta-analysis. For the diagnosis of colorectal polyps with a diameter of 6-10 mm, the pooled sensitivity and specificity were 84% (95% CI, 80% -88%) and 88% (95%CI, 85% -90%). For the diagnosis of 10 mm or bigger colorectal polyps, the pooled sensitivity and specificity were 84% (95% CI, 76%-89%) and 96% (95% CI, 94 %-97%). The sensitivity and specificity of the capsule in the detection of any size polyps were 93% (95% CI, 97%-84%) and 66% (95% CI, 48%-81%), respectively.

    Conclusion

    There is little evidence to show the accuracy of CCE-2. Nevertheless, this review showed that the second-generation colon capsule endoscopy has good accuracy in the detection of polyps and colorectal cancer among high- and middle-risk patients.

    Keywords: Colon capsule endoscopy, Colonic polyp, Accuracy, CCE-2, Colonoscopy
  • Ameneh Homami, Zohreh Ataei Kachoei, Mojgan Asgarie, Farideh Ghazi* Page 107
    Background

    Bladder cancer is the most frequent malignancy that affects the urinary tract. Studies have shown different types of FGFR3 and HRAS genes mutations in human bladder cancer, with a comprehensive range of mutation number in various populations. This study aimed to determine the specific point mutations of these 2 genes among Iranian patients with bladder cancer.

    Methods

    In this study, 100 specimens of patients with transitional cell carcinoma were analyzed.  All samples were examined for FGFR3 and HRAS mutations using PCR and direct DNA sequencing methods.

    Results

    A total of 9 pathogenic mutations and 9 polymorphisms were found in 2 exons (7 and 15) of the FGFR3 genes in patients with bladder cancer (S249Y, I633I, L645L, D646E, Y647*, D628V, P250T, Q263H, Y305H). However, no mutation was found in exon 10 of FGFR3 and exon 1 of HRAS genes.

    Conclusion

    In this study, 5 mutations were found in FGFR3 gene that have not been detected previously. There was no mutation in exon 10 of FGFR3 and exon1 of HRAS. The results of this study confirmed the association of ethnic-genetic factors in the occurrence of bladder cancer, so that these variables may not be present in all ethnic groups.

    Keywords: TCC, FGFR3, HRAS, FFPE, Touch down PCR
  • Jalal Ale-Ebrahim, Leila Janani, Seyed Ahmad Seyedalinaghi, Behnam Farhoudi, Abbas Abbasi Ghahramanloo, Mansoor Sajadipour, Seyed Abbas Motevalian* Page 108
    Background

    Acquired Immunodeficiency Syndrome (AIDS) is one of the most important health challenges worldwide. Moreover, the prevalence of the Human Immunodeficiency Virus (HIV) infection differs among Iranian prisoners and the general population. The present study aimed to identify the patterns of HIV-related high-risk behaviors in male prisoners.

    Methods

    In this cross-sectional study, 2832 inmates were examined for HIV-related high-risk behaviors. The required data were collected using a questionnaire on high-risk behaviors, including a history of heterosexual and homosexual intercourse, and a history of drug use disorders. A Latent Class Analysis (LCA) was performed to analyze the obtained data in WinLTA software.

    Results

    Five latent classes were defined for the male prisoners, as follows: low-risk (20%), moderate-risk (23%), Injection Drug Use (IDU) (8%), heterosexual intercourse/methamphetamine use (38%), and high-risk (11%). The LCA results revealed that high-risk sexual behaviors, IDU, and sharing injection equipment in prisons significantly influence the classification. The obtained data suggested that a history of imprisonment was not frequent in class 2 (OR=1.0033, %95CI:0.9936–1.01) and class 4 members (OR=1.0053, %95CI:0.9929–1.0179). However, it was more prevalent in class 3 (OR=1.0164, %95CI:1.0068–1.0262), and 5 (OR=1.0211, %95CI:1.0129–1.0293). Heterosexual contact had the highest prevalence (75%) in this regard. The results showed that the lowest prevalence of high-risk behaviors was associated with morphine use (0.3%). Among illicit drugs, methamphetamine was the most prevalent drug (42%) in the studied subjects.

    Conclusion

    The present study indicated a high prevalence of high-risk sexual behaviors and methamphetamine use in the investigated participants. We observed the co-occurrence of HIV-related high-risk behaviors in male prisoners. Thus, providing safe sex education for prisoners is highly recommended. It is also necessary to pursue care programs about IDU as a key risk factor for HIV transmission in prisons.

    Keywords: Latent class analysis, Male prisoners, Male non-prisoner, Human Immunodeficiency Virus (HIV)
  • Alireza Raeisi, Ahmad Hajebi*, Maryam Rasoulian, Maryam Abbasinejad Page 109
  • Azadeh Lak*, Shideh Shakouri Asl, Ali Maher Page 110
    Background

    The worldwide emergence of future pandemics emphasizes the need to assess the pandemic resilient urban form to prevent infectious disease transmission during this epidemic. According to the lessons of the COVID-19 outbreak, this study aimed to review the current strategies of responding to pandemics through disaster risk management (DRM) to develop a pandemic-resilient urban form in phases of response, mitigation, and preparedness.

    Methods

    The research method is developed through desk study was used to explore the current literature of urban form responded to COVID-19 pandemic and for the text analysis; qualitative content analysis was applied developing a conceptual framework.

    Results

    To create pandemic resilient urban form, this study proposes principles to enhance the urban form resiliency in 3 scales of housing, neighborhoods/public spaces, and cities. These principles focus on the concept of resilient urban form from new perspectives focusing on the physical and nonphysical aspects of resilient urban form, which develops a new understanding of pandemics as a disaster and health-related emergency risks.  The physical aspect of resiliency to epidemic outbreaks includes urban form, access, infrastructure, land use, and natural environment factors. Moreover, the nonphysical aspect can be defined by the sociocultural, economic, and political (including good governance) factors. By providing and enhancing the physical and nonphysical prerequisites, several benefits can be gained and the effectiveness of all response, mitigation, and preparedness activities can be supported.

    Conclusion

    As the pandemic’s disruptions influence the citizens’ lifestyle dramatically, the prominent role of place characteristics in the outbreak of pandemics, policymakers, urban planners, and urban designers should be pulled together to make urban areas more resilient places for epidemics and pandemics.

    Keywords: Pandemic resilient urban form, Disaster risk management (DRM), COVID-19, Urban planning, design
  • Ghobad Ramezani, Azam Norouzi, Eshagh Moradi, Ghadir Pourbairamian, Maryam Aalaa, Somayeh Alizadeh, Zohreh Sohrabi* Page 111
    Background

    Evidence-based medicine is one of the most important topics in medical sciences that requires a proper teaching method. Very few studies have evaluated EBM education outcomes through peers and TBL workshops. The purpose of this study was to compare the effect of evidence-based medicine (EBM) education through peers with TBL workshop method in medical students.

    Methods

    This quasi-experimental study was conducted on 42 medical students of the Faculty of Medicine in Iran University of Medical Sciences (IUMS) in 2019 who were selected through convenience sampling. Students were divided into 2 experimental and control groups based on the randomized blocking method. The data collection tools were 2 questioners that evaluated EBM knowledge and satisfaction in both intervention and control groups. The knowledge of students was compared using pretest and posttest and their satisfaction was evaluated at the end of the TBL workshop and peer education. Data were analyzed by SPSS software and descriptive tests (t test and ANOVA), and significance level was set at 0.95.

    Results

    A significant difference was found between the level of basic knowledge (pretest) and secondary knowledge (posttest) in the EBM education through TBL workshop method compared to peer method. The average scores gained by students in TBL workshop were 3.8 more than the peer teaching method. The results of the Satisfaction Questionnaire were 74% in control group and 86% in the experimental group.

    Conclusion

    EBM education through TBL workshop both increased students’ knowledge and satisfaction compared to peer education. Thus, it can be concluded that providing EBM education by expert and qualified teachers through face to face teaching strategy can be effective in knowledge translation. However, peers can participate in educational sessions as facilitators.

    Keywords: evidence-based medicine, peer education, TBL workshop, Education