مجله دانشگاه علوم پزشکی قم
سال چهاردهم شماره 8 (پیاپی 103، آبان 1399)

The Full Outline of Un-Responsiveness (FOUR) scale is a tool to assess the consciousness level in patients admitted to the Intensive Care Units (ICU). The validity and reliability of this scale can be affected by distorting factors, such as social, cultural, biological, and physiological conditions. This study aimed to evaluate the standardization of the FOUR scale to assess the consciousness level of the patients based on demographic characteristics in the Iranian population.

This experimental cross-sectional study was conducted on 60 patients hospitalized in the ICU. The FOUR scale was used to determine the consciousness level of the patients. Reliability, internal consistency, as well as correlations between the scales were estimated using Cronbach's alpha and Spearman-Brown formula. The data were analyzed in SPSS software (version 16.0) (SPSS Inc., Chicago, Illinois, USA). A p-value less than 0.05 was considered statistically significant.

According to the results, the internal consistency values of the Glasgow Coma Scale (GCS) and FOUR scale were estimated at 0.943 and 0.889, respectively, using Cronbach's alpha. In addition, there was a significant correlation between the FOUR scale and GCS (r=0.948, P=0.001).  Furthermore, the sum of sensitivity and specificity of the total score of the FOUR scale and GCS were obtained at 5 (sensitivity=0.72; specificity=31.43) and 7 (sensitivity=0.68; specificity=0.3714), respectively. In addition, the Area under the ROC Curve value in predicting in-hospital mortality for the FOUR scale was 0.491 (P=0.910 and 95% CI: 0.338-0.645), while it was obtained at 0.527 (P=0.725 and 95% CI: 0.374-0.679) for the GCS.

The results revealed that the GCS could be used as a standard scale to assess the consciousness level of the patients. The FOUR scale and GCS have similar benefits, and the former is a valuable tool to assess the consciousness level due to the combination of eye and motor components. Therefore, GCS could be used as substitute for the FOUR scale.

Gastrotomy can be accompanied by serious postoperative complications. In this regard, the present study aimed to evaluate the effects of oral administration of silymarin on the histopathological and biomechanical characteristics of the gastric wall after experimental gastrotomy in rats.

Full-thickness incision on the gastric wall and then suturing were conducted on 36 male Wistar rats. In the negative control group, 2 ml of normal saline was orally administered once a day (for 5 days). Moreover, omeprazole (3.6 mg/kg) and silymarin (50 mg/kg) in the positive control and treatment groups were administered in a similar manner, respectively. Euthanasia and sampling were performed on the 6th day. The data were analyzed using one-way analysis of variance and Kruskal-Wallis test.

Histopathological findings demonstrated a significant increase in the maturation of fibroblasts, deposition and arrangement of collagen, angiogenesis, and formation of epithelial layer in the silymarin treatment group, compared to the two control groups. According to the results, the infiltration of inflammatory cells significantly reduced in the omeprazole and silymarin treatment groups in comparison to that reported for the negative control group. The levels of maximum strength, yield strength, stress, and energy absorption were higher in the silymarin-treated group, compared to those reported for other groups.

The obtained results of the present study showed that the oral administration of silymarin improved the tissue indicators of wound healing and its biomechanical features in the experimental model of the full-thickness gastric wound in rats. Based on the results, it is recommended to administer silymarin following gastrotomy.

The sudden outbreak of coronavirus disease 2019 (COVID-19) as a shock to the international community, especially global health policymakers, has affected millions of individuals. The current study aimed to investigate the mental health status of social media users during the outbreak of COVID-19 in Iran.

The present descriptive study was carried out on a total of 443 Telegram and WhatsApp users selected using convenience sampling. Data collection was conducted by the online questionnaire of the symptoms of mental disorders of Hopkins Symptoms Checklist (HSCL)-25. The statistical methods of mean and standard deviation and t-test were used in order to analyze the data.

The obtained findings showed that the mean total score of the symptoms of mental disorders was relatively high among the participants. Based on the results, it was shown that the mean score of mental symptoms among the study subjects at low levels was 9.27%. In this study, phobia among the respondents was reported with an average of 27.3%. The lowest rate among mental disorders was related to psychosis with an average of 0.5% (P˂0.05).

Based on the findings of the current study, the mean scores of women in mental disorders, physical complaints, obsessive-compulsive disorder, interpersonal sensitivity, and paranoid thoughts were higher than those reported for men. The infected individuals with COVID-19 had higher symptoms of mental disorders in the components of physical complaints, obsessive-compulsive disorder, anxiety, and phobia than those not infected with COVID-19. The single participants had higher symptoms of mental disorders than the married subjects. The symptoms of physical complaints, anxiety, and phobia were higher among the patients with chronic illnesses than those without chronic diseases. The frequency of phobia was higher among the participants with parents suffering from chronic diseases.

According to hazardous infection possibility in patients with a weakened immune system, old adults, and children, microbial contamination in the waterlines of dental units has become a recent concern. The aim of the present study was to evaluate the microbial contamination in dental unit waterlines in the School of Dentistry, Qom University of Medical Sciences, Qom, Iran.

This descriptive-analytical study investigated 94 water samples collected from three parts of each unit, including air/water syringe, turbine headpiece, and cup filler, in the School of Dentistry in 2019. The water samples were taken on Saturday and Wednesday before and 60 sec after flushing on the same unit. The samples were transported in closed sterile containers to the Microbiology Laboratory. All the samples were incubated on nutrient agar plates using the Spread plate technique. Subsequently, bacterial contaminations were counted and reported based on CFU/ml for every plate. The data were analyzed using the Kruskal-Wallis test and Wilcoxon signed-rank test by SPSS software version 25.

The total mean of the bacterial counts was reported as 16,457 CFU/ml. The pre-clinic and periodontics were reported with the highest and lowest bacterial counts, respectively. The mean of bacterial counts after flushing was significantly lower than that reported before flushing on the same unit (P<0.001). The mean bacterial contamination of different parts of the dental units was similar (P=0.145). There was no statistically significant difference between the mean bacterial counts of Saturday and Wednesday (P=0.074).

The obtained results of this study demonstrated that the biological contamination level of dental unit waterlines is high, and flushing can result in a partial decrease in this regard.

 Rheumatoid arthritis is one of the most common diseases of the immune system which is increasing rapidly. The results of the recent literature review confirm the roles of stress and psychosocial stressors on physiological mechanisms, such as psychoneuroimmunology, as causal factors leading to the development of rheumatoid arthritis. Considering the effectiveness of psychological problems in the development of this disease, the present study was conducted to compare the effectiveness of coping therapy and cognitive-behavioral therapy in cognitive immunity and psychological well-being indicators of patients with rheumatoid arthritis referring to Imam Khomeini Hospital, Tehran, Iran.

 This was a quasi-experimental study with a pretest-posttest control group design. In the present study, the effectiveness of two independent variables (i.e., coping therapy and cognition-behavioral therapy) on dependent variables (i.e., immune-cognitive and psychological well-being indicators) was examined. The statistical population consisted of patients with rheumatoid arthritis referring to Imam Khomeini Hospital from March-August in 2019. The final sample (n=60) was selected by the purposive sampling method and the subjects were randomized into two groups of experimental and control (n=20 each). Subsequently, the experimental group was subjected to coping therapy and cognitive-behavioral therapy interventions. The instruments used in the present study included Psychological Welfare Scale, C-reactive protein (CRP) immunological indicators test, and erythrocyte sedimentation rate (ESR) test. The collected data were analyzed using the analysis of covariance model.

 The results of the analysis of covariance model were indicative of a p-value of < 0.05 as significant. Moreover, it was found out that the effectiveness of coping therapy and cognitive-behavioral therapy on CRP, ESR, psychological well-being was significant (P<0.001, P<0.001, and P=0.004, respectively).

 The results of this study revealed that coping therapy and cognitive-behavioral therapy were effective in cognitive immunity and psychological well-being indicators. Therefore, this treatment can be adopted as a complementary therapy, alongside conventional medicines, for patients with rheumatoid arthritis.

Atrial fibrillation is one of the most common disorientations after coronary artery bypass graft surgery and can affect the chance of survival in the first year after surgery. The present study aimed to determine the incidence of atrial fibrillation after coronary artery bypass graft surgery and its risk factors.

This cross-sectional study was performed on 854 patients undergoing coronary artery bypass graft in hospitals affiliated to Shiraz University of Medical Sciences. The required data were collected using the electrocardiogram, angiography, and demographic characteristic form. Finally, the collected data were analyzed in SPSS software (version 22).

According to findings, 46% of the patients suffered from a disorder in three coronary arteries. The most common structural disorders in patients were mitral regurgitation (14.9%) and left atrium enlargement and hypertrophy (10.5%). The most common underlying conditions in the participants were hypertension, hyperlipidemia, and diabetes which were observed in 74.4%, 56.2%, and 31.8% of them, respectively. Moreover, the incidence rate of atrial fibrillation in the participants was 18.9%. Furthermore, atrial fibrillation after coronary artery bypass graft surgery had a significant relationship with left ventricular size and its hypertrophy, age, and duration of smoking (P<0.001)

Since atrial fibrillation was observed in about one-fifth of the subjects and smoking is a moderating factor in the incidence of this disease, smoking cessation is recommended. In addition, healthcare providers can consider the size of the left atrium and its hypertrophy during care and treatment.

MutL homolog (MLH1) is a key component of heterodimeric complex MutLα, which recognizes and repairs base-base mismatches or insertion/deletion loops that arise from nucleotide misincorporation. In the absence of MLH1 protein, the number of unrepaired mismatches will increase and cause tumors in organs. The present study aimed at quantitative analysis of MLH1 gene expression and its association with depth of tumor invasion (T) and lymph node invasion (N) factors in blood samples of Iranian patients with colorectal cancer (CRC).

Blood samples from 33 patients with CRC were collected. RNA (Ribonucleic acid) was extracted and cDNA (Deoxyribonucleic acid) was fabricated according to the kit protocol extracted. The primer was designed by the Exon-Exon Junction method, and Real-time Polymerase Chain Reaction (Real-Time PCR) test was performed three times for MLH1 and β-actin (Beta-actin) genes. Data were analyzed in  REST 2009 Software, and a T-test was used to evaluate the expression of MLH1 gene and its association with T and N factors.

The results of Real-Time PCR in 33 patients with the male to female ratio of 42.5% to 57.5% and a mean age of 55 years demonstrated a significant decrease in MLH1 gene expression in the late stages of the disease (P<0.05 *). Furthermore, the reduction of expression in this gene was associated with T (P <0.05*) and N factors (P<0.05 *).

As evidenced by the obtained results, a direct relationship was observed between decreased expression of MLH1 gene and late stages of colorectal cancer. Moreover, the association of this gene with T and N factors was investigated and confirmed in several Iranian patients with colorectal cancer.

Given the importance of effective communication in emergency and crisis situations, the use of a valid and reliable tool is vitally important to assess the health sector's preparedness in terms of risk communication. This study, conducted in Persian, aimed to investigate the psychometrics of emergency risk communication checklist in the public health sector.

In this psychometrics research, initially, the checklist designed by the Centers for Disease Control and Prevention was translated into Persian using back translation method. Subsequently, the opinions of experts in various fields of health education in disasters and accidents were applied to evaluate the quality and quantity of content validity of the checklist items. In this regard, the content validity index (CVI) and content validity ratio (CVR) of each item were assessed. Accordingly, the items with the CVI of ˂ 0.62 and CVR of ˂ 0.79 were deleted from the checklist. The face validity of the items was also evaluated. The reliability of the items was estimated in 30 health centers affiliated to Sharekord University of Medical Sciences, Chaharmahal and Bakhtiari Province, Iran, using the Cohen’s kappa coefficient by two independent evaluators.

Based on the results of the quantitative and qualitative content validity, eight items were edited, one item was removed, and six items were merged. Cohen’s kappa coefficient between the evaluators was obtained as 0.87 (P<0.0001) which is acceptable. Eventually, a 191-item checklist was obtained and confirmed.

The psychometrically valid checklist used in this study can assess the preparedness of the healthcare sector for risk communication in emergencies.