فهرست مطالب

  • Volume:35 Issue: 1, Winter 2021
  • تاریخ انتشار: 1400/06/30
  • تعداد عناوین: 200
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  • Nemat Azizi, Bahram Delgoshaei*, Aidin Aryankhesal Pages 1-9
    Background

    One of the important aspects in the field of refugee health is the availability of primary health care, and the quality improvement of health care requires identifying barriers and facilitators. The present study aimed to identify obstacles and facilitators of providing primary health care to Afghan refugees from the perspective of health care providers.

    Methods

    In this qualitative study, a semi-structured interview was conducted based on purposeful sampling with the involvement of 21 managers and experts in primary health care centers. Data were analyzed using the content analysis method and MaxQDA.

    Results

    Data analysis led to the production of 4 main themes: (1) challenges while providing primary health care, with 10 subthemes; (2) challenges after providing care, with 4 subthemes; (3) opportunities, with 3 subthemes; and (4) solutions, with 6 subthemes.

    Conclusion

    According to the results of this study, identifying the challenges and providing opportunities and solutions to existing problems seem to be effective steps in the quality improvement of providing primary health care to refugees.

    Keywords: Barriers, Facilitator, Primary health care, Health care providers, Refugees
  • Saiedeh Bahrampouri, HamidReza Khankeh*, Seyed Ali Hosseini, Mohammadreza Mehmandar, Abbas Ebadi Pages 10-21
    Background

    Iran will face the "aging Tsunami" phenomenon by the 2040s. Therefore, paying attention to the elderlychr('39')s driving to maintain and promote their independence and quality of life on the one hand and paying attention to the dangers of driving by the elderly for road safety will be important. The purpose of this research was to determine the components of driving competency in the elderly.

    Methods

    The research has employed a scoping review. To this end, searches of scientific databases were conducted using keywords between 1990 and 2019. The process of selecting the documentation was-based on the PRISMA chart.

    Results

    In the first phase, 2769 records were found, and finally, 37 records met the inclusion criteria set for this study. The results indicated that 18 components were extracted that were classified into seven main categories including cognitive, sensory, motor, mental functions, and medications, diseases, and driving history.

    Conclusion

    Sensory, motor, and cognitive abilities are the most important components of elderly safe driving. Therefore, as age increases, chronic disease, multiple drug use, and subsequent problems increase. This can affect the ability to drive safely and can cause traffic injuries. Therefore, it is recommended to use the results of this research to design a suitable tool and model for assessing driving competency in the elderly.

    Keywords: Automobile driver examinations, Aged, Automobile driving, Licensure, Traffic crashes, Geriatric assessment, Driving competency, Safe driving, Elderly
  • Farnaz Farsi, Nasser Ebrahimi Daryani, Mahmood Barati, Leila Janani, MohammadYahya Karimi, Abolfazl Akbari, Pardis Irandoost, Naimeh Mesri Alamdari, Shahram Agah, Mohammadreza Vafa* Pages 22-32
    Background

    Ulcerative colitis (UC) is specified by a chronic mucosal inflammation that has a deleterious impact on the quality of life (QoL). Coenzyme Q10 (CoQ10) appears to influence disease activity by its obvious properties. Therefore, the current research intends to assess the impacts of CoQ10 on QoL, disease activity, and blood pressure in UC patients.

    Methods

    This clinical trial performed on men and women with UC in 2017 who were attended the gastrointestinal center of Hazrat Rasool Akram Hospital and private clinic. Eighty-eight UC patients were randomly allocated to receive either CoQ10 (200 mg/day) or placebo for 8 weeks. The anthropometric parameters, blood pressure, inflammatory bowel disease questionnaire-32 (IBDQ-32) score, and the Simple Clinical Colitis Activity Index (SCCAI) score were measured pre and post-intervention. P-value <0.05 was considered to be statistically significant. All statistical analysis was done using SPSS software version 24.

    Results

    Eighty-six UC patients (44 males) with a mean age of 39.29 (10.19) years completed the trial. The results of between- and within-group analysis revealed that the SCCAI score (p<0.001 and p<0.001, respectively), diastolic blood pressure (p=0.025 and p=0.001, respectively), and systolic blood pressure (p=0.001 and p<0.001, respectively) decremented significantly; while, the mean IBDQ-32 (p<0.001 and p=0.001, respectively) increased substantially in the CoQ10 group; whereas there was no significant difference in anthropometric indices in both groups.

    Conclusion

    Findings suggest that CoQ10 can be used as a potential intervention for diminishing the disease severity and blood pressure and may improve QoL and UC patients.

    Keywords: Coenzyme Q10, Quality of life, Ulcerative colitis, SCCAI score, IBDQ-32
  • Sara Masihi, Mojgan Barati, Elham Karimi Moghaddam, Afshin Rezazadeh, Fatemeh Ronaghi* Pages 33-37
    Background

    Although soft markers may be seen as normal variants, they are important due to their association with chromosomal and congenital abnormalities.

    Methods

    This cross-sectional descriptive-analytical study was done on 3016 women who referred for perinatal care. Fetuses with any of soft markers including thickened nuchal fold (TNF), mild pyelectasis (MP), choroid plexus cyst (CPC), single umbilical artery (SUA), mega cisterna magna (MCM) and mild ventriculomegaly (MVM) were followed during pregnancy and birth. Data analysis was carried out using SPSS for Windows (version 22). Data were analyzed using chi-square and T-test. A p-value <0.050 was considered statistically significant.

    Results

    285 (9.4%) fetuses with soft markers Including 148 (4.9%) fetuses with CPC, 118 (3.9%) fetuses with MP, 2 (0.1%,) fetuses with isolated TNF, 8 (0.3%) fetuses with isolated MVM, 4 (0.13%) fetuses with SUA, 4 (0.13%) fetuses with MCM were identified, and one fetus had TNF and MVM simultaneously. In cases with CPC, no abortion or major structural abnormalities were observed and all 148 neonates had normal phenotypes at birth. Among 118 cases with MP, one case had a major cardiac disorder, and 2 cases of abortions (1.7%) were reported (p=0.481). 83 cases (70.3%) were male and 35 cases (29.7%) were female (p=0.021) and all neonates had a normal phenotype. Both pregnancies with isolated TNF resulted in abortion. Of the 8 cases with isolated MVM, two cases had major structural abnormalities. 2 cases of abortion were reported and all infants had a normal phenotype. In one case, that fetus had TNF and MVM simultaneously. Amniocentesis showed no aneuploidy. No major structural abnormalities were observed in fetuses with SUA. One case of abortion was reported. Among the three births, two pre-term births were reported, and all three infants had normal phenotype. In four cases with MCM, no major structural abnormality was observed and all four neonates had normal phenotype. 

    Conclusion

    In cases without association with other structural abnormality, mothers who have fetuses with CPC or MP should be reassured that the pregnancy outcomes are generally favorable.

    Keywords: Ultrasonography, Fetus, Soft marker, Outcome
  • Arezoo Orooji, Eisa Nazar, Masoumeh Sadeghi, Ali Moradi, Zahra Jafari, Habibollah Esmaily* Pages 38-42
    Background

    Aging is a major challenge not only for high-income countries but also for middle- and low-income countries. The length of stay (LOS) in hospitals is one of the major concerns of elderly patients, which should be taken into consideration. We aimed to investigate the factors affecting LOS of elderly patients admitted to a referral hospital of northeast of Iran.

    Methods

    A relatively large population of 7130 hospitalized elderly patients (over 65 years old) who referred to Ghaem hospital (Mashhad, Iran) from March 20, 2016 to March 19, 2017 were selected. The demographic and medical records data of patients were extracted from the hospital database. Univariate analyses as well as count regression models, including poisson regression and negative binomial regression, were conducted to assess the influential factors on the LOS and the number of admissions considered for potential confounders using SAS software. In this study α =0.05 was considered as statistically significant.

    Results

    The mean age of participants was 76.57±7.29 years, and 54.8% were male and 45.2% were female. The mean LOS was 8.11±13.97 days and the mean number of admissions 1.5±1.73 times. The negative binomial regression model had better fitness than Poissonchr('39')s model. Findings indicated that emergency hospitalization (RR: 0.21), admission to the CCU (RR: 0.33), and male gender (RR: 0.92) were statistically reducing factors for LOS among elderly patients, respectively. Discharge status (deceased, RR: 1.50), patients with diagnosis of injuries and poisoning (RR: 1.34), and native residence (RR: 1.10) were factors that statistically increased the length of stay among hospitalized elderly patients.

    Conclusion

    LOS in hospitals is affected by multiple factors and the negative binomial regression model is a better statistical method for estimating the influencing factors.

    Keywords: Elderly, Length of stay, Count regression models, Negative binomial regression
  • Fatemeh Poorahmadieh, Naiire Salmani*, Zohre Kalani Pages 43-49
    Background

    It is assumed giving oxygen to patients with acute myocardial infraction may increase the oxygenation of the ischemic tissue; however, the usefulness of oxygen in these patients has become a challenging topic. Thus, the present study aimed to determine the effect of oxygen inhalation on cardiac biomarkers in patients with acute myocardial infarction.

    Methods

    This randomized clinical trial study was performed on 2 groups of intervention and control within 2 days of admission to critical care unit (CCU). A total of 64 patients with ST-segment elevation acute myocardial infarction who referred to Zeyaei hospital, Ardakan, were selected using simple random sampling. In the intervention group, the pulse oximetry was monitored and they only breathed regular air and received supplemental oxygen in case their oxygen level dropped below 94%. The levels of creatine kinase-MB and troponin I enzymes were measured. Data were analyzed using SPSS version 20 through repeated measure ANOVA, t test, and chi-squared test. Significance level was set at 0.05.

    Results

    This study showed that during the 48 hours of hospitalization, there were no significant differences between the 2 groups regarding the levels of creatine kinase-MB (p=0.509) and troponin I (p=0.604).

    Conclusion

    Since the level of cardiac biomarkers is a sign of the extent of infracted area, it is assumed receiving supplemental oxygen in patients with acute myocardial infarction has no effect on decreasing the infracted area.

    Keywords: Troponin I, Creatine kinase, Oxygen inhalation therapy, Myocardial infarction
  • Hashem Jarineshin, Fateme Saljoughi, Hamideh Estabraghnia Babaki, Mehdi Hassaniazad, Masoumeh Kheirandish, Amin Ghanbarnejad, Shahla Sohrabipour* Pages 50-59
    Background

    There is sparse information to describe the clinical features and outcomes of patients infected with coronavirus disease 2019 (COVID-19).

    Methods

    In a single-center retrospective observational study, 50 patients infected with COVID-19 were studied. Epidemiological, demographic, clinical, laboratory, radiological, and treatment data were collected and analyzed. Outcomes of critically ill patients and noncritically ill patients were compared. 

    Results

    The mean age of the patients was 48.8 years, with male predominance. Dry cough, fever, and dyspnea were the most complaining symptoms on admission. Chronic medical illnesses before admission were present in 56% of the patients. The most common laboratory abnormalities were lymphopenia, neutrophilia, thrombocytopenia, increased aspartate aminotransferase, high serum creatinine level, elevated lactate dehydrogenase, and increasing ESR and CRP levels. Bilateral mixed ground-glass opacity and consolidation were observed in chest CT scan of most patients. Some patients required supplemental oxygen and some needed invasive mechanical ventilation. Blood oxygen saturation was different between survivors and nonsurvivors. 10% of patients died, of whom 60% were men. 40% of dead cases had chronic medical illnesses; 60% underwent invasive mechanical ventilation.

    Conclusion

    Among the patients diagnosed with COVID-19 infection, the frequent clinical presentation was with a wide range of signs and symptoms. The laboratory changes suggest that COVID-19 infection may be related to cellular immune deficiency, myocardial, hepatic, and kidney injury. Additional research is needed to elucidate COVID-19 pathogenesis.

    Keywords: SARS-CoV-2, Coronavirus disease 2019, COVID-19, Clinical features, Laboratory, Chest CT scan, Outcomes
  • Mitra Hakim Shooshtari, Behnam Shariati, Leila Kamalzadeh*, Morteza Naserbakht, Batool Tayefi, Mozhgan Taban Pages 60-71
    Background

    Attention deficit hyperactivity disorder (ADHD) is among the most common neurodevelopmental disorders in children and adolescents. There is a controversy over the true prevalence of ADHD in Iran, the knowledge of which is crucial for allocating health care resources and identifying research priorities. This is an updated systematic review of the prevalence of ADHD in Iranian children and adolescents.

    Methods

    For this systematic review, PubMed/Medline, Web of Science, Scopus, PsycINFO, IranPsych, IranMedex, Irandoc, Google Scholar, and grey literature were reached for publications between January 1990 and December 2018 that reported prevalence estimates of ADHD in Iran. Parallel independent assessments were conducted. The Quality Assessment Checklist for Prevalence Studies was used to assess the overall quality of studies.

    Results

    A total of 34 original studies covering 33 621 Iranian children, adolescents, and adults were included. The included studies were mostly conducted on the population of preschool, elementary, middle, and high school-aged children as well as adolescents. Also, 6 studies addressed university students. Prevalence estimates of ADHD reported varied substantially across the studies and offered a range of heterogeneous data.

    Conclusion

    Overall, making exact comparisons among studies was not easy because the assessment method and the type of sampling could impact prevalence estimates. These factors need to be considered when comparing data from different studies.

    Keywords: Attention deficit disorder with hyperactivity, Iran, Prevalence, Review
  • Hadi Ghaffari, Angila Ataei Pirkooh, Sayid Mahdi Mirghazanfari, Mohammad Barati* Pages 72-77
    Background

    The emergence of drug-resistant strains of herpes simplex virus type 1 (HSV-1) has been increasingly reported. Therefore, attempts to discover new antiviral agents in particular from natural compounds are required. In this study, we evaluated the possible inhibitory effects of hydroalcoholic extract of Sambucus ebulus (S. ebulus) against HSV-1.

    Methods

    S. ebulus extract was produced by maceration method. MTT assay was used to evaluate the cytotoxicity effects of the S. ebulus extract; also, antiviral effects were measured both by test TCID50 and quantitative real-time PCR methods. To study the inhibitory impact of S. ebulus extract on the expression of HSV-1 antigens, indirect immunofluorescence assay (IFA) was also performed.  All analyses were performed using the GraphPad Prism software v. 7.0.

    Results

    In the postexposure assay of HSV-1 with S. ebulus extract at the highest nontoxic concentration (75 μg/mL), S. ebulus extract led to 2.6 log10 TCID50 reduction in infectious virus titer. At the highest nontoxic concentration, the S. ebulus extract led to inhibition rates of 91.2%, based on the quantitative real-time PCR assay results (p<0.001). Also, in the immunofluorescence assay, a significant reduction was observed in fluorescence emission intensity in HSV-1-infected cell treated with S. ebulus extract compared to the control group.

    Conclusion

    S. ebulus extract is a novel and effective natural compound in reducing HSV-1 titer and future studies should be conducted to discover the complete mechanism of antiviral effect of this natural compound.

    Keywords: Herpes simplex virus, Antiviral activity, Natural product, Sambucus ebulus
  • Zahra Najafi, Kianoush Abdi*, MohammadSaeed Khanjani, Hamid Dalvand, Mehdi Amiri Pages 78-86
    Background

    The International Convention on the Rights of Persons with Disabilities (CRPD) is the most important International Document for recognizing the rights of persons with disabilities, including the right to health and rehabilitation.   Islamic Republic   Iran acceded to the Convention in 2008, but still has a long way to go to achieve its desired status and in line with the objectives of the convention. This study aimed to identify the barriers to the implementation of articles 25   and 26   of the CRPD in Iran.

    Methods

    This study was performed using conventional content analysis. Twenty-one individuals were recruited by purposive sampling with maximum variation and were continued until saturation. Data were gathered through in-depth, semi-structured interviews from June 2018 to May 2019.   MAXQDA version 10 was used for analyzing data.

    Results

    The resulting data analysis yielded 860 initial or open codes. The concepts were categorized into 27 subcategories and 7 categories. Main categories were included: "Structure inefficiency", "lack of comprehensive rehabilitation program", "inadequate awareness", "neglected economy of people with disabilities", "weak access to services", "cultural challenges" and "disregard for new technologies".

    Conclusion

    The findings showed that the executive structures in the country have a lot of problems with health and rehabilitation programs for people with disabilities. It seems understanding the barriers to implementation of articles 25   and 26   of the international CRPD empowers officials in the field and improve services by providing a better view of the disabled. Nevertheless, it is recommended for policymakers to consider rehabilitation   as a main element of the health system.

    Keywords: Convention on the Rights, Disabilities, Health, Rehabilitation, Content analysis
  • Seyed Mahdi Mousavi, Saeid Yazdanirad, Mahsa Jahadi Naeini, Milad Abbasi, Marzieh Sadeghian* Pages 87-94
    Background

    Given the importance of maintaining the mental health of workers, the present study was conducted to determine the effect of the individual factors on hypochondriasis and job stress under the corona epidemic condition in a company.

    Methods

    This cross-sectional study was performed on 275 workers in 2020 in one of the industries in southern Iran. To gather the data, demographic, researcher-made, standard hypochondria, and job stress questionnaires were sent electronically along with a guide and study objectives. The participants completed the questionnaires during 2 weeks and send them electronically to the research team. Finally, data were analyzed using tests of one-way ANOVA and linear regression in SPSS software version 22.

    Results

    The results showed that the mean score of hypochondriasis in different groups of variables, including age, work experience, use of personal protective equipment, corona experience, and attention to preventive measures was significantly different (p<0.05). Based on the results, the mean score of job stress significantly differed in different groups of variables of personal protective equipment use, corona experience, and awareness on corona (p<0.05). Moreover, based on the regression relationships, hypochondriasis could be predicted by variables of personal protective equipment, corona experience, awareness on corona, and attention to preventive measures; and job stress could be predicted by variables of awareness on corona and attention to preventive measures.

    Conclusion

    Regarding the importance of providing the physical and mental health of employees, the implementation of measures to reduce stress and hypochondriasis of employees, particularly in identified groups, is helpful.

    Keywords: Individual factors, COVID-19, Hypochondriasis, Job stress
  • Alireza Mirzaei, Seyed Adel Jahed, Azade Amini Kadijani, Mozhdeh Zabihiyeganeh* Pages 95-98
    Background

    There is no clear consensus regarding the potential of denosumab for increasing the risk of infection in patients who concurrently receive biologic disease-modifying anti-rheumatic drugs (bDMARDs). In this study, we compared the rate of infection in postmenopausal women with rheumatoid arthritis who received concurrent bDMARDs and denosumab with those who received bDMARDs alone.

    Methods

    In a case-control study, postmenopausal patients with a confirmed diagnosis of rheumatoid arthritis who received concurrent bDMARDs and denosumab for at least one year were identified and included as the case group (n=40). A total of 44 age-matched postmenopausal rheumatoid arthritis women who received bDMARDs alone were included as the control group of the study. Using a chi-squared test, the incidence of bacterial or viral infections was extracted from the patients’ profiles and compared between the two study groups. Statistical analyses were performed by SPSS for Windows, version 16 (Chicago, Illinois, USA). A p-value of fewer than 0.05 was regarded as significant.

    Results

    The clinical and demographic characteristics of the patients of the two study groups were not significantly different. In total, four infections were recorded in the present series, two infections in each group. Accordingly, the rate of infection was 4.5% in the bDMARDs alone group and 5% in bDMARDs + denosumab group. This difference was not statistically significant (p=0.655, 95% CI: 0.121-6.742). Three out of four infections were herpes zoster infection. The other one was osteomyelitis of the first metatarsal bone, which occurred in the bDMARDs+denosumab group. None of the infections needed a hospitalization of IV antibiotics.

    Conclusion

    The risk of infection is comparable between postmenopausal osteoporotic women with rheumatoid arthritis who receive bDMARDS alone and those who receive bDMARDS in combination with denosumab.

    Keywords: Rheumatoid arthritis, Postmenopausal osteoporosis, Denosumab, bDMARDs
  • Mohammad Khajedaluee, Mahshid Nasehi, Saeid Sharafii, Maliheh Dadgarmoghaddam* Pages 99-103
    Background

    Tuberculosis (TB) is a major global health problem, so for better planning in the health sector, it is necessary to know the real burden of tuberculosis in our country. The main aim of this study was to calculate the burden of TB for the Iranian population in 2001-2012. 

    Methods

    The Disability Adjusted Life Years (DALYs) index was calculated using a computer model (DisMod version II) in Iran between the years 2001 and 2012. DALYs are age-weighted (β= 0.04) and are discounted for time preference (r= 0.03).

    Results

    The trend was decreasing from 2001 till 2006, and after it, there is an increasing trend. The incidence was more in younger age groups and in female, and the YLL is higher in men (11744 in male vs 7897 in female in 2012); it showed that the life lost is higher in men. The YLD in men and women are very close. In comparison, the DALY of TB was higher in men than women.

    Conclusion

    In the present investigation, it has been found that the overall tendency to get TB was higher in the female population. It shows that the incidence was higher in the younger age groups but the mortality was higher in the elderly   groups. It that shows the significant success of the country in controlling the disease.

    Keywords: Tuberculosis, Burden of disease, Disability-Adjusted life Years
  • Farideh Doostan, Ali Amirinejad, Mehran Rahimlou, Mehran Hassanzadeh, Rahim Sharafkhani* Pages 104-109
    Background

    Household food insecurity is one of the major public health issues that may affect an individual’s nutritional state, especially in patients with chronic diseases. The aim of this study was to evaluate the prevalence of household food insecurity and its association with sociodemographic and clinical factors among patients with HIV/AIDS in Kerman province, Iran.

    Methods

    A cross sectional study was performed among the 179 patients with HIV/AIDS in Kerman province. Participants completed a questionnaire focusing on personal information, health, and clinical status. Also, household food security status was evaluated by the USDA (US Department of Agriculture) questionnaire. Data were analyzed using SPSS (Version 22) by descriptive, univariate, and multivariate logistic regression. P<0.05 was considered statistically significant.

    Results

    Overall, 98 responding men and women were classified as household food secure (n=41; 40.8%) and household food insecure (n=58; 59.2%). Among the household food insecure patients, 14% (n=8) experienced lower household food insecurity, 38% (n=22) moderate household food insecurity, and 48% (n=28) severe household food insecurity. No significant differences were observed between household food secure and insecure groups in demographic variables. In clinical variables, only BMI index was significantly different between the two groups (p=0.040), but CD4 count was not significant between groups (p=0.220).

    Conclusion

    Prevalence of household food insecurity was high among people living with HIV/AIDS in Kerman. It seems clinical variables such as BMI index, which indicates the nutritional status of individuals, affect household food security status among people living with HIV/AIDS.

    Keywords: AIDS, HIV, Food insecurity, CD4 cell counts
  • Mohammad Karimi Alavije, Mohammad Hadi Karbalaie Niya, Afsaneh Sadeghzadeh Bazargan, Mehdi Nikkhah, Amirhossein Faraji, Nima Motamed, Fahimeh Safarnezhad Tameshkel, Farhad Zamani* Pages 110-113

    COVID-19 was first discovered in Wuhan, China, and has spread rapidly around the world. The most important manifestation of COVID-19 was ARDS-like lung injury at first, but the involvement of other organs, such as kidney, heart, liver, and skin, was gradually reported. It is important to report and share all atypical manifestations of this disease to help other physicians to gain more knowledge about this new viral disease. As mentioned, there are also studies that show different types of cutaneous involvement in these patients, but due to the lack of more detailed studies in this field, and on the other hand, the possible usefulness of skin lesions as a diagnostic or alarming sign in the COVID-19 era, in this study we report a COVID-19 patient with a large hemorrhagic blister similar to sepsis-induced skin lesion. Despite the lack of common symptoms of the disease, the lung scan of the patient was positive for COVID-19.

    Keywords: COVID-19, Skin lesion, Extra pulmonary complication, Cutaneous manifestation, Coagulopathy, Hemorrhagic bullae, Vascular injury, Vasculitis, Vasculopathy
  • Masoud Zarei, Moghaddameh Mirzaee, Hosniyeh Alizadeh, Yunes Jahani* Pages 114-120
    Background

    Determining the factors affecting survival and appropriate treatment methods leads to improving the survival rate and quality of life in cancer patients; therefore this study was aimed to determine the effective factors on the survival rate of patients with Laryngeal cancer in Kerman city, Iran.

    Methods

    This retrospective cohort study included 370 patients with Laryngeal cancer who referred to the hospitals of Kerman city, Iran during 2008 to 2018. Data were analyzed using Cox Proportional Hazards and Lin-Ying’s Additive Hazards models. Data analysis was done using SAS software version 9.4. The P-value of less than 0.05 was considered as statistically significant.

    Results

    The mean age at the time of diagnosis was 58.16±10.60 years. About 92% of the patients were men. The patient’s 1, 3, 5, 7 and 10-years of overall survival rates were equal to 82.38%, 60.68%, 55.98%, 49.83%, and 30.91%, respectively. Age at the diagnosis (p=0.001), radiotherapy (p=0.001), chemotherapy (p=0.015), surgery (p=0.031), and smoking (p=0.001) were found to have significant effect on the patient’s survival rate in the Cox model. These variables were significant in the Lin-Ying model too.

    Conclusion

    Treatment is an important factor in controlling the disease and survival of cancer patients, and choosing the best treatment depends on the condition of the patient and the disease level.

    Keywords: Survival analysis, Laryngeal cancer, Treatment, Hazard ratio, Excess risk
  • Muzamil Latief, Obeid Shafi, Zhahid Hassan, Summyia Farooq, Farhat Abbas* Pages 121-124

    COVID-19 is a novel highly contagious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Immunosuppressed people are at a higher risk for unfavourable outcomes if infected with SARS-CoV-2, as cellular immunity plays a key role in determining the course and outcome in COVID-19.  Kidney transplant recipients (KTRs) are thus a distinct subset of the population. We describe our early experience with 2 KTRs requiring hospital admission due to COVID-19 and who recovered well. We conclude that timely intervention in the form of modifying immunosuppression and close monitoring and institution of further measures based on clinical severity is needed in KTRs with COVID-19.

    Keywords: Severe acute respiratory syndrome coronavirus 2, Kidney transplant
  • Rafah Manafikhi*, M. Bassam Haik, Raghda Lahdo, Faizeh Alquoubaili Pages 127-131
    Background

    The pathogenesis of Alzheimer’s disease (AD) is believed to be occurred by the production of neurotic plaques of the beta-amyloid peptide (Aβ) and deposition of them. Therefore, biomarkers of abnormal Aβ processing may represent before the AD clinical biomarkers, which could be benefit for a successful disease management that may prevent the AD development. The aim of this study is to investigate of plasma Aβ40,42 levels in Alzheimerchr('39')s patients in Syria and thus determine whether they may have a potential role as biomarker for identifying and predicting AD.

    Methods

    In this cross-sectional study, the plasma levels of Aβ1-40 and Aβ1-42 were investigated in two groups represent Syrian population, AD group; clinically diagnosed AD patients (n=50) and CN group; cognitively normal participants (n=33). This study first determined the reference interval of plasma Aβ1-40 and Aβ1-42 for cognitively normal Syrian. Results were analyzed using SPSS, 24, depending on independent-samples t test, considering that the value of p < 0.05 is statistically significant.

    Results

    The results showed that the plasma levels of Aβ1-40 (p<0.001, OR=1.031, 95%CI: 1.012-1.051) and Aβ1-42 (p<0.001, OR=1.306, 95%CI: 1.145-1.490) were significantly higher in AD patients than in cognitively normal participants, and no significant association was shown between both of education and sex with plasma Aβ levels.

    Conclusion

    The plasma levels of Aβ1-40 and Aβ1-42 could be potential biomarkers for identifying and predicting AD.

    Keywords: Alzheimer disease, Aβ40, 42, Biomarkers, Syria
  • Maryam Okhovati, Homa Arshadi* Pages 132-142
    Background

    Coronavirus primarily targets the human respiratory system, COVID-19 (Coronavirus disease 2019) triggered in China in the late 2019. In March 2020, WHO announced the COVID-19 pandemic. This study aims to analyze and visualize the scientific structure of the COVID-19 publications using co-citation and co-authorship.

    Methods

    This is a scientometric study. Web of Science Core Collection (WoSCC) was searched for all documents regarding COVID-19, MERS-Cov, and SARS-Cov from the beginning to 2020. An Excel spreadsheet was applied to gather and analyze the data and the CiteSpace was used to visualize and analyze the data.

    Results

    A total of 5159 records were retrieved in WoSCC. The structure of the network indicated that the network mean silhouette was low (0.1444), implying that the network clusters’ identity is not identifiable with high confidence. The network modularity was 0.7309. The cluster analysis of the co-citation network on documents from 2003 to 2020 provided 188 clusters. The largest cluster entitled, “the Middle East respiratory syndrome coronavirus” had 255 nodes. The coauthorship network illustrated that the most prolific countries, USA, China, and Saudi Arabia, have focused on a specific field and have formed separate clusters.

    Conclusion

    The present study identified the important topics of research in the field of COVID-19 based on co-citation networks as well as the analysis of clusters of countrieschr('39') collaborations. Despite the similarities in the production behavior in prolific countries, their thematic focus varies so that a country like China plays a role in “Quantitative Detection” cluster, while USA is the leading country in the “Biological Evaluation” cluster.

    Keywords: Covid-19, Scientometrics, Visualization analysis, Co-citation, Collaboration network, Coauthorship, CiteSpace
  • Ali Reza Kalantari, MohammadHossein Mehrolhassani, Mohsen Shati, Reza Dehnavieh* Pages 143-156
    Background

    Current Health care delivery systems are not effective for the elderly. Countries with high elderly populations are expected to design special models to serve their elderly population. The aim of this study is to investigate the models of health care delivery to the elderly in different countries.

    Methods

    The present study is a systematic review based on PRISMA standard guidelines. The search for related studies was conducted in electronic databases (Cochran Library, Scopus, PubMed, Embase, Web of Science) and the Google Scholar search engine without time limits until May 2019. Keywords were extracted based on MeSH strategies. At first, 16243 articles were found. After the screening phase (elimination of duplicated articles, title screening, abstract screening, and full-text screening) 19 articles remained. Two articles deleted after text appraisal using the CASP checklist. In the next stage, after reviewing the gray literature and reviewing the references of remaining articles, three new articles were added (Included studies = 20). 

    Results

    Twenty articles (models) corresponding to the study objectives were finally extracted. These models are limited to nine countries and most have local scopes. These models mainly use a case manager, an intra- or inter-disciplinary team, and an elderly assessment tool in their structure. In addition to the use of an information system, these models provide a wide range of services to the elderly.

    Conclusion

    Most of the models mentioned are local models. Smaller models to become applicable at the national level, they need to be reviewed and evaluated by policymakers and experts. Given the inefficiency of current systems in providing services to the elderly, it is recommended that countries use an integrated model of health care provision for the elderly.

    Keywords: Aging, Elderly, Integrated care, Health care delivery, Financing
  • Farshid Fardad, Kobra Bagheri Valami, Nafiseh Ansarinejad, Bahareh Taleghani, Seide Masoomeh Khataii Khosroshahi, Tayeb Ramim* Pages 157-160
    Background

    Lung cancer accounts for about 13% of all cancers and about 60% of patients with lung cancer also experience weight loss during treatment. There seems to be a clear correlation between the therapeutic outcomes of patients based on their weight changes during treatment. The aim of this study was to investigate the relationship between weight changes during and after treatment and the therapeutic outcomes of a patient with metastatic lung cancer.

    Methods

    This cohort study was performed on patients with the diagnosis of non-surgical metastatic lung cancer referred to Hematology and Oncology Clinic, Rasoul-e-Akram Hospital. Patients were divided into two groups with a weight gain of more than 5% and a weight gain of 5% and less. The information was entered into the SPSS version 21 software. In the descriptive analysis, mean and standard deviation (SD) were used. To compare quantitative variables, independent samples t-test , Mann-Whitney, chi-square or Fisher exact tests were used to compare qualitative variables and correlation test was used to determine the correlation between quantitative data. Survival curves were used to show differences in two groups of studies. A regression model was used to calculate the hazard ratio. The significance level was less than 0.05. 

    Results

    Sixty patients, including 40 males (66.7%) and 20 females (33.3%) were studied. The mean age of patients was 62.22±9.00 years (43-83 years). The mean weight changes in the patients were -1.28±6.11 kg (-16 to 16kg). Forty-seven patients (78.3%) had weight gain less than 5%. There was no significant difference in overall survival (OS) and progression-free survival (PFS) according to weight gain.

    Conclusion

    Finally, the findings of the study showed that, despite the fact that PFS and OS in the weight gain group were greater than 5% of the original weight; the difference was not statistically significant.

    Keywords: Metastatic lung cancer, Weight gain, Overall survival, Progressive free survival
  • Rohaneh Rahimisadegh, Ali Akbar Haghdoost, Samira Emadi, Somayeh Noori Hekmat* Pages 161-168
    Background

    The health sector evolution plan was implemented in 2014 in government hospitals across the country as a part of the universal health coverage achievement programs. This study assessed the performance of hospitals before and after the implementation of this plan, using the Pabon Lasso model.

    Methods

    The population of this study consisted of the hospitals of the country in the 2013-2015 time frame; overall, 874 hospitals (94.5% of the population) were included in the study. In order to assess performance, we used the Pabon Lasso model and hospital performance indicators (Average Length of Stay, Bed Turnover, and Bed Occupancy Rate). The data were collected from the Hospital Information System and provincial deputies of curative affairs and were then analyzed using the descriptive indicators of mean, frzquency, and median in SPSS 22. Also, Paired Student T-test and ANOVA were used to compare the performance of different groups of hospitals before and after the implementation of the health sector evolution plan.

    Results

    The implementation of the health sector evolution plan has led to a significant improvement in the three performance indicators in the hospitals of the country. Before the implementation of the health sector evolution plan, the most inefficient, inefficient, fairly efficient, and most efficient zones included 31%, 18%, 17%, and 33% of the studied hospitals, respectively. However, the implementation of the health sector evolution plan changed the percentages to 29%, 21%, 20%, and 30%, respectively. Teaching hospitals, which are governmental and are mostly located in capital cities of the provinces, were overall more inefficient than non-teaching hospitals.

    Conclusion

    The number of the most efficient and most inefficient hospitals has decreased, and the number of average performance hospitals has increased after the implementation of the health sector evolution plan. Therefore, the health sector evolution plan has not led to an overall increase or decrease in the performance of hospitals but has reduced the difference in the performance of hospitals. Equal support of government hospitals along with financial protection against health expenses, improves the performance indicators of hospitals and reduces performance differences among them.

    Keywords: Average length of stay, Bed occupancy rate, Bed turnover, Teaching hospital, Health Sector Evolution Plan, Iran
  • Mohammad Karim Saberi, Arezoo Farhadi, Samira Karami, Heidar Mokhtari* Pages 169-177
    Background

    COVID-19 pandemic crisis motivated researchers worldwide to deeply investigate it from different perspectives. As Iran is one of the highly-affected countries by Covid-19, Iranian researchers have focused on studying it. This study aimed at analyzing and visualizing Iranian researcherschr('39') papers on COVID-19 from a bibliometric perspective.

    Methods

    By searching MeSH-selected keywords related to COVID-19 in Scopus, Iranian researcherschr('39') papers on COVID-19 were extracted in a CSV format and underwent bibliometric techniques, such as coauthorship analysis, citation, and co-citation analysis, keyword and term co-occurrence mapping and etc. in the Microsoft Excel and VOSviewer software package.   

    Results

    A total of 405 papers were authored by Iranian researchers on COVID-19 during the study period, with the average number of citations per paper of 2.60 and a mean h-index of 15. The majority of papers were original articles in English. Archives of Clinical Infectious Diseases and Archives of Iranian Medicine and Medical Hypotheses were highly ranked publishing journals, respectively. The most productive institute and author were Tehran University of Medical Sciences with 119 papers and Rezaei, N. with 12 papers. Iranian researchers collaborated with the researchers of 73 countries, with the USA ranking first in Covid-19 research, followed by Italy, Canada, and United Kingdom. In publishing papers on COVID-19, Iran ranked first among the Middle Eastern countries and thirteenth internationally.

    Conclusion

    Iranian researchers were active in 5 main areas of COVID-19 research, including epidemiology, diagnosis, treatment, virology, and systematic review.

    Keywords: Bibliometrics, COVID-19, Data visualization, Iran, SARS-CoV-2
  • Mahdiyeh Harati Sadegh, Saman Sargazi*, Hamed Taheri, Narges Arbabi, Ramin Saravani, Shekoufeh Mirinejad Pages 178-187
    Background

    To quantitatively estimate the relationship between IL‐1β -511C>T, −31T>C, and +3954C>T polymorphisms and risk of gestational disorders.

    Methods

    In this meta-analysis, eligible publications were searched in Web of Knowledge, MEDLINE, PubMed, Scopus, and Google Scholar databases (updated April 2020), using appropriate or relevant keywords. Case-control population-based reports were included if provided with genotypic frequencies of both studied groups. Statistical analyses were performed using the MetaGenyo web tool software, where a P value less than 0.05 indicated a significant association. For the assessment of between-study variations, heterogeneity analysis was applied with the I² statistics.

    Results

    A total of thirteen studies were included. We observed a significant association between IL‐1β−31T>C polymorphism and reduced risk of gestational disorders under codominant CT vs. CC [OR= 0.74, CI (0.59-0.92)], and dominant CT+TT vs. CC [OR= 0.74, CI (0.60-0.91)] contrasted genetic models. The stratified analysis considering the disease type showed that the 511C>T variant, under the recessive CC vs. CT+TT model, enhanced the risk of preterm birth by 1.29 fold.

    Conclusion

    Our results failed to support an association between two IL‐1β polymorphisms, 511C>T and +3954C>T, with the overall risk of gestational disorders. In contrast, the 31T>C variant reduced the incidence of such diseases. Further studies are encouraged to get more precise estimates of effect sizes.

    Keywords: Cytokine, Interleukin, Polymorphism, Pregnancy, Meta-analysis
  • Essra Al-Dawood, Mubashir Zafar* Pages 188-196
    Background

    Metabolic syndrome (MetS) and osteoporosis are two of the worldchr('39')s major healthcare issues. There are several studies which explored the association between MetS and bone mineral density (BMD), but all of them are cross-sectional. These studies cover all populations, including expatriated, which did not determine the actual problem among Saudi women. This is the first case-control study that determines the causal relationship between MetS and BMD. The objective of this study is to determine the relationship between metabolic syndrome and bone mass density among Saudi menopausal women in Eastern Province - Saudi Arabia.

    Methods

    It’s a case-control study and 380 menopausal Saudi women were selected through simple random sampling. They were divided into 190 cases with osteoporosis and 190 without osteoporosis. Bone Mineral Density (BMD) at the total hip was determined using dual-energy X-ray absorptiometry (DEXA). T score was calculated. The association between the risk factors of MetS and bone mineral density was determined by binary logistic regression analysis using SPSS (statistical package of social science) software.

    Results

    Among women, the prevalence of MetS was substantially higher in those with osteoporosis. The Mets is positively correlated with bone mineral density. (r=0.08, p=0.051). The occurrence of MetS was associated with increased osteoporosis among Saudi women (B=0.004; p=0.005) after adjustment of confounders. The existence of obesity was significantly associated with increased odds of Bone marrow density among women (OR 2.56; 95 % CI, 2.22-3.44; p=0.030) after adjustment of confounders.

    Conclusion

    The incidence of MetS was associated with osteoporosis in Saudi women.

    Keywords: Bone mineral density, Menopausal women, Metabolic syndrome, Osteoporosis
  • Leila Shahmoradi, Reza Safdari, Hossein Ahmadi, Maryam Zahmatkeshan* Pages 197-212
    Background

    Clinical decision support systems (CDSSs) interventions were used to improve the life quality and safety in patients and also to improve practitioner performance, especially in the field of medication. Therefore, the aim of the paper was to summarize the available evidence on the impact, outcomes and significant factors on the implementation of CDSS in the field of medicine.

    Methods

    This study is a systematic literature review. PubMed, Cochrane Library, Web of Science, Scopus, EMBASE, and ProQuest were investigated by 15 February 2017. The inclusion requirements were met by 98 papers, from which 13 had described important factors in the implementation of CDSS, and 86 were medicated-related. We categorized the system in terms of its correlation with medication in which a system was implemented, and our intended results were examined. In this study, the process outcomes (such as; prescription, drug-drug interaction, drug adherence, etc.), patient outcomes, and significant factors affecting the implementation of CDSS were reviewed.

    Results

    We found evidence that the use of medication-related CDSS improves clinical outcomes. Also, significant results were obtained regarding the reduction of prescription errors, and the improvement in quality and safety of medication prescribed.

    Conclusion

    The results of this study show that, although computer systems such as CDSS may cause errors, in most cases, it has helped to improve prescribing, reduce side effects and drug interactions, and improve patient safety. Although these systems have improved the performance of practitioners and processes, there has not been much research on the impact of these systems on patient outcomes.

    Keywords: Clinical decision support system, Medication, Significant factors, Patient outcomes, Systematic review
  • Natasha Subhas*, Firdaus Mukhtar, Khadeeja Munawar Pages 213-223
    Background

    Over the years, cognitive-behavioural therapy (CBT) has gained momentum because of its robust evidence in the treatment of several disorders. However, there is an issue of religious and cultural appropriateness as CBT principles are based on Western conceptualization.  This single‐case study (N = 1) implements a culturally and religiously adapted CBT on a 34‐year‐old male with panic disorder with agoraphobia in Malaysia. The client had symptoms comprising various episodes of sudden onset of breathlessness, accelerated heart rate, and fear of dying for the last 14 years.  The CBT was culturally and religiously adapted based on (1) A CBT manual in Bahasa Malaysia that was previously modified and adjusted according to the norms of the Malaysian society and (2) General guidelines in “Religious–Cultural Psychotherapy in the Management of Anxiety Patients” by Razali et al in 2002.  The present modified CBT had 3 assessments formulation sessions and 12 intervention sessions.

    Methods

    The first 6 sessions were based on the behaviour component of CBT (ie, a relaxation technique using Islamic prayer, reciting verses from the Holy Quran, slow breathing exercise, body scan, and progressive muscular relaxation). However, sessions 7 to 12 were focused on cognitive restructuring and exercises, such as identification of negative automatic thoughts, cognitive distortions, dysfunctional thought records, vertical arrow technique, and the coping statement was practised through collaborative empiricism, while implementing Islamic and cultural elements. The focus of termination sessions was on interoceptive exposure, cognitive rehearsal, and in vivo situational exposure.

    Results

    Beck Anxiety Inventory (BAI) was administered at regular intervals. BAI scores revealed the effectiveness of adapting the intervention.

    Keywords: Psychotherapy, Religion, Cognitive-Behavioural Therapy, Culturally Adapted Treatment
  • Mostafa Shanbehzadeh, Hadi Kazemi Arpanahi, Raoof Nopour* Pages 224-231
    Background

    The novel 2019 Coronavirus disease (COVID-19) poses a great threat to global public health and the economy. The earlier detection of COVID-19 is the key to its treatment and mitigating the transmission of the virus. Given that Machine Learning (ML) could be potentially useful in COVID-19 identification, we compared 7 decision tree (DT) algorithms to select the best clinical diagnostic model.

    Methods

    A hospital-based retrospective dataset was used to train the selected DT algorithms. The performance of DT models was measured using performance criteria, such as accuracy, sensitivity, specificity, receiver operating characteristic (ROC), and precision-recall curves (PRC). Finally, the best decision model was obtained based on comparing the mentioned performance criteria.

    Results

    Based on the Gini Index (GI) scoring model, 13 diagnostic criteria, including the lung lesion existence (GI= 0217), fever (GI= 0.205), history of contact with suspected people (GI= 0.188), O2 saturation rate in the blood (GI= 0.181), rhinorrhea (GI= 0.177), dyspnea (GI = 0.177), cough (GI = 0.159), history of taking the immunosuppressive drug (GI= 0.145), history of respiratory failure (ARDS) (GI= 0.141), lung lesion situation (GI= 0.133) and appearance (GI= 0.126), diarrhea (GI= 0.112), and nausea and vomiting (GI = 0.092) have been obtained as the most important criteria in diagnosing COVID-19. The results indicated that the J-48, with the accuracy= 0.85, F-Score= 0.85, ROC= 0.926, and PRC= 0.93, had the best performance for diagnosing COVID-19.    

    Conclusion

    According to the empirical results, it is promising to implement J-48 in health care settings to increase the accuracy and speed of COVID-19 diagnosis.

    Keywords: COVID-19, Novel Coronavirus, Machine Learning, Decision Tree, Data Mining
  • Elham Zarehoseinzade, Abbas Allami*, Mehrnoosh Ahmadi, Behzad Bijani, Navid Mohammadi Pages 232-237
    Background

    There is controversy about the efficacy of 5-alpha-reductase inhibitors in COVID-19 patients. Some assumed that finasteride might be a risk factor for deterioration and others proposed it as a possible adjunct treatment for moderate to severe COVID-19 infection in the elderly.

    Methods

    We performed a randomized controlled clinical trial (registration ID IRCT20200505047318N1) on 80 hospitalized male patients aged ≥50 years diagnosed with COVID-19 pneumonia in a tertiary hospital in Qazvin (Iran) from April to July 2020.   The patients were randomized into one of the 2 treatment groups using simple randomization.  Treatment group patients underwent routine drug therapy and 5 mg finasteride once daily for 7 days. The primary endpoint was mortality rate and length of hospital stay (LOS), and secondary endpoints were peripheral capillary oxygen saturation, respiratory rate, and inflammatory markers changes. The study protocol was approved by the medical ethics committee of Qazvin University of Medical Sciences (registration ID IR.QUMS.REC.1399.080). Data were analyzed by statistical tests and SPSS version 25. Also, p<0.05 was considered to be statistically significant.

    Results

    We found a significant difference on O2 saturation among the 2 study groups on fifth day compared with the admission time (p= 0.018). The results did not show significant differences in mortality rate (2.5% vs 10%; p= 0.166) and LOS (p= 0.866) between patients in the finasteride and the control group.

    Conclusion

    A short course of finasteride administration partially improves O2 saturation but does not influence other outcomes in hospitalized male patients aged ≥50 years with COVID-19 pneumonia. Further research in a large scale with longer follow-up is required to help clarify the role of finasteride in this setting.

    Keywords: Finasteride, Adult, Male, Therapy, COVID-19 Infection
  • Pooya Derakhshan*, Ali Khatibi, Seyed HamidReza Faiz, Poupak Rahimzadeh, Nasrin Nouri Pages 238-243
    Background

    Perioperative glycemic control is an important factor in the clinical management of a patient with diabetes mellitus under surgery. Poorly controlled long-term hyperglycemia not only predisposes individuals to systemic complications of diabetes mellitus and cardiovascular morbidity but also increases the risk of anesthesia and weakens the outcome of the surgery. Given the importance of the issue and the limited studies on glucose control using insulin glargine during surgery, we aimed to investigate the effects of glargine on glucose control in patients with diabetes mellitus during vitrectomy surgery.

    Methods

    This randomized, double-blind trial was conducted in two groups of 35 patients with diabetes mellitus under treatment with insulin. In the control group, the patients received regular insulin based on the blood glucose and the sliding scale, and in the intervention group, they received insulin glargine (0.3 unit/kg) before surgery. From the start of the operation up to 3 hours of the surgery blood glucose of the patients was measured every 45 minutes and once 6 hours after the operation, and if needed, the regular insulin was injected. Data were analyzed using SPSS 16. Frequency, percentage, mean, and standard deviation (SD) were used to describe the data. To compare the quantitative variables, the independent t-test or U-Mann-Whitney test was used. For comparison of the qualitative variables, Chi-square test or Fischerchr('39')s exact test and repeated measure ANOVA was employed. The significance level (P-value) was considered as p<0.05.

    Results

    Use of insulin glargine was associated with significantly lower blood glucose levels compared to regular insulin at 90-minutes (p=0.004), 135 minutes (p=0.001), and 6 hours after the operation (p=0.005).

    Conclusion

    Glycemic control using glargine compared to regular insulin has a better performance with less need for surplus insulin dose administration during surgery.

    Keywords: Type 2 Diabetes Mellitus, Regular Insulin, Insulin Glargine, Perioperative Glycemic Control
  • AliAsghar Ghorbani, Zohreh Sohrabi*, Shahram Yazdani, Salimeh Khalili Azandehi Pages 244-256
    Background

    Undoubtedly, economic and social value added depends on the functions of universities. Moving toward third-generation universities (3rd GU) is an inevitable process. These universities need different functions than traditional ones; therefore, identifying and determining their functions is essential. The purpose of this study is to collect, match and explore the functions of universities in the transition to 3rd GU and ultimately offer a functional model of the 3rd GU for the use of professors, academics and policymakers in order to evaluate and promote universities.

    Methods

    A critical review method was adapted.  Literature was included based on their relevant empirical data to research objectives and referral rates, and texts with more conceptual richness entered the study without time limitations.

    Results

    A total of 20 texts were included in the final analysis.  While presenting the basic model, extracts the overarching concepts associated with the success of 3rd GU. These key concepts include the 7 core functions of innovative and entrepreneurial activities, supportive activities (financial and non-financial), entrepreneurial education ( curriculum and  academic workforce empowerment), creation and provide applied knowledge, boundary-spanning function or communications and interactions with other elements of the national innovation system (state and industry), develop innovative and entrepreneurial culture and institutional governance and leadership in the direction of economic growth and development.

    Conclusion

    Using new functions at universities would be a move toward 3rd GU, economic growth and development in the country. So, these functions are a practically useful guide to policymakers to estimate the rate of success in each university and deliver the necessary suggestions to provide the mechanisms for the establishment of a successful university.

    Keywords: Innovation Function, Transition, Third Generation University
  • Sana Eybpoosh, Mahdi Afshari*, AliAkbar Haghdoost, Parvin Afsar Kazerooni, MohammadMehdi Gouya, Katayoon Tayeri Pages 257-262
    Background

    Higher mortality due to coronavirus disease 2019 (COVID-19) is reported among some immunocompromised patients; however, the relation between immunosuppression due to HIV infection and severity of COVID-19 infection remains unclear. We aimed to investigate the severity and mortality of COVID-19 infection in HIV-infected patients.  

    Methods

    This was a retrospective cohort study on all COVID-19 suspected and confirmed cases hospitlized in Iran between Febuary 19 (epidemic onset date) and April 8, 2020, whose data were recorded in the national database for Medical Care Monitoring Center. Hospitalized patients were followed from admittion to death/discharge. Patients’ HIV status was recorded based on their self report. Logistic and Cox regression models were used to evaluate the association between HIV infection and the severity (according to the Glascow-Coma Scale situation, need for intubation and hypoxemia) and mortality of COVID-19 infection, respectively. Analyses were performed separately for COVID-19 suspected and confirmed cases.

    Results

    Out of 122 206 severe acute respiratory infection (SARI) cases, 90 were HIV-positive (0.07%), with a similar mean age (Pt-test= 0.750) and distrubtion of gender (PChi-square= 0.887) and nationality (PChi-square= 0.202) as HIV-negative patients. A comparable proportion of HIV-positive and HIV-negative cases were tested for COVID-19 (p= 0.170); however, the frequency of positive results was lower among HIV-positives (p= 0.038). The frequency of COVID-19 and HIV coinfection was lower than expected among confirmed cases (adjusted OR= 0.54; 95% CI: 0.29-1.02) and suspected cases (adjusted OR= 0.68; 95% CI: 0.45-1.02), which means that the frequency of COVID-19 infection was lower among HIV-positive cases. HIV infection decreased the risk of death among confirmed (adjusted HR= 0.33; 95% CI: 0.05-2.32), suspected cases (adjusted HR= 0.81; 95% CI: 0.33-1.94), and among SARI cases (adjusted HR= 0.73; 95% CI: 0.35-1.54). 

    Conclusion

    Our findings support the concept that HIV infection was not a risk factor to increase the severity and risk of death among COVID-19 infected patients.

    Keywords: COVID-19, HIV, Severity
  • Afsane Ahmadi, Zohreh Mazloom*, MohammadHassan Eftekhari, Sayed Masoom Masoompour, Mohammad Fararooei, MohammadHadi Eskandari, Samrad Mehrabi, Morteza Zare, Zahra Sohrabi Pages 263-269
    Background

    Chronic obstructive pulmonary disease (COPD), as an airway limitation condition, is accompanied by alteration of muscle mass and function. We aimed to determine the relationship between disease severity and body composition, muscle function, and nutritional status in COPD patients. 

    Methods

    This cross-sectional study was conducted on 129 COPD participants. Muscle strength, body composition, and calf circumference (CC) were measured using a hydraulic hand dynamometer, bioelectrical impedance analysis (BIA), and a tape measure, respectively. Furthermore, fat-free mass index (FFMI), body mass index (BMI) and muscle mass value were calculated by equations. Forced expiratory volume in one second (FEV1) was assessed as well. Nutritional status was also evaluated by subjective global assessment (SGA) questionnaire. SPSS software (version 21 ) was used, chi-square, fisher’s exact test, univariate and multivariate linear regression models were used for statistical analysis. P-values less than 0.05 were considered significant.

    Results

    Based on FEV1 classification, 52.7% of the patients had severe conditions. The reports indicated that the prevalence of low CC was 54.2%, low muscle mass 38.7%, low FFMI 34.8%, low right handgrip strength 61.2% and low left handgrip strength 64.3%. Furthermore, there was an increasing trend based on FEV1 in low CC (p=0.032),  low muscle mass (p=0.005), low FFMI (p=0.002), low right handgrip strength (p=0.004) and low left handgrip strength (p=0.014). The results of univariate analysis showed muscle mass (p=0.036), total protein (p=0.043), FFM (p=0.047), FFMI (p=0.007), SGA (p=0.029), right handgrip strength (p=0.004)  and left hand grip strength (p=0.023) were associated with FEV1. In addition, the results of multivariate analysis demonstrated low values of FFMI (p=0.005)  and right handgrip strength (p=0.042) were the main detrimental factors for FEV1. The results of  multivariate analysis were confirmed by stepwise model.

    Conclusion

    Low values of muscle mass and function are prevalent among COPD patients. The present study revealed that low FFMI and handgrip strength were closely related to disease severity.

    Keywords: Muscle Mass, Lean Body Mass, Nutritional Status, Muscle Strength, Respiratory Disease
  • Ebrahim Ghaderi, Seyed Mohsen Zahraei, Ghobad Moradi, Elham Goodarzi, Abbas Norouzinejad, Behzad Mohsenpour, Hasan Naemi, Zaher Khazaei* Pages 270-276
    Background

    Salmonella induced infections remain one of the most important health problems worldwide. The purpose of this study is to investigate the incidence and geographical distribution of typhoid using GIS and to predict its incidence in Iran in 2021. 

    Methods

    This study is a descriptive analytical study. Information on pertussis was obtained from the Center for Communicable Diseases Control during 2009-2015. In the next step, ArcGIS 9.3 was used to prepare geographic maps of the disease incidence and frequency Therefore, using the Raster Calculator tool, the disease prediction map was drawn.

    Results

    The results showed that the highest incidence of typhoid during 2009-2014 was in Kermanshah, Lorestan, Hamadan, Kurdistan, and Ilam provinces. The incidence of typhoid in Iran increased during 2009-2010. The annual incidence of typhoid decreased from 0.85 per 100,000 in 2010 to 0.5 in 2014. Based on the modeling results for Iran, Kermanshah, Lorestan, Kurdistan, Ilam and Hamadan provinces with 92.17%, 46.56%, 31.74%, 25.62% and 22.96% of their areas (Km2) are at high risk for typhoid in the coming years, respectively.

    Conclusion

    Considering that the provinces of Kermanshah, Lorestan, Kurdistan, Ilam, and Hamadan are at risk of typhoid incidence in the coming years in Iran, and given that salmonella infections have a direct relationship with the individual’s health status and individual’s environmental health and socioeconomic status, improving the health status and disease control in carriers as well as improving the socio-economic status of the population living in these areas can prevent the disease in the years to come.

    Keywords: Incidence, Typhoid, GIS, Iran
  • Behzad Amiri, Ebrahim Ghaderi*, Parvin Mohamadi, Samira Shirzadi, Shahla Afrasiabian, Heyman Salimi Zand, Asrin Karimi, Elham Goodarzi, Zaher Khazaei, Leili Moayed Pages 277-282
    Background

    Anthrax is a zoonotic infectious disease that is still considered as a health problem in developing countries. Therefore, the aim of this study was to investigate the incidence and geographical distribution of anthrax using the Geographic Information System (GIS) and predict its incidence in Iran in 2021.

    Methods

    This study is descriptive analytical study. Information on anthrax was obtained from the Center for Communicable Diseases Control during 2010-2015. In the next step, ArcGIS 9.3 was used to prepare geographic maps of the disease incidence and frequency. Therefore, using the Raster Calculator tool, the disease prediction map was drawn.

    Results

    The highest incidence of anthrax during 2010-2015 was observed in the provinces of Kurdistan, North Khorasan, and Chaharmahal and Bakhtiari, respectively. The trend of the incidence of anthrax in Iran had increased from 2010 to 2013, while its incidence decreased in 2014. Based on the results of modeling in Iran, the provinces of Kurdistan, West Azarbaijan, Tehran, and Zanjan, respectively, with 37.16%, 33.83%, 16.78%, and 10.49% of their area (km²) had the highest risk of anthrax disease in the country in the year 2021.

    Conclusion

    Since the provinces of Kurdistan, West Azerbaijan, Tehran, and Zanjan are among the high-risk areas in the country in the coming years, the cooperation between the veterinary organization and the health care system and the vaccination of livestock in these areas can significantly help to control and prevent the disease.

    Keywords: Prediction of the Incidence, Anthrax, GIS, Iran
  • Solmaz Sadat Naghavi Alhosseini, Ata Pourabbasi*, Sevil Banay Razi Pages 283-288
    Background

    Entrepreneurship leads to an increase in national income by creating new jobs and plays a role as a positive factor in economic growth by serving as a bridge between innovation and the market. The aim of this study was to identify the capacity and barriers existing in the medical universities of Iran to develop entrepreneurship from the viewpoint of some of the officials and academic experts.

    Methods

    This qualitative, descriptive-analytic study was conducted to explore threats and opportunities in educational entrepreneurship at medical universities. The sample consists of medical universitieschr('39') deputies of education across the country, attending the national meeting of education deputies. A questionnaire containing 10 open questions was tailored and given to the participants. After returning the questionnaires, the responses were evaluated using the content analysis method.

    Results

    The issues related to the strengths of the medical universities in entrepreneurship development can be summarized in 3 categories: human factors, organizational and infrastructure factors, and technical and technological factors. With regard to the existing weaknesses while developing entrepreneurship in the context of medical universities, there are 3 general categories: education and research barriers, state-legal-political, and economic-managerial shortcomings.
    The barriers to entrepreneurship development among medical graduates can be categorized in 4 groups, including education and information, cultural and social factors, financial barriers as well as structural and infrastructural drawback.

    Conclusion

    The most important movement toward entrepreneurship development in medical universities could be making structural revisions in transforming into third-generation universities. This important issue is being pursued and implemented by the government in the form of Plan for Development and Innovation in Medical Education.

    Keywords: Entrepreneurship, Entrepreneurial University, Barriers of Entrepreneurship, Entrepreneurship Development
  • Maryam Seyedtabib, Hossein Mahjub, Mahmood Mahmoudi, Abbas Moghimbeigi* Pages 289-296
    Background

    The number of children ever born (CEB) to a woman, as an index of her fertility behavior, are interesting for the governments and demographer policymakers. In recent years, a notable reduction of fertility and population aging in Iran has caused concern among politicians, and it has led to starting new changes in demographic policies. Therefore, to adopting new demographic and health policies programs, identification of factors that affecting CEB is essential.

    Methods

    To evaluate determinant factors on CEB, information of 20093 married Iranian women aged between 15 and 54 years has been analyzed from the Iranian National Institute of Health Research survey. Based on the structure of data and the possible influential unobserved population heterogeneity on CEB in each city and province, a multilevel count regression model was applied. The analysis was performed using the ‘R’ software (version 3.5) with a significant level of 0.05.

    Results

    Findings show that the mean and median number of CEB was 2.82 and 2.00 for all women, respectively. Meanwhile, these values were 4.56 and 4.00 for the women who reached menopause. There was a significant unobserved heterogeneity affecting CEB in each province (σp=0.018). Also, the results of the multilevel model show that living in an urban area (RR=0.90), higher age at first marriage (RR=0.96), higher education (RR=0.84, RR=0.81), and exposure to mass media (RR=0.87) decrease the risk ratio of the number of CEB (p <0.001).

    Conclusion

    It seems that the tendency of women to academic education and their access to mass media has a significant effect on reducing childbearing. Therefore, in future planning, attention to these two factors can be useful and helpful to move to increase fertility.

    Keywords: Fertility, Multilevel Analysis, Count Response, Children ever Born
  • Neda Sadeghi, MohammadAli Nazari, Ali Shahbazi, MohammadTaghi Joghataei* Pages 297-304
    Background

    There is conflicting evidence in favor of the hemispheric distribution of motor planning. Some studies supported the left-hemisphere-dominance hypothesis for motor planning and claimed that the left-hemisphere has a crucial function in motor control even in left-handers. The present study aimed to compare the right- and left-handed participants on motor planning ability and to investigate the performance of their dominant hands in a specific action selection task. Also, the effect of task complexity was assessed.

    Methods

    Twenty right-handers and 20 left-handers performed an action selection task. The participants had to grasp a hexagonal knob with their dominant hand and consequently rotated it 60° or 180 ° clockwise or counterclockwise. Depending on our objects, we used mixed factorial ANOVA and the groups were examined in terms of the planning time, grasping time, releasing time and planning pattern for initial grip selection. The SPSS 19 was used for analyzing the data and p≤0.05 was considered as the significant level.

    Results

    No significant differences were observed between the two groups. The movement-related measures revealed a main effect of rotation (p˂0.001). However, a significant interaction between direction × planning pattern × group (p˂0.001) indicated a preferential bias for rotatory movements in the medial direction which is consistent with the “medial over lateral advantage”.

    Conclusion

    Both left- and right-handed participants had a similar motor planning ability while performing a planning task with their dominant hands. Because our study was behavioral, it only provided a test of the left-hemisphere hypothesis of motor planning.

    Keywords: Motor Control, Hemispheric Specialization, Handedness
  • Mohammadreza Mobinizadeh, Efat Mohamadi, Hosein Arman, Amirashkan Nasiripour*, Alireza Olyaeemanesh, Sara Mohamadi Pages 305-313
    Background

    Various studies have used multiple attribute decision making (MADM) techniques to assess and rank health technologies.  The goal of the present study was to prioritize health technologies using various techniques of MADMs in combination with decision rules.

    Methods

    The study is an applied research using multi-attribute decision making (MADM) methods. This study extracted the attributes related to health technology assessment from global literature and experts’ opinions. In this study, two different types of experts were consulted: the first type, including three experts in the field of the decision-making techniques, on the subject of setting priority on health focusing on MADM; and the second one consists of seven experts in the field of HTA, asked about the selection of attributes and determination their importance. Candidate health technologies were individually weighted and ranked using TOPSIS, SAW and VIKOR by the weight and decision matrix. The results obtained from various techniques were combined and ranked using Copeland’s technique to obtain the final ranking of health technologies. To determine HTA type reports, decision rules were defined. All models were designed via MS Excel.

    Results

    This study chose eight technologies according to six tradeoff attributes. These attributes included health benefits at the population level, vulnerable population size, availability of alternative technologies, budget impact, financial protection, and quality of evidence. Their exact weights were 0.25, 0.121, 0.146, 0.132, 0.167 and 0.181, respectively. Also, safety and uncertainty about the cost-effectiveness were considered as the veto and decision rules respectively. Copeland’s method was therefore used to combine the methods Whereas HT2 (The technology for treating patients suffering from varicose) was ranked the highest priority and HT3 (The palliative method for patients who suffer from various cancers) was ranked the lowest (for preventing from any ethical issue, the exact name of each technology wasn’t mentioned).

    Conclusion

    Finally, in accordance with decision rules which are based on various conditions of “uncertainty about the cost-effectiveness”, it is recommended that full health technology assessment report be performed on three technologies, rapid health technology assessment report be performed on four others, and, finally no prioritizing for health technology assessment be made on one of them.

    Keywords: Topic Selection, Health Technology Assessment, Multiple Attribute Decision Making
  • Forouzan Akrami, Gohar Mohammadi, Mehdi Azizmohammad Looha, Abbas Habibelahi, Yadollah Mehrabi, Shahnaz Delbarpoor Ahmadi, Mohammad Heidarzadeh* Pages 314-321
    Background

    Estimation of the survival of very preterm infants is necessary to make decisions and design interventions in order to improve their quality of care. This survey aimed to estimate the survival of very preterm infants born at 23 up to 33 weeks of gestational age (GA) in Iran.

    Methods

    This population-based retrospective cohort study included 8536 infants born before 33 weeks of GA, from March 21st to December 22nd  2013 in Iran. The primary data were extracted from the Iranian national maternal and neonatal registration network (IMAN). All infants who have been discharged alive, followed up by telephone contact up to one year after birth. The Kaplan-Meier and Log-rank tests were performed to estimate survival and to compare survivals, respectively, using SPSS version 26 and R 3.5.2 softwares.

    Results

    The overall survival was estimated at 56.70% (95% C.I: 55.60%-57.80%) at the end of the follow-up period. Total death rate was estimated at 43.30% and was significantly decreased with increasing birth weight (p<0.0001). Survival was increased significantly with increasing GA (p<0.0001), from 5.7% at 23 weeks to 79.6% at 32 weeks. The estimated cumulative proportion of death until the end of the neonatal period had a decreasing trend and then had a steady trend until the end of the follow-up period. The hazard ratio of quadruple or more birth and GA were 1.46 (p=0.021) and 0.83 (p<0.001), respectively.

    Conclusion

    The overall estimated survival of very preterm infants was not high. Even with modern perinatal technology and care, early deaths of very preterm infants were still common.

    Keywords: Preterm Birth, Survival, Death Rate, Iran
  • Bahram Pakzad, Farzaneh Yousefisadr, Hadi Karimzadeh, Maryam Mousavi, Elham Noormohamadi, Rasoul Salehi* Pages 322-326
    Background

    Rheumatoid arthritis (RA) is a progressive and common autoimmune disease with multifactorial etiology. Several pieces of research show that genetic factors play a major role in the incidence of RA. Several genome-wide association studies (GWAS) have identified the tumor necrosis factor alpha inducible protein 3 (TNFAIP3) genes as one of the candidate loci. The TNFAIP3 gene encoding ubiquitin-editing protein A20 witch restricts B cell survival and prevents autoimmunity. Previous studies have indicated that single nucleotide polymorphisms (SNPs) in the TNFAIP3 gene are correlated with several autoimmune disorders. In the present study, we assessed the possible association between SNP rs5029937 (intronic variant) in the TNFAIP3 gene with RA risk in the Iranian population.

    Methods

    A case-control study using 50 RA patients and 50 control subjects was undertaken to evaluate rs5029937 (G>T) genotypes using real-time PCR high resolution melting method (HRM). The SPSS22 was used for statistical analyses and the significance level was set at P<0.05.

    Results

    Logistic regression analysis demonstrates that homozygous TT + heterozygous TG genotypes compared with GG genotype increase the risk of RA (TT+TG vs GG; P= 0.004, OR= 3.46; 95%CI [1.492-8.075]). Also, individuals with allele T were more frequently affected with RA than subjects with G allele (T vs G; P= 0.004, OR= 2.61; 95%CI [1.382-4.919]).

    Conclusion

    Our findings propose a substantial correlation between rs5029937 (G>T) polymorphism and RA risk in Iranian population.

    Keywords: Rheumatoid Arthritis, TNFAIP3 Gene, Single-nucleotide Polymorphism, Autoimmune Disorder, HRM
  • Parisa Eslami, Sharareh R. Niakan Kalhori, Moloud Taheriyan* Pages 327-340
    Background

    eHealth has a notable potential to help in prevention, diagnosis, treatment, screening, management, and control of the COVID-19 pandemic. Since ehealth is considered here broadly, as an umbrella term, it also covers subsets like telehealth and mhealth. This study aimed to review the literature to identify and classify subdomains of eHealth solutions that have been utilized, developed, or suggested for the COVID-19 pandemic.

    Methods

    A comprehensive literature search was performed using the PubMed, Scopus, Embase, and Cochrane library databases in April 2020, with no time limitation. The search strategy was built based on 2 concept domains of eHealth solutions and covid-19. For each concept domain, the search query comprised a combination of free text keywords identified from reference papers and controlled vocabulary terms. Obtained results were classified, graphically presented, and discussed.

    Results

    Of the 423 studies identified initially, 35 were included in this study. From related papers, general characteristics, study objective, eHealth-related outcomes, target populations, eHealth interventions, health service category, eHealth solution, and eHealth domain were extracted, classified, and tabulated. Most publication types were ideas, editorials, or opinions (46%). The most targeted populations were people of the community and medical staff (80%). The most implemented or suggested eHealth solution was telehealth (63%), followed by mhealth, health information technology, and health data analytics. Most of the COVID-19 ehealth interventions designed or suggested for improving prevention (48%) and diagnosis (48%). Most of the studies applied or proposed eHealth solutions for general practice or epidemiological purposes (48%).

    Conclusion

    eHealth solutions have the potential to provide useful services to help in COVID-19 pandemics in terms of prevention, diagnosis, treatment, screening, surveillance, resource allocation, education, management, and control. The obtained results from this review might be used for a better understanding of current ehealth solutions provided or recommended in response to the COVID-19 pandemic.

    Keywords: COVID-19, eHealth, Telemedicine, Public health, Health informatics
  • Raoof Nopour, Mostafa Shanbehzadeh, Hadi Kazemi Arpanahi* Pages 341-348
    Background

    Colorectal Cancer (CRC) is the most prevalent digestive system- related cancer and has become one of the deadliest diseases worldwide. Given the poor prognosis of CRC, it is of great importance to make a more accurate prediction of this disease. Early CRC detection using computational technologies can significantly improve the overall survival possibility of patients. Hence this study was aimed to develop a fuzzy logic-based clinical decision support system (FL-based CDSS) for the detection of CRC patients.

    Methods

    This study was conducted in 2020 using the data related to CRC and non-CRC patients, which included the 1162 cases in the Masoud internal clinic, Tehran, Iran. The chi-square method was used to determine the most important risk factors in predicting CRC. Furthermore, the C4.5 decision tree was used to extract the rules. Finally, the FL-based CDSS was designed in a MATLAB environment and its performance was evaluated by a confusion matrix.

    Results

    Eleven features were selected as the most important factors. After fuzzification of the qualitative variables and evaluation of the decision support system (DSS) using the confusion matrix, the accuracy, specificity, and sensitivity of the system was yielded 0.96, 0.97, and 0.96, respectively.

    Conclusion

    We concluded that developing the CDSS in this field can provide an earlier diagnosis of CRC, leading to a timely treatment, which could decrease the CRC mortality rate in the community.

    Keywords: Colorectal cancer, CRC, Fuzzy logic, Artificial intelligence, Risk analysis, Screening
  • Behzad Damari*, Hossain Almadani, Hossein Mirzaei Pages 349-356
    Background

    Happiness, a factor in social, political, and economic development, leads to higher performance, increase in production, and great efficiency. The goal of this study was to assess the level of happiness in Iran’s work communities.

    Methods

    In this cross-sectional survey study, we randomly selected 13842 people from 380 workplaces in 31 provinces of Iran. Trained interviewers based on structured questionnaires collected data. Reliability of the questionnaire determined by using internal consistency. Collected data were analyzed through SPSS 16 software (SPSS Inc., Chicago, IL) and the charts and tables were prepared to indicate each province’s happiness level and the national mean.

    Results

    Average age of employees was 35.4±7.78 years. The majority of the respondents were male(n=11835, 85.5%), had finished middle/secondary school (n=7142, 51.6%) and were married (n=11323, 81.8%). The level of happiness varied from the highest value 148.97±21.49 in Boushehr Province and the lowest 130.39± 25.28 in Hormozgan Province.  The mean ± SD value of happiness in the work communities of Iran was 141.22±22.89.

    Conclusion

    Policymakers should consider workers’ happiness as an effective factor in production and efficiency.

    Keywords: Happiness, Workplace, Iran
  • Masoud Salehi, Nasim Vahabi, Hassan Pirhoseini, Farid Zayeri* Pages 357-365
    Background

    Tuberculosis (TB) is still a serious health problem with a remarkable global burden. In this study, we aimed to assess the trend of TB mortality in Asian and North African countries in the period 1990-2017 and provide a new classification according to TB mortality trend.

    Methods

    TB mortality rates from 1990 to 2017 were extracted from the Global Burden of Disease website for 55 Asian and North African countries. Trend analysis of TB mortality rates for males, females, and the total population was performed using the marginal modeling approach. Moreover, the latent growth mixture modeling (LGMM) framework was applied to classify these 55 countries based on their trend of TB mortality rate 

    Results

    In the period between 1990 and 2017, South Asia and High Income Asia-Pacific regions had the highest and lowest death rates due to TB, respectively. The marginal modeling results showed that the Asian and North African countries had experienced a downward trend with an intercept of 28.79 (95%CI: 19.64, 37.94) and a slope (mean annual reduction) of -0.67 (95%CI: -0.91, -0.43)  per 100,000 the study period. Finally, the LGMM analysis classified these 55 countries into four distinct classes.

    Conclusion

    In general, our findings revealed that although the countries in Asia and North Africa super region experienced a descending TB mortality trend in the past decades, the slope of this reduction is quite small. Also, our new classification may be better suited for combating TB through future healthcare planning in lieu of the commonly used geographic classifications.

    Keywords: Tuberculosis, Asia, North Africa, Trend Analysis, Classification
  • Mohsen Shati, Seyede Salehe Mortazavi*, Mozhgan Taban, Seyed Kazem Malakouti, Shiva Mehravaran, Ali Norouzi, Nancy A. Pachana Pages 366-374
    Background

    Despite studies about anxiety in the older adult, the prevalence of anxiety in this age group is not exactly clear, which may be due to the use of tools and criteria that were not born for this age group. One of the instruments designed to assess anxiety in the elderly is the Geriatric Anxiety Inventory (GAI). The aim of this research was to analyze the psychometric properties of the Persian version of the Geriatric Anxiety Inventory (GAI-PV) and its short form (GAI-PV-SF) in a sample of older adults in Iran.

    Methods

    In this cross-sectional study, a sample of 150 community-dwelling and a psychogeriatric sample of 48 adults older than 60 years completed the GAI-PV and GAI-PV-SF, the anxiety sub-scale of the General Health Questionnaire (GHQ-28), the Geriatric Depression Scale (GDS-15), and the Structured Clinical Interview for DSM-IV (SCID-I). Different types of validity and reliability were evaluated for GAI-PV and GAI-PV-SF using SPSS and the LISREL software. 

    Results

    Both the GAI-PV and GAI-PV-SF exhibited excellent internal consistency (over 80 %) and desirable concurrent validity against GHQ-28 and GDS-15. The optimal cutpoint score to detect current generalized anxiety disorder (GAD) was 10/11 and 13/14 for GAI-PV in the community-dwelling and psychogeriatric samples, respectively, and 3/4 for GAI-PV-SF in both study samples.  Good test-retest reliability (correlation coefficient: 0.96 and 0.88 for GAI-PV and GAI-PV-SF, respectively) and a single-factor structure were also demonstrated.

    Conclusion

    Sound psychometric properties of the GAI-PV in both subsamples suggest that the instrument could be used successfully as an accurate screening instrument in the elderly Iranian population.

    Keywords: Geriatric Anxiety Inventory (GAI), Aged, Psychometric Property, Validity, Reliability
  • Marzieh Nojomi, Arash Tehrani Banihashemi, Hassan Niksima, Maryam Hashemian, Azadeh Mottaghi*, Reza Malekzaddeh Pages 375-382
    Background

    Dietary patterns and diet quality index (DQI) are widely discussed in relation with different health conditions and have recently been taken into consideration for all cancer types. Since chronic inflammation has been recognized as an important biologic risk factor for cancer occurrence, especially in epithelial tissues, proinflammatory or anti-inflammatory characteristics of diet has become the center of attention. In the present study, we aimed to identify whether a specific dietary pattern, Mediterranean dietary score (MDs), and dietary inflammatory index (DII) were associated with overall cancer risk in Iranian population.

    Methods

    This study was performed in the context of the Golestan cohort study. Participants with extreme daily energy intake or those who did not answer more than 30 question of the Food Frequency questionnaire (FFQ) were excluded. Dietary patterns, MDs, and DII were measured from FFQ. Age, sex, total energy, place of residence, smoking, wealth score, ethnicity, opiate use, BMI, education, marital status, and physical activity score were considered as confounding variables. Using Cox proportional hazards regression models, hazard ratios (HRs) and 95% confidence interval of cancer were estimated.

    Results

    HRs (95% CIs) of all cancers by quartiles of Western dietary pattern, DII, and MDs showed that the forth quartile of the Western dietary pattern is attributed to 23% higher cancer risk (HRs: 1.23, CI: 1.09-1.40, P< 0.001, adjusted for age and sex) compared to the first quartile. It also remained significant after further adjustments (HRs = 1.20, CI: 1.06-1.36, P< 0.001).  There was a higher cancer risk in the fourth quartile of DII in comparison with the first quartile (HRs = 1.16, CI: 1.01-1.32, P trend < 0.001, adjusted for age and sex). The lower adherence to the Mediterranean dietary pattern also largely contributes to 27% higher cancer risk (HRs: 1.27, CI: 1.12-1.44), P trend < 0.001, adjusted for age and sex), which also remained remarkable after further adjustments ((HRs =1.19, CI: 1.05-1.35, P trend < 0.001).

    Conclusion

    Cancer is highly correlated to dietary intake and dietary patterns, such as the Western dietary pattern, while the Mediterranean diet score was inversely associated with cancer risk. Further investigations are required to get a broader insight into cancer determinants in population.

    Keywords: Dietary Patterns, Dietary Quality Index, Dietary Inflammatory Index, Risk, Cancer, Golestan Cohort Study
  • Abbas Edalatkhah, MohammadReza Kazemi*, Zohreh Akhoundimeybodi, Seyed Mohsen Seyedhosseini, Soheila Rostami, Bibi Vaghihe Hosseini, Zohreh Akhondi, Yaser Ghelmani Pages 383-386
    Background

    Among the medications administered for the management of COVID-19 patients, the induction drugs used for intubation have received little attention. The aim of this study was to compare the effect of induction drugs on the mortality of patients with COVID-19 requiring intubation.

    Methods

    In this retrospective study, all patients who were admitted to Shahid Sadoughi and Shahid Rahnemoun hospitals in Yazd from February to March 2020 with definitive diagnosis of COVID-19 and needed intubation were enrolled. Patients were divided into 4 groups based on the type of drugs used in intubation, and mortality rate was assessed at the end of the first, second, fourth, and seventh days of the study. Statistical analyses were performed using SPSS 20 and P values < .05 was considered significant  .

    Results

    In this study, 76 patients were examined. Patients were divided into 4 groups, of which 21 were in etomidate group, 8 in ketamine group, 21 in sodium thiopental group, and 35 in midazolam group. Mortality rate in these 4 groups was 25%, 12.5%, 14.3%, and 14.3% (p=0.822), respectively at the end of the first day after intubation; it was 83.3%, 12.5%, 28.6%, and 25.7% (p=0.001), respectively, at the end of the second day; it was 83.3%, 12.5%, 42.9%, and 42.9% (p=0.015), respectively, until the end of the fourth day; it was 100%, 25%, 61.9%, and 65.7% (p=0.007), respectively, until the end of the seventh day. Admission to intubation time interval was 0.91±0.99, 3.12±1.95, 4.09±2.44, and 4.74±2.62 days, respectively (p<0.001).

    Conclusion

    The results of this study suggest that the use of etomidate may be associated with higher mortality in COVID-19 patients. Further studies are needed to verify the results of this study.

    Keywords: Mortality, COVID-19, Intubation, Etomidate
  • Masoud Abolhallaje, Hossein Ebrahimipour, Mehdi Jafari*, Arefeh Pourtaleb Pages 387-393
    Background

    Board of Trustees (BOTs) in Iranian medical universities has been considered as one of the most important structural and managerial changes to create a revolution in decision-making and accountability. This study aimed to explore challenges facing BOTs in governing Medical Universities (MUs).   

    Methods

    In this qualitative study, 27 semi-structured interviews were conducted with current and former members of BOTs, chancellors of universities, BOTs’ secretaries, and staff in the Ministry of Health and Medical Education in 2017. These participants were selected using a purposive and snowball sampling method. Data were analyzed by framework analysis and using Atlas-Ti software.

    Results

    Five key themes were identified, including 1) infrastructure (problems in BOT laws and membership requirement), 2) planning and decision-making (evidence-based decision making and planning and meeting), 3) organizing (ambiguity in positions and lack of necessary administrative structure), 4) performance evaluation (self-reporting, lack of time allocation, lack of evaluation criteria and lack of required structure for evaluation), 5) independence and influence on performance (dependency on the Ministry of Health and Medical Education and financial independence).

    Conclusion

    Due to obsolete laws, it seems that the structural and executive reform of BOTs is essential. The issues of university autonomy and empowerment of the boards’ members should particularly be considered in such reforms. However, it appears that more delegation and empowering the position of the boards could be effective strategies in governance medicals universities.

    Keywords: Governing board, Trustees, Qualitative study, Iran
  • Hesam Ghiasvand, Efat Mohamadi, Alireza Olyaeemanesh, MohammadMehdi Kiani, Bahram Armoon, Amirhossein Takian* Pages 394-408
    Background

    Health inequities are among debatable and challenging aspects of health systems. Achieving equity through social determinants of health approach has been mentioned in most upstream national plans and acts in Iran. This paper reports the findings of a systematic review of the current synthesized evidence on health equity in Iran.

    Methods

    This is a narrative systematic review. The relevant concepts and terminology in health equity was found through MeSH. We retrieved the relevant studies from PubMed/MedLine, Social Sciences Database, and Google Scholar in English, plus the Jihad University Database (SID), and Google Scholar in Farsi databases from 1979 until the end of January 2018. The retrieved evidence has been assessed primarily based on PICOS criteria and then Ottawa-Newcastle Scale, and CASP for qualitative studies. We used PRISMA flow diagram and a narrative approach for synthesizing the evidence.

    Results

    We retrieved 172 455 studies. Following the primary and quality appraisal process, 114 studies were entered in the final phase of the analysis. The main part (approximately 95%) of the final phase included cross-sectional studies that had been analyzed through current descriptive inequality analysis indicators, analytical regression, or decomposition-based approaches. The studies were categorized within 3 main groups: health outcomes (40.3%), health utilization (32%), and health expenditures (27%).

    Conclusion

    As a part of understanding the current situation of health equity in the policymakers’ need to refer the retrieved evidence in this study, they need more inputs specially regarding the social determinants of health approach. It seems that health equity research plan in Iran needs to be redirected in new paths that give appropriate weights to biological, gene-based, environmental and context-based, economic, social, and political aspects of health as well.
    We advocate addressing the aspects of Social Determinant of Health (SDH) in analyzing health inequalities.

    Keywords: Health Equity, Health Inequality, Health Care Disparity, Health Care Inequality, Health Social Determinants, Health Care Availability, Health Care Accessibility, Health Disparity, Health Care Utilization
  • Hassan Bazmamoun, Danyal Isapour, Zahra Sanaei, Rahimpour Amiri* Pages 409-412
    Background

    Idiopathic nephrotic syndrome is one of the most common glomerular diseases, which may be secondary to infections or systemic diseases. The aim of this study was to evaluate the effect of Helicobacter pylori (H. pylori) eradication on childhood nephrotic syndrome. 

    Methods

    In this randomized controlled clinical trial study, 38 children with concomitant idiopathic nephrotic syndrome and H. pylori infection were divided into 2 equal groups; the intervention group received a cotreatment for both diseases and the control group received only nephrotic syndrome treatment. Patients were followed for 6 months. Data were analyzed using SPSS 21 software.  Chi square test, Fisher exact test, and student t test were used. P value <0.05 was considered statistically significant.

    Results

    The mean interval time from treatment to the recovery of nephrotic syndrome was 48.36±14.48 days in the intervention group and 51.68± 17.32 days in control groups, which was shorter in the intervention group, but not statistically significant. The recurrence of nephrotic syndrome and the mean number of recurrences in the intervention group were lower than the control group, but were not statistically significant. The frequency of diarrhea in the intervention group was significantly higher than the control group (p=0.003).

    Conclusion

    In children with concomitant idiopathic nephrotic syndrome and H. pylori infection, the treatment of both diseases may accelerate the recovery and decrease the recurrence of nephrotic syndrome.

    Keywords: Nephrotic Syndrome, Helicobacter pylori Infection, Children
  • Behshid Farahmand, Ensieh Pourhosaingholi*, Azam Bagheri Pages 413-417
    Background

    Carpal tunnel syndrome (CTS) is the most common compressive neuropathy presenting with sharp pain, parenthesis, dysfunction of the hand in coordination and gripping. Splinting is the most common conservative intervention to improve pain and enological symptom of this Syndrome (CTS). With regard to the importance of these interventions and controversies about different designs of splints, the aim of this study was to compare the therapeutic effects of volar wrist cock-up orthosis and dorsal lock wrist hand orthosis on pain, sensory and motor latency in carpal tunnel syndrome.

    Methods

    In this Randomized controlled trial study, 30 patients diagnosed with mild to moderate CTS were recruited. The subjects were randomly divided into two equal groups. Both groups received one form of splints for three weeks. Before receiving the splints, Electromyography (EMG) and Visual analog scale (VAS) were performed. Then, two different designs of splints were used for a period of three weeks. After that, EMG and Numerical Rating Scale (NRS-11) were repeated to reveal the effects of splints on reducing pain, sensory and motor latency in CTS. Independent t and paired t-tests were done uding SPSS software version 19.0 . P-value was set at 0.05.

    Results

    All the variables in both groups showed significant improvement. The NRS-11 test was significantly improved in the dorsal lock wrist hand orthosis group (p<0.05).

    Conclusion

    This study showed that the use of the dorsal lock wrist hand orthosis for about three weeks was significantly improved pain and neurological symptoms of patients with CTS because of maintaining the wrist in the neutral position. Knowing this fact helps us to design and make a less cumbersome and restrictive splint with an accurate position for the wrist and distal joints.

    Keywords: Carpal Tunnel Syndrome, Electromyography, Wrist Splint
  • Mohammadhossein Saei, Sardar Valadi, Kianoosh Karimi, Mohammad Khammarnia* Pages 418-422
    Background

    By informing and educating, the Media play a main role in increasing the health literacy of the community. Broadcasting health channels (BHCs) are established to improve health literacy and public health worldwide. This study was aimed to evaluate the role of Islamic Republic of Iran the broadcasting health channel (IRIB HC) on public health.

    Methods

    A cross-sectional, comparative study was performed on 500 participants throughout 6 urban areas in Tehran, the capital of Iran in 2019. About 250 of the samples were included in viewing the health channel group. A standard questionnaire was used to measure the levels of public health in the 2 groups. Data were analyzed and compared using SPSS software version 25.

    Results

    According to the results, health literacy was higher in the group that used the health channel rather than the other group. Also, with regard to physical and psychological health levels, a significant difference was observed between audiences and nonaudiences (p= 0.013, p= 0.001, respectively).

    Conclusion

    The IRIB HC has positive effects on increasing the level of health literacy, Physical and psychological health, and consequently improving public health. Therefore, these channels have a great role in the implementation of health polices to improve health status.

    Keywords: Mass Media, Public Health, Health Literacy, Iran
  • Salah Eddin Karimi, Nasibeh Zanjari, Neda Soleimanvandiazar, Elaheh Ahounbar, MohammadAli Mohammadi Gharehghani, MohammadAli Ahmadi* Pages 423-428
    Background

    Injection of drugs is one of the most serious  health problems among Iranian living with HIV/AIDS. The injection of drugs, accounting for the transmission of more than two-thirds of HIV infections. HIV remains a major concern around the world and is expected to be the third leading cause of mortality worldwide. Thus, the aim of this study was to explore the predictors of injection drug use in the elderly patients living with HIV/AIDS.

    Methods

    This was a cross-sectional study executed in Tehran City, Iran, in 2018. A total of 160 individuals aged 60 years and older with HIV from different counseling centers were selected by convenience sampling. Data were collected using questionnaires including a positive state of mind, coping, social support, and a checklist of demographical variables. Bivariate analysis and multiple logistic regression using SPSS software version 21.0 were employed to determine factors associated with drug injection. The statistical tests were performed with a significance level of 5% (p≥0.05).

    Results

    The study participants’ mean(SD) age was 65.6(±6.6) years. In total, 33 people (20.6%) of the samples reported injection drug use. The frequency of injection drug use was greater among men (AOR: 2.28, 95% CI 2.2-22.8; p=0.010), those reporting a monthly income of ≥30000000 Rials (AOR: 31.56, 95% CI 2.95-338; p=0.004), subjects with past experience of drug use (AOR: 7.11, 95% CI 2.18-23.2; p=0.001), those with ≥2 years past from their HIV diagnosis (AOR: 4.04, 95% CI 1.12-14.58; p=0.033), and those living with more than two people in one residential place (Household size AOR: 5.9, 95% CI 1.64-21.24; p=0.007).

    Conclusion

    It seems that the design and implementation of harm reduction programs among the elderly with HIV/AIDS who inject drugs are essential and should be considered as an agenda of policymakers and health professionals.

    Keywords: Drug Injection, Elderly People, HIV, AIDS, Drug Use, Determinants
  • Farhad Mokhtarinejad, Ali Asghar Peyvandi, Shahin Shadnia, Hassan Peyvandi, Manijeh Rezvani, Shahrokh Khoshsirat, Mahbobeh Oroei* Pages 429-434
    Background

    The overdose of illicit drugs is not always fatal but can lead to various complications. One of the unusual medical complications is a sensorineural hearing loss (SNHL). There are multiple case reports about this subject. Considering the importance of hearing loss on quality of life, we investigated hearing status in patients with overdose of illicit drugs.

    Methods

    This cross-sectional study was performed in Loghman Hakim hospital in Shahid Beheshti University of Medical Sciences, Tehran, Iran, in 2016-2017. The hearing status of 95 patients with illicit drugs overdose and 44 healthy individuals were assessed using standard pure tone audiometry and distortion product otoacoustic emissions. The patient group was categorized based on hearing status and compared based on some variables. We applied 2 independent t tests, Mann-Whitney, Chi-square, and binary logistic regression tests. All analyses were conducted in Stata 12 (STATA Corp, USA) and significance level was set at less than 0.05.

    Results

    We found higher percentage frequency of SNHL in the patient group than the control group (15.8% vs 2.3%; p=0.021). The frequency of hearing loss was 21.7% in opioid users, 5.3% in stimulant users, and 6.3% in concomitant use of both. There was a significant relationship between SNHL and overdose of illicit drugs (aOR = 14.48, 95% CI = 1.53-136.44; p=0.019) with adjusting age, sex, and smoking.

    Conclusion

    Illicit drugs overdose can potentially affect the hearing system. Opioid drugs, especially methadone and tramadol, have been found to affect the hearing system. Therefore, it is important to conduct longitudinal studies to demonstrate the role of opioid drugs on the hearing system.

    Keywords: Hearing Loss, Illicit Drugs, Inner Ear
  • Elahe Hojati Abed, Narges Shafaroudi*, Malahat Akbarfahimi, Armin Zareiyan, Akram Parand Pages 435-442
    Background

    Self-determination skills enable to support an individual’s needs and make decisions to function independently. Improvement of self-determination skills has had a positive result for adolescents at risk of Emotional and Behavioral Disorders (EBD). The aim of this study was to investigate the effect of occupational therapy interventions on the self-determination skills of adolescent girls at risk of emotional-behavioral disorders.

    Methods

    In this single-blind control trial study, 14-16-years-old girl students (n=54) at risk of  EBD were recruited by cluster sampling from secondary high schools of Tehran, Iran. Youth self-report Questionnaire (YSR) was used to include adolescents at risk of EBD in the study and were randomized into the intervention (n=27) and control group (n=27) by block randomization. The Student Self-Determination Scale (SDSS) and the Self-determination Parent Perception Scale (SDPPS) were used to collect data. Students in the intervention group participated in 8 – once a week- sessions of occupational therapy and the control group received no training. Data were analyzed by repeated-measures analysis of variance (RMANOVA), Bonferroni test and SPSS 16.0 version. The significance level was set at 0.05.

    Results

    The score of self-determinations (SDSS) increased significantly in the intervention group after the intervention (p<0.001). Although the mean scores of self-determination at follow-up have increased in the intervention group compared to the post-test. No significant differences were found (p>0.05); also, the score of parentschr('39') perception of student self-determination (SDPPS) increased but there were not significantly different (p=0.064).

    Conclusion

    The findings indicated self-determination skills could be taught to adolescents at risk of EBD in OT sessions. Since self-determination has been identified as the necessary skills for adolescents at-risk to transition into adulthood, occupational therapists have an important role in promoting self-determination skills in adolescents at risk of EBD.

    Keywords: Occupational Therapy Interventions, Self-Determination, Emotional, Behavioral Disorders, Adolescents
  • Hadi Asady, Adrian Fuente, Siamak Pourabdian, Farhad Forouharmajd*, Ismail Shokrolahi Pages 443-447
    Background

    Exposure to noise associated with injuries has become a public health issue in recent years. This study aimed to show the role of the acoustical structure of the ear canal on the typical occupational sound pressure levels at different frequencies.

    Methods

    This cross-sectional study was done on 20-30-year-old participants. White noise was used at 3 levels, including 75, 85, and 95 dB as the stimulus sound pressure levels (SSPLs). The speakers had a 1.5-meter distance from the participants and at the height of 87 centimeters from the lab ground and were located in front of the participants. The SSPLs were measured outside (cavum part of the external ear) and inside the right ear of each participant. Measurements were done at the total sound pressure level and in the 1/1 octave frequencies. The duration for each measurement was 10 seconds. The independent sample t test was used for the statistical analysis, and the equality of means were rejected at p<0.05.

    Results

    There were 30 (50%) males out of the 60 participants. The mean ± SD for the age of all the participants was 23.29±2.93 years.  The total sound pressure level difference between the inside and outside of the ears of male and female participants was statistically significant (p<0.001) at the stimulus sound pressure levels. The peak resonance was observed in the frequencies 2000 Hz and 8000 Hz for males and 8000 Hz for females. 

    Conclusion

    The ear canal can amplify the sounds and increase the sound pressure levels. This amplification was found to be greater for males than for females.

    Keywords: Ear Canal, Resonance, Occupational Noise
  • Zeinab Ahmadpour Emshi, Farshad Okhovatian*, Marzieh Mohammadi Kojidi, Alireza Akbarzadeh Baghban, Hadi Azimi Pages 448-456
    Background

    Myofascial pain syndrome is one of the most common complaints in patients referring to orthopedic treatment centers. The present study aimed to examine the effects of instrument-assisted soft tissue mobilization (IASTM) and dry needling (DN) on active myofascial trigger points (AMTrP) of the upper trapezius muscle (UTM).

    Methods

    The current study was designed as a randomized clinical trial and a total of 81 patients, aged 18-40 years, with active myofascial trigger points in the upper trapezius muscle were randomly divided into 3 groups: group 1 (n = 30) received DN treatment, group 2 (n = 26) received IASTM treatment, and group 3 (n = 25) was considered as the control group (no intervention). The numeric pain scale (NPS), pain pressure threshold (PPT), active cervical contra-lateral flexion (ACLF), neck disability index (NDI), and muscle thickness (MT), according to rehabilitative ultrasonic imaging (RUSI), were measured at baseline, immediately after the last session (session 4 in week 2), and 1 month after the last session. The statistical analysis was conducted at a 95% confidence level. The P values less than .05 were considered as statistically significant.

    Results

    Both techniques were effective in treating active trigger point of the upper trapezius (p<0.05), but there was no significant difference between the treatment groups in terms of any of the above variables except for ACLF (p>0.05)

    Conclusion

    Both IASTM and DN were determined to improve NPS, PPT, ROM, and NDI in participants with active trigger points in the upper trapezius, although IASTM was more effective in increasing ACLF in these patients.

    Keywords: Instrument Assisted Soft Tissue Mobilization Technique, Dry Needling, Active Myofascial Trigger Points, Trapezius Muscle, Myofascial Pain Syndrome
  • Elham Mohebbi, Hamideh Rashidian, Ahmad Naghibzadeh Tahami, AliAkbar Haghdoost, Afarin Rahimi Movaghar, Monire Sadat Seyyedsalehi, Abass Rezaianzadeh, Maryam Marzban, Abdolvahab Moradi, Mahin Gholipour, Maryam Hadji, Farin Kamangar, Kazem Zendehdel* Pages 457-463
    Background

    There are relatively scant data to determine whether hospital visitors could serve as a proper source of controls in case-control studies of illicit drug use. The aim of this study was to evaluate using neighborhood versus hospital visitor controls in reporting opium use. 

    Methods

    We used data from 2 independent case-control studies of cancer in Iran. In the first study, controls were selected from neighborhoods of the patients. For the second one, controls were selected from among hospital visitors. In the latter study, hospital visitors were companions of the patients or others visiting the hospital for reasons other than disease treatment. We used stata (version 12; Stata Corp( for all analyses and with a significance level of 0.05.

    Results

    Data from 616 of neighborhood controls and 414 of hospital visitor controls were analyzed. Opium point prevalence among men was significantly higher in hospital visitors than neighborhood controls (43.3% vs 32.2%; P = 0.047), while the prevalence of cigarette smoking was very similar in both control groups (46.3% vs 47.2%; P = .847). Using a logistic regression analysis, in an unadjusted analysis, neighborhood controls were less likely to report opium use in both genders, with (unadjusted OR = 0.77; 95% CI: 0.59,1). After adjusting for potential confounders, the differences of opium use between the 2 control groups became more pronounced (Adjusted OR = 0.26; 95% CI: 0.10, 0.69).

    Conclusion

    Because of the similarity of reporting cigarette smoking among neighborhood controls but substantially lower reporting of opium use among them, we concluded that neighborhood controls underreport opium use—a sensitive question— and that using neighborhood control biases the findings in case-control studies. Hospital visitor controls may be more appropriate than neighborhood controls for case-control studies of illicit drugs.

    Keywords: Substance-Related Disorders, Opium, Case-Control Study, Epidemiologic Studies, Cigarette Smoking, Hospital Visitor Control
  • Kazem Khalagi, Safoora Gharibzadeh, Davood Khalili, Siamak Mirab Samiee, Seyed Mahmoud Hashemi, Saeide Aghamohamadi, Maryam MirMohammadAli Roodaki, Katayoun Tayeri, Hengameh Namdari Tabar, Keyhan Azadmanesh, Jafar Sadegh Tabrizi, Kazem Mohammad, Samira Goudarzi, Firoozeh Hajipour, Saeid Namaki, Alireza Raeisi, Afshin Ostovar* Pages 464-472
    Background

    Serological surveillance of COVID-19 through conducting repetitive population-based surveys can be useful in estimating and monitoring changes in the prevalence of infection across the country. This paper presents the protocol of nationwide population-based surveys of the Iranian COVID-19 Serological Surveillance (ICS) program.

    Methods

    The target population of the surveys is all individuals ≥6 years in Iran. Stratified random sampling will be used to select participants from those registered in the primary health care electronic record systems in Iran. The strata are the 31 provinces of the country, in which sampling will be done through simple random sampling. The sample size is estimated 858 individuals for each province (except for Tehran province, which is 2574) at the first survey. It will be recalculated for the next surveys based on the findings of the first survey. The participants will be invited by the community health workers to the safe blood sampling centers at the district level. After obtaining written informed consent, 10 mL of venous blood will be taken from the participants. The blood samples will be transferred to selected reference laboratories in order to test IgG and IgM antibodies against COVID-19 using an Iranian SARS-CoV-2 ELISA Kit (Pishtaz Teb). A serologically positive test is defined as a positive IgG, IgM, or both. After adjusting for the measurement error of the laboratory test, nonresponse bias, and sampling design, the prevalence of COVID-19 will be estimated at the provincial and national levels. Also, the approximate incidence rate of infection will be calculated based on the data of both consecutive surveys.

    Conclusion

    The implementation of these surveys will provide a comprehensive and clear picture of the magnitude of COVID-19 infection and its trend over time for health policymakers at the national and subnational levels.

    Keywords: COVID-19, Serological, Surveillance, Sero-prevalence, Antibody tests, Survey, Nationwide, Population-based, Iran
  • Zahra Sehat*, Esmaeil Fakharian, Mojtaba Sehat, Abdollah Omidi Pages 473-480
    Background

    Trauma is the first leading cause of death and disability in the active population in developing countries. In Iran, traumatic injuries are the second leading cause of death after cardiovascular disease and also the leading cause of years of life lost (YLL). Population-based surveys can estimate all types of injuries. This study aimed to estimate the annual incidence of nonfatal injuries in adults older than 15 years in Kashan.

    Methods

    In a cross-sectional population-based study, people older than 15 years who were living in Kashan during 2018-2019 were studied. A cluster stratified sampling method was used. Data analysis was performed using SPSS 22 software. Chi-square and  t tests and ANOVA were used to analyze the data. Significance level was set as P ≤ .05 and confidence interval (CI) at 95%.

    Results

    In this study, which included 3880 households residing in Kashan during 2018-2019, the incidence of all injuries was estimated to be 70.61(62.60-78.70) per 1000 people in 1 year. For traffic accidents, the incidence was estimated at 36.08 (30.20-42.00) per 1000 in 1 year. Also, 231 (77.7%) of people with trauma were male, 137 (50.0%) aged 20 to 39 years, and 191 (69.7) were married. The most common cause of injuries (n = 140; 51.1%) was related to traffic accidents, and among the traffic accidents, the highest cause was motorcycle accident (n = 99; 70.71%).

    Conclusion

    The results of this study showed that the highest rate of injuries occurred among men, younger ages, married, and those with primary education. Also, the results showed the most common causes of trauma were injured hand and foot and head, and the most common location in which trauma occurred was street. The findings of this study are important to better explain the epidemiology aspects of injuries in Kashan.

    Keywords: Epidemiology, Incidence, Population-based, Trauma
  • Siavash Kooranifar, Alireza Sadeghipour, Taghi Riahi*, Azadeh Goodarzi, Sanaz Tabrizi, Navid Davoody Pages 481-490
    Background

    In the pandemic era of Coronavirus   disease 19 (COVID-19), one of the most important issues is the nature of real pathological events that occur during disease course in different parts of the body. There are several ways to know more about COVID-related histopathological events,such as tissue sampling which means biopsy from the tissues of either livepeople or necropsy/autopsy of people who died from COVID-19.

    Methods

    We conducted an original study for assessing histopathological findings of lung necropsy samples collected from 15 Iranian patients.The continuous variables were presented as mean and standard deviation, and for the qualitative data on histopathological findings, the percentage or qualitative scores (0 to +3) were used.

    Results

    We found similar presentations of COVID-related histopathologic events regarding percentage and severity in pulmonary tissue, includinglymphocytic infiltrations, inflammatory infiltrations of septal and perivascular areas, desquamated type2 pneumocytes, hyaline membrane changes, fibrin material depositions, abnormal changes of alveolar capillaries, presence of megakaryocytes, PMN infiltrations, septal necrosis, microabscess formation and bacterial colony formation. Also, we found few interesting features which were not completely compatible with previous similar studies or newly reported by ours asa high percentage of anthracosis (86%: 13 patients) that was not clearly reported in other previous studies, also a lower percentage of microthrombotic vascular lung injuries (20%: 3 patients), and a higher percentage of viral cytopathic effects (27%: 4 patients).

    Conclusion

    This article suggests a greater need for evaluatingthe autopsy samples of COVID-19 patients to provide better management strategies and propose the question of whether anthracosismay be a mortality risk factor in COVID-19 patients.

    Keywords: COVID-19, Autopsy, Necropsy, Biopsy, Tissue Sampling, Histopathology, Lung, Anthracosis
  • Malihe Sadat Moayed, Esmail Heidaranlu, Akram Parandeh* Pages 491-498
    Background

    The COVID-19 epidemic is one of the major health problems worldwide due to its inconceivable spreading power and potential damage. Given the increasing prevalence of the disease, the identification of care needs and preferences of patients could play an important role in providing effective training and caring programs. This study was conducted to explain the preferences and needs of care based on the experiences of patients with COVID-19.

    Methods

    This qualitative study with a content analysis approach was performed in 2 months at a referral general hospital and quarantine centers of COVID-19 in Tehran, the capital of Iran, in 2020. The participants consisted of 15 COVID-19 patients selected through purposive sampling. The data analysis was performed using the conventional content analysis method according to the procedure proposed by Graneheim and Lundman.

    Results

    The results were classified into 5 main categories: (1) access to desirable care and comfort services; (2) access to education and information from credible sources; (3) access to specialized care; (4) support social needs; and (5)  need for deep emotional interactions.

    Conclusion

    According to our results, identifying priorities and care needs from the perspective of patients with COVID-19 can help improve knowledge, reduce unrealistic patient concerns, and improve emotional interactions between patients and health care providers.

    Keywords: Coronavirus Disease 2019, Health Preferences, Iranian Health System, Needs Assessment, Qualitative Study
  • Maryam Soheili, Hossein Keyvani, Marzieh Soheili, Sherko Nasseri* Pages 499-514
    Background

    Human papillomavirus (HPV) infection is considered as the most common viral sexually transmitted infection worldwide. This poses an increasingly interdisciplinary medical challenge. Since there is vast scattered information in databases about HPV and the correlated diseases, we decided to collect useful data so that the experts can get a more comprehensive view of HPV.

    Methods

    In this article, HPV-associated diseases, prevalence, prevention, and new treatments are discussed. The retrieved  articles reporting the latest data about the required information for our review were selected through searching in Web of Science, Scopus, Medline (PubMed), EMBASE, Cochrane Library, Ovid, and CINHAL with language limitations of English and German.

    Results

    There are 2 groups of HPVs: (1) low-risk HPV types that can lead to genital warts, and (2) high-risk HPV types that are involved in HPV-associated oncogenesis. About 70% of all sexually active women are infected and most of these infections heal within many weeks or months. In the case of HPV-persistence, a risk of preneoplasia or carcinoma exists. These types of viruses are responsible for the existence of genitoanal, gastrointestinal, urinary tract, and head and neck tumors. There is still no definite successful treatment. The detection of HPV-related condylomata occurs macroscopically in women and men, and the diagnosis of the precursors of cervical carcinoma in women is possible by Pap smear.

    Conclusion

    For extragenital manifestations, there is no structured early detection program. Meanwhile, studies on HPV vaccines confirm that they should be used for the primary prevention of HPV-dependent diseases. However, we need more research to find out the real advantages and disadvantages of vaccines.

    Keywords: Human Papilloma Virus, Cancer, Epidemiology, Warts, Vaccines, Virology, Diagnostic
  • Mehran Asadi-Aliabadi, Arash Tehrani Banihashemi, Fariba Mirbaha Hashemi, Leila Janani, Ebrahim Babaee, Seyed M Karimi, Marzieh Nojomi, Maziar Moradi Lakeh* Pages 515-522
    Background

    Risk factors of noncommunicable diseases (NCD) are increasingly contributing to morbidity and mortality in Iran. Health care providers’ competencies and motivation are essential factors for the success and efficiency of primary health care.  This field trial aims to evaluate the impact of a results-based motivating system on population level of the NCD risk factors field trial (IRPONT) in Iran.

    Methods

    Population groups of 24 rural or urban catchment areas from 3 provinces were randomized to 1 of the 4 types of study groups. The groups were defined based on a set of 4 intervention packages. Extra 8 rural or urban catchment areas in a separate city were considered as independent nonintervention (control) group.  Population levels of major NCD risk factors in all 32 population groups were measured at the beginning of the trial, at the end of the first year, and will be measured in the second year through standardized population surveys. As the outcome measure, the difference in population levels of the risk factors will be compared among the study groups. Study group IV will be compared with combined control groups (study groups I, II, and III). Also, we will conduct subgroup analysis to determine the effects of interventions 2, 3, and 4.

    Ethics: 

    This trial has received ethical approval from National Institute for Medical Research Development in Iran (IR.NIMAD.REC.1396.084) in 2017.

    Trial Registration Number: 

    This trial has been registered on the Iranian Registry of Clinical Trials (identifier: IRCT20081205001488N2). Registered on 3 June 2018 and updated on 12 April 2020.

    Keywords: Pay for performance, Risk factors, Noncommunicable diseases, Trial, Iran
  • Muhammad Saaiq* Pages 523-528
    Background

    To document the clinical presentation of carpal tunnel syndrome (CTS) and evaluate the outcome of mini-incision open carpal tunnel release in terms of surgical complications, relief/persistence of symptoms at 4 months, and recurrence at 1 year.

    Methods

    This prospective case series included patients of all genders and ages who presented with CTS. They underwent release of transverse carpal ligament (TCL) under local anesthesia and tourniquet control on day care basis. Mini-incision of 2 cm to 2.5 cm was employed. The data were   subjected to statistical   analysis using SPSS version 21 (SPSS Inc). The percentages of key categorical variables were compared by employing the chi square test, and a P value of less than .05 was regarded as statistically significant.

    Results

    There were 67 patients with 77 CTS affected wrists.  A Significant majority of the patients (n = 54; 80.59%) were females, whereas 13 (19.40%) patients were males. The age range was 26 to 69 years, with a mean age of 41.01 ± 11.70 years. The CTS was found to be moderate among 34 (44.15%) and severe among 43 (55.84%) patients. The majority of patients had no operative complications. At 4 months follow-up, the majority of patients (n = 74; 96.10%) reported symptomatic relief, whereas 3 (3.89%) patients continued to have persistent severe symptoms. All the cases with persistent symptoms had diabetes mellitus of more than 5 years duration. There was no case of recurrence at one year follow-up. 

    Conclusion

    CTS predominantly affected women aged 30 to 45 years. The open carpal tunnel release with mini-incision yielded good results in terms of relieving symptoms among the majority of patients and was associated with no critical complications or recurrence at 1 year.

    Keywords: Carpal tunnel syndrome, Transverse carpal ligament release, Open carpal tunnel release, Compressive neuropathies
  • Zahra Koohmareh, Majid Karandish, Ali Mohammad Hadianfard* Pages 529-534
    Background

    Nowadays, digital games are not just entertainment, but beside routine treatments, they are used in patient care, especially in patients with diabetes. Application of digital games in patient’s education can improve self-management of diabetes. The aim of the present study was to evaluate the effect of a mobile game (Amoo) implementation on enhancing dietary information in patients with type 2 diabetes.

    Methods

    A mobile game (called Amoo), which was developed by researchers of this study, was applied to assess the self-education of patients with diabetes. Sixty patients with type 2 diabetes participated in the study. The participants took part in a pre-intervention test to determine their dietary information. The participants were randomly divided into one of two groups, including the intervention group: played the game for 15 minutes daily for 6 weeks, and the control group: did not involve in the game. A post-intervention test was run to show a possible improvement in dietary information. Data were analyzed using paired t test and suitable non-parametric testes including Mann-Whitney and Wilcoxon signed rank tests as well as Spearman and Pearson correlation coefficients via IBM SPSS statistics version 21 (SPSS, v 21.0, IBM, Armonk, NY, USA). A P-value less than 0.05 was considered as a significant level.

    Results

    The results indicated a statistically significant difference between the pre and post test scores in the intervention group (p<0.001). However, there was no significant difference in fasting blood sugar (p=0.125).

    Conclusion

    The mobile game (Amoo) could enhance the knowledge of patients with type 2 diabetes about food calories and glycemic index. This means that mobile games may serve as an educational aid to these patients.

    Keywords: Diabetes, Mobile Game, Education, Mobile-Health
  • Amir Mohammad Arefpour, Mahshid Abbasi*, Seied Rabi Mahdavi, Mahdiyeh Shafieesabet, Pedram Fadavi Pages 535-541
    Background

    Radiation-induced rectal toxicities remain as a major risk during prostate radiotherapy. One approach to the reduction of rectal radiation dose is to physically increase the distance between the rectal wall and prostate. Therefore, the aim of this study was to evaluate whether the application of the rectal retractor (RR) can reduce rectal dose and toxicity in prostate cancer 3-dimensional conformal radiotherapy (3D-CRT).

    Methods

    Overall, 36 patients with localized prostate cancer were randomized into the 2 groups, 18 patients with RR in-place and 18 without RR. All patients underwent planning computed tomography (CT). Patients were treated with 70 Gy in 35 fractions of 3D-CRT. In the RR group, RR was used during cone-down 20 treatment fractions. Acute and late gastrointestinal (GI) toxicities were assessed using EORTC/RTOG scoring system weekly during radiotherapy, 3, and 12 months after treatment. Device-related events were recorded according to CTCAE version 4.0. Patient characteristics, cancer differences, and dosimetric data for the RR and non-RR groups were compared using a Man-Whitney U test for continuous variables, and Fisher exact test for categorical data. The EORTC/RTOG scores for the 2 groups were compared using Fisher exact test. A P value <0.05 was considered statistically significant.

    Results

    A RR significantly reduced mean dose (Dmean) to the rectum as well as rectal volume receiving 50% to 95% (V50-95%) of prescribed dose. The absolute reduction of rectal Dmean was 10.3 Gy. There was no statistically significant difference in acute GI toxicity between groups during treatment or at 3 months. At 12 months, 2 patients in the RR group and 9 in the control group experienced late grade ≥ 1 GI toxicity (p=0.027). No patients in the RR group reported late grade ≥ 2 GI toxicity, whereas 3 patients in the control group experienced late grade 2 GI toxicity. In the RR group, 6 patients reported grade 1 rectal discomfort and pain according to CTCAE version 4.0.

    Conclusion

    The application of the RR showed a significant rectum sparing effect, resulting in substantially reducing late GI toxicity.

    Keywords: Prostate cancer, Radiotherapy, Rectal toxicity, Rectal retractor
  • Behrouz Parhampour, Mehdi Dadgoo*, Giti Torkaman, Roya Ravanbod, Tina Delsouz Bahri, Mohammad Jazebi, Seyed Mehdi Mohsenipour, Behnoosh Vasaghi Gharamaleki Pages 542-553
    Background

    Overweight is related to increased risks of cardiovascular diseases and dyslipidemia, and reduced quality of life (QOL). Exercise training improves QOL and modifies cardiovascular risk factors and lipid profile. The present study was conducted to compare three types of exercise in terms of their short term effects on QOL and lipid profile in overweight individuals with moderate hemophilia A (IWMHA).  

    Methods

    This study was a randomized, controlled, assessor-blinded trial (IRCT20180128038541N1). Sixty IWMHA with a body mass index (BMI) of 25-30 kg/ m2 and a mean age of 35-55 years were randomly assigned to four groups of 15, namely aerobic training (AT), resistance training (RT), combined training (CT) and control. The intervention groups participated in 45-minute exercises three days a week for six weeks. The 36-item short-form health survey (SF-36) was used to measure QOL. Total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), waist-to-hip ratio (WHR), and waist circumference (WC) were measured before and after six weeks of training. For the data analysis using SPSS version 20, the ANCOVA was used to determine the differences among the four groups.

    Results

    A significant decrease was observed in the intervention groups compared to the control group in terms of weight, BMI, LDL-C, TC, WHR, and WC (p<0.05). Significant increase was observed in HDL-C and SF-36 subscales in the intervention groups compared to the control group (p<0.001). There was no significant difference among the intervention groups (p>0.05). In comparison with the control group, more significant improvement was observed in the TC, TG, LDL-C, HDL-L, and SF-36 subscales in the CT group compared to the RT and AT groups.

    Conclusion

    CT was the most effective training method in improving lipid profile and QOL in overweight IWMHA.

    Keywords: Hemophilia A, Overweight, Lipid Profile, Combined Training, Quality of Life
  • Neda Soleimanvandiazar, Seyed Hossein Mohaqeqi Kamal, Homeira Sajjadi, Hossein Malekafzali Ardakani, Ameneh Setareh Forouzan, Salah Eddin Karimi, Gholamreza Ghaedamini Harouni* Pages 554-562
    Background

    Health service utilization (HSU) is a significant health and political issue. Awareness of factors that affect HSU and the status of health service utilization can help health professionals improve their services. The aim of this study was to investigate the status of HSU and identify the factors affecting health service utilization among households residing in Tehran.

    Methods

    The present cross-sectional study included 1200 residing households from different regions of Tehran, the capital of Iran. They were selected by a multi-stage cluster sampling method in accordance with the zoning of Tehran concerning socio-economic development. Interviews were conducted by trained individuals using a health service utilization questionnaire introduced by the World Health Organization, Zimet’s social support questionnaire, and demographic checklist during winter 2018 and spring 2019. Simple and multiple logistic regression models were applied to analyze the data. In order to include the factors related to the status of outpatient health service utilization, a set of bivariate analyses was conducted, and then the factors with a p-value of ≤0.20 were included in the multiple models. Data were analyzed using Stata 12 software.

    Results

    The results of the study indicated that the rate of outpatient HSU among households residing in Tehran was 63.61% (CI:60, 66.80). In addition, regarding the results of the study, asset index of family (OR=0.51, 95% CI: 0.28, 0.91), the level of awareness and knowledge of family members regarding health issues (OR=0.55, 95% CI: 0.34, 0.88) as well as the mother knowledge  on health issues (OR=0.64 , 95% CI: 0.45, 0.93), the level of social support (OR = 0.50, 95% CI: 0.37,0.68), family health expenditure (OR=1.20, 95% CI: 1.18, 4.06), having a member with a  sort of disability in family (OR=1.66, 95% CI: 1.01, 2.77), and having an alcoholic member in family (OR=2.44, 95% CI: 1.27, 4.68) were factors associated with outpatient HSU among households. Considering the adjusted values of odds ratios, the prevalence of the HSU varied according to the area of residence. It should be noted that the variables included in the model explained 15% of the changes in the prevalence of HSU.

    Conclusion

    According to the results of the study and in order to increase HSU in different classes, the level of social support, especially among women in the family due to their role in the general health of family members, should be enhanced. Also, policies should be adopted to increase the awareness, knowledge, and information of family members about health issues, lifestyle changes, nutrition, and health behaviors through social media.

    Keywords: Outpatient, Health service utilization, Household, Tehran
  • Elham Haghighifar, Fatemeh Norouzi, Razie Kamali Dolatabadi* Pages 563-567
    Background

    Uropathogenic Klebsiella pneumoniae is one of the well-kown uropathogens that have the main rule in biofilm formation. Increased prevalence of ESBL enzyme is one of the therapeutic problems. However, the aims of this study were to characterize  the ability of biofilm formation and ESBL-producing isolates produced by urinary tract infection’s K. pneumoniae to identify the prevalence of this type of infection in the studied area.

    Methods

    Between the 500 nonrepetitive clinical isolates, 128 isolates were detected as K. pneumoniae. Biofilm production of these isolates was showed by Merrit and Christensen method. The standard Kirby-Bauer disk diffusion method was used for antimicrobial susceptibility testing.  The phenotype ESBL was confirmed by double disc synergy test (DDST). Genotypic identification of ESBLs did by molecular detection. The statistical analysis was done  using software IBM SPSS Statistics (SPSS Inc) and chi-square and Fisher exact tests.

    Results

    The result of microtiter plate was observed and it was found that 86 (67.2%) isolates had weak biofilm, 24 (18.8%)  moderate biofilm, and 18 (14.1%) strong biofilm. Also, 57 (44.5%) out of 128 isolates were diagnosed as MDR. The highest frequency of resistance was identified for cefotaxime 60 (46.9%) and tetracycline 60 (46.9%), and the lowest rate was for amikacin 16 (12.5%). The results of DDST showed 55 of 128 (43%) produced ESBL enzymes. PCR detection in ESBL-producing isolates showed contained blaTEM  33 of 55(63.1%), and blaVEB  13 of 55 (23% ). Also, 1 of 55 (2%) had both blaTEM and blaVEB. Also, 5 of 13 (38.4%) isolates that had the blaVEB gene were also MDR and had weak biofilm (8/13; 61.5%),  intermediate biofilm (3/13; 23%),  and strong biofilm (2/13; 15.4%).

    Conclusion

    To decrease treatment complications and mortality rate of drug-resistant bacterial infections, rapid detection of β-lactamases genes and evaluation of these properties and infection management programs can help to prevent the transmission of drug resistant-strains.

    Keywords: Extended-spectrum β-lactamases (ESBLs), Biofilm Formation, Klebsiella pneumonia, Antibiotic resistance, blaTEM, blaVEB
  • Mina Moradi, Masoud Fallahi Khoshknab*, Asghar Dalvandi, Mohammad Farhadi, Sadat Seyed Bagher Maddah, Eesa Mohammadi Pages 568-579
    Background

    Recovery of children does not appear on its own after cochlear implantation. Coherent, thoughtful, and comprehensive rehabilitation is needed to achieve complete success. The purpose of this study was to identify the types of rehabilitation interventions for children with cochlear implants that have been performed in Iran.

    Methods

    A scoping review study was conducted. An electronic search was carried out both in English and Persian. In English, the following keywords were used: cochlear implantation, child, cochlear implants, auditory rehabilitation, deaf, hearing loss, comprehensive, interventions, rehabilitation, and telerehabilitation and a combination of them in ProQuest, PubMed, Science Direct, and Scopus databases, Web of Sciences, Medline and Embase. Persian electronic search was conducted in the Scientific Information Database (SID) of Jihad Daneshgahi, Iran Journals Database (MagIran), and Islamic World Science Citation Database (ISC). Searches were done using articles published until September 25, 2020, and a total of 902 articles were found, of which 14 were directly related to the purpose of the study. Interventional studies were included in the study, and the quality of studies was measured using the Structured Effectiveness Quality Evaluation Scale.

    Results

    The results showed that using music and rehabilitation equipment, different methods of speech therapy and auditory training, story-based instruction, creative play, family-centered instruction, and occupational therapy are interventions in cochlear implant rehabilitation. Speech therapy accounts for 54% of the rehabilitation share. The mean number of rehabilitation sessions was 26. These interventions were all somehow effective in children with cochlear implantation; the longer the training duration, the better the results.

    Conclusion

    The process of cochlear implant rehabilitation in children is multi-professional; auditory training and speech therapy possesses the highest share of rehabilitation. Therefore, it is recommended to develop speech therapy centers in Iran.

    Keywords: Rehabilitation, Cochlear Implant, Child, Iran
  • Roza Bahari, Farkhondeh Amin Shokravi*, Monireh Anosheh, Maryam Moridi Pages 580-585
    Background

    One of the most important aspects of life is reproductive health, which receives less attention in public policy considerations because of its sociopolitical sensitivities. The aim of this study was to evaluate the effect of a designed health education program on knowledge about puberty health among visually impaired female adolescent students during 2011 and 2015.

    Methods

    This quasi-experimental study was conducted on 100 visually impaired female students aged 10 to 19 years. Data collection tool was a researcher-made questionnaire. Participants were recruited using convenience sampling method from Narjes educational center in Tehran. The educational needs assessments survey was used to learn about important issues and problems faced by this group to design effective educational programs. The effectiveness of the designed program was assessed by comparing the studentschr('39') knowledge at the baseline and at 1-month follow-up. Data were analyzed in SPSS V.21 by using parametric descriptive statistics. The significant level was set as p<0.05

    Results

    The results showed that the puberty knowledge of participants was increased in all educational domains after intervention compared to the baseline (p<0.05). The knowledge about the onset of puberty changes showed the highest increase (from 2.02 at baseline to 7.51 at follow-up) and the knowledge about personal hygiene had the least change after the intervention (from 6.67 to 8.23). The majority of students did not have any information resources regarding puberty health, and about one quarter of them reported their mother as the main resource of puberty information.

    Conclusion

    Providing educational programs during puberty has a crucial role in young girls’ knowledge increase. Providing a continuous health educational program that is tailored to the needs of this group of students using suitable strategies is recommended.

    Keywords: Puberty, Health Education, Blindness, Visually Impaired, Adolescent, Women's Health
  • Rabah Asreah*, Ali Abdullhameed Pages 586-590
    Background

    Gastroesophageal reflux disease (GERD) is a prevalent condition. Erosive esophagitis (EE) and Barrett’s esophagus (BE) are the two important complications of GERD. We aimed to study the prevalence of EE and BE in a group of Patients with reflux symptoms who were referred for endoscopy. The relationship between reflux symptoms and endoscopic findings was also examined.

    Methods

    We enrolled 139 consecutive patients with characteristic symptoms of GERD. Demographic and clinical characteristics of the patients including duration and severity of reflux symptoms, were recorded. Endoscopic findings of EE were identified and classified according to the Los Angeles classification, while BE was confirmed by histopathology examination. The Fisher’s exact test and the two-sample 𝑡-test were used to test the association of esophageal lesions (BE and/or EE) with the patientschr('39') clinical and endoscopic data.

    Results

    Forty seven and 13 patients were found to have EE and BE, respectively. Multivariate analysis showed that older age (p=0.001) and hiatal hernia (p=0.004) was significantly related risk factors for erosive esophagitis and BE. While an increase in BMI (p=0.004) was related to EE, patients with BE were more likely to have severe reflux symptoms than others (p=0.002).

    Conclusion

    In patients with GERD, the presence of hiatal hernia may be strong risk factor for erosive esophagitis and BE, as does older age. For Barrett’s esophagus, severe reflux symptoms are more likely.

    Keywords: Barrett’s esophagus, Reflex esophagitis
  • Foroozan Faress, Maryam Ameri*, Hanieh Azizi, Hanieh Saboori Shekofte, Rozita Hosseini Pages 591-594
    Background

    Using morphologic features of the bones is the basis of gender determination in anthropology and forensic medicine. In this study, we evaluated the calcaneus diameters for gender determination in the Iranian population.

    Methods

    This cross-sectional study was conducted on Iranians referring to Hazrat-e Rasool Hospital’s radiology ward for plain lateral X-ray of the foot. Lateral foot X-rays from 100 men and 100 women were gathered and evaluated for calcaneal indexes. These patients aged between 18 and 80 years old who did not suffer major trauma to the calcaneus bone were recruited. Using a picture archiving and communication system (PACS), four variables were calculated for each X-ray graph: Maximum anterior-posterior length of the calcaneus (MAXL), Maximum height of the bone (MAXH), Height of the cuboid facet (CFH) and Height the calcaneal body (BH). Cut off points for each index were calculated using the area under curve (AUC) in ROC curves.

    Results

    Lateral foot X-rays from 100 men and 100 women were gathered and evaluated for calcaneal indexes. The means of the four indexes were compared between the sexes which showed all four means are significantly different p value <0.001. AUC for MAXL in differentiating the genders was 0.824 , which showed 86.8 as the cut off with a  sensitivity of 80% and specificity of 69.0%. Cut off point for MAXH was set at 59.8 with sensitivity and specificity of 78.0% and 60.0%, respectively. For BH, 49.5 was set as the cut off point with a sensitivity of 79.0% and specificity of 64.0%. The best cut off point for CFH was 27.8 with 76.0% sensitivity and 63.0% specificity.

    Conclusion

    It can be concluded that the calcaneal diameters are reliable criteria for sex determination. Although the cutoff points are different between various races and populations, it is evident that these diameters can be used for sex determination in general.

    Keywords: Gender determination, X-ray, Calcaneus, Iranian population
  • Ghobad Moradi, Fatemeh Gholami, Mohammad Aziz Rasouli*, Fahimeh Bagheri Amiri, Yousef Moradi Pages 595-604
    Background

    Given the various reports of the clinical spectrum of the disease, the aim of the present study was to determine possible scenarios of Coronavirus 2019 (COVID-19) iceberg using published articles.

    Methods

    The present study was a rapid review of all international databases, including PubMed (Medline), Scopus, Web of Sciences, Embase, and Cochrane Library from January 1 to October 30, 2020.

    Results

    In this review, 7 scenarios were considered for COVID-19 iceberg, in which the range of fatality percentage was estimated to be 0.5% to 7%, the range of asymptomatic cases 1% to 88.6%, the range of cases with mild symptoms 8% to 78%, no symptoms 1 % to 90 %, the range of intensive care unit (ICU) admission was 0.5% to 14.2%, and finally the intubation percentage was estimated to be 0.2% to 12.2%. The Scenarios Diamond Princess Cruise Ship and Iceland are closer to the reality of the clinical spectrum of COVID-19 around the world, which represent 0.6% and 0.5% of deaths, 0.7% and 1% of intubations, 2.5% and 9.7% of ICU admissions, 1.1% and 6% of hospitalizations, 15% and 31% of cases with mild symptoms, and finally 56.9% and 75% of asymptomatic cases of COVID-19, respectively, which should now be considered as the basis of the clinical knowledge of the disease. 

    Conclusion

    Understanding the clinical spectrum and natural knowledge of the disease and paying attention to asymptomatic or mild-symptom cases can help to make better decisions and develop more effective interventions to control COVID-19.

    Keywords: Best Estimates, Iceberg, COVID 19, Clinical Spectrum, Natural Knowledge, Rapid Review
  • Mehdi Sharafi, Ehsan Bahramali, Mojtaba Farjam, Shahab Rezaeian, Sima Afrashteh, Zahra Amiri* Pages 605-609
    Background

    Contrary to health indices advancement during recent years, health inequalities are still a global challenge. This study aimed to determine socioeconomic factors for noncommunicable diseases using concentration indices (CI).

    Methods

    This cross-sectional study was conducted on the baseline data from a cohort study in Fasa (southern Iran). Principle component analysis was used to measure asset index. Moreover, socioeconomic inequalities were calculated by CI. Analysis was done at 95% confidence level using STATA software.

    Results

    A total of 7990 individuals were included in the study. The highest negative CIs were significantly found for epilepsy (-0.334), paramnesia (-0.255), and learning disabilities (-0.063), respectively, and the lowest were significantly found for chronic headaches (-0.046), recurrent headaches (-0.03), infertility (-0.028) and hypertension (-0.057). This index was positive for breast cancer (0.298). Furthermore, it was not Significant for diabetes, thyroid disorders, depression, and chronic lung diseases.

    Conclusion

    The findings showed a significant inequality in the most of the noncommunicable diseases in the region, which are more concentrated among the poorest population. Policymakers in the health system and city planners should consider these results to decrease the burden of noncommunicable diseases in the society by identifying vulnerable subcategories.

    Keywords: Inequality, Noncommunicable Diseases, Concentration Index
  • Alireza Bameshki*, HamidReza Khayat Kashani, Majid Razavi, Maryam Shobeiry, Mehryar Taghavi Gilani Pages 610-615
    Background

    High tidal volume leads to inflammation, and low tidal volume leads to atelectasia and hypoxemia. This study was conducted to compare the effect of 6 mL/kg with positive end-expiratory pressure (PEEP) and 8 mL/kg without PEEP on pulmonary shunt and dead space volume.

    Methods

    This clinical trial was done on 36 patients aged 20 to 65 years old with ASA I-II. They were candidates for upper abdominal surgery and divided randomly into 2 groups. One group were ventilated with the tidal volume = 8 mL/kg without PEEP (TV8). The other group received the tidal volume = 6 mL/kg with low PEEP = 5 cm H2O (TV6). Arterial and central venous blood gases were taken after intubation and 2 hours later. Additionally, the vital signs of the patients were checked every 30 minutes. Data analysis was performed using t test, chi-square test, and repeated measures analysis of variance with SPSS software, version 16 (SPSS Inc). P value less than .05 were meaningful.

    Results

    There was no significant difference on the preanesthesia parameters. The pulmonary shunt was 13.5±0.1% and 18.6±0.2% in the groups TV6 and TV8, respectively (p=0.132), which slightly decreased after 2 hours in both groups without any significant difference (p=0.284). Prior to the ventilation, the ratios of dead space to tidal volume were 0.25±0.2 and 0.14±0.1 in the TV6 and TV8 groups, respectively (p=0.163), and after 2 hours, they were 0.23±0.11 and 0.16±0.1 in the TV6 and TV8 groups, respectively (p=0.271). There was no significant difference between the groups for blood pressure and peripheral and arterial oxygenation changes.

    Conclusion

    The tidal volume of 6 mL/kg with the PEEP of 5 mmHg was similar to the tidal volume of 8 mL/kg without PEEP for hemodynamic and pulmonary changes (oxygenation, shunt, and dead space).

    Keywords: Mechanical Ventilation, Tidal Volume, Pulmonary Shunt, Positive End-expiratory Pressure
  • Sahar Golabi, Mitra Amini, Atefeh Zahedi, Maryam Adelipour, Zahra Shamekhi, Leila Fakharzadeh, Samaneh Mansouri, Mahshid Naghashpour* Pages 616-624
    Background

    Training needs assessment is the process of recognizing educational needs. This study aimed to apply a community-based nutrition education needs assessment to revise the nutrition course plan in the curriculum of the doctorate of medicine and that of the baccalaureate of nursing.

    Methods

    The study was designed in 2 phases: (1) nutritional needs assessment; (2) community-based revision of nutrition course plan. In the first phase, 13 nutrition professionals working in the region set out 5 priorities of nutrition-related health problems in the community by a training need assessment based on a survey and scoring system. Then, an expert panel determined the priorities of behavioral and nonbehavioral causes of the nutrition-related health problems by the nominal group technique (NGT). The results of the first phase were used to review the topics of nutrition course plans up to 20%.

    Results

    The priorities identified in Abadan, Khorramshahr, and Shadegan were obesity and type 2 diabetes mellitus in adults as well as anemia in pregnant women, respectively. Also, wrong eating habits and insufficient nutrition knowledge were among the most important behavioral causes of nutrition-related health problems in the target community. These results were applied to a community-based review of nutrition course plans for medical and nursing students.

    Conclusion

    The use of nutritional needs assessment approaches by a survey and nominal group technique with a group of professionals provided an opportunity for a community-based review of the nutrition course plan for medical and nursing students as a first phase in the development of a community-based nutrition course plane.

    Keywords: Community, Course Plan, Educational Content, Nutrition-Related Health Problems
  • Anahita Shokri Jamnani, Aziz Rezapour*, Najmeh Moradi, Mostafa Langarizadeh Pages 625-649
    Background

    The Willingness to pay (WTP) for and acceptance of cervical cancer prevention (CCP) methods have an important role in the control of this type of cancer. Therefore, the aim of this study was to estimate the WTP and acceptance of CCP methods with the contingent valuation method (CVM).

    Methods

    In this systematic review and meta-analysis study, the required information was collected by searching relevant keywords in PubMed, Scopus, Embase, Web of Knowledge, and their Persian equivalent in the Scientific Information Database (SID) and Elmnet databases during  January 1, 2000 to June 30, 2020‎. All studies that reported the WTP and CCP methods with the CVM in English or Persian were included. The reporting quality of studies was assessed by strengthening the Reporting of Observational Studies in Epidemiology (STROBE). Comprehensive meta-analysis (CMA: 2) software was used to conduct the meta-analysis. The content analysis method was used for qualitative data analysis.

    Results

    Finally, 28 articles (with 49610 people) were included in the study. Most of the participants were women (35.7%). The HPV vaccine was the most common method of prevention (75%). The overall acceptance rate was 64% and the overall positive WTP rate was 66%. The average WTP was US$30.44, which accounts for about 0.84% of GDP per capita. The most significant effective factors included income, age, education, high-risk sexual behaviors, and awareness of cervical cancer, belief in the risk of cervical cancer, and belief about the effectiveness of prevention methods. The cost was the most important reason for the unwillingness to pay and accept.

    Conclusion

    Results show that the WTP and acceptance rate of CCP methods are relatively high. It is recommended to reduce the cost of prevention methods, especially the HPV vaccine, and to increase awareness and improve the attitude of people. Also, it is recommended to consider other methods of estimation of WTP and other cancers in future studies.

    Keywords: Acceptance, Preventive Measures, Cervical Cancer, Human Papillomavirus Vaccine
  • Maryam Kheila, Fazel Gorjipour, Ladan Hosseini Gohari, Masoomeh Sharifi, Nahid Abotaleb* Pages 650-656
    Background

    Currently, stem cell therapy has been proposed as an efficient strategy to prevent or treat myocardial injuries. The current study was conducted to examine cardioprotective effects of human mesenchymal stem cells derived from amniotic membrane (hAMSCs) against isoproterenol (ISO)-induced myocardial injury and explore its potential mechanisms.

    Methods

    The hAMSCs were injected intramyocardially in male Wistar rats 28 days after last injection of ISO (170 mg/kg body weight for 4 consecutive days). The echocardiography was performed to confirm induction of myocardial damage and cardiac function 28 days after last injection of ISO and 4 weeks hAMSCs transplantation after HF induction. The expression of apoptotic markers such as Bcl-2, Bax and P53 was evaluated using Western blotting assay. Masson’s trichrome staining was used to determine fibrosis. The cytoarchitecture of myocardial wall and morphology of cells were investigated using hematoxylin and eosin (H&E) staining.

    Results

    As compared to ISO group, hAMSCs transplantation after heart failure (HF) induction significantly blunted the increasing of cardiac dimensions and restored ejection fraction (EF) and fractional shortening (FS) parameters (p<0.05). Moreover, hAMSCs transplantation after HF induction increased the expression of antiapoptotic markers such as Bcl-2 and decreased the expression of pro-apoptotic markers such as P53 and Bax (p<0.05). As compared to ISO group, hAMSCs transplantation after HF induction markedly reduced interstitial myocardial fibrosis and contributed to maintain of normal cytoarchitecture of myocardial wall and morphology of cells.

    Conclusion

    Collectively, the results of current study suggest that transplantation of hAMSCs confers cardioprotection by targeting ISO‐induced mitochondria‐dependent (intrinsic) pathway of apoptosis.

    Keywords: Cardiac injury, Apoptosis, Human mesenchymal stem cells, Cardiac function, Fibrosis
  • Shirin Sayyahfar, Mahnaz Sadeghian*, Mojgan Amrolalaeii Pages 657-663
    Background

    Currently, the role of calcium in reducing the duration and severity of diarrhea and its consequences has been considered as a topic of concern. The aim of this study was to evaluate the effect of oral calcium on the duration of acute gastroenteritis in children.

    Methods

    This single-blind randomized clinical trial was performed from 2014 to 2016 at Ali Asghar Children’s Hospital, Tehran, Iran. Totally, 124 patients (one month to twelve years old) with acute gastroenteritis were enrolled in this study. The patients were divided equally into intervention and placebo groups and received the calcium gluconate 10%, 0.5cc/kg/day and distinct water, respectively. Data analysis was performed using the statistical software SPSS version 20.0 for windows (SPSS Inc., Chicago, IL) and p<0.05 was considered significant.

    Results

    The mean age of the intervention and placebo groups was 26.43±3.74 and 20.84±2.70 months, respectively, and the difference was not significant (p=0.228). The duration of diarrhea in the intervention and placebo groups was 5.27±2.01 and 6.71 ± 2.44 days respectively (p=0.001). In the placebo group, the plasma calcium level was less than 8mg/dl in 1 (1.6%), 8 - 10 mg/dl in 55 (88.7%) and more than 10mg/dl in 6 cases (9. 7%). In the intervention group, there were 7 (11.3%), 55 (88.7%) and 0 (0%) cases in three groups, respectively (p=0.005).

    Conclusion

      The oral calcium gluconate might shorten the duration of acute gastroenteritis. Therefore, it could be considered as an adjunctive therapy. Whether the formulation of the oral rehydration solution (ORS) will be updated in the future with adding the calcium salts remains to be defined and needs more investigations.

    Keywords: Calcium, Calcium-sensing receptor, Diarrhea, Gastroenteritis, Pediatrics
  • Mahdi Alemrajabi*, Seyedeh Fahimeh Shojae, Mohammad Moradi, Amin Dehghanian, Amirreza Ehsani, Seyed Soroosh Valinia Pages 664-667
    Background

    Constipation is one of the most common gastrointestinal discomforts that affects various age groups in humans. Different mechanical cleansing devices have been introduced yet. However, they are very expensive and not available in our country.

    Methods

    This was a pilot experimental trial. Fifteen patients with eligible ROME III criteria and at least two years of chronic constipation and resistant to medical therapy entered the study. Wexner and Longochr('39')s scores were checked before and after using the “Roodeshur” device. Data entered SPSS 16 and analyzed using T-test. A p value below 0.05 was considered as a statistically significant difference.

    Results

    Five patients were female and 10 males. The mean age of patients was 53.56±18.34 years. There was a significant difference regarding intestinal movement before and after using the device (p˂0.001). Wexnerchr('39')s score decreased after the intervention with a significant difference (p˂0.001).

    Conclusion

    Our mechanical cleansing device (Roodeshur) was effective and safe for patients with resistance constipation. No complication occurred. Due to its low cost and easy access in our country, it can be recommended for other patients as well. However, more studies with a larger sample size are recommended.

    Keywords: Chronic Constipation, Mechanical Cleansing, Wexner
  • Hamed Manoochehri, Reza Gheitasi, Mona Pourjafar, Razieh Amini, Amirhossein Yazdi* Pages 668-673
    Background

    Coronary artery disease (CAD), as a most common cause of death, is mainly caused by atherosclerosis. Due to the role of inflammation in the process of atherosclerosis, in the present study, the relationship between the severity of coronary artery disease and inflammatory factors of ‎ monocyte to HDL-C ratio (MHR), platelet-to-HDL-C ratio (PHR), neutrophil to HDL-C ratio (NHR), and IL-25 was investigated.

    Methods

    In this cross-sectional study, 64 patients with diagnosis of coronary artery disease who were undergoing angiography in Farshchian heart center in Hamadan were studied. For each patient, the count of monocytes, neutrophils, platelet, and HDL-C, and IL-25 were measured from their blood and serum samples. Also, demographic information, such as age, gender, diabetes, smoking, and history of hypertension, was collected using a checklist. Data were described using frequency, percent, mean, and standard deviation. Statistical analysis was performed using independent t test, Mann-Whitney, Wilcoxon, and Spearman rank correlation tests, and multiple linear regression by SPSS version 25.0 SPSS Inc). P < .05 was considered as significant.

    Results

    The results of this study showed that IL-25 and MHR index has a significant correlation with coronary artery disease and Gensini score (P ˂ .001). The PHR index was associated with coronary artery disease. Also, qualitative variables, such as history of hypertension, history of smoking, and gender, have a significant association with the severity of coronary artery disease (P < .05).

    Conclusion

    Among the inflammatory markers examined, IL-25 and MHR are stronger markers for assessing the severity of coronary artery disease. Simple and available IL-25 and MHR measurements may be able to, along with common risk factors and lipid profiles, predict the amount of vascular occlusion in treatment centers as an alternative of angiography as well as screening high risk patients prone to cardiovascular disease.

    Keywords: Coronary Artery Disease, IL-25, HDL-C, MHR, NHR, PHR
  • Hakimeh Afaghi, Farshad Sharifi, Mitra Moodi, Gholamreza Ananisarab, Tooba Kazemi, Ebrahim Miri Moghaddam, Zoya Tahergorabi* Pages 674-680
    Background

    Anemia is a multifactorial and common public health problem in geriatric age groups, especially in developing countries. Therefore, this study was designed to study the prevalence of anemia and associated factors among the elderly population in Birjand, Iran, in 2019.

    Methods

    This was a cross-sectional approach to the baseline data of the Birjand longitudinal aging study (BLAS) in which 1396 people aged ≥ 60 years were screened for the presence of anemia based on the World Health Organization (WHO) criteria. For each participant, a standard questionnaire was administered. Furthermore, the height, weight, and body mass index (BMI) were calculated. Blood samples were obtained from each participant for hematological examination. Hemoglobin, hematocrit, and other indices of cell blood count were measured using an automatic cell counter. The prevalence rates were estimated using survey analysis with the weight of Birjand county older population. Univariate and multivariable logistic regression analyses were applied to detect the associated factor with anemia.

    Results

    The mean age of the participants was 69.73±7.66 years. The crude prevalence of anemia was 11.10%, and the age-standardized prevalence based on the standard WHO population 2000-2025 was equal to 16.78% (12.81%–21.66%) (15.95% [10.41%–23.69%] in women and 17.32% (12.65%–23.25%) in men. Mild and normocytic anemia were the predominant types. The mean hemoglobin, hematocrit, mean cell volume (MCV), mean corpuscular hemoglobin (MCH), and mean corpuscular hemoglobin concentration (MCHC) were lower in women than in men and the mean platelet count in women was higher (p<0.001). In the final multivariate logistic regression model, only age groups, BMI, fish consumption, and chronic kidney disease (CKD) were related to anemia.

    Conclusion

    In conclusion, our findings showed the association of anemia with some risk factors and diseases. Anemia in geriatric age groups is often underdiagnosed; hence, identification of subgroups at risk for anemia and its associated risk factors in geriatric groups has a paramount importance in preventing adverse outcomes.

    Keywords: Anemia, The Elderly, Population, Prevalence, South Khorasan
  • Mojtaba Ghorbi, Mahboobe Rashidi*, Alireza Olapour, Fatemeh Javaherfrooshzade, Reza Akhondzadeh Pages 681-687
    Background

    N-acetylcysteine (NAC) is an antioxidant derived from the amino acid cysteine and is one of the drugs used in the treatment of respiratory diseases. The aim of this study was to investigate the effect of NAC on the treatment of acute respiratory distress syndrome in mechanically ventilated patients admitted to the intensive care unit.

    Methods

    This study was a randomized clinical trial. Patients under mechanical ventilation admitted to the intensive care unit were examined. Patients in the intervention group received daily 150 mg/kg of NAC on the first day of admission and then 50 mg/kg up to the fourth day of admission. Patients in the control group received routine care. The vital signs, level of consciousness, and other important variables were recorded. Data were analyzed using statistical tests and SPSS software version 24.

    Results

    There was no significant difference between MAP, heart rate, respiratory rate, O2Sat, APACHE II score, and pulmonary capacity of the patients in the two groups on the first, second, third and fourth days after the intervention (p>0.05 ). There was no significant difference between the level of consciousness (according to GCS criteria), respiratory index (PAO2/FIO2) and PEEP of patients in the two study groups within 1 to 2 days after the intervention (p>0.05). There was a significant difference between the level of consciousness (based on GCS criteria), respiratory index (PAO2/FIO2) and PEEP of patients in the two study groups within 3 to 4 days after the intervention (p<0.05). There was no significant difference between the duration of hospitalization in the ICU, the time required for mechanical ventilation and the mortality rate of the patients in the two groups (p>0.05).

    Conclusion

    It seems that N-acetylcysteine has a positive effect on the treatment of acute respiratory distress syndrome in mechanically ventilated patients admitted to the intensive care unit.

    Keywords: N-acetylcysteine, Acute respiratory distress syndrome, Mechanical ventilation, Intensive care
  • Firouz Salehpoor, Amir Kamalifar*, Farhad Mirzaii, Javad Aghazadeh, Mehrnoush Mousavi Aghdas, Samar Kamalifar, Asgar Bagheri, Hosein Hamadani Pages 688-691
    Background

    Pituitary adenoma (PA) is a frequent intracranial lesion, that needs surgical evacuation. In this study, we  evaluated the surgical outcome of PA treated via endoscopic and microscopic  trans-sphenoidal approach

    Methods

    In this retrospective cross-sectional study, we evaluate ten years of PA surgery experience  in the northwest of Iran. 721 patients underwent trans sphenoidal surgery of PA. Complication of the surgery, extension of tumors resection, demographic and clinical findings (gender, age , tumor type ,..) were reviewed in this study. SPSS version 25 and statistical tests including chi square and T-test were used. P-value ˂0.5 was considered as statistically significant.

    Results

    483 males (58.9%) and 336 females (41.02%) were included in this study. Mean age of patients was 47.3±1.96 years.The most common initial complaints were deterioration of vision (n=528, 64.4%) and headache (n=343, 41.88%), followed by accelerated development (n=254, 31.01%), amenorrhea and galactorrhea (n=253, 30.8%). 57 (6.95%) patients had symptoms of Cushing’s disease. 105 (12.8%) patients had acromegaly. TR was achieved in 87.5% of cases and sub-TR in 103 (12.5%) cases and no patient had a partial or insufficient resection. After surgery, the endocrine function was normalized in 76 (31.7%) patients who had preoperative hyper hormonal levels. 36 (4.3%) patients developed postoperative CSF leakage; of which, 4 (0.48 %) patients did not improve by lumbar drainage and other conservative treatments  and needed reoperation for reconstruction of the skull base.

    Conclusion

    The combination of microscopic and endoscopic trans-sphenoidal approach in PA surgery can be lead to total resection of tumors.

    Keywords: Pituitary Adenoma, Pituitary Hormone, Trans-Sphenoidal Approach
  • Seyed Ali Javad Moosavi, Jafar Aslani, Zahra Aslani, Hanieh Raji* Pages 692-695
    Background

    Impulse oscillometry (IOS) is a method that does not depend on the cooperation of the patient and can detect small airway diseases with higher sensitivity than spirometry. However, the clinical application value of IOS in the screening of patients exposed to risk factors COPD and early diagnosis remains unclear.  The aim of this study is to evaluate diagnostic sensitivity of IOS in the early detection of patients exposed to risk factors COPD.

    Methods

    A prospective cross-sectional study was conducted in Rasoul Akram Hospital, Tehran, Iran, from 2013 to 2015. 28 patients with COPD risk factors and normal spirometry participated in the study. The IOS was performed. We obtained the respiratory resistance and impedance of 5 Hz (R5) and 20 Hz (R20) and 5 Hz (Z5), respectively. The data were analyzed using SPSS version 17 using Chi-square and two independent sample t-test. Spearman correlation test was used to measure the correlation of oscillometry parameters in the diagnosis of COPD. P-value <0.05 was considered significant for all statistical analyses.

    Results

    The mean patient age was 55.50±11.27 years. In this study, the sensitivity of Z5, R5, and R20 was respectively 28.5%, 25%, and 31.5%. All oscillometry parameters were significantly correlated with each other but none of the oscillometry parameters showed significant correlations with FEV1/FVC (rZ5=0.018, rR5=0.082, rR20=0.041 and PZ5=0.932, PR5=0.711, P R20=0.850). According to the results, only 9 patients (32.5%) with normal values of FEV1/FVC had abnormal values of oscillometry.

    Conclusion

    IOS has a low sensitivity and cannot be used in the screening of early-stage chronic obstructive pulmonary disease.

    Keywords: COPD, Impulse oscillometry, Spirometry, Airway obstruction
  • Rasoul Masoomi, Mohammad Shariati, Ali Labaf, Azim Mirzazadeh* Pages 696-715
    Background

    Transfer of learning (ToL) is the endpoint of simulation-based training (SBT). It is affected by numerous factors, which can be classified into 3 categories: learner characteristics, work environment, and training design. The first 2 have been identified to some extent in previous research. In this study, the aim was to identify the instructional design (ID) features affecting the ToL in SBT.  

    Methods

    This qualitative study was conducted in 2 phases. Phase 1 covers thematic analysis of comparative studies in the field of SBT. A systematic search was performed on 6 databases of Ovid MEDLINE, EMBASE, PsycINFO, CENTRAL, Scopus, and Web of Science, and the references of related systematic reviews were also checked. In phase 2, semi-structured interviews were conducted with key informants (instructors and learners) and analyzed using directed content analysis. The results of the 2 phases were combined, and finally ID features of SBT were identified and categorized.

    Results

    In the first phase, 121 comparative studies were reviewed and in the second phase, 17 key informants were interviewed. After combining the results of the phases, the ID features affecting the ToL in SBT were classified into 3 broad categories and 15 subcategories as follows: (1) presimulation: preparation, briefing, and teaching cognitive base; (2) underlying theories: deliberate practice, mastery learning, and proficiency-based training; (3) and methods and techniques: distributed practice, variability, increasing complexity, opportunity for practice, repetitive practice, active learning, feedback/debriefing, simulator type, and simulator fidelity.

    Conclusion

    Although learning is transferred from the simulated setting to the clinical setting, this process is not automatic and straightforward. Numerous factors affect this transfer. The results of this research can be used in designing and evaluating the SBT programs.

    Keywords: Simulation Training, Manikins, Transfer, Psychology, Education, Medical, Students
  • Azita Tavasoli, Shahrbanoo Nakhaiee, Nazanin Zafaranloo, Rozita Hoseini, Hasan Otukesh, Behnam Sobouti* Pages 716-726
    Background

    Diarrhea-associated-hemolytic-uremic-syndrome (D+HUS) is a common from of HUS. Central-nervous-system (CNS) involvement is one of the most common extrarenal organ involvements in children with D+HUS. This systematic review and meta-analysis aim to recognize the frequency of neurological complications in pts with HUS. 

    Methods

    Databases of PubMed, Embase, and Web of Science were searched systematically to find the papers on neurological involvement in HUS pts. Two researchers independently assessed the papers’ quality and extracted data. CMA v. 2.2.064. was used for data analysis. Heterogeneity was evaluated using the I-squared (I2) test, and a fixed/random-effects model was used when appropriate.

     Results

    In this review, 21 studies including 2,189 participants with a median age between 1.3-40-year-old, entered the meta-analysis. The meta-analysis in D+HUS patients indicated 27.0% with neurological complications (95% CI, 22.0%-32.6%), 25.5% of symptoms weren’t categorized (95% CI, 15.9%-38.3%), 20.8% of them developed the seizures (95% CI, 2.3%-74.4%). In D-HUS pts, 20.8% of them were presented neurological symptoms (95% CI, 17.9%-24.0%), of which 29.0% weren’t categorized (95% CI, 19.2%-41.2%), 17.5% of pts got into coma (95% CI, 9.6%-29.7%), 5.6 % showed hemiparesis (95% CI, 2.8%-10.9%), 17.2% experienced lethargy (95% CI, 5.2%-44.1%), 30.5% developed the seizures (95% CI, 18.2%-46.2%), 7.4% manifested speech abnormalities (95% CI, 0.2%-7.22%), 6.4% of D-HUS pts presented visual-disturbances (95% CI, 3.4%-11.6%).

    Conclusion

    This systematic review and meta-analysis indicated more than one-fourth of both D+HUS and D-HUS patients were presented with neurological symptoms, and the most prevalent symptoms were seizures, which can lead to an epilepsy sequel.

    Keywords: HUS, CNS, Diarrhea, Neurological symptoms, Pediatrics, Adults
  • Shiva Soraya, Mohaddese Zolfi*, Ruohollah Seddigh, Homa Mohammadsadeghi, Fatemeh Hadi Pages 727-731
    Background

    Discharge from the hospital against the doctor’s advice and refusal of receiving treatment is one of the significant issues at the time of hospitalization, which is especially crucial in relation to psychiatric patients. It can exacerbate the disorder and the subsequent complications and increase further hospital admissions. The present study was designed to evaluate the causes of discharge from the hospital and the refusal of receiving treatment against medical advice in hospitalized patients in Iran Psychiatric Hospital.

    Methods

    The present study was a descriptive cross-sectional study. One hundred patients hospitalized in Iran Psychiatric Hospital discharged with personal consent against medical advice from July to December 2018 were studied. Two methods were used for assessment; the fulfillment of a routine ministry-approved checklist by the dischargers themselves and the face-to-face interview with both the patient and discharger based on a researcher-made checklist. Cohen’s Kappa coefficient was used to assess the agreement of the answers of patients to both routine ministry-approved and researcher-made checklists by SPSS software version 16.0 with an overall accuracy of 95%.

    Results

    Based on the results extracted from the researcher-made checklist, 43 (43%) of the discharges were generally based on patient-related factors. The personal insistence to discharge by the patient was cited as the main reason for discharge. Cohen’s Kappa coefficient showed no significant agreement between the patient’s answers to the interview and what they have previously filled in the routine ministry-approved checklist. More specifically, the measure of agreement for answers of patients to questions in the standard checklist and the questions asked by the interviewer was 0.078 (p=0.167).

    Conclusion

    From the results of this study, it can be concluded that the face-to-face interview based on the researcher-made checklist can more effectively determine the reasons for discharge of patients due to the accuracy of the interview.

    Keywords: Discharge against medical advice (DAMA), Psychiatric patient, Hospitalization
  • Maliheh Arab*, Behzad Nemati Honar, Behnaz Ghavami, Robabeh Ghodssi Ghassemabadi, Mahsa Aghaei, Nasrin Yousefi, Kourosh Sheibani Pages 732-736
    Background

    Although acute appendicitis is a common problem, it remains a difficult diagnosis to establish, particularly among females of reproductive age. The present study was conducted to devise a new decision making model for diagnosing acute appendicitis in non-pregnant women.

    Methods

    The present study was a retrospective study consisting of women who had undergone an appendectomy between 2007 and 2015 at the emergency department of Imam Hossein Medical Center, Tehran, Iran. The inclusion criteria were being a female, presenting with abdominal pain, being a suspected case of acute appendicitis, and undergoing an emergency appendectomy. A classification and regression tree (CART) analysis was performed to partition exam and laboratory data obtained from these patients into homogeneous groups in order to develop a prediction rule for appendicitis diagnosis.

    Results

    The study population included 433 non pregnant women who underwent emergency operations with a preliminary diagnosis of acute appendicis. Out of these patients, 295 patients (68.1%) were appendicitis positive based on the pathology exam results, while 138 patients had a normal appendix, indicating a negative appendectomy rate of 31.8%. The final devised CART model included hemoglobin level, PMN count, age, and history of abdominal incision and yielded a sensitivity of 82.7% and specificity of 55.8%, which were better than Alvarado prediction results for the Asian population.

    Conclusion

    We have devised a simple and cost effective prediction model for predicting the outcome among non-pregnant women undergoing emergency appendectomy operation with good sensitivity and specificity compared to the Alvarado model.

    Keywords: Appendicitis, Prognosis, Decision Making, Model
  • Ali Bidari, Morteza Hassanzadeh, Mahya Naderkhani*, Milad Gholizadeh Mesgarha, Arash Pour Mohammad, Alireza Azadeh, Hasti Hossein, Elham Zarei, Mahmoud Khodadost Pages 737-743
    Background

    Ever since coronavirus disease 2019 (COVID-19) has emerged as a global public health problem, risk factors for severe disease have been reported in studies from Western countries. However, apart from studies of Chinese origin, few reports are available on COVID-19 severity among the Asian population. This study investigates potential risk factors for development of critical COVID-19 in an Iranian population.

    Methods

    In this retrospective cohort study, we included all adults with COVID-19 from 2 tertiary centers in Iran who had been diagnosed between February 20 and April 1, 2020, in either inpatient or outpatient settings. “Critical COVID-19” was proposed when a hospitalized patient was scheduled for admission to intensive care unit, assisted by mechanical ventilation, or pronounced dead. We used univariable and multivariable logistic and linear regression models to explore the potential risk factors associated with critical COVID-19, admission to hospital, and length of hospital stay.

    Results

    Of the 590 recruited patients, 427 (72.4%) were hospitalized, 186 (31.5%) had critical COVID-19, and 107 (18.2%) died. In the multivariable regression analysis, age  >60 years and physical/mental disabilities were associated with critical COVID-19 (odds ratio (OR), 2.33 and 7.03; 95% CI, 1.51-3.60 and 2.88-17.13, respectively); and history of renal, heart, or liver failure was associated with both COVID-19 hospitalization (OR, 4.13; 95% CI 1.91-8.95; p<0.001) and length of hospital stay (Beta 1.90; 95% CI, 0.76-3.04; p=0.001).

    Conclusion

    Age >60 years and physical/mental disabilities can predict development of critical COVID-19 in the Iranian population. Also, the presence of renal, heart, or liver failure might predict both COVID-19 hospitalization and length of hospital stay.

    Keywords: COVID-19, Prognosis, Risk Factor, Age, Disability, Iran
  • Saiedeh Haji Maghsoudi, Azadeh Mozayani Monfared, Majid Sadeghifar, Ghodratollah Roshanaei, Hossein Mahjub* Pages 744-749
    Background

    Typically, blood pressure dips during sleep and increases during daytime. The blood pressure trend is affected by the autonomic nervous system. The activity of this system is observable in the low and high activity conditions. The aim of this study was to assess the effect of individual characteristics on systolic blood pressure (SBP) across day-night under low and high activity conditions.

    Methods

    The samples were 34 outpatients who were candidates for evaluation of 24 hours of blood pressure with an ambulatory. They were admitted to the heart clinic of Farshchian hospital, located in Hamadan province in the west of Iran. The hourly SBP during 24 hours was considered as a response variable. To determine the factors effecting SBP in each condition, the hidden semi-Markov model (HSMM), with 2 hidden states of low and high activity, was fitted to the data.

    Results

    Males had lower SBP than females in both states. The effect of age was positive in the low activity state (β=0.30; p<0.001) and negative in high activity state (β= -0.21; p=0.001). The positive effect of cigarette smoking on SBP was seen in low activity state (β=5.02; p=0.029). The overweight and obese patients had higher SBP compared to others in high activity state (β=11.60; p<0.001 and β=5.87; p=0.032, respectively).

    Conclusion

    The SBP variability can be displayed by hidden states of low and high activity. Moreover, the effects of studied variables on SBP were different in low and high activity states.

    Keywords: Activity, Body mass index, Ambulatory monitoring, Systolic blood pressure, Cigarette smoking
  • Sara Heydari, Peyman Adibi, Athar Omid, Nikoo Yamani* Pages 750-757
    Background

    Clinical faculty development plays a significant role in the professional empowerment of future physicians. Identification of educational needs is an important step in planning faculty development. This study identified the educational needs of medical faculties in the clinical setting.

    Methods

    This cross-sectional needs assessment study was conducted in Iranian medical universities during 2016-2018 using a triangulation paradigm. A total of 384 medical clinical faculties, 54 medical education specialists, and 194 faculty evaluation forms completed by medical residents participated in the study using a convenient randomized sampling method. The data were gleaned with a researcher-made questionnaire with 14 areas developed on the basis of clinical education goals and contexts and were analyzed with SPSS16 using descriptive statistic indices such as mean, standard deviation, and frequency percentile. Analytical tests including independent t-test, chi-square and Cramerchr('39')s V were also applied (p<0.05). The content validity, face validity, and reliability were approved.

    Results

    The response rate was %59 (227) for clinical faculties, %77 (42) for medical education specialists, and %58 (110) for residents. Professionalism was the first priority of needs from the viewpoint of clinical faculties and faculty development planners. The clinical teacherschr('39') highest level skills, in their own perspective and also students’ perspective, were procedure training and grand round, whereas their lowest level skills were emotional intelligence and morning report. The greatest gap existed between the current skill and the need is management and leadership in the clinical setting. Cramer’s index ranged between 0.18 and 0.34 (p<0.05); hence, there was a correlation between the current status and the announced needs in all subjects.

    Conclusion

    Designers of faculty development programs ought to pay due attention to areas of professionalism, management, and leadership and carry out accurate and comprehensive planning to enable students to become competent future physicians in the roles of therapist, manager, teacher, supporter, and researcher.

    Keywords: Needs Assessment, Faculty, Medical, Clinical Teacher, Triangulation
  • Marzieh Nojomi*, Maziar Moradi Lakeh, Farshad Pourmalek Pages 758-762

    The current COVID-19 pandemic started in Wuhan, China, in December 2019. The World health Organization (WHO) declared the COVID-19 as a public health emergency of international concern on January 30, 2020, and recognized the situation as a pandemic on March 11, 2020.  Around 135 million confirmed cases and around 2.9 million deaths until the first week of April 2021 have been among its direct impacts on human health.All countries have been affected in different degrees, and each of them has used different strategies to protect themselves against health and nonhealth consequences of this epidemic. Although all approaches are full of mistakes with fatal and painful results, some of them were successful in limiting the epidemic. One of the astonishing improvements is development of several vaccines in a relatively short period of time, which has increased hopes for epidemic control. This review aims to critically appraise the strategies for COVID-19 epidemic control in Iran since the beginning of the disease until the fourth peak of disease in March 2021.

    Keywords: COVID-19, Control, Iran
  • Maryam Vahidi, Vahid Zamanzadeh, Saeed Musavi, Fariborz Roshangar, Raheleh Janani* Pages 763-769
    Background

    Gaming disorder has been identified as a health problem. Disorders in emerging adulthood might negatively affect individuals’ attitude toward the world, their communication with others, and formation of their personal identity. Thus, the present study was performed to identify the frequency of gaming disorder and its related factors among students of Tabriz University of Medical Sciences. 

    Methods

    A total of 813 undergraduate students of Tabriz University of Medical Sciences participated in this descriptive correlational study in 2018. All students filled the personal-social information form and Social Readjustment Rating Scale, and gamers filled gaming behaviors form and Internet gaming disorder-20 test (IGD). Data were analyzed using descriptive statistics and Pearson correlation coefficient, t- test, ANOVA, chi-square, and multiple linear regression.

    Results

    A total of 394 (48.5%) students were currently playing games. The mean of IGD scores among the gamers was 45.47 ±13.93, and 17 (4.3%) of them were recognized as having gaming disorder. The frequency of the disorder among all students was 17 (2.1%). Being male, playing online games, and having access to all 3 gaming devices (computer, smart phone, and tablet) were recognized as determining factors of gaming disorder.

    Conclusion

    This study revealed that almost half of the university students were playing video and or on line games; however, a low percentage of the gamers had addictive gaming behaviors. The results indicated the necessity of applying modifications to individuals’ gaming methods as well as implementing the individual and family-centered interventions to prevent and manage gaming disorder.

    Keywords: Video Games, Internet, Behavior, Addictive, University students
  • Nader Saki, Vedat Topsakal, Marzieh Amiri, Wael Jasem Alshahabi, Arash Bayat* Pages 770-772

    Since the discovery of coronavirus disease 2019 (COVID-19), which started in Wuhan, China, the epidemic has not only swept through China but also spread throughout the world in spite of the concerted attempts from the governments to contain it. Thus, prevention and control of COVID-19 infection is very effective in ensuring the safety of medical specialists, health care workers, and patients. Audiology clinics are also crucial in the fight against the infection epidemic, as audiologists provide their diagnostic and rehabilitative services in an environment with different contaminated objects that come in either direct or indirect contact with multiple patients. The current article explains the importance of infection control in audiology and priority setting for audiologic evaluation in COVID-19 pandemic.

    Keywords: COVID-19, Coronavirus, Audiology, Audiometry, Protection
  • Parisa Arzani*, Minoo Khalkhali Zavieh, Khosro Khademi Kalantari, Alireza Akbarzadeh Baghban Pages 773-776
  • Jeiran Rahmati, Saba Ahmadi, Sepide Rezaei, Hossein Hosseinifard, Afsaneh Dehnad, Hosein Shabaninejad, Aidin Aryankhesal, Shabnam Ghasemyani, Samira Alihosseini, Zahra Mansour Kiaee, Zahra Noorani Mejareh, Sepideh Aghalou, Ahmad Ghashghaee*, Mahnaz Shoghi, Mohammad Ahmadi Nasab, Anahita Khajehvand Pages 777-786
    Background

    Anxiety affects social, economic, and physical aspects of daily life in patients with AIDS. Therefore, it is necessary to take preventive measures and design plans to maintain their general health. The present study was the first comprehensive systematic literature review research that examined the worldwide prevalence rate of anxiety in patients with AIDS. 

    Methods

    We searched for papers published in the English language in the major databases including Embase, PubMed, Web of Science, Scopus, Cochrane, and Google Scholar from 2000 to October 2018. There were 40 studies which found to be eligible. These studies were independently evaluated and the collected data were entered in a data extraction form, which was then analyzed by two authors and a third author if necessary. Der Simonian-Laird model was used to estimate the prevalence rate on a Forest plot at the interval confidence of 95%.

    Results

    The total sample size was 24111, and the total number of people with anxiety was 5546. The results based on the random-effects model showed that the rate of anxiety prevalence in the patients was 25% (CI: 95%, 21% -30%) with heterogeneity of 97.9% and a significance level of p<0.001. The South America continent with a prevalence of 38% (95% CI, 34%-42%) had the highest anxiety prevalence rates and Africa with 19% (95% CI, 12% -29%) had the lowest anxiety prevalence rates.

    Conclusion

    Based on findings, the prevalence of anxiety in developed countries was partially higher than in underdeveloped countries and the obtained mean in the present study. It can be a significant point for policymakers. Therefore, WHO and the world community should have special plans for these countries.

    Keywords: Worldwide, Prevalence, Anxiety, Acquired Immune Deficiency Syndrome, HIV
  • Mohammad Khammarnia, Alireza Ansari Moghaddam, Eshagh Barfar, Hossein Ansari, Azar Abolpour, Fatemeh Setoodehzadeh*, Javad Shahmohammadi Pages 787-795
    Background

    Hospital-acquired infections (HAIs) are a global problem in hospitals and significant causes of mortality and morbidity regardless of advances in supportive care, antimicrobial therapy and prevention. The study aimed to determine a comprehensive estimate of the HAIs prevalence, influential factors, and types of these infections in Iran.

    Methods

    A systematic literature review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using the online databases; Medline, EMBASE, Scopus, Cochrane, SID, Magiran, and Medlib from January 1995 to September 2020 using a combination of medical subject heading terms (‘Nosocomial infection [Mesh] OR ‘’ Hospital infection [Mesh] OR Hospital Acquired Infection[Mesh]  OR Healthcare-associated infection ‘’AND (‘Iran’ [Mesh]) among observational and interventional studies. SPSS version 25 and STATA version 11 were used for data analysis.

    Results

    A total of 66 (cross-sectional, cohort, and case-control) observational studies were identified. More of the studies had been done before 2014(43 papers or 65%). Based on the random-effects model, the overall prevalence of HAIs in Iran was 0.111 [95% CI: 0.105 - 0.116] with a high, statistically significant heterogeneity (I2= 99.9%). The infection rate was 0.157 and 0.089 before and after the Iranian Health Transformation Plan (HTP), respectively. HAIs rates reported more in the South and West of Iran rather than other regions (0.231 and 0.164) (p= 0.001). Escherichia coli and klebsiella infections were reported in 53 and 52 papers (0.239 and 0.180, respectively). In addition, respiratory and urinary infections were reported 0.296 and 0.286 in 51 and 38 papers, respectively.

    Conclusion

    The prevalence of HAIs in Iran is relatively high. Preventing and decreasing hospital nosocomial infections can considerably affect reducing mortality and health-related costs. This should be taken into consideration by health policymakers for pathology and revision of some previous programs and standards as well as the development of appropriate and evidence-based control and education programs to reduce this health problem.

    Keywords: Hospital infection, Nosocomial infection, Meta-analysis, Hospital, Iran
  • Manoochehr Karami, Mohammad Mirzaei, Fatemeh Shahbazi, Fariba Keramat, Ebrahim Jalili, Saeid Bashirian, Rashid Heidarimoghadam, Jalal Bathaei, Salman Khazaei* Pages 796-800
    Background

    Coronavirus disease 2019 (COVID-19) is a contagious disease caused by a newly identified coronavirus. Our knowledge about the survival rate and prognostic factors of the disease is not established well. The purpose of this study was to evaluate the predictors of COVID-19 mortality in Hamadan province in western Iran.

    Methods

    In this study, we included all laboratory-confirmed COVID-19 cases with known treatment outcomes in Hamadan province, Iran, between 20, 2020, to May 10, 2020. Demographic, clinical, laboratory data, and treatment outcomes were obtained from computerized medical records and compared between survived cases and patients with death outcomes. Univariable and multivariable logistic regression models were used to determine the predictors of death.

    Results

    From 749 investigated patients, 77 patients (10.28%) died during the treatment. The Mean age of patients was 53.97±19.04 years. Multivariable logistic regression showed that males had 2.07 (95% CI: 1.73, 2.54) fold higher odds of death. Those with 60 years old and more had 6.49 (95% CI: 4.53, 7.93) fold higher odds of death. Patients with an underlying disease had 7.14 (95% CI: 6.94, 7.38) fold higher odds of death, and patients who were hospitalized in the ICU ward had 2.24 (95% CI: 1.75, 2.90) times higher odds of COVID-19 related mortality.

    Conclusion

    The potential predictors of death in COVID-19 cases, including the male gender, older age, and having an underlying disease could help physicians to identify patients with poor prognoses at an early stage and better management of them.

    Keywords: Coronavirus, COVID-19, Epidemiology, Mortality, Iran
  • Ebrahim Salavati, Hamidreza Hajirezaee, HamidReza Niazkar*, MuhammadSadegh Ramezani, Alireza Sargazi Pages 801-803

    The Coronavirus disease 2019 (COVID-19), which was declared to be pandemic on March 12, 2020, is the latest health concern worldwide. COVID-19 patients may develop cerebrovascular complications either during the course of COVID-19 or even as an initial presentation of the disease. Herein, a case of myocarditis in a COVID-19 patient without any respiratory signs and symptoms is presented.

    Keywords: COVID-19, SARS-CoV-2, Coronavirus, Myocarditis, Myopericarditis
  • Nurlan Tabriz*, Zhanara Nurtazina, Margulan Kozhamuratov, Kuliya Skak, Zhumat Mutaikhan Pages 804-810
    Background

    Tuberculosis (TB) causes over a million deaths annually and is still one of the most important public health problems worldwide. According to the World Health Organization estimates, the highest rates of TB in the European Region are in Tajikistan, Kazakhstan, Moldova, Kyrgyzstan, Romania, and Uzbekistan. The purpose of this study was to investigate the spectrum of nonspecific microorganisms isolated in patients with multidrug-resistant TB in Central Kazakhstan and to assess their susceptibility to antimicrobial drugs.

    Methods

    The patients were divided into 2 groups: group 1 with multidrug-resistant forms of pulmonary TB (n = 107 patients); group 2 with sensitive forms of pulmonary TB (n = 122 patients). Gender, age, and social status of the patients were studied. Microorganisms were identified using the MALDI-TOF method. The statistical significance of different values for binary and nominal parameters was determined using the chi-square test. Changes in binary variables were analyzed using the McNeimer test.

    Results

    During the study, an expectedly high proportion of tetracycline-resistant pneumococcal strains (66.7% and 60%, respectively) was isolated, which was a consequence of a long-term and practically uncontrolled use of these drugs in Kazakhstan. Fluoroquinolones showed low activity. The results showed that beta-lactam antibacterial drugs maintained their high activity against the causative agents of pneumococcal infection.

    Conclusion

    It was concluded that secondary microorganisms isolated in patients with multidrug-resistant TB were represented by the strains that were resistant to modern antibacterial drugs. Therefore, for appropriate antibiotic prescription, it is necessary to study materials from the respiratory system in all patients admitted for TB treatment to study the spectrum of nonspecific microorganisms and assess their susceptibility to antimicrobial drugs.

    Keywords: Health care, Treatment efficacy, Non-specific microorganisms, Antibacterial drugs
  • Murat K. Jakanov*, Bazylbek S. Zhakiev, Uteugaly G. Karsakbayev, Bulat A. Kurmanbayev, Kairat R. Taishibayev, Serik K. Sagynganov Pages 811-817
    Background

    Diabetic foot syndrome (DFS) causes damage to the peripheral arteries in 50% of patients with diabetes mellitus (DM). The purpose of this study was to evaluate the efficacy of endovascular interventions, stenting, and balloon angioplasty for the treatment of patients with purulent and necrotic lesions in DFS.

    Methods

    This was a retrospective study. During 2019-2020, stenting and balloon angioplasty were performed in 51 patients (study group) with purulent and necrotic complications of diabetic foot with limb ischemia. There were 32 women (62.7%) and 19 men (37.3%). The age of the patients varied from 45 to 81 years. Endovascular interventions were performed in combination with conservative therapy and topical treatment on 2 to 3 days after the debridement of the purulent lesions. To assess the outcomes of endovascular interventions, we studied the nature of changes in arterial circulation in the lower extremities. The mean blood flow velocity was calculated using the Doppler ultrasonography. The study was performed on the popliteal artery (PA), the posterior tibial artery (PTA), and on the dorsalis pedis artery. In this study, patients were divided into 2 groups: the study group— those who received endovascular intervention— and the control group— those who received only conservative therapy, which included local treatment without surgery.

    Results

    The weightbearing function of the foot at discharge from the hospital was preserved in 94.2% (48 patients) of the study group and in 73.4% (22 patients) of the control group. During the next 6 months, repeated small foot surgeries were required in 7.3% (3 patients) of patients from the study group and in 20% (4 patients) of patients from the control group. Six months after discharge, the weightbearing function of the foot was preserved in all the patients from the study group available for follow-up and in 85% of the patients from the control group.

    Conclusion

    The results of the study demonstrate the positive corrective effects of endovascular interventions, stenting, and balloon angioplasty on the clinical course of ischemic and neuroischemic forms of DFS.

    Keywords: Diabetes Mellitus, Revascularizing Surgery, Weightbearing Function of The Foot, Purulent Complications, Wound Healing
  • Mostafa Dahmardehei, Majid Khadem Rezaiyan, Farhang Safarnejad, Ali Ahmadabadi* Pages 818-821
    Background

    Due to the COVID-19 outbreak, protective measures including alcohol-based hand rub, received unexampled popularity in Iran. Alcohol hand rub is effective, inexpensive and simple to use, but it is a flammable liquid, which might cause burn injuries. In this study, we investigated burn injuries due to alcohol hand sanitizers during the COVID-19 disease outbreak in Iran.

    Methods

    This cross-sectional study was performed on burn patients referred to Motahari Burns and Reconstruction Center from February 20th, 2020 (official announcement of the epidemic of COVID-19 in Iran) up to April 19th, 2020. All outpatients and hospitalized burn injuries caused by alcohol during the abovementioned period were included.

    Results

    There were 76 burn injuries due to the use of alcohol hand sanitizer. Sixty patients were treated outpatient, and 16 were hospitalized. The mean ± SD age of patients was 33.2±17.9 years and most were males (57 individuals, 75%). Also, the mean ± SD of TBSA was 6.1±6.5%. In hospitalized ones, the mean ± SD hospital stay was 11.7±8.6 days. The most burnt area was the head (39.5%) followed by the right upper limb (35.5%) and the left upper limb (23.7%). Patients were actively engaged in burn injury in 61.8% of cases, while they were passively burnt in 34.2% of cases and in 3.9% the mechanism was unknown. Burn injuries mostly happened in the yard (22.4%) followed by the rooftop (21.1%) and outdoors (18.4%).

    Conclusion

    Appropriate general education, especially through mass media, can reduce burns caused by alcohol-based sanitation during the COVID-19 outbreak. Most of these burn injuries involved face and hands, which are cosmetically and functionally important.

    Keywords: Alcohol-Based Hand Sanitizer, COVID-19 Outbreak, Burns
  • Seyed Mohsen Zahraei, Parvin Mohamadi, Ghobad Moradi, Samira Shirzadi, Fatemeh Azimian, Zaher Khazaei, Hasan Naemi, Elham Goodarzi* Pages 822-828
    Background

    Pertussis is a respiratory tract infection caused by Bordetella pertussis, which causes inflammation of the lungs and respiratory tract. The purpose of this study was to investigate the incidence and geographical distribution of pertussis using the geographic information system (GIS) and to predict its incidence in Iran in 2021.

    Methods

    This was a descriptive analytical study. Information on pertussis was obtained from the Center for Communicable Diseases Control during 2009-2015. In the next step, the ArcGIS 9.3 was used to prepare geographic maps of the disease incidence and frequency. Therefore, the disease prediction map was drawn.
    using the Raster Calculator tool.

    Results

    The results showed that the highest incidence of pertussis during 2009-2015 was in Zanjan, Qom, Mazandaran, and Qazvin provinces. The incidence of pertussis in Iran increased from 0.74 in 2009 to 1.53 in 2015. Based on the modeling results for Iran, Qom, Mazandaran, Tehran, Qazvin, and Zanjan provinces, with 76.76%, 73.69%, 66.32%, 30.94% and 24.18% of their areas (Km2), are at high risk for pertussis in the coming years, respectively.

    Conclusion

    The incidence of the disease has been increasing in recent years, indicating the emergence of the disease in Iran. The modeling maps show that the Iranian provinces of Qom, Tehran, Zanjan, and Qazvin are at risk of the disease incidence in the coming years, indicating the need for planning, appropriate interventions and more precise implementation of the vaccination program against the disease.

    Keywords: Incidence, Prediction, Pertussis, GIS, Iran
  • Ghobad Moradi, Hossein Masoumi Asl, Nasrin Bahmani, Ahmad Vahabi, Samira Shirzadi, Zahra Zare, Elham Goodarzi, Hasan Naemi, Zaher Khazaei*, Asrin Karimi Pages 829-835
    Background

    Leptospirosis is known as a public health problem in developing and developed countries. The aim of this study was to investigate the incidence and geographical distribution of leptospirosis using the Geographic Information System (GIS) and to predict its incidence in Iran in 2021.  

    Methods

    This was a descriptive analytical study. Information on leptospirosis was obtained from the Center for Communicable Diseases Control during 2009-2015. In the next step, The ArcGIS 9.3 was used to prepare geographic maps of the disease incidence and frequency. Therefore, using the Raster Calculator tool, the disease prediction map was drawn.

    Results

    The results showed that the highest incidence of leptospirosis during 2009-2015 was observed in Gilan, Mazandaran, and Golestan provinces, respectively. The incidence of the disease had an increasing trend from 2013 to 2015. Based on the results of the modeling in Iran, the provinces of Gilan, Mazandaran, and Golestan, with 72.18%, 8.54%, and 4.95% of their area, respectively, have the largest areas at a high-risk for leptospirosis in the coming years.

    Conclusion

    The prevalence of leptospirosis is affected by geographical and climatic conditions of every region; thus, the incidence of the disease is higher in the provinces located at the Caspian coastal side and in some regions in Semnan province. Hence, if health authorities pay more attention to developing health plans to prevent the disease, the risk of disease in these areas will be reduced in the future.

    Keywords: Incidence, Leptospirosis, GIS, Iran
  • Ghobad Moradi, Seyed Mohsen Zahraei, Zaher Khazaei, Parvin Mohammadi, Sirous Hemmatpour, Katayoun Hajibagheri, Fatemeh Azimian, Hasan Naemi, Elham Goodarzi* Pages 836-841
    Background

    Meningitis is classified as a medical emergency where the identification and early treatment of bacterial meningitis can eliminate serious consequences, such as hearing loss, memory problems, learning disabilities, brain damage, seizures, and death. The purpose of this study was to investigate the incidence and geographical distribution of meningitis using Geographic Information system (GIS) and to predict its incidence in Iran in 2021.

    Methods

    This was a descriptive analytical study. Information on pertussis was obtained from the Center for Communicable Diseases Control during 2010-2015. In the next step, ArcGIS 9.3 was used to prepare geographic maps of the disease incidence and frequency. Then, the disease prediction map was drawn using the Raster Calculator tool.

    Results

    The results showed that the highest incidence of meningitis during 2010-2015 was in Qazvin, Qom, and Kurdistan provinces. The incidence of meningitis in Iran increased from 9.77 in 2010 to 10.33 in 2015. Based on the modeling results for Iran, Qom, Qazvin, Kurdistan, Hamadan, and Mazandaran provinces with 78.89%, 74.68%, 70.07%, 43.97%, and 22.93% of their areas (Km2) are at high risk for meningitis in the coming years, respectively.

    Conclusion

    According to the results of this study, it can be concluded that Qom, Qazvin, Kurdistan, Hamedan, and Mazandaran provinces are at risk of the disease. Monitoring vaccination in high-risk groups can partially prevent the incidence of the disease in these areas.

    Keywords: Incidence Rate, Meningitis, GIS, Iran
  • Ali Asilian, Hoda Safaei, Fariba Iraji*, Farahnaz Fatemi Naeini, Gita Faghihi, Fatemeh Mokhtari Pages 842-847
    Background

    Bullous pemphigoid (BP) is a widely recognized autoimmune blistering disease (AIBD) linked with a high incidence of morbidity and mortality. The aim of this study was to evaluate the available findings of randomized clinical trial studies to update interventions for Bullous pemphigoid.

    Methods

    This article provides an updated overview of interventions for BP. A literature search was performed using Cochrane Central Register of Clinical Trials, MEDLINE, Scopus, and Web of Science from August 2010 to December 2020. All randomized clinical trials (RCTs) were done on adults and investigated the effectiveness of administered topical or systemic medications versus placebos or controls included in the current systematic review. Three RCTs comprising 363 patients were included in the systematic review. One of the eligible studies was placebo-controlled. All of the included studies used various interventions including, methylprednisolone plus azathioprine versus methylprednisolone plus dapsone, doxycycline versus prednisolone, and intravenous immunoglobulin (IVIG).

    Results

    Following their potentials in disease control, no difference was observed between dapsone and azathioprine; although, dapsone had a higher corticosteroid-sparing potential. The evaluation of the effect of doxycycline in short-term blister control in comparison to corticosteroids showed that the medication was not inferior to prednisolone, although it had a higher long-term safety.

    Conclusion

    Therapeutic outcome of IVIG for steroid-resistant patients was satisfactory. Moreover, the effectiveness and reliability of various immunosuppressive drugs and tetracyclines are investigated by blinded RCTs for the treatment of BP.

    Keywords: Bullous pemphigoid, Intervention, Treatment, Randomized controlled trials
  • Alireza Amanollahi, Sahar Sotoodeh Ghorbani, Hamed Basir Ghafouri, Sima Afrashteh, Seyed Saeed Hashemi Nazari* Pages 848-858
    Background

    The unknowingness of COVID-19 compared to other respiratory diseases and gaining an overview of its diagnostic criteria led to this study, which was designed to summarize the signs and symptoms along with the clinical tests that described these patients.

    Methods

    PubMedMEDLINE, Web of Science, Core Collection, Scopus, and Google Scholar were systematically searched on September 27, 2020. After screening, we selected 56 articles based on clinical characteristics and laboratory and imaging findings in confirmed COVID-19 patients as eligibility criteria. To evaluate risk of bias, the Newcastle Ottawa scale, for publication bias, Egger’s test, and for heterogeneity, I2 and tau test were used; and finally, random-effects models were used for pooled estimation.

    Results

    Pooled estimates for frequently clinical symptoms were as follows: fever (78% [95% CI, 74-82]), cough (60% [95% CI, 57-63]), and fatigue (31% [95% CI, 26-36]); and they were as follows for laboratory findings in lymphocyte (1.02 [95% CI, 0.92-1.12]), CRP (19.64 [95% CI, 13.96- 25.32]), and platelet count (175.2 [95% CI, 165.2-185.2]); they were as follows for imaging findings in bilateral pneumonia (64% [95% CI, 56-72]), and ground glass opacity (60% [95% CI,  48-7]). Also, in the subgroup analysis, bilateral pneumonia with 18% and fatigue with 15%, had the highest difference in values between the groups.

    Conclusion

    According to Forest plots, the CI and dispersion among studies were smaller in laboratory findings than in symptom and imaging findings, which might indicate a high alignment in the laboratory findings among studies.

    Keywords: COVID-19, Clinical Signs, Imaging, Laboratory Findings, Meta-Analysis
  • Oralbek Z. Ilderbayev*, Gulmira M. Zharmakhanova, Assem K. Okassova, Akmaral Zh. Nursafina, Gulzhan O. Ilderbayeva Pages 859-864
    Background

    Under physiological conditions, the activity of the formation of active oxygen is low. The activity of these processes is intensified under stress-induced situations. This study aimed to investigate the role of free-radical oxidation (FRO) in adrenal tissues and immunocompetent organs and cells in mature white rats after 6 hours of immobilization stress.

    Methods

    The studies were performed on 40 White male rats of the Wistar line with a bodyweight of 200 to 240 g. Two series of experiments were conducted: I series: determination of indices in intact rats (10 rats); II series: determination of indices after a 6-hour immobilization stress action on them. Animals of II series were divided into 3 groups of 10 rats in each: group 1: those undergoing acute immobilization stress, withdrawal from the experiment in 1 hour; group 2: those undergoing acute immobilization stress, withdrawal from the experiment in 25 hours; and group 3: those undergoing acute immobilization stress, withdrawal from the experiment in 49 hours. The obtained data were processed by statistical methods with the help of the "Biostat" and "Excel" software packages. 

    Results

    In groups 1, 2, and 3, the animals were simulated acute immobilization stress by fixing the animals for 6 hours in bright light. The results of the conducted studies indicate changes in lipid peroxidation and antioxidant system (LPO-AOS) in case of immobilization stress-excitation. In developing free-radical pathology at immobilization stress-excitation, the more expressed disturbance of LPO-AOS, and accordingly the intensity of lipoperoxidation in the structural membrane of all investigated organs was high at the initial stage of exposure.

    Conclusion

    At 49 hours after immobilization, stress less pronounced influence on the lipoperoxidation process was noted. The increase in the intensity of excessive lipoperoxidation testifies to the inhibited manifestation of AOS in the organism.

    Keywords: Immobilization Stress, Antioxidation, Free Radicals, Lipid Peroxidation
  • Saeed Kalantari, Afsaneh Sadeghzadeh-Bazargan, Saedeh Ebrahimi, Zeynab Yassin, Seyed HamidReza Faiz, Ali Kabir, Amir Baghestani, Farzaneh Mashayekhi, Farah Bokharaei Salim, Azadeh Goodarzi* Pages 865-869
    Background

    The COVID-19 infection is a novel virus that mainly targets the respiratory system via specific receptors without any coronavirus-targeted therapies. Many efforts have been made to prepare specific vaccines for COVID-19 or use of prefabricated vaccines of other similar viruses, especially severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), and influenza (flu). We aimed to evaluate the effects of previous flu vaccine injection on severity of incoming COVID-19 infection.

    Methods

    We conducted a large cross-sectional study of 529 hospitalized Iranian COVID patients to evaluate the severity of disease courses in patients with or without previous flu vaccination history using some main factors like length of hospitalization, need for the intensive care unit (ICU) admission and length of stay in the ICU for comparison between COVID-19 infected patients with or without flu vaccination history. For the quantitative data, we used independent-samples t and Mann-Whitney tests. The qualitative data were calculated using the Fisher exact and chi-square tests in IBM SPSS Statistics version 22 (SPSS Inc) and P value <0.05 was considered statistically significant.

    Results

    There were no significant differences in the demographic data of patients, disease, and severity-related parameters between the 2 groups. It means that there were not any significant differences between patients with and without history of flu vaccination regarding mean days of hospitalization, percentage of needing to be admitted to the ICU, days being admitted to the ICU (8.44±6.36 vs 7.94±8.57; 17% vs 11.5%; and 1.17±3.09 vs 0.92±3.04, retrospectively) (p=0.883, 0.235, and 0.809, respectively).
    In the laboratory tests, in comparison between patients with and without history of previous flu vaccination, only lymphocytes count in the vaccine positive group was higher than the vaccine negative group (20.82±11.23 vs 18.04±9.71) (p=0.067) and creatine phosphokinase (CPK) levels were higher in the vaccine negative group (146.57±109.72 vs 214.15±332.06) (p=0.006).

    Conclusion

    We did not find any association between flu vaccination and decrease in disease severity in our patients.  It seems that patients with previous history of flu vaccination may experience less laboratory abnormalities in some parameters that could be interpreted in favor of lower overall inflammation; however, this study cannot answer this definitely because of its design. As we collected retrospective data from only alive discharged patients and had no healthy control group, we could not discuss the probable effect of the vaccine on the mortality rate or its probable protective role against the infection. We need more well-designed controlled studies with different populations in different geographic areas to address the controversies.

    Keywords: Corona, COVID-19, SARS-CoV-2, Influenza Vaccine, Flu, Vaccine, Vaccination, Severity, Outcome
  • Taghi Riahi, Afsaneh Sadeghzadeh Bazargan*, Sima Shokri, Davoud Ahmadvand, Babak Hassanlouei, Amir Baghestani, Ali Khazaeian, Forough Seifi Gharabaghloo, Morteza Hassanzadeh, Azadeh Goodarzi Pages 870-874
    Background

    The COVID-19 infection is a novel virus without any specific targeted therapies; thus, focusing on primary epidemiologic concerns, preventive strategies, risk factors, exacerbation factors, and mortality-related factors are of great importance to better control this disorder. There are some controversies about the factors associated with COVID-19 in different theories, and addiction is no exception.

    Methods

    We conducted a large cross-sectional study of 513 hospitalized Iranian patients with COVID-19 infection to evaluate the severity of disease courses in patients with or without history of opium addiction. We recorded these data retrospectively after patients’ discharge from the hospital. For the quantitative data, we used independent-samples t and Mann-Whitney tests. The qualitative data were calculated using Fisher exact and chi-square tests in IBM SPSS Statistics Version 22. Also, p<0.05 was considered statistically significant.

    Results

    There was no significant difference regarding mean days of hospitalization in opium positive and negative groups (7.95±8.39 vs 8.35±5.11, respectively) (p=0.771); however, the need for intensive care unit (ICU) admission was significantly higher in the opium positive group (36% vs 11%) (p=0.005). The mean days of ICU stay was significantly higher in the opium positive group (2.36±3.81 vs 0.86±2.90) (p=0.026). The percentage of febrile patients, anosmia/hyposmia, and dysgeusia at the initiation of hospitalization was significantly lower in the opium positive group (39% vs 66%; 8% vs 23%; 8% vs; 20%, respectively) (p=0.002, 0.018, and .031, respectively). In the laboratory tests, only the white blood cell (WBC) count and the segmented cells were higher in the opium positive group (10.1±6.60 vs 7.38±4.14 and 73±20.47 vs 56.5±32.60, respectively) (p=0.018 and .001, respectively) and lymphocytes were lower in the opium positive (15.60±8.25 vs18.70±10.12) (p=0.048). Opium addicts had a significantly lower rate of azithromycin and lopinavir/ritonavir prescription in their initiation therapy (19% vs 34%, and 47% vs 70%, respectively) (p=0.038 and 0.012, respectively).

    Conclusion

    Opium addict patients with COVID infection may be more febrile and experience more disease-specific symptoms and more severe disease course. These patients may show more evidence of laboratory inflammation and probable superinfections, so may manage with more caution and somehow different therapeutic regimen.

    Keywords: Corona, COVID-19, SARS-CoV-2, Opium, Substance, Addiction, Drug Abuse, Severity, Outcome
  • Habibollah Azarbakhsh, Kimia Jokari, Leila Moftakhar, Mousa Ghelichi Ghojogh, Azimeh Karimyan, Shokrollah Salmanzadeh, Mehrdad Parian Zeitooni, Rozhan Khezri, Aliasghar Valipour* Pages 875-879
    Background

    COVID-19 spread rapidly throughout the world and affected many people. The purpose of this study was to investigate the epidemiological characteristics of patients with COVID-19 in southwest of Iran from February 19 to June 20, 2020.

    Methods

    In this retrospective study, the epidemiological characteristics of 7313 patients with COVID-19 in southwest of Iran were analyzed and reported from February 19, 2020, to the end of Jun ,2020. Data were extracted from electronic records in hospitals. Sex ratio and mortality rate of the disease were calculated.  A multiple logistic regression analysis was used to evaluate the factors affecting mortality.

    Results

    From all patients studied, 3920 (53.5%) were men and 2066 (28.24%) were in the age 30 to 40 years age group. The case fatality rate of the disease based on the total number of patients (hospitalized and nonhospitalized) was 4.84%. The highest mortality rate was seen in patients with various cancers and in those aged over 80 years. The most common symptoms in patients were fever and cough, diabetes, hypertension, and cardiovascular diseases. Logistic regression results also showed that the chances of death in the 70-60 and 80-70 years age group were 5.94 (OR, 5.94; 95% CI, 2.14-16.43) and 8.63 (OR, 8.63, 95% CI, 3.09-24.14) compared to 10-20 years age group.

    Conclusion

    These results indicate the need to increase primary care, provide the necessary equipment to treat patients, and more importantly, early identification of patients and treatment for them.

    Keywords: COVID-19, Coronavirus, Eepidemiology, Iran
  • Navindi Fernandopulle* Pages 880-883

    Hierarchical leadership is an antiquated practice seen commonly in health care, whereby strictly defined roles and their importance are overemphasized. This can have unintended negative consequences in a pressurised environment. In contrast, flat hierarchies are gaining popularity, as they afford the flexibility and equality that is vital in a caring environment, where no one should be afraid to raise concerns and voice their opinions.
    Are hierarchical power structures inhibiting hospitals from achieving effective medical leadership and quality care? With increasing pressures on the health care system, is it time to move away from a hierarchical power structure that has been present for over 70 years? To inspire culture change, is it time to explore alternatives, such as a flat hierarchy?

    Keywords: Hierarchial Leadership, Leadership In Healthcare, Patient Safety, Reverse Ward Rounds
  • Humaira Ansari* Pages 884-888
    Background

    Non-fatal birth defects and developmental disabilities are the most important causes of congenital disabilities in young children. This study was performed to determine the prevalence of congenital disabilities among children aged 0-2 years resident in urban slums of Pune. 

    Methods

    In 2016, using a random sampling method, 840 children from 28 registered slums located in each of the 14 wards of Pune city, India, were included in the study.  Data on congenital disabilities and the clinical diagnosis responsible for the disability were collected. Data were also collected on selected risk factors for these conditions and current treatment through a structured questionnaire.   Descriptive analysis was used to describe relationships among variables. Pearson’s chi-square test was used to determine associations, and the level of significance was established at P<0.05.  Associations between outcomes of interest and risk factors were expressed as Odds Ratios (OR) at 95% Confidence Interval (CI).

    Results

    In this age group, the prevalence of congenital disability was 1.67% (95% CI 0.91-2.78) (14/840). The prevalence of clinically diagnosed birth defects was 1.19% (95% CI 0.57-2.18) (10/840). The prevalence of developmental disabilities was 0.48% (95% CI 0.13-1.21) (4/840). Children with birth defects were more likely to be premature (P=0.045, OR=4.34, 95% CI=1.03-18.28) and low birth weight (P=0.003, OR=10.41, 95% CI=2.21-48.38). Only seven out of 14 children with birth defects and developmental disabilities were taken for treatment after the initial diagnosis.

    Conclusion

    Birth defects and developmental disabilities are prevalent conditions. Community awareness, provision of appropriate medical and habilitation care, as well as screening and early intervention for these conditions are essential to prevent morbidities and ameliorate disabilities.

    Keywords: Congenital, Disability, Birth Defects, Developmental Disabilities, Prevalence, Child Health, Congenital Abnormalities
  • Kamilla B. Srailova*, Bekmurat N. Raimkulov, Erkyn S. Nurguzhaev, Bakhtiyor G. Gafurov, Gulsym B. Taukebayeva Pages 889-898
    Background

    Studies of treatment methods for patients with acute ischaemic stroke should include aetiological causes, concomitant pathology, and localisation of the lesion, and the extent of the lesion in the brain. The purpose of the study was to determine changes in clinical and neurological parameters in patients with ischaemic stroke in the acute period.

    Methods

    This is an open clinical study for which 240 patients were selected with an acute condition after an ischaemic stroke. All patients were divided into 4 groups (depending on the treatment). Clinical neurological examination and testing was performed upon admission to the hospital and upon discharge– after treatment. Electroencephalographic biofeedback (EEG-BFB) therapy was performed using a EEG-BSE device (Bio-Link). Data was processed according to the statistical method of experimental data assessment.

    Results

    To study the effectiveness of treatment upon acute ischaemic stroke, a comprehensive treatment system was developed, involving acupuncture, Qigong breathing exercises, and electroencephalographic biological feedback (EEG-BIOFEEDBACK), based mainly on the mechanisms of action. The study investigated the features of the acupuncture treatment in patients with ischaemic stroke during recovery. The authors noted the degree of effectiveness of EEG-BFB therapy, Qigong therapy, acupuncture, and standard treatment. Studies revealed that the development of ischaemic stroke begins gradually and at an early age.

    Conclusion

    It was concluded that the most effective method for treating the clinical and neurological manifestations of acute ischaemic stroke is EEG-BFB therapy, followed by acupuncture, Qigong therapy, and standard treatment.

    Keywords: Treatment, Rehabilitation Programme, Subarachnoid Haemorrhages, Illness, Neurorehabilitation
  • Leili Jamil, Ahmad Ashouri, Somayeh Zamirinejad*, Behzad Mahaki Pages 899-905
    Background

    Procrastination is a common and widespread phenomenon that affects 15-20% of the general population and 50% of students. Since developing and providing beneficial and effective interventions for procrastination needs a strong, comprehensive theoretical background explanation, the aim of the study was to assess the underlying transdiagnostic factors of procrastination and presenting a causal model.

    Methods

    In this cross-sectional study, 390 college students were asked to fill out a packet of self-report measures, which included the Pure procrastination scale, Difficulties in emotion regulation scale, Depression-anxiety-stress scales, Frost multidimensional perfectionism scale, Rumination response scale, Penn state worry questionnaire, Acceptance and action questionnaire. The causal model was tested using structural equation modeling (SEM).

    Results

    Results of the SEM indicate that perfectionism was significantly associated with increasing emotion dysregulation (β=0.446, P<0.001) and emotion dysregulation was significantly associated with increasing anxiety (β=0.499, P<0.001) and depression (β=0.478, P<0.001), and then anxiety and depression with other variables, such as worry (β=0.245, P<0.001; β=0.004, P=0.935), rumination (β=0.046, P=0.424; β=0.418, P<0.001) and experiential avoidance (β=0.277, P<0.001; β=0.319, P<0.001) related to procrastination. Finally, worry has the most significant increasing effect on procrastination. The very small root mean square error of approximation (RMSEA=0.038), together with large values of comparative fit index (CFI=0.985), relative fit index (RFI=0.917), and normed fit index (NFI=0.979) indicated that the model was well fit.

    Conclusion

    Perfectionism, emotion dysregulation, negative affects, worry, rumination, and experiential avoidance, known as transdiagnostic factors, had a causal relationship with procrastination, and reducing each transdiagnostic factor will improve procrastination. This study could be considered as a cornerstone for further studies on procrastination from a transdiagnostic approach.

    Keywords: Procrastination, Emotion Dysregulation, Transdiagnostic Factors, Structural Equation Modeling
  • Hosein Ebrahimipour, Salman Shojaei*, Ameneh Esfandyari, Salah Eddin Karimi, Ali Vafaee Najar, Habibollah Esmaily Pages 906-912
    Background

    Congenital hypothyroidism is a disease able to cause severe mental retardation and developmental delays. However, timely diagnosis and treatment of infants with this disease could prevent relevant complications. This study aims to investigate the effects of the implementation of the Six Sigma model on reducing the treatment initiation time in infants with congenital hypothyroidism in the population chosen from Samen Health Center in Mashhad.

    Methods

    In this quasi-experimental study, the referral process of infants for congenital hypothyroidism screening and treatment was evaluated for the time period starting from March 20, 2017, to March 19, 2018, using the standard five-phase quality strategy, description, measurement, analysis, improvement and control phase (DMAIC), based on Six Sigma. Data were collected using the sampling form of the national screening program for congenital hypothyroidism. To analyze the data, software including Expert Choice V11, Microsoft Excel 2013, and SPSS 18, were utilized. In addition, a p-value less than 0.05 was considered statistically significant.

    Results

    The number of infants who entered the intervention process was 4,574, of whom 51.3% (2346 infants) were boys. The mean time to start treatment before the implementation of the model was 21.72±7.72 days, which decreased to 17.41±6.47 days after the implementation of the model (p≤ 0.05). Besides, 81.8% of the patients received treatment during infancy before the intervention, which increased to 94.1% after it. After the implementation of the Six Sigma model, the Sigma level of treatment initiation improved from 2.41 to 3.06.

    Conclusion

    Six Sigma could be used as an intervention tool for improving indices of health intervention processes.

    Keywords: Congenital Hypothyroidism, Mental Retardation, Six Sigma, DMAIC, Sigma Level, Analytical Hierarchy Process
  • Merina Eskandari*, Fakhrolsadat Hosseini, Katayoon Razjouyan, Alireza Abadi Pages 913-918
    Background

    This study aimed to determine the level of communication skills in residents of Shahid Beheshti University of Medical Sciences in the final year of the main courses in accordance with the Calgary Cambridge Observation Guide for the purpose of improving their skills and improving the quality and correcting the existing problems.

    Methods

    In this cross-sectional study, 190 residents of 14 majors were evaluated using a checklist of patient and physician communication skills based on the Calgary Cambridge Guide that has been localized in Persian language and culture using the cross-cultural adaptation standard in 6 stages. Content validity was verified by the primary author. The skills within the 71-item checklist were examined via a 3-point Likert-type rating scale, with scores ranging from 1 to 3 (good to poor) and the data were analyzed using the SPSS 16 software.

    Results

    Of the190 residents, 161 were enrolled in the study. Of them 74 were internal and 87 surgical residents, and 89 were male and 72 were female. The mean score of the total communication skills in 14 major courses was 128.68±37.2264; it was 121.7±36.990 in the Department of Surgery, and 136.8±36.073 in the Department of Internal Medicine, with p=0.010, in female students 126.6 and in male student 130.3 with p=0.500.

    Conclusion

    The score of 71 communication skills points in the list was prepared using the Likert scale option 3. In the overall skills, the weak score is 71 to 118.33, the average score is 118.34 to 165.66, and the good score is 165.67 to 213. Based on the findings of the study and examining the educational curriculum, it can be stated that unlike in psychiatry with an average score of 168.83, which is at a good level, the other fields are not well-developed and overall the communication skills in the residents, with a mean score of 128.68, are moderately poor and therefore further education and training is needed in these fields for resident students.

    Keywords: Calgary Cambridge Guide, Physician-Patient Relations, Communication Skills
  • Leila Ghalichi, Morteza Naserbakht, Mehrdad Eftekhar Ardebili*, Leila Janani, Omid Pournik, Fatemeh Tavakoli, AliAkbar Haghdoost, Hamid Sharifi Pages 919-926
    Background

    The need for informed policymaking highlights the importance of data on human immunodeficiency virus (HIV) prevalence on key populations. In this systematic review and meta-analysis, we aimed to provide an overview of HIV prevalence in men who have sex with men (MSM) in Iran.

    Methods

    We searched literature published between January 2008 and December 2019 to identify studies reporting the prevalence of HIV infection or acquired immunodeficiency syndrome (AIDS) in a population of adult Iranian men with history of sexual contact with other men. We employed Metaprop command in Stata to pool proportions from different studies.

    Results

    Among the 16 studies retrieved, 2 were performed on MSM population directly, 7 among people who inject drugs, 4 among prisoners, 2 among the homeless, and 1 among methamphetamine users. HIV prevalence was 7% (95% CI, 5%-10%) based on the meta-analysis, although noticeable heterogeneity existed because of target population, study year, and study location, which imposed limitations to provide a robust summary measure for the prevalence of HIV.

    Conclusion

    There is a potential risk of observing a high prevalence of HIV in MSM that could hamper the results of various preventive strategies and their achievements in other subpopulations.

    Keywords: Human Immunodeficiency Virus, Acquired Immunodeficiency Syndrome, Sexual, Gender Minorities, Key Population
  • Kourosh Barati, Elham Esfandiari, Mojtaba Kamyab, Ismail Ebrahimi Takamjani*, Rasha Atlasi, Mohammad Parnianpour, Hamidreza Yazdi, Shabnam Shahali, Shahrbanoo Bidari Pages 927-935
    Background

    To identify and synthesize available published studies on the effect of local muscle vibration (LMV) on pain, stiffness, and function in individuals with knee OA. 

    Methods

    Five databases were searched to find relevant papers on April 29, 2020, including, PubMed, Scopus, EMBASE (Ovid), Science Citation Index, and COCHRANE Central Register for Controlled Trials (CENTRAL). Randomized controlled trials (RCTs) and nonrandomized-controlled-trials (non-RCTs), such as interrupted time series and prospective cohort studies were included. Two independent reviewers screened articles and assessed inclusion through predefined criteria. Participants’ characteristics, study design, intervention characteristics, outcomes, and main results were collected independently by 2 reviewers. The risk of bias assessment of included studies was conducted using Cochrane risk of bias tools for RCTs and non-RCTs.

    Results

    Six studies were included: 3 RCTs and 3 non-RCTs. The risk of bias in included studies was generally moderate to high. Improvement of pain, stiffness, and function following the application of LMV were reported in all studies.

    Conclusion

    This review revealed the promising effect of LMV on pain, stiffness, function, and knee range of motion (ROM) improvements for individuals with knee Osteoarthritis (OA) . However, further well-designed studies are required to have a convincing conclusion on the effect of LMV in individuals with knee OA.

    Keywords: Knee Osteoarthritis, Local Muscle Vibration, Pain
  • Morteza Khavanin Zadeh, Zahra Omrani, Roozbeh Cheraghli*, Mehdi Hashemaghaee Pages 936-939
    Background

    The survival of arteriovenous fistula (AVF) remains an important problem for hemodialysis patients, accounting for 20% of all hospitalizations related to AV access problems in western countries. We designed an observational prospective cohort study on 265 AVFs and evaluated their results after 4 months of fistula creation and its relation to laboratory tests as ESR and CRP levels.

    Methods

    Wrist or antecubital AVFs  were created for patients with End-Stage renal disease. All laboratory tests (ESR and CRP) were checked quantitatively. The patients were followed-upfor at least 4 months and failure or maturation of AVFs were recorded in a checklist.

    Results

    177 (66.8%) males and 88 (33.2%) females were included. The surgeon created 161(60.8%) wrist and 98 (37%) antecubital AVFs. The mean age of patients was 53.18±17.1, ranged from 8 to 91 years old. CRP and total protein had significant differences between the two groups of failure and mature accesses (0.029 and 0.045 respectively).

    Conclusion

      High CRP level is recognized as a reliable predictor for the survival of AVF.

    Keywords: ESR, CRP, Arteriovenous fistula (AVF), Failure
  • Nasibe Soltaninejad, Nahid Jalilevand, Mohammad Kamali*, Reyhane Mohamadi Pages 940-946
    Background

    Previous studies have shown that children with cochlear implants have difficulty in grammar acquisition. Vocabulary acquisition and grammar abilities are important during language development. The purpose of this study was to investigate the effect of grammar therapy on the lexical ability of cochlear implanted children.

    Methods

    Five children with cochlear implants and grammatical problems were treated using a grammar task designed for the current study. Before and after the treatment, repeated evaluations were performed using the Mean Length of Utterance (MLU) and Persian Developmental Sentence Scoring (PDSS) indices for grammar and NDW and NTW indices for vocabulary abilities; these show the number of different words and the number of total words respectively.

    Results

    Grammar intervention was successful in cochlear implanted children of the present study. In addition, treatment of grammatical problems increased the lexical ability of all children; NDW and NTW scores increased, which was confirmed by the effect size indices. In the follow-up phase, the cochlear implanted children were able to maintain the increase in NTW and NDW values.

    Conclusion

    Improving grammar skills in cochlear implanted children also increased their lexical ability. Therefore, grammar therapy helps to increase the vocabulary of children too.

    Keywords: Grammar, Lexical Ability, Children, Cochlear Implant, Language Therapy
  • Fateme Jafaraghaee, Abbas Ebadi, Shadi Dehghanzadeh, Neda Mehrdad* Pages 947-953
    Background

    Promotion of nurses’ professional commitment is one of the strategies for retaining nurses and preventing their turnover. The aim of this study was the development and psychometric testing of the Nurses’ Professional Commitment Inventory.

    Methods

    This mixed method study was performed in an item generation and a psychometric testing phase. In the first phase, a 34-item inventory was developed based on the results of a grounded theory and the existing literature. Search date was 2010 to May 2018. In the second phase, we recruited 272 clinical nurses and tested the psychometric properties of the inventory. Construct validity was tested via the exploratory factor analysis. Reliability testing was performed through test-retest stability and internal consistency testing. SPSS version 21.0 (SPPS Corp) was used for statistical analysis. Significance level was set at p<0.05.

    Results

    In the first phase, a 74-item pull was extracted. After reviewing, the primary version of the Nurses’ Professional Commitment Inventory (NPCI) with 34 items was developed. Eight items were deleted during psychometric testing. In factor analysis, the remaining 26 items were loaded on 3 factors, namely professional attachment, professional performance, and internalization of the profession. These factors explained 53.92% of the total variance of professional commitment. The Cronbach’s alpha and mean test-retest intraclass correlation coefficient  for NPCI were 0.92 and 0.88, respectively.

    Conclusion

    The Nurses’ Professional Commitment Inventory has acceptable validity and reliability. This inventory includes dimensions that indicate the formation of professional commitment. The items of the scale can reveal nurses’ strengths and weaknesses related to professional commitment.

    Keywords: Instrument development, Nurse, Professional commitment, Psychometric testing
  • Azadeh Lak, Ali Maher*, Alireza Zali, Siamak Badr, Ehsan Mostafavi, Hamid R Baradaran, Khatereh Hanani, Ara Toomanian, Davood Khalili Pages 954-961
    Background

    Analyzing and monitoring the spatial-temporal patterns of the new coronavirus disease (COVID-19) pandemic can assist local authorities and researchers in detecting disease outbreaks in the early stages. Because of different socioeconomic profiles in Tehranchr('39')s areas, we will provide a clear picture of the pandemic distribution in Tehranchr('39')s neighbourhoods during the first months of its spread from February to July 2020, employing a spatial-temporal analysis applying the geographical information system (GIS). Disease rates were estimated by location during the 5 months, and hot spots and cold spots were highlighted.

    Methods

    This study was performed using the COVID-19 incident cases and deaths recorded in the Medical Care Monitoring Centre from February 20, to July 20, 2020. The local Getis-Ord Gi* method was applied to identify the hotspots where the infectious disease distribution had significantly clustered spatially. A statistical analysis for incidence and mortality rates and hot spots was conducted using ArcGIS 10.7 software.

    Results

      The addresses of 43,000 Tehrani patients (15,514 confirmed COVID-19 cases and 27,486 diagnosed as probable cases) were changed in its Geo-codes in the GIS. The highest incidence rate from February to July 2020 was 48 per 10,000 and the highest 5-month incidence rate belonged to central and eastern neighbourhoods.  According to the Cumulative Population density of patients, the higher number is estimated by more than 2500 people in the area; however, the lower number is highlighted by about 500 people in the neighborhood. Also, the results from the local Getis-Ord Gi* method indicate that COVID-19 has formed a hotspot in the eastern, southeast, and central districts in Tehran since February. We also observed a death rate hot spot in eastern areas.

    Conclusion

    Because of the spread of COVID-19 disease throughout Tehranchr('39')s neighborhoods with different socioeconomic status, it seems essential to pay attention to health behaviors to prevent the next waves of the disease. The findings suggest that disease distribution has formed a hot spot in Tehranchr('39')s eastern and central regions.

    Keywords: Spatial-temporal analysis, COVID-19 outbreak, Hotspot cases, GIS, Tehran, Iran
  • MohammadReza Kouchakian, Morteza Koruji, Mohammad Najafi, Seyedeh Farzaneh Moniri, Alireza Asgari, Marjan Shariatpanahi, Seyed Akbar Moosavi, HamidReza Asgari* Pages 962-968
    Background

    A wide variety of cytokines are released from human amniotic membrane cells (hAMCs), which can increase the rate of differentiation of mesenchymal stem cells into the neurons. We studied the effect of Retinoic Acid (RA) on the differentiation rate of human Umbilical Cord Mesenchymal Stem Cells (hUMSCs) which were co-cultured with hAMCs. 

    Methods

    In this experimental study, both hUMSCs and hAMCs were isolated from postpartum human umbilical cords and placenta respectively. The expression of mesenchymal (CD73, CD90 and CD105), hematopoietic and endothelial (CD34 and CD45) markers in hUMSCs were confirmed by flow cytometry. The hUMSCs were cultured in four distinct groups: group 1) Control, group 2) Co-culture with hAMCs, group 3) RA treatment and group 4) Co-culture with hAMCs treated by RA. Twelve days after culturing, the expression of NSE, MAP2 and ChAT differentiation genes and their related proteins were examined by real-time PCR and immunocytochemistry respectively. 

    Results

    The flow-cytometry analysis indicated increased expression of mesenchymal markers and a low expression of both hematopoietic and endothelial markers (CD73:98.24%, CD90: 97.32%, CD105: 90.75%, CD34: 2.96%, and CD45:1.74%). Moreover, the expression of both NSE and MAP2 markers was increased significantly in all studied groups in comparison to the control group  On the other hand, the expression of ChAT had a significant increase in the group 2 and 4 (RA and RA+ co-culture).

    Conclusion

    RA can be used as an effective inducer to differentiate hUMSCs into cholinergic-like cells, and hAMCs could increase the number of differentiated cells as an effective factor.

    Keywords: Amniotic Membrane, Cell Differentiation, Mesenchymal Stem Cell, Neurons, Retinoic acid
  • Mitra Moodi, Hamid Salehiniya, Fatemeh Baghernezhad Hesary*, Mohammadreza Miri Pages 969-975
    Background

    The COVID-19 epidemic is a newly emerging infectious disease. This study was conducted to design an appropriate psychometric questionnaire of cultural and social characteristics to evaluate beliefs and preventive behaviors toward COVID-19 among the Iranianchr('39')s population according to change behavior theory as   health belief model (HBM). 

    Methods

    The study population included all those who had access to social networks and answered the questionnaire voluntarily. The sample size in this study was 350 people. In this cross-sectional study, a questionnaire was designed using scientific sources and based on the health belief model, and its face and content validity was determined by Content Validity Ratio (CVR), and reliability was determined by the internal consistency; Test-retest was applied to examine the internal consistency of the questionnaire. Data were analyzed using SPSS software version 19. Cronbach’s alpha and Intra-class Correlation Coefficient (ICC) were used for the assessment of the reliability of data.

    Results

    Initially, the questionnaire was designed based on the literature reviews and expert’s opinion in the field of health education with 79 items. After that, 2 of them were deleted and corrected qualitatively by performing the face and content validity of some items. Therefore, finally, a questionnaire with 77 questions was approved. Based on the constructs of the health belief model, the domains of the questionnaire included perceived sensitivity , severity , benefits barrier , self-efficacy, knowledge and behavior .The content validity of the questionnaire was confirmed. The Cronbach’s alpha and ICC for each domain were greater than 0.7.

    Conclusion

    The Questionnaire of beliefs and preventive behaviors toward COVID-19 based on HBM is a valid and reliable instrument in the Iranian population that could be used in related research.

    Keywords: COVID-19, Preventive behaviors, Health belief model, Validity
  • Mahta Alsadat Aarabi, Kianoush Abdi*, MohammadSaeed Khanjani Pages 976-986
    Background

    COVID-19 has become a global pandemic and has inevitably affected the whole world. This effect is greater on people with ASD (ASD) and their families. Depression, attempts to cope with change, and having difficulty interacting with others are some of the challenges people with ASD often face. The aim of this study was to review the psycho-social consequences of COVID-19 in people with ASD and their families.

    Methods

    This study is a Literature Review. Extensive electronic search results for the keywords ASD, COVID-19, Coronavirus, psychological, psychosocial, and consequence in Google Scholar, PubMed, Scopus, ProQuest, Science Direct, SID and Magiran in 2020, eventually provided a total of 130 articles. After reviewing the titles of the articles, we excluded 85 articles as they were duplicated and/or irrelevant. Finally, based on the inclusion and exclusion criteria, 17 articles remained.

    Results

    In general, the change in routine and uncertainty caused by COVID-19 have caused distress for people with ASD and will worsen their symptoms and mental health. Excessive stress worsens the mental health of caregivers, and as this burden increases, they report higher rates of social harm, depression, and anxiety that affect their daily functioning.

    Conclusion

    The COVID-19 epidemic affects all strata of society. People with ASD are particularly vulnerable to the psychosocial effects of this epidemic. COVID-19 increases anxiety, distress, depression, financial problems, loss of a job, and even marital conflict. Access to necessary services and transmission problems are also the result of rapid social and environmental changes.

    Keywords: Autism Spectrum Disorder, COVID-19, Coronavirus, Psychological, Psychosocial, Consequence
  • Seyyedeh Sara Azimi, Sama Ashraf Samavat, Vahid Rezaei Tabar, Hamid Soori* Pages 987-993
    Background

    Evidence-based policymaking for the genetic preventive interventions at the community level requires information on the effectiveness of interventions in the operational areas taking into account the characteristics of health system and customer behaviour. These information are limited in many low- and middle-income countries. In this study, we estimated the effectiveness of preventive interventions for chromosomal disorders using the conceptual framework of Iran’s community genetics program (ICGP) using a Bayesian Network as a modeling method in limited access situation to the complete and accurate observational data.

    Methods

    Expert elicitation method based on global and national scientific evidences was applied to determine the structure of the Bayesian Network (BN) and to quantify the probability of nodes. The nomological and face validity of the network was checked. Also, a sensitivity analysis against the sources of uncertainty of probabilities was conducted.

    Results

    By ICGP interventions, 63% (95% CI, 0.55-0.71) of all chromosomal disorders can be prevented, which is responsible for 80% (95% CI, 0.76-0.84) and 38% (95% CI, 0.31-0.45) reduction of expected baseline birth prevalence of trisomis and other autosomal disorders, respectively. Improving the access to and the uptake of screening service can also result in a 12% and 11% increase in effectiveness, respectively.

    Conclusion

    Effectiveness of ICGP’s intervention is between the same interventions’ effectiveness in Western Europe and the Eastern Mediterranean region. Opportunities for increasing the uptake of and the access to the interventions are strengthening the public genetic literacy and implantation of a system of laboratory sample transfer at the side of the utilization of telehealth for delivering the counseling services at remote areas.

    Keywords: Bayesian Network, Effectiveness, Preventive Intervention, Congenital Disorder, Chromosomal Disorders, Iran’s Community Genetics Program
  • Suriya Yessentayeva*, Valeriy Makarov, Zhanna Kalmatayeva, Zhanar Zhakenova, Dauranbek Arybzhanov Pages 994-1004
    Background

    Recent changes in understanding of the nature of cancer allow us, in some cases, to consider it a chronic process that requires constant or periodic treatment. The purpose of this study was to assess the efficacy of the methods for diagnosis and treatment of non-small cell lung cancer (NSCLC) in the Republic of Kazakhstan and present scientifically proven methods for the improvement of existing diagnostic algorithms and treatment programs.

    Methods

    This work was a retrospective study. A retrospective study using descriptive and analytical statistics was used as the main method. Reported data and medical records of the patients with NSCLC who were treated from 2015 to 2017 in 6 oncology clinics in the Republic of Kazakhstan were used as study materials. The methods used for histological studies and influence of the patientchr('39')s sex on the frequency of various histological forms of NSCLC were studied. Polymerase chain reaction (PCR) studies to determine the epidermal growth factor receptor (EGFR) gene status as well as surgical methods were also studied.

    Results

    A comparative analysis of the compliance of oncologists from various regions of the republic with molecular genetic testing as an essential component of the diagnosis of NSCLC showed that the coverage of patients with immunohistochemical (IHC) and PCR studies in this country is low, 50.9% and 21.2%, respectively. The study included data on 423 patients. At the same time, the majority of studies, 64.2% (IHC) and 100% (PCR), were performed in patients in Almaty and only 35.8% of IHC studies were performed in other 5 regions included in this study.

    Conclusion

    The morphological verification of malignant neoplasms in the lungs was based on histological studies. IHC and PCR coverage of the patients in the country was low. Most of the patients received pharmacotherapy. Surgical interventions were rarely performed. Also, the lack of IHC status data were a risk factor for the patients with NSCLC.

    Keywords: Chronic Process, Histological Type, Malignant Process, Gene, Drug Therapy
  • Keyvan Rahmani, Saeed Karimi*, Reza Rezayatmand, Ahmad Reza Raeisi Pages 1005-1013
    Background

    Despite this seemingly simple definition of value in different perspectives, the definition of value-based procurement for medical devices is still unclear. This study aimed to delineate the definition of value-based procurement for medical devices and its characteristics.

    Methods

    According to the systematic method for scoping review described by Arksey and O’Malley, we reviewed related literature through target databases (PUBMED, ProQuest, Web of Science, Scopus, and Science Direct) during 2004-2020. The publications that focused on the procurement of medical devices and address the issue of value in procurement were selected. The publications whose full-text was not available and were not in English were excluded. By using data charting tables, selected articles were reviewed and concepts and definitions were extracted

    Results

    According to the eligibility criteria and reference checking, 24 documents were selected. There are different definition and understanding for value-based procurement (VBP). Identified characteristics of VBP are information, actors Collaboration, patient experience, value analysis team, ability to evaluate alternatives, value proposition, competitive dialogue, and weighing evaluation criteria.

    Conclusion

    VBP is a framework that guides the review and decision-making to procure medical devices. In this framework, all dimensions of the value equation (outcome/related costs) must be considered and weighted. Health systems need to work on identified aspects.

    Keywords: Value, Value-Based Health Care, Value-Based Procurement, Medical Devices
  • Fatemeh Kia, Fraydoon Rahnamay Rood Poshti*, Farhad Ghafari, Seyed Ahmad Hashemi, Nader Tavakoli Pages 1014-1019
    Background

    The ultimate goal of development from the perspective of human capital development is to have a long, healthy, and creative life. This study aimed to identify the requirements for the effective human resource development in the health system.

    Methods

    This mixed method study was performed on 20 managers of Iran’s health sector in the qualitative part to reach data saturation in qualitative research. The standard questionnaire of the health system consisting of 15 questions was distributed and collected among 302 managers of the health sector (senior and intermediate managers) and faculty professors who were selected by the stratified random sampling method using the Morgan table. Finally, for data analysis in the quantitative part, confirmatory factor analysis and modeling with partial least squares were used.

    Results

    The results showed that 4 of the requirements affecting human resource development were financial requirements with 13 components, service requirements with 14 components, educational requirements with 14 components, and partnership requirements with 7 components.

    Conclusion

    According to the results, it is suggested that in order to develop effective human resources in the health system, it is necessary to pay attention to the 4 financial, service, educational, and partnership requirements.

    Keywords: Human Resource, Health System, Development
  • Arash Pour Mohammad, Mohammadreza Ghassemi* Pages 1020-1027

    Chickenpox is a highly communicable disease caused by Varicella Zoster Virus. Varicella rash commonly evolves into permanent depressed scars, documented in up to 18% of post varicella patients, leaving life-long cosmetic issues for patients. Although there is a lot of reviews on depressed scars, the viral etiology and the unique scar morphology of post varicella scar discriminate it from other depressed scars. Therefore it is required to assess the efficacy of scar removal modalities on these scars, specifically. Yet, despite the prevalence, there is no comprehensive review on chickenpox scars’ treatment, particularly. This review provides an overview and categorization of efficacy and adverse events of various methods used in the treatment of post varicella skin scars. A comprehensive literature search was performed on major databases, including all papers related to post varicella scar treatment until 2020.   The results were categorized into topical treatment with tretinoin, systemic medical treatments with topiramate and isotretinoin, non-invasive procedures including chemical peelings, micro-needling and laser, invasive procedures including dermal grafting and subcision-suction method, and combination therapies. According to literature, chemical peeling with trichloroacetic acid was the most frequently used method in the treatment of chickenpox scar, revealing moderate to excellent response in patients. However, there is insufficient evidence to accurately compare the efficacy of other modalities on these scars specifically.

    Keywords: Varicella-Zoster, Chickenpox, Scar treatment, Atrophic Scar
  • Rana Tabar Asad Laleh, Zohreh Sharifi*, AliAkbar Pourfathollah Pages 1028-1031
    Background

    The microRNA‐122 (miR‐122) is a liver‐specific microRNA that can be used as a potential molecular marker for predicting liver injury. There is a positive correlation between miR‐122 level in serum and hepatitis B virus (HBV) replication in patients infected with this virus. The present study was conducted to study the clinical importance and expression of miR-122 in asymptomatic and symptomatic patients with HBV infection in comparison to the healthy group.

    Methods

    This study was performed on 60 samples to examine the presence of HBsAg and total HBc antibody (IgM-IgG) using an enzyme-linked immunosorbent assay. HBV-DNA extraction and real time polymerase chain reaction (PCR) assay were performed on all samples via the Real ART HBV LC PCR kit on a LightCycler instrument. RNA was extracted from the serum of all participants. Next, miRNA expression was assessed using quantitative real time reverse-transcription PCR. Also, ALT levels were measured as a surrogate parameter for liver injury using Pars Azmoon Biochemical assay Kit on Hitachi autoanalyzer. The Levene , Kruskal Wallis, Mann-Whitney and Spearman’s correlation tests were used for assessing the differences between the studied groups.

    Results

      Based on the obtained results, miR-122 expression in patients with HBV without clinical symptoms was 1.6 times, while in patients with clinical symptoms was 2.7 times more than the control group (p=0.001). A significant increase was observed in the ALT enzyme of symptomatic patients (p=0.001). HBV DNA in the people with clinical symptoms was higher than 105 copies/mL and in the asymptomatic group was less than 103 copies/mL, suggesting a statistically significant increase in a group with clinical symptoms (p=0.001). Finally, it was found that the miR‐122 serum concentration correlated with HBV DNA and serum ALT (p=0.001).

    Conclusion

    Based on the obtained results, measuring the miR-122 levels can serve as a biomarker and an indicator of hepatitis B replication, especially in cases where ALT levels are unchanged; however, more research and more samples are needed.

    Keywords: MicroRNA, Hepatitis B, MiR-122, ALT
  • Marjan Mirsalehi*, Golrokh Malihi, Eshagh Bahrami, Zeinab Akbarnejad, Sayedali Ahmadi Pages 1032-1036
    Background

    Lamotrigine (LTG) is an antiepileptic drug used in the treatment of seizures, mood disorders, and cognitive problems. The cardiac effects of LTG, such as LTG toxicity and SUEDP, have been studied. This is an in vitro study examining the effect of LTG on isolated atria of guinea pigs.

    Methods

    The atria of 21 male Guinea pigs were isolated and stabilized in Krebs-solution and physiologic condition. The rhythm of contraction, contractile force, and heart rate were recorded. In 7 atria, LTG at the doses of 2, 4, 8, and 16 mg/mL were added and the contractile forces and heart rates were recorded and compared together. In the next step, in 14 atria, 8 were pretreated with LTG, and 6 without pretreatment were exposed to ouabain, and the times of the onset of effect, arrhythmia, and asystole were recorded. The statistical comparisons were made by using Student’s t test and repeated measure analysis of variance followed by the Bonferroni method.

    Results

    Lamotrigine (4, 8, and 16 mg/mL) significantly decreased the heart rate and contractile force of the isolated guinea pigs’ atria (P < .001). Pretreatment with LTG significantly increased the mean time of onset of the effect of ouabain, the onset of ouabain-induced arrhythmia, and time of ouabain-induced asystole (P < .001).

    Conclusion

    LTG reduces the heart rate and contractile force, and also inhibit ouabain induced-arrhythmia of the isolated atria of guinea pigs.

    Keywords: Lamotrigine, Arrhythmia, Sudden Unexpected Death in Epilepsy, Cardiac Effect, Cardiac Arrest
  • Soheila Aminimoghaddam, Setareh Nasiri, Aida Abrari, Maryam Yazdizadeh*, Romina Rashidishomali Pages 1037-1042

    SARS-CoV-2 is a newly identified virus that causes COVID 19, spreading very fast in the world. Uncontrolled diabetes in pregnancy can increase the risk of pregnancy outcomes. Pregnant women are at high risk of developing a viral infection, like SARS-COV and on the other hand, diabetes ketoacidosis (DKA) which is coupled with COVID-19, can increase maternal mortality. The patient was a 27-years-old female G3P1L1Ab1 with a history of a previous cesarean section. On 26 March 2020, a fetal ultrasound revealed intra-uterine fetal death (IUFD) and also diagnosis of DKA and COVID-19 in the patient that she was expired eventually due to the uncontrolled DKA. In this case report, a pregnant woman with a diagnosis of IUFD, DKA, and COVID-19 simultaneously is described. To the best of the authors of this paperchr('39')s knowledge, no previous work has been reported for the comorbidity of diabetes and COVID-19 in pregnancy, but it seems that the coincidence of the above-mentioned diseases can delay the recovery period and also can increases maternal and fetal mortality. When DKA and COVID-19 appear in the patient simultaneously, we cannot control DKA by the routine protocol treatments of DKA which were used formerly.

    Keywords: COVID-19, IUFD, Diabetes ketoacidosis, Pregnancy
  • Aida Cheraghi, Maedeh Barahman, Ramyar Hariri, Alireza Nikoofar*, Pedram Fadavi Pages 1043-1047
    Background

    Neoadjuvant chemoradiation is one of the main treatment approaches in esophageal cancer treatment, which can improve outcomes of a patient with esophageal cancer. In the current study, we aimed to compare the response rate and side effects of 2 distinctive neoadjuvant chemoradiation protocols.

    Methods

    The study was a randomized clinical trial that was performed on 70 patients with esophageal and gastroesophageal junction cancer in Iran. The study participants were randomly assigned to 1 of our treatment groups. The first group received capecitabine (625 mg/m2/TID) and oxaliplatin (50 mg/m2/weekly), while the second group was given a combination of carboplatin (AUC:2/weekly) and paclitaxel (75mg/m2/weekly). Both groups were given weekly 50.4-54 Gy dose of RT. Chi square and Fisher exact tests have been used for data analysis. All statistical tests were performed using SPSS software Version 22.0 and the significance level was set at 0.05.

    Results

    Complete pathological response was detected in 18(51.4%) of patients in group I and 8 (22.8%) in group II (p=0.013). We also observed higher thrombocytopenia in CarTax arm 19 (54.2%) in comparison to CapOX arm 8(22.8%), and the difference was statistically significant (p=0.007). No statistical difference was found regarding neutropenia, fatigue, anorexia, esophagitis, and diarrhea.   

    Conclusion

    The CapOxRT regime provides more favorable outcomes and also it is more tolerated by patients.

    Keywords: Neoadjuvant, Chemoradiotherapy, Esophagogastric, Cancer
  • Zahra Goudarzi, Shekoufeh Nikfar, Abbas Kebriaeezadeh, Reza Yousefi Zenouz, Akbar Abdollahi Asl*, Nader Tavakoli Pages 1048-1059
    Background

    Investing in the R&D sector of new medical technologies is associated with the risk of being rejected by paying organizations because of the lack of value-for-money. The purpose of this study is to investigate the different methods of evaluating the impacts of emerging medical technologies.

    Methods

    Using scoping review method, we analyzed studies that investigated methods for assessing the impacts of emerging medical technologies on development. To find these studies, the Cochran Library, ISI Web of Knowledge, Embase, Ebsco and Pubmed databases from 2000 to 2018 were searched. The methodological quality of the studies was assessed using the STROBE Checklist. Two reviewers independently selected the qualified studies. Charting and collating the data were used based on the method proposed by Arksey and Ochr('39')Malley.

    Results

    Overall, 38 studies met the inclusion criteria. Sixteen methods were identified and put in five distinct categories: forecasting, Pro-HTA, Early-HTA, priority setting, and HHS were found to measure the impact of emerging technologies. The quality of these studies was acceptable. Few studies were conducted on emerging pharmaceutical technologies, and they were mostly on emerging medical devices. The Early HTA methods were often used to measure the effects of pharmaceutical technologies and medical devices technologies. The Pro-HTA method used dynamic modeling to examine the impact of medical technologies on a broad range of dimensions, while the HTA and Early-HTA methods used cost-effectiveness techniques throughout the development process. The HHS method used a multivariate decision-making technique.

    Conclusion

    Different methods were used to investigate the impacts of emerging medical technologies. Chronologically Pro-HTA methods are new ways for investigating emerging medical technologies beyond clinical and economic impacts. Assessing the feasibility of implementing Pro-HTA in real environments deserves further research.

    Keywords: Early Stages of Technology Development, New Medical Technologies, Health Technology Assessment, Emerging Pharmaceuticals
  • Mehdi Jafari, Payam Mahmoudian*, Hossein Ebrahimipour, Reza Vafaee-Nezhad, Ali Vafaee Najar, Seyede Elahe Hosseini, Hajar Haghighi Pages 1060-1064
    Background

    The response time is considered as one of the most important criteria for the quality of given care to the injured. This research aimed to investigate the frequency and causes of prehospital emergency delays in the 115 emergency center, in city of Mashhad, in 2015.

    Methods

    In this cross-sectional study, 21,142 missions performed in 2015 were investigated, from among which 640 missions with delays in systematic sampling were recognized. For data analysis purposes, descriptive statistics (frequency, mean and SD) in Excel 2013 software was implemented.

    Results

    Nearly 60% of the injured were men, 23% women, and the gender of 17% was not recorded in their profiles. The mean age of the injured was 29.8+15.9 years and 30% of the injured were in the age group of 16 to 25. The mean response time was 9:01+2:46. The most prevalent causes related to missions out of the operational zone (29.3%) and the second cause has been related to traffic groups (24.2%).

    Conclusion

    Establishing new bases and completing the number of ambulances and human recourses, intervention in traffic causing factors, and training the public about emergency cases can be effective in reducing the number of missions and the pace and quality of services provided to the injured.

    Keywords: Response Time, Causes of Delay, Prehospital Emergency, Iran
  • Asma Torfi, Fatemeh Jahangirimehr, Hossein Bagheripour, Arash Bayat, Nader Saki* Pages 1065-1069
    Background

    Following the development of new hearing technologies, assessment of speech intelligibility in hearing-impaired children is of great interest.  The main purpose of this study was to compare speech intelligibility and auditory perception abilities in children with normal-hearing (NH) and children with hearing aid (HA) and cochlear implant (CI).

    Methods

    This analytic cross-sectional study consisted of 60 Persian-speaking children aged 5 to 7-years. Participants were classified into 3 groups of 20 people, including NH (mean age, 71.70±5.05 months), CI (mean age, 72.60±8.20 months), and HA (mean age, 71.45±10.56 months) children. The speech intelligibility rating (SIR) and categories of auditory performance (CAP) tests were conducted for all children to measure their speech intelligibility and auditory perception, respectively. A one-way analysis of variance (ANOVA) test was used to compare CAP and SIR scores among the 3 groups.

    Results

    The mean SIR score in the NH children was significantly higher than the HA (p=0.002) and CI (p=0.009) groups. However, these differences between the HA and CI children were not significant (p=0.885). We found a significant difference between the CAP scores in the 3 groups (p=0.038). Furthermore, the post hoc analysis results indicated that the mean CAP scores in NH children were significantly higher than the HA and CI participants. Based on the results, the speech intelligibility and auditory performance abilities in NH children were significantly greater than the hearing-impaired (CI and HA) children. However, these abilities between HA and CI users were not significantly different.

    Conclusion

    Based on the results, the early acoustical amplification on auditory and speech functions in children with hearing loss is of paramount importance.

    Keywords: Speech Intelligibility, Hearing Aids, Cochlear Implant, Auditory Performance
  • Babak Eshrati, HamidReza Baradaran, Ghobad Moradi, Hojat Dehghanbanadaki, Nima Azh, Marzieh Soheili, Nogol Moetamed Gorji, Yousef Moradi* Pages 1070-1082
    Background

    The evaluation of reinfection and the genetic structure of all human and virus genomes could help to develop programs and protocols for providing services and ultimately to prevent the disease by producing more effective vaccines. Therefore, the aim of this study was to investigate the presence and occurrence of COVID-19 reinfection through a narrative review study.

    Methods

    We searched the Medline (PubMed), Embase, Scopus, Web of Science, Cochrane library, Ovid, and CINHAL databases. Inclusion criteria included all studies whose main purpose was to provide information about the occurrence or presence of reinfection in patients with COVID-19. An independent samples t test was used to compare the continuous outcomes between the 2 groups.

    Results

    The mean duration of the first episode in the group with mild or moderate COVID-19 was 24.42±1.67 days, and it was 21.80±3.79 days in the group with severe COVID-19.  The mean duration of the second episode (reinfection) in patients with mild or moderate form was 15.38 ± 5.57 days, and it was 19.20±2.98 days in patients with severe form. In both episodes, the duration of the disease did not significantly differ between the 2 groups (p=0.484 in the first episode; p=0.675 in the second episode), but the interval to the occurrence of reinfection in patients with the mild or moderate form was significantly longer than those with the severe form (p<0.001). In this instance, the time interval in patients with the mild or moderate form was 36.63±5.71 days while in those with the severe form of the disease it was 29.70±5.65 days. Besides, the genomes of the viruses isolated from the first and second episode were different. 

    Conclusion

    According to the results, all patients should be very careful about the severity of the second episode because of the more need for medical interventions for saving the patients. The interval between the first end and the second episode as well as the duration of each episode is highly important for better management of the disease.

    Keywords: Reinfection, COVID-19, Narrative Review
  • Mahshid Mehdizadeh, Sayeh Parkhideh, Sina Salari, Elham Roshandel, MohammadHossein Kazemi, Hossein Bonakchi, Masoud Soleimani, Abbas Hajifathali* Pages 1083-1089
    Background

    Graft-versus-host disease (GVHD) is a serious complication associated with allogeneic hematopoietic stem cell transplantation (allo-HSCT). Thus, it is necessary to evaluate the risk factors of GVHD in allo-HSCT. Herein, we studied the effects of some risk factors on GVHD incidence in patients with allo-HSCT.

    Methods

    We retrospectively evaluated the GVHD incidences and risk factors in 199 patients diagnosed with hematological disorders who underwent allo-HSCT in Taleghani hospital, Tehran, Iran, between 2007 and 2017. The univariable and multivariable analyses of time to event data were performed using the Logistic regression model. Computations were performed using SAS, and the level of statistical significance for univariable and multivariable analyses was set at 20% and 10%, respectively.

    Results

    Acute GVHD (aGVHD) was seen in 59 (29.6%) patients, and 18 (9%) patients developed chronic GVHD (cGVHD). The odds of GVHD incidence in male to female transplants was 3.49 times greater than the male-to-male transplantations (CI, 1.16, 11.5; p<0.001). The patients with body mass index (BMI) below 18.5 had 96% lower odds of GVHD incidence compared with those with BMI above 30 (CI, 0.007-0.27; p=0.013). The odds of GVHD incidence in patients who were negative for cytomegalovirus (CMV) antigen was 76% lower than patients with positive CMV antigen (CI, 0.06-0.93; p=0.081).

    Conclusion

    In a nutshell, our results indicated that the donor-recipient gender disparity, the recipientchr('39')s BMI, and CMV infection/reactivation status might be pivotal risk factors, which should be taken into account for prevention and management of GVHD.

    Keywords: Hematopoietic Stem Cell Transplantation, Graft-Versus-Host Disease, Body Mass Index, Cytomegalovirus
  • Siamak Farokh Forghani, Reza Jahangiri, Farzaneh Ghasemi, Reza Shirani, Hosein Bagheri, Razieh Mahmoodi, Saeed Bagheri Faradonbeh* Pages 1090-1095
    Background

    Epidermolysis bullosa (EB) is prevalent in Iran and incurs direct and indirect costs on the health care system and the patient.Therefore, this study was conducted to estimate the economic burden of this disease in Iran.

    Methods

    This study includes all patients with EB disease who had been referred to the medical centers of Iran in 2019-2020 for treatment of their disease, especially Hazrat Fatimah Hospital and their medical records are available in Iran EB Patients Association (IEBPA). In estimating the economic burden of diseases and costing studies, we calculated the average direct and indirect costs for a patient and used it to estimate the costs of the patient population. In this study, a prevalence approach was used to calculate the economic burden of this disease. For this purpose, the existing cases of the disease in 2019-2020 were calculated. The data collected from the questionnaires that were completed through interviews with patients as well as the data extracted from the review of their files were entered into Excel software and analyzed.

    Results

    The total direct medical costs of direct non-medical and indirect are equal to 7.319.428.315 & 5.390.440.775 and 45.875.654.514 Rials respectively, and the total economic burden of the disease and the average of each patient is 58.585.514.604 and 155.890.789 respectively.

    Conclusion

    High indirect costs, especially informal care, represent the socio-economic burden of this disease and constitute more than half of the total indirect costs. Therefore, the obvious gap and hidden social costs of this disease are related to health policymakers, especially when they want to study the impact of this disease on different income classes of families.

    Keywords: Economic Burden, Epidermolysis Bullosa, EB, Iran
  • Mohammad Eghbali, Hamidreza Khankeh*, Seyed Ali Hosseini, Abbas Ebadi, Vafa Rahimi Movaghar Pages 1096-1103
    Background

    Traumatic brain injury is now regarded as the silent epidemic. This disease can cause some physical, cognitive, and psychological impairments that require proper and early rehabilitation interventions. Therefore, the aim of this study was to explore the factors affecting early rehabilitation care in patients with traumatic brain injury based on the experiences of the rehabilitation team.

    Methods

    This qualitative study was conducted as a conventional content analysis from September 2019 to August 2020. For this purpose and given the maximum diversity, 22 members of the rehabilitation team, patients, and their caregivers in trauma level 1 hospitals affiliated with Tehran University of Medical Sciences were selected based on a purposeful sampling method. The data were also collected using semi-structured interviews until data saturation is obtained. Graneheim and Lundmanchr('39')s content analysis method was performed to analyze the data.

    Results

    The data analysis results eventually led to the introduction of three main themes and eight categories. The main themes were associated with early rehabilitation barriers, which included cultural factors and rehabilitation infrastructures. Rehabilitation management was regarded as the main theme regarding the early rehabilitation facilitator.

    Conclusion

    Early rehabilitation is considered a vital rehabilitation stage for patients with traumatic brain injury. Hence, accurate identification of the influential factors on early rehabilitation can help the rehabilitation team promote early rehabilitation care among these patients; it can lead to the revival of the patientschr('39') abilities and the improvement of their quality of life.

    Keywords: Traumatic Brain Injury, Early Rehabilitation, Qualitative Research, Content Analysis
  • Maryam Mansoori, Alireza Mirzaei, Isa Abdi Rad, Rahim Mahmodlou, Fatemeh Mansouri, Leili Saeednejad Zanjani, Zeynab Asadi- Lari, Zahra Madjd Pages 1104-1112
    Background

    GD2 synthase (GD2S) is the key enzyme required for ganglioside GD2 synthesis. It is commonly expressed in normal tissues and various cancers. Ganglioside GD2 is identified as a breast cancer stem cells (BCSCs) marker that promotes tumorigenesis. As GD2S has been found to be a useful molecular marker in neuroblastoma and retinoblastoma tumors, we suggest that it can be considered as a suitable candidate for the detection of CSCs in breast cancer tissues.

    Methods

    Expression of GD2S was examined in 65 breast tumors compared to adjacent normal tissues, applying quantitative real-time PCR (qRT-PCR) and enzyme-linked immunosorbent assay (ELISA). The association between GD2S expression level and patients’ clinical characteristics was also assessed.

    Results

    Our findings showed that GD2S mRNA expression was significantly higher in breast cancer tissues in comparison to normal adjacent tissue samples (4.92-fold change, p<0.001) in advanced grades (p<0.001) and stages (p<0.001). It was also shown that GD2S protein expression was significantly higher in breast cancer tissues in comparison to normal adjacent tissues (4.86-fold change, p=0.010) in advanced grades (p=0.010), stages (p=0.005) and larger tumor size (p=0.002).

    Conclusion

    The current study showed that increased expression of GD2S in advanced breast cancer potentiates it as a promising tumor marker in these patients.

    Keywords: Breast cancer, Cancer Stem Cells, ELISA, GD2 Synthase, qRT-PCR
  • Bahareh Nazemi Salman, Shilan Sallah, Fatemeh Abdi, Sarvenaz Salahi, Kobra Rostamizadeh, Samira Basir Shabestari* Pages 1113-1119
    Background

    Tooth decay and periodontal disease are the most common chronic human and oral diseases, respectively, and bacterial plaque has a major role in their occurrence. Because of the importance of plaque control, this study was done to compare the antimicrobial effects of Nigella sativa nanoparticles and chlorhexidine emulsion on the most common dental cariogenicic bacteria.

    Methods

    In this experimental study, the effects of 0.2% chlorhexidine mouthwash and Nigella sativa nanoparticle with different dilutions on Streptococcus mutans, Streptococcus sobrinus, Streptococcus salivarius, Lactobacillus acidophilus, Minococcal fecalis, and Enterococcus fecalis were compared using minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) assessment. Data were analyzed by SPSS Version 16.0 software, and statistical tests, including an independent sample t test.

    Results

    Mean diameters of growth inhibition zone because of the nanoemulsion of Nigella sativa nanoparticle was close to each other in different bacteria (p=0.665). In addition, there was no significant difference between these values because of different dilutions of nanoemulsion even in different microbial species (p=0.778). The MIC and lethal concentrations of Nigella sativa nanoemulsion were similar for Enterococcus faecalis and Streptococcus mutans, and it was higher than other bacteria. In comparison, the MIC and MBC values of all bacteria in chlorhexidine were lower than those of the nanoemulsion.

    Conclusion

    MIC and MBC values showed that Nigella sativa nanoemulsion affects tooth cariogenicic bacteria. Enterococcus faecalis and Lactobacillus acidophilus were the most resistant and susceptible bacteria to this nanoparticle, respectively, while the antimicrobial effects of Nigella sativa nanoemulsion were weaker than the chlorhexidine mouthwash.

    Keywords: Nigella sativa, Nanoemulsion, Chlorhexidine, Dental Caries, Bacteria, Antimicrobial
  • Muzamil Latief*, Reyaz Ahmed Para, Obeid Shafi, Zhahid Hassan, Summyia Farooq, Farhat Abbas Pages 1120-1125
    Background

    Acute kidney injury (AKI) is frequent in hospitalized patients with critical illness and presents in up to one-quarter of patients with non-severe community-acquired pneumonia (CAP), resulting in increased short and long-term mortality. There is a paucity of literature from resource-limited settings regarding the incidence and risk factors for AKI in patients with CAP. In this study, we looked at the incidence and risk factors for AKI in patients hospitalized with CAP in a resource-limited setting

    Methods

    This prospective observational study conducted over 1 year period included patients ≥ 18 years of age diagnosed with CAP admitted to a tertiary care center. The differences in baseline characteristics between hospitalized CAP patients with and without AKI; and risk factors for AKI and the need for renal replacement therapy (RRT) were analyzed using Chi-square test, t-test, Mann-Whitney U test, and logistic regression with p-value <0.05 considered statistically significant.

    Results

    We observed 27.6 % (58/210) of patients had AKI in our study. Patients with AKI had significantly higher baseline comorbidities of chronic kidney disease (p=0.005) and coronary artery disease (p=0.032), and significantly higher uric acid (p=0.002), lower albumin  (p=0.005), lower total protein (p=0.015), higher bilirubin (p=0.001), higher LDH (p=0.041), and higher CURB-65 score (p<0.001) in addition to elevated creatinine, BUN (p<0.001) compared to the no-AKI group. The patient group requiring RRT had significantly more males (p=0.019), with significantly higher phosphorus (p=0.038), lower ALT (p=0.022), and expectedly higher creatinine (p<0.001) and blood urea nitrogen (p=0.016). The adjusted logistic regression analysis revealed that patients with higher CURB-65 scores were at increased odds of undergoing RRT (OR 8.74, 95% CI 5.27 to 12.21, p=0.039).

    Conclusion

    There is a high incidence of AKI in patients hospitalized for CAP in developing countries. Clinicians should be alert for the prevention and early detection of AKI in CAP patients.

    Keywords: Kidney Injury, Pneumonia, Dialysis, CURB-65
  • Meissam Sadeghisani*, Farideh Dehghan Manshadi, Khosro Khademi Kalantari, MohammadTaghi Karimi, Hadi Azimi, Afshin Aghazadeh Pages 1121-1129
    Background

    To our knowledge, no study has examined the kinematics of lumbopelvic-hip complex of individuals with chronic low back pain (CLBP) who had lumbar flexion+rotation (F+R) syndrome during sit to stand (SiToSt) and stand to sit (StToSi) activities. Thus, this study aimed to examine movement patterns of the lumbopelvic-hip complex in participants with CLBP classified into F+R syndrome subgroup.

    Methods

    This was a cross sectional study. A 3-dimensional motion capture system was used to record movements of the lumbar spine and hips during SiToSt and StToSi. Participants were 20 patients with LBP classified in lumbar F+R subgroup, based on the movement impairment system model, and 20 asymptomatic individuals. The study was approved by Shahid Beheshti University of Medical Sciences (IR, SBMU.RETECH, and REC.1395.365).

    Results

    Greater and significant lumbar flexion, with SiToSt, and lumbar extension, with StToSi, were observed in the patients. In addition, the patients exhibited a greater magnitude of lumbar rotation during SiToSt. No significant difference was observed between the 2 groups in hip motions.

    Conclusion

    The patients with lumbar F+R syndrome tend to move their lumbopelvic region to a greater extent in sagittal and horizontal planes during SiToSt and StToSi compared with participants without low back pain.

    Keywords: Low Back Pain, Lumbopelvic, Hip, Kinematics, Rotation
  • Azar Moezy* Pages 1122-1125
  • Mehdi Jafari, Shabnam Ghasemyani*, Rahim Khodayari-Zarnaq, Samira Raoofi Pages 1126-1135
    Background

    The Health Transformation Plan (HTP), the latest reform in Iranchr('39')s health system to achieve the 3 main goals of financial protection, equity, and quality of health care, was started on May 5, 2014. This study aimed to review all available literature regarding the achievements and outcomes of this reform after 6 years of its implementation.

    Methods

    The 5 English databases were examined by using appropriate keywords to find documents published on the HTP between June 5, 2014, and the end of April 2020. Out of 532 recovered articles, 137 were included in the study. The studychr('39')s organization was based on the Arkesy and Ochr('39')Malley framework and data analysis was done using the content analysis method. 

    Results

    The findings of the study were divided into 11 sections. Studies on the planchr('39')s impact on financial protection (22.6%), performance indicators (14.5%), and natural delivery promotion (14.5%) were the most frequent, respectively. Regarding the impact of the HTP on patient satisfaction ,performance indicators, and efficiency, mostly positive results have been obtained. However, in terms of the impact of the HTP on financial protection and informal payments, the outcomes have been different, contradictory, and sometimes negative.

    Conclusion

    Although the HTP has successfully achieved a number of its goals, in some of the goals, the results are not significant. Given the changing health conditions and funding constraints, it is better to consider measures to fundamentally review the HTP and executive packages.

    Keywords: Heath Transformation Plan, Health Reform, Health System, Iran
  • Niloofar Kaykhaei, Zahra Heidari Pages 1130-1135
    Background

    Thyroid dysfunction is accompanied with significant metabolic alterations that affect body weight, appetite, and energy expenditure, as well as lipid and carbohydrate metabolism. Leptin, an adipokine produced by adipocytes, regulates food intake and energy storage. Thyroid hormones and leptin share some physiological effects. Changes in leptin have been shown in patients with dysfunction of the thyroid; however, the results are contradictory. The aim of this study was to evaluate the circulating levels of leptin in patients with Graves disease (GD) and Hashimoto thyroiditis (HT) before and after normalization of thyroid function compared with the control group.

    Methods

    Newly diagnosed adult patients with GD, HT, and healthy euthyroid controls were recruited. Various clinical and biochemical parameters, including thyroid function tests and serum leptin level, were assessed before and after treatment and compared between groups.

    Results

    Data from 56 patients with HT, 54 patients with GD, and 54 healthy controls were analyzed. Serum leptin levels of patients with HT (30.96 ± 3.88 ng/mL) were found to be significantly higher than the controls (22.35 ± 4.72 ng/mL) (p<0.001), whereas patients with Graves had lower serum leptin levels (14 ± 4.54 ng/mL) (p<0.001). In patients with HT, serum leptin levels showed a significant decrease after treatment (31 vs 27 ng/mL; p<0.001), while in patients with GD, leptin increased significantly after treatment (14 vs 17 ng/mL; p<0.001).

    Conclusion

    The present study showed that serum leptin levels increased in patients with HT and decreased in those with GD than the control group. However, after treatment, leptin decreased in the Hashimoto group and increased in the Graves group, although it was still significantly different from the control group.

    Keywords: Graves Disease, Hashimoto Disease, Leptin
  • Hassan Motamed, Kambiz Masoumi, Meisam Moezzi*, Payam Ghoraian Pages 1136-1140
    Background

    Shoulder joint dislocation and displacement is a common clinical condition. The present research aims to compare the clinical efficacy of ketamine versus dexmedetomidine during shoulder joint reduction.

    Methods

    In this randomized clinical double-blind trial method, patients aged 18 to 65 years with shoulder dislocation referred to the Emergency Hospital of Imam Khomeini Hospital in Ahvaz, Iran, were enrolled. Patients were separated into two groups, patients in group A received 1mg/kg nebu-lized ketamine and patients in group B received 1 μg/kg nebulized dexmedetomidine. Pain score was recorded at 5 different time points: Zero (before intervention), 10 minutes, 20 minutes, 30 minutes, and 60 minutes after intervention., The pain score was evaluated using the visual analog scale (VAS) test. A linear regression test was carried out to compare the slopes. Also, ANOVA repeated measures test variables differences between groups. Then Tukeychr('39')s multiple comparisons as post-hock were applied to compare the pains at different time points. Using IBM SPSS version 19.0 software, all analyzes were accomplished.

    Results

    The pain score in both groups significantly decreased during different time points. The pain reduction slope in the group that received dexmedetomidine is meaningfully upper than that of ketamine (-0.08 vs. -0.06, p=0.012). The ketamine action onset time was 20 minutes after the in-tervention. In comparison, the effect of dexmedetomidine has an onset of 10 minutes after the in-tervention.

    Conclusion

    Overall, the results of current research demonstrated that although nebulized dexme-detomidine and nebulized ketamine produce a significant decrease in pain score, dexmedetomidine provides a faster effect. Therefore, nebulized dexmedetomidine seems to be used as an appropriate choice to induce sedation during shoulder joint reduction in emergency departments.

    Keywords: Dexmedetomidine, Ketamine, Nebulized, Shoulder Dislocation, Trial, Reduction
  • Vahid Sheikhi, Zahra Heidari Pages 1136-1141
    Background

    Prevalence and clinical significance of hyperprolactinemia in subclinical hypothyroidism have been reported in few studies. The upper limit of the normal range for TSH used to diagnose subclinical hypothyroidism is a matter of controversy. Some experts believe that the upper limit of the normal TSH range should be reduced from 4.2 to 2.5 mIU/L. Some evidence suggests a positive relationship between TSH > 2.5 mIU/L and cortisol as an indicator of metabolic stress. With this view prolactin as a stress hormone can be elevated in TSH >2.5 in comparison to TSH< 2.5. Hence the aim of this study was to evaluate the relationship between TSH and prolactin levels in the TSH range <10.

    Methods

    This cross-sectional study was performed on apparently healthy subjects with TSH<10 mIU/L. Subjects with the age of 18 to 35 years were enrolled. The sera were analyzed for prolactin, FT3, FT4, TSH, TPO-Ab and Tg-Ab.

    Results

    From the total number of 519 participants, in 65 subjects (12.5%) TSH was < 2.5. Seventy-nine subjects (15.2%) had TSH: 2.5-4.2 and 375 (72.3%) of the participants had TSH> 4.2 mIU/L. The mean age, weight and BMI of subjects in the three TSH groups were not significantly different. In the three TSH groups, the prevalence of hyperprolactinemia was zero, 3.8 and 30.7%, respectively. There was a positive and significant correlation between prolactin and TSH levels (r=0.613).

    Conclusion

    Hyperprolactinemia is common in patients with subclinical hypothyroidism (30.7%) and there is a positive correlation between TSH and PRL in subjects with TSH<10 mIU/l.

    Keywords: Thyrotropin, Prolactin, Hypothyroidism
  • Seyed Kamran Kamrava, Seyedeh Fahimeh Hosseini, Mohammad Farhadi, Maryam Jalessi, Atefeh Talebi, Elehe Amini, Rafieh Alizadeh* Pages 1141-1148
    Background

    Psychophysical tests are typically used for clinical assessment of human smelling function. Given that olfactory identification is linked to the regional culture, the main aim of this study was to provide the comprehensive “sniffin’ sticks” olfactory test, culturally adapted on the Iranian population as well as to examine the discriminatory power of this test between normal people and patients with olfactory disorder.

    Methods

    This cross-sectional study consisted of 3 steps. A total of 200 healthy people were recruited to determine odor familiarity (using Likert- scale) for the first step. In the second step, based on the original sniffin’ sticks test and odor familiarity, 16 odor items were selected. Odor modification was performed and the identification part of the sniffin’ sticks test was created. Then, 99 patients with olfactory disorders and 214 healthy participants were tested using the Iranian sniffin’ sticks test (Ir-SST). After 2 to 4 weeks, participants were reexamined and test reliability was evaluated by using a Pearson correlation coefficient test. 

    Results

    The Ir-SST showed that scores of patients with smell loss were significantly lower than normosmic participants (13.6 ± 5.24 vs 34.3 ± 3.41, P < 0.001). The sensitivity (95.2%) and specificity (93.5%) of the test were also found to be high. Test-retest reliability was as follows: composite score: r = 0.8; odor identification: r = 0.83; odor threshold: r = 0.77; and odor discrimination test: r = 0.56; P < 0.001.

    Conclusion

    The results suggest that the Ir-SST can be effectively adapted to the Iranian population. The current study validates that the sniffinchr('39') sticks olfactory test is applicable as a useful screening tool for comprehensive assessment of olfactory function in an Iranian population.

    Keywords: Olfaction, Sense of Smell, Smell Disorders, Cultural Adaptation, Sniffin’ Sticks Test
  • Shirin Saravani, Azra Karimkoshteh, Majid Samaei Rahni, Hamideh Kadeh Pages 1142-1147
    Background

    Diabetes mellitus is one of the major global health threats. Diabetes can cause adverse cytopathological changes in cells and predispose them to pathological lesions. The present study aimed to investigate the cytopathological changes of oral mucosal cells in type 1 and 2 diabetes patients and its relationship with blood sugar status.

    Methods

    This study descriptive-analytical was performed on 40 type-1 diabetes patients, 40 type-2 diabetic patients, and 20 non-diabetic individuals (control group) with simple sampling in Zahedan (2019). Their buccal mucosa was sampled by a cytobrush and the microscope slides were prepared with Papanicolaou staining. The nuclear and cytoplasmic area and cytoplasmic-nuclear ratio were calculated. Furthermore, the relationship of hemoglobin A1C and fasting blood sugar with these parameters were also examined. Data was analyzed with one-way-ANOVA, Kruskal-Wallis, Post Hoc Tukey, Mann-Whitney, Pearson correlation and Spearman correlation tests. In this regard, the statistical software SPSS (version 21) was used and a p-value <0.05 was considered statistically significant.

    Results

    Based on the findings, only the nuclear area was significantly larger in type 1 and type 2 diabetes patients, compared to the control group (p<0.001 and p=0.010), respectively. Moreover, the comparison of cytomorphometric changes between type 1 and type 2 diabetes patients did not show a significant difference. In addition, the hemoglobin A1C levels were merely associated with the cytoplasmic area in type 2 diabetes patients (p=0.011), while fasting blood sugar levels were not associated with any of the parameters in type 1 and type 2 diabetes patients (p>0.050).

    Conclusion

    Diabetes, as an independent factor, can cause cytomorphometric changes in the buccal mucosal cells of type 1 and type 2 diabetes patients. It seems that the type of diabetes does not affect these changes. hemoglobin A1C levels were correlated with cytoplasmic area in type 2 diabetes patients.

    Keywords: Diabetes mellitus, Cytology, Glycemic Index, Papanicolaou Test
  • AmirHoushang Behesht Nejad, Tohid Seif Barghi, Bahar Hassanmirzaei, Leila Ghanbari, Homa Naderifar Pages 1148-1152
    Background

    As a soccer referee or an assistant referee, having perfect visual skills is mandatory, which will help make quick and accurate decisions in the field of the play and during matches; however, this skill is not well studied among referrers. This study aimed to assess the visual skills of referees and assistant referees.

    Methods

    Men’s professional referees and assistant referees working for the Iran football federation were investigated in 2019. The visual skill investigation consists of the evaluation of static visual acuity, color vision, stereoacuity, intraocular pressure, confrontation test, and eye anatomical assessment with slit lamp. The statistical analysis was performed using the SPSS software Version 18.

    Results

    In this study, 159 men’s professional referees and assistant referees with a mean age of 35.52±5.39 were selected. The results of this study showed that 1.88% of the referees and assistant referees had color blindness dyschromatopsia) and 3.14% of them needed more follow-up examinations. The mean spherical equivalent of examined eyes was -0.42D in the right eye and -0.16 D in the left eye.

    Conclusion

    Our results showed that referees and assistant referees both had some kind of visual skill deficiencies. As visual skills are among the fundamental skills for success in referees in dynamic sports such as soccer, all of them must undergo visual skill assessments during the precompetition period to avoid any errors in judgment due to visual disturbances.

    Keywords: Visual, Soccer, Sports
  • Nahid Hashemi Madani, Marzieh Miri, Zahra Emami, Mitra Barati, Fatemeh Golgiri* Pages 1149-1152
    Background

    Adrenal insufficiency (AI) is associated with an increase in the risk of mortality in ICU-admitted septic patients. It should be suspected not only in patients with septic shock but also in those with sepsis. The aim of this study was to investigate the prevalence of AI in the spectrum of septic patients and determine the main predictors of this condition.

    Methods

    This study included 99 patients with the diagnosis of sepsis, severe sepsis, or septic shock. Patients with basal cortisol < 10 μg/dl or those with ∆ cortisol < 9 μg/dl after the cosyntropin test were considered as having AI. Appropriate statistical tests were used for comparing the variables between the two groups. A logistic regression model was applied to determine the predictors of AI. The P-value <0.05 was considered as a significant level.

    Results

    AI was found in 25 (25.3%) of these patients. There was no significant difference in the occurrence of AI in patients with sepsis, severe sepsis, or septic shock. Patients with positive blood culture (OR (95% CI); 7.8 (3.5-9.1); p=0.021) or those with CRP≥ 3+ (OR (95% CI);  14.1 8 (5.7-16.2); p<0.001) were more likely to develop AI.

    Conclusion

    AI is prevalent among ICU admitted septic patients even in the absence of septic shock. The main predictors of AI are high levels of CRP and positive blood culture.

    Keywords: Adrenal Insufficiency, Sepsis, Septic Shock, C-Reactive Protein (CRP)
  • Soheila Aminimoghaddam, Bahareh Fooladi*, Maryam Noori, Zeynab Nickhah Klashami, Armita Kakavand Hamidii, Mahsa M. Amoli Pages 1153-1158
    Background

    Endometrial cancer is the fourth most widespread cancer among females, with a growing prevalence in recent years. Management by combined therapies along with surgery, radiotherapy, and chemotherapy have improved patients’ prognoses. Besides, the development of new therapies helps preserve fertility and prognosis in aggressive tumors.The purpose of this research was to identify the efficacy of metformin on the H19 long non-coding RNA expression in endometrial cancer to provide further insight into the pathogenesis and treatment of the disease.

    Methods

    A total of 23 patients with endometrial cancer, diagnosed by biopsy or diagnostic curettage, were recruited and divided into three groups, before and after metformin treatment and placebo. Real-time PCR was used to evaluate the H19 expression in cancer tissue in all patients.

    Results

    It has been observed that in endometrial tissue of the “after-metformin” treatment group, the H19 expression level was significantly reduced, compared with the “before-metformin” treatment group, but not in comparison with the placebo. These findings indicate that metformin reduced the H19 expression in endometrial cancer.

    Conclusion

    Anti-diabetic drugs, such as metformin, may be beneficial by reducing the H19 expression in endometrial cancer due to the H19 relation to cancer progression.

    Keywords: Endometrial Cancer, Non-Coding RNA, H19 Gene, Metformin
  • Alireza Mohebbi, Amitis Nozari, Sanaz Asadian, Sara Sohrabi, MohammadReza Babaei, Hesam Jahandideh Pages 1154-1157
    Background

    A few studies have been published on the clinical efficacy and safety of nasal tip defatting plus rhinoplasty, particularly among people with bulbous noses. Therefore, the present study aimed to assess the consequences of nasal tip defatting for skin thickness reduction.

    Methods

    This quasi-experimental study was performed on 72 consecutive patients, candidates for aesthetic rhinoplasty. Twenty-seven patients were scheduled for nasal tip defatting with routine open rhinoplasty concomitantly. Besides, 45 patients underwent rhinoplasty without nasal tip defatting method. Tip and supra-tip skin thickness were assessed before and 12 months after the operation using ultrasonography. The patients' and surgeon's satisfaction with aesthetic results after the operation were also evaluated based on visual analog scaling (VAS). SPSS version 16.0 (SPSS Inc., Chicago, IL., USA) was used for the analyses. P values below 0.05 were considered statistically significant.

    Results

    Seventy-two patients (4 men, 68 women; mean age 26.40 ± 4.61 years) entered the study. Twenty-seven candidates underwent rhinoplasty plus nasal tip defatting (group A). Open rhinoplasty alone was performed for the other 45 patients (group B). The mean nasal tip thickness was 3.98±0.84 mm in group A and 3.69±0.64 mm in group B before the surgery (p=0.059). Preoperative nasal supra-tip thickness of the patients was also assessed using ultrasonography (3.54±0.72 mm in group A versus 3.73±0.54 mm in group B; p=0.065). Both preoperative tip and supra-tip thickness did not statistically differ between the two groups. No significant difference in postoperative tip skin thickness was obtained between two groups after 12 months (3.24±1 mm in group A versus 3.25±0.625 mm in group B; p=0.960), while postoperative supra-tip skin thickness differed significantly according to ultrasonography assessments (2.86±0.60 mm in group A versus 3.25±0.71 mm in group B; p=0.016). Postoperative satisfaction of the candidates was obtained using theVAS scoring system 12 months after the operation in both groups (8±1 in group A, 7.5±1 in group B; p=0.021). Surgeon’s satisfaction in terms of the aesthetic outcome was also assessed based on the VAS system which did not statistically differ between the two groups as well as the patients’ satisfaction (7.84±1.42 in group A, 7±1.61 in group B; p=0.014).

    Conclusion

    Nasal tip skin defatting is the main component in aesthetic rhinoplasty, but its significant effect on the reduction of tip skin thickness is controversial. However, in patients with moderate or thick nasal tip skin, such a procedure can result in higher postoperative satisfaction with the aesthetic outcome compared to rhinoplasty alone.

    Keywords: Rhinoplasty, Nasal Tip, Nasal Tip Defatting, Nasal Skin, Nasal Skin Thickness
  • Ataollah Asadi Louyeh, Amirhossein Takian, Batoul Ahmadi, Mohammad Arab, Ali Davoudi kiakalayeh