فهرست مطالب

  • Volume:16 Issue: 3, 2014
  • تاریخ انتشار: 1392/11/14
  • تعداد عناوین: 28
|
  • Hayriye Gonullu, Yasemin Ozturk, Serhat Akay, Mehmet Boncu, Nazif Erkan Page 2975
  • Min Li, Zhiying Wang *, Yang Xing, Jin Yu, Luming Tian, Dianming Zhang, Zengxi Xin Page 13185
    Background
    Vascular endothelial growth factor (VEGF), matrix metallopeptidase-9 (MMP-9) and tissue inhibitor of metalloproteinase-2 (TIMP-2) are potential markers of oral and maxillofacial squamous cell carcinoma (SCC)..
    Objectives
    To explore the association between expression of VEGF, MMP-9 and TIMP-2 in oral and maxillofacial SCC and clinicopathological factors..Patients and
    Methods
    Immunohistochemical Envision method was used to analyze the expression of VEGF, MMP-9 and TIMP-2 in 54 cases of oral and maxillofacial SCC and the association with clinicopathological factors such as clinical staging and lymphatic metastasis..
    Results
    Brownish-yellow staining is correlated with positive expression of VEGF, MMP-9 and TIMP-2. Positive expression of VEGF and MMP-9 was correlated with lymphatic metastasis, and their positive expression rates were significantly higher in patients with lymphatic metastasis than those without it (VEGF: χ2 = 30.00; P = 0.001; MMP-9: χ2 = 18.27, P = 0.001). The positive expression rate of MMP-9 decreased at earlier clinical stages (P < 0.05). Positive expression of TIMP-2 was correlated with lymphatic metastasis, clinical staging and T classification. The positive rate of TIMP-2 expression in patients with lymphatic metastasis was significantly lower than those without it (χ2 = 26.74, P = 0.002), which significantly reduced with increasing clinical stage and T classification (P < 0.05)..
    Conclusions
    Lymphatic metastasis in patients with oral and maxillofacial SCC is closely related to the positive expression of VEGF, MMP-9 and TIMP-2. MMP-9 and TIMP-2 can affect the progression of cancer, which is valuable for studies on oral and maxillofacial SCC genes..
    Keywords: Oral Surgical Procedures, Carcinoma, Squamous Cell, Vascular Endothelial Growth Factor A, Matrix Metalloproteinase 9, Tissue Inhibitor of Metalloproteinase, 2
  • Maryam Ghorbani, Mahrokh Dolatian, Jamal Shams, Hamid Alavi, Majd Page 13461
    Background
    Premature birth is one of the most important unresolved reproductive health problems. Premature birth is often traumatic and a source of distress for parents. Increased parental stress during the first year of their infant''s life is a risk factor for later behavioral problems in infants..
    Objectives
    This study was designed to compare anxiety, post-traumatic stress, and social supports in parents of premature and mature infants..Patients and
    Methods
    This was a comparative descriptive study conducted at healthcare centers of Qom city, in 2012. In this study, 82 couples (164 parents) divided into two groups including parents who have preterm and term infants. Questionnaires including items such as demographic characteristics, obstetric and post-traumatic stress disorders, Spielberger anxiety and Multidimensional Scale of Perceived Social Support were completed two months after childbirth. Data were analyzed using χ2 test, Fisher’s exact test, Mann-Whitney test, independent t-test, and regression logistic using SPSS18 software..
    Results
    The levels of anxiety was not significantly different in mothers and fathers in the two groups, but the trait anxiety level of mothers (P < 0.001) and fathers who had preterm infants (P = 0.01) was significantly greater than the parents of full-term infants. Post-traumatic stress disorder was significantly greater in mothers of preterm infants than those of term infants (P = 0.03), but this amount was not significantly different between the two groups of fathers. Mothers'' social support did not differ significantly (P = 0.08), however, it was significantly different in fathers (P = 0.01)..
    Conclusions
    Premature infants'' parents are more at risk of mental disorders than term infants'' parents. This result shows the need of interventions, so these parents can better deal with the problems of premature infants..
    Keywords: Infant, Premature, Anxiety, Stress Disorders, Post, Traumatic, Social Support
  • Nader Aghakhani, Farkhondeh Sharif *, Zahra Molazem, Hosein Habibzadeh Page 13748
    Background
    Various treatments such as hemodialysis prolong the life of chronic renal failure disease patients who must tolerate many physical, emotional, social and economic difficulties. Therefore, social support is considered as a vital area of investigation for such patients..
    Objectives
    In this qualitative research, a grounded theory approach was used and written as a content analysis form to study hemodialysis patients and family experience of perceived social support..Patients and
    Methods
    Three nurses, 4 general practitioners, a specialist and two family members who participated were interviewed from April to September 2012 in Urmia, Iran. Interviews were guided to divulge the perception of changes in their lives, needs for social support for disease complications, and the type of treatment process. Purposive sampling continued up to data saturation. Data analysis was performed based on Strauss and Corbin Method. Constant comparison analysis was performed until data saturation..
    Results
    The research results are shown in 3 steps. In the first step, 113 categories and four main themes from 993 first codes were explored. Social support was explored based on the implications of five general themes including “Perceived Threats Caused by Disease Complications”, “Searching for Social Support”, “Accessible Social Support”, “Beliefs and Values”, and “Perceived Social Support”..
    Conclusions
    The core variable of our research is acceptance of the reality of the conditions caused by the disease. The research finalized our knowledge about patient problems regarding social support and revealed many problems of supporting patients by Health Team Members, family members and organizations. The findings suggest that individual aspects of patient experiences must be considered if social support is to be given and Healthcare Providers have to facilitate positive health services..
    Keywords: Qualitative Research, Social Support, Content Analysis
  • Behrooz Ghanbari, Shiva Khaleghparast *, Behshid Ghadrdoost, Hooman Bakhshandeh Page 13841
    Background
    Nutrition is among the most important factors influencing coronary artery disease..
    Objectives
    Here we aimed to study the nutritional status of patients with and without coronary artery disease (CAD)..Patients and
    Methods
    We performed a cross-sectional study on 600 patients referred to a cardiology clinic with the signs of ACS. The patients were then classified in to two groups (CAD group and the normal group) based on angiographic findings. The amount of nutritional profile was questioned from all participants..
    Results
    Men were more often diagnosed with CAD compared to women (198/362 vs. 102/238; P < 0.01). Patients with coronary artery disease were mostly older, smoker, coffee and black tea drinker had a higher BMI and more frequently diagnosed with hypertension, hyperlipidemia and diabetes. On the other hand, green tea consumption was seen more in women (92/238 vs. 115/362; P < 0.05) and those with regular physical activity (119/299 vs. 88/301; P < 0.01). Backward regression modeling was employed to study the predictors of CAD. Type of tea and meat remained as one the most important nutritional factors predicting CAD..
    Conclusions
    White mean and type of tea were the most important predictors of CAD. Dietary prevention strategies from childhood could prevent early CAD..
    Keywords: Tea, Meat, Cardiovascular Diseases
  • Masoume Pourganji, Mahmoud Hosseini *, Mohammad Soukhtanloo, Hoda Zabihi, Mosa Al Reza Hadjzadeh Page 13954
    Background
    The contribution of neuroinflammation in Alzheimer’s disease (AD) has been widely reported. The effects of female gonadal hormones in both neuroinflammation and brain cognitive functions have also been well considered..
    Objectives
    In the present study, the possible protective role for endogenous ovarian hormones against learning and memory impairment as well as brain tissues oxidative damage induced by lipopolysachride (LPS) was investigated in rats..
    Materials And Methods
    The rats were divided into four groups: Sham-LPS, Ovariectomized (OVX)-LPS, Sham, and OVX. The animals of sham group were in proestrous phase in which the serum concentration of estradiol is high. The Sham-LPS and OVX-LPS groups were treated with LPS (250 µg/kg) before acquisition. The animals were examined using passive avoidance (PA) test. The brains were then removed and malondialdehyde (MDA) and total thiol groups concentrations were measured..
    Results
    The time latency to enter the dark compartment by OVX-LPS group was shorter than that of OVX at both first and 24th hours after the shock (P < 0.05 - P < 0.001). In Sham-LPS and OVX-LPS groups, total thiol concentration in hippocampal and cortical tissues were significantly lower while MDA concentrations were higher than that of Sham and OVX groups (P < 0.05 - P < 0.001).). The hippocampal MDA concentration in OVX-LPS group was higher than Sham- LPS group (P < 0.01)..
    Conclusions
    Brain tissue oxidative damage contributed in deleterious effects of LPS on learning and memory. Some protective effects for the endogenous ovarian hormones against damaging effects of LPS on learning and memory function, as well as brain tissues oxidative damage could be postulated; however, it needs more investigation..
    Keywords: Learning, Memory, Ovariectomy, Lipopolysaccharide, Oxidative Stress
  • Mohsen Adib Hajbaghery *, Farzaneh Maghaminejad, Mohammad Paravar Page 14274
    Background

    Trauma is a major healthcare challenge worldwide. In developing countries, most road deaths happen during the pre-hospital phase; consequently, pre-hospital trauma care has received considerable attention during the past decades..

    Objectives

    The aim of this study was to investigate the quality of pre-hospital oxygen therapy in patients with multiple trauma..Patients and

    Methods

    This cross-sectional study was conducted in the year 2013. The study population consisted of all patients with multiple trauma who had been transferred by emergency medical services to the central trauma department in Shahid Beheshti Medical Center, Kashan, Iran. The data collection instrument had three parts including demographic, a trauma assessment, and an oxygen therapy quality assessment questionnaires that were designed by the researchers. In total, 350 patients with multiple trauma were recruited from March through July 2013. Data were described by using frequency tables, central tendency measures, and variability indices. Moreover, we analyzed data by using the Chi-square test, Mann-Whitney U test, and the logistic regression analysis..

    Results

    The study sample consisted of 263 (75.1%) male and 87 (24.9%) female patients. Overall, 211 patients needed oxygen therapy during the pre-hospital phase; however, only 35 (16.60%) patients had received oxygen. The quality of oxygen therapy was undesirable in 92.42% of cases. In addition, 83.4% of patients, whose pre-hospital records indicated the administration of oxygen, reported that they had not received oxygen therapy. Logistic regression analysis revealed that the place of accident and the level of patients'' education were significant predictors for administration of oxygen during the pre-hospital phase (P < 0.001)..

    Conclusions

    The quality of pre-hospital oxygen therapy had been provided for the patients with multiple trauma was poor while these patients, particularly patients with chest traumas and head injuries, were in urgent need of oxygen therapy. Consequently, developing and implementing standard evidence-based oxygen therapy protocols and administrating continuous education programs are recommended..

    Keywords: Oxygen Inhalation Therapy, Emergency Medical Services, Multiple Trauma
  • Seyran Naghdi, Hesam Ghiasvand, Nasrin Shaarbafchi Zadeh, Saeidreza Azami, Tayebeh Moradi Page 14335
    Background
    Inequality in households’ and individuals'' consumption expenditures is one of the most important aspects of health status difference among households and individuals..
    Objectives
    We investigated the impact of some macro-economic factors specially inequality factors on the Iranian rural health status since 1986 through 2012..Patients and
    Methods
    We conducted a longitudinal ecological and analytical study. The average sample size was 14602 households whom Iranian Statistics Center selected by a multi-stages clustering sampling approach. All required data has been collected from Iranian Statistics Centre and Deputy for Curial Affaires of Iranian Ministry of Health. We calculated the Gini coefficients for the rural food and health expenditures, then conducted a transloge autoregressive order one (AR1) to investigate the association between the Iranian rural households'' key mortality rates and the food and health expenditure Gini coefficients, time trend, GDP per capita (PPP), and GDP per capita Gini coefficients..
    Results
    The mean of Gini coefficients were 0.137 and 0.21 for the rural food expenditures inequality based on current and constant price, respectively. In addition, the mean of Gini coefficients were 0.26 and 0.31 for the rural health expenditures inequality based on current and constant price, respectively. The time trend, transloged form of Gini coefficients for health expenditures and GDP per capita Gini coefficients presented a significant negative correlation with transloged form of neonatal mortality rate. With regard to the transloged form of under five mortality we observed a significant negative correlation with time trend and transloged form of Gini coefficients for health expenditure and GDP per capita. Finally, there was a significant negative correlation between transloged forms of maternal mortality rate..
    Conclusions
    Iranian policy makers should consider the rural health and food expenditures inequality and try to adopt more effective policies and plans to decrease it. In addition, they should improve the macro-economic factors to improve the rural households'' health status..
    Keywords: Health Expenditures, Socioeconomic Factors, Health status
  • Parisa Yavari Kia, Farzaneh Safajou, Mahnaz Shahnazi, Hossein Nazemiyeh Page 14360
    Background
    Nausea and vomiting of pregnancy are amongst the most common complaints that effects on both the physical and mental conditions of the pregnant women. Due to the increasing tendency of women to use herbal medications during pregnancy, the effect of lemon inhalation aromatherapy on nausea and vomiting of pregnancy was investigated in this study..
    Objectives
    The aim of this study was to determine the effect of lemon inhalation aromatherapy on nausea and vomiting during pregnancy..
    Materials And Methods
    This was a randomized clinical trial in which 100 pregnant women with nausea and vomiting who had eligibility criteria were randomly divided into intervention and control groups based on four- and six-random block sampling method. Lemon essential oil and placebo were given to the intervention and control groups, respectively, to inhale it as soon as they felt nausea. The nausea, vomiting, and retch intensity were investigated 24 hours before and during the four days of treatment by means of PUQE-24 (24-hour Pregnancy Unique Quantification of Emesis)..
    Results
    There was a statistically significant difference between the two groups in the mean scores of nausea and vomiting on the second and fourth days (P = 0.017 and P = 0.039, respectively). The means of nausea and vomiting intensity in the second and fourth days in the intervention group were significantly lower than the control group. In addition, in intragroup comparison with ANOVA with repeated measures, the nausea and vomiting mean in the five intervals, showed a statistically significant difference in each group (P < 0.001 and P = 0.049, respectively)..
    Conclusions
    Lemon scent can be effective in reducing nausea and vomiting of pregnancy..
    Keywords: Nausea, Vomiting, Aromatherapy, Citrus
  • Seied Saeid Esmaeili, Faramarz Fallahi *, Mohammad Gholami Fesharaki, Gholamreza Noormohammadi Page 14601
    Background
    Metabolic syndrome can cause cardiovascular disease and diabetes in the affected subjects. With 20 to 30% prevalence rate among the adult population of most countries, it is considered a pandemic problem. The guidelines currently available on the management of the specific components of metabolic syndrome highlight some lifestyle changes such as enhanced physical activity and weight reduction. Adherence to Mediterranean-style diet has been shown to be associated with lower risk of metabolic syndrome in some clinical studies..
    Objectives
    The aim of this study was the evaluation of the effect Razavi dietary pattern, on metabolic syndrome. This is the first study performed to address this issue.. Patients and
    Methods
    Seventy five eligible subjects with metabolic syndrome were recruited into a single-blind randomized controlled clinical trial to determine the effect of Razavi diet on metabolic syndrome. Intervention was carried out by educating the Razavi diet in the experimental group while giving no dietary recommendations to the control group. The level of physical activity was similar between the two groups. Features of the metabolic syndrome as defined by the criteria of the Iranian National Committee of Obesity were assessed after two months..
    Results
    The net reduction in the waist circumference (-2.85), weight (-1.44) and BMI (-0.58) in test group was significantly (P < 0.001) higher than the control. Decreases in systolic and diastolic blood pressure, fasting blood sugar and triglycerides were observed but were not statistically significant..
    Conclusions
    The results suggest that Razavi diet can improve some components of metabolic syndrome leading to reduced risk of cardiovascular disease and diabetes..
    Keywords: Metabolic Syndrome X, Obesity, Diet therapy
  • Oya Ogenler *, Huseyin Selvi Page 14648
    Background
    Training provided in medical faculties is mainly composed of two phases: preclinical and clinical. Preclinical period, or the first three years, consists of theoretical classes and practical implementations to develop vocational skills. In the clinical period, students are given applied courses..
    Objectives
    This study aimed to determine the role of demographic characteristics and medical students’ life habits on their academic achievement..Patients and
    Methods
    For this purpose, a 20-item survey form with two sections developed by the researchers was used. Students were also asked to identify the averages of committee exams as the academic achievement indicator. Participating students (n = 287) were from Mersin University Medical Faculty during 2012-2013 session..
    Results
    Totally, 60.3% of the students were males with an average age of 21.16 ± 1.39, and their general grade point average was 63.39 ± 9.08. Students in their second year (P = 0.000), who were females (P = 0.000), graduated from Anatolian Teachers High Schools (P = 0.002), financially well off (P = 0.026), stayed in state hostels (P = 0.032), did not smoke (P = 0.042) and regularly did sports (P = 0.016) were significantly more successful compared to others..
    Conclusions
    Students’ socioeconomic resources and habits play roles on academic achievement. Solutions that incorporate economic support which can eliminate negative situations leading to inequality of opportunity among students would increase students'' achievement..
    Keywords: Education, Education, Medical, Achievement
  • Safar Ali Alizadeh, Seyyed Saeed Eshraghi *, Mohammad Reza Pourmand, Taghi Naserpour, Gholamreza Abdollahpour, Abbas Rahimiforoshani, Reza Najafipour Page 14753
    Background
    Timely diagnosis of leptospirosis is essential for early and effective treatment, for there are many differential diagnoses for it.. Leptospiral researchers have an increasing interest in developing new serological methods with recombinant antigens to improve the Leptospirosis diagnosis. Several serological tests have been developed for the proper diagnosis of leptospirosis..
    Objectives
    To improve the previous works we developed an enzyme linked immunosorbent assay (ELISA) with novel recombinant leptospiral surface adhesion (Lsa63) protein to offer a new test..
    Materials And Methods
    In an experimental study, Recombinant Lsa63 (rLsa63) was produced in Escherishia coli (E.coli) BL21 (DE3). By using rLsa63, we generated IgM and IgG ELISA. Performance of these tests was compared to microscopic agglutination golden test (MAT). Two hundred twenty human serum samples were obtained from individuals suspicious of leptospirosis who were referred to Guilan Province Central Leptospira Laboratory for definitive diagnosis. The sensitivity, specificity and other statistical indexes of Lsa63-ELISAs were also determined..
    Results
    Among 220 serum samples, 30% (n = 65) had positive MAT responses, and also 38% (n = 84) and 40.9% (n = 90) showed positive reaction to IgG and IgM rLsa63-ELISA, respectively. The sensitivity, specificity and accuracy were 93.8%, 81.29 % and 85.0 for IgM-Lsa63- ELISA and 83.07, 80, 64 and 81.36 for IgG-Lsa63- ELISA, respectively..
    Conclusions
    Our results demonstrated that the sensitivity and specificity of Lsa63-ELISAs are promising for the detection of Leptospira serovars..
    Keywords: Enzyme, Linked Immunosorbent Assay, Leptospira, leptospirosis, Lsa63
  • Fatemeh Assarian, Alireza Moravveji *, Hamideh Ghaffarian, Reihaneh Eslamian, Fatemeh Atoof Page 14839
    Background
    Maternal health status might have an important effect on breastfeeding, growth, and general health of the infants..
    Objectives
    This study was conducted to assess the association between maternal mental health and breastfeeding status of mothers in Kashan province..Patients and
    Methods
    This case-control study was conducted on 458 mothers in two groups of unsuccessful breastfeeding (case) and successful breastfeeding (control) attending Kashan province health clinics. In this study, the GHQ questionnaire and clinical interview were employed to collect data. The data were statistically analyzed using Chi-square and Fisher’s exact tests..
    Results
    It was found that mothers of the case group had a greater susceptibility to depression than those of the control group, that is, breastfeeding status was directly associated with susceptibility to depression (P = 0.001, OR = 5.48). Furthermore, there was a significant association between basic characteristics such as maternal occupational status (P = 0.04) or their educations (P = 0.006) with breastfeeding. Besides, clinical interview revealed that mixed depression and anxiety disorder was the most prevalent type of psychological disorder in the case group..
    Conclusions
    Screening depression during pregnancy and postpartum period appeared to be necessary and it should be incorporated into prenatal and postnatal care due to its influence on mothers’ successful breastfeeding..
    Keywords: Breast feeding, Maternal Welfare, Mental Health, Iran
  • Davoud Shojaezadeh, Nooshin Peyman, Mohammad Taghi Shakeri, Saharnaz Nedjat, Abbas Mohaddes Hakkak, Mohammad Hossein Taghdisi, Hamid Reza Mohaddes Hakkak, Keivan Shariati, Ali Taghipour Page 14879
    Background
    Health warning labels on cigarette packages are among the most straightforward and important tools to communicate with smokers and various studies have illustrated their efficacy..
    Objectives
    The current study aimed to investigate the opinions of male smokers in Mashhad city about the efficacy of health warning labels printed on cigarette packages on the smoking status of smokers..Patients and
    Methods
    This cross-sectional descriptive study was conducted in 2013 using a questionnaire. The research population included the male smokers of Mashhad. The participants were selected from the customers referring to the newsstands for cigarettes. The obtained data were analyzed employing SPSS software Version 16, and the statistical tests including Kruskal-Wallis, Spearman, and correlation coefficient of Pearson, Chi Square, Mann-Whitney, and Bonferroni correction were used in this regard..
    Results
    In this research, there were 500 participants with the average age of 25 years. The initiation age of smoking was eight years while the maximum age was reported as 45 years. Results of this research about the effect of these labels on decreasing cigarette consumption rate showed that almost half of the participants believed that these labels were ineffective for them (52.2%) and other smokers (53.8%).Furthermore, significant relationship was found between the age and opinion of the smokers about the influence of these labels on reducing their cigarette consumption (P < 0.001)..
    Conclusions
    To promote the effect of printed images on cigarette packages, it is recommended to consider the suitability of labels in the targeted culture. In addition, to be more effective consultation sites to quit smoking should be introduced under the images..
    Keywords: Smoking, Tobacco Products, Iran
  • Zhaleh Shadman, Mahdieh Akhoundan, Nooshin Poorsoltan, Bagher Larijani, Seyed Masoud Arzaghi, Mohsen Khoshniat Page 14941
    Background
    No comprehensive study has been conducted on risk factors of sexual dysfunction in women with diabetes mellitus..
    Objectives
    The aim of this study was to consider all possible influencing variables including hormonal, physical and, psychological status, socioeconomic status, and dietary intake to get more accurate and reliable results..Patients and
    Methods
    Sexual function was assessed by Iranian validated female sexual function index (FSFI).The variables of the study were demographic and diabetes-related factors, stress-depression, physical activity, blood pressure, anthropometric measurements, lipid profile, cortisol, sex and thyroid hormones, 25-hydroxy vitamin D, and dietary intake..
    Results
    Among all investigated variables, partner relationship showed a strong positive association with FSFI (β = 1.93 ± 0.41, P < 0.0001). In addition, not considering partner relationship, FSFI showed a significant negative association with age (β = -0.19 ± 0.20, P = 0.04), stress-depression score (β = -0.08 ± 0.04, P = 0.04), DD (β = -0.03 ± 0.01, P = 0.04), and systolic blood pressure (β = -0.14 ± 0.06, P = 0.03). Significant associations between FSFI and serum sex hormones and other biochemical were found in neither postmenopausal nor non-menopausal women. The means of SFSI in postmenopausal women were greater than non-menopausal (P = 0.02)..
    Conclusions
    It seems that in our population, female sexual function was much more than just a hormonal or physical problem and psychological factors, especially partner relationship and stress-depression, are the most determinants. In addition, age, duration of challenging with disease, and the lack of controlling systolic blood pressure were common factors that decreased sexual function..
    Keywords: Diabetes Mellitus, Hormones, Blood Pressure, Psychology
  • Safura Taheri *, Soheila Ehsanpour, Shahnaze Kohan, Saba Farzi, Molouk Jaafarpour, Ashraf Direkvand Moghaddam Page 15075
    Background
    Family planning is a lifestyle that is selected voluntarily and is based on the knowledge, attitude and responsible decision making by couples in order to promote the health and welfare of the family and the advancement of the society. In this regard, family planning counseling plays an important role in making informed decisions if used properly and in a responsible way. Detection of individual barriers in family planning counseling based on the viewpoints of managers, employees and clients who are key participants in the healthcare service provision is a major step towards appropriate planning to modify or eliminate such barriers..
    Objectives
    The present study was conducted with the goal of comparing managers’, employees’ and clients’ viewpoints about individual barriers in family planning counseling in health care centers in Isfahan in 2012..Patients and
    Methods
    This was a cross-sectional one-step three-group comparative descriptive study conducted on 295 subjects including 59 managers, 110 employees and 126 clients in medical health care centers in Isfahan in 2012. The managers and employees were selected by census sampling, and the clients were recruited through convenient random sampling. The data collection tool was a researcher-designed questionnaire, which was designed in two sections of fertility and personal characteristics, and viewpoint measurement. Descriptive and inferential statistical tests were used to analyze the data..
    Results
    The obtained results showed significant differences between mean scores of viewpoints in three groups of managers, employees and clients concerning individual barriers in family planning counseling. In addition, most of the managers, employees and clients reported individual barriers as an intermediate level barrier in the process of family planning counseling..
    Conclusions
    Results indicate that subjects in three studied groups hold different views regarding the individual barriers in family planning counseling. This difference in the perspectives may be a factor that affects the quality of the provided services. Therefore, it is necessary for the healthcare providers to consider the main concerns of their clients regarding family planning..
    Keywords: Family Planning Policy, Counseling, Contraception, Barrier, Iran
  • Majid Shohrati, Reza Haji Hosseini, Malek Ashtar Esfandiari, Nastaran Najafian, Bita Najafian, Abbas Golbedagh Page 15129
    Background
    Matrix metalloproteinases (MMPs) are a group of endopeptidases which comprised of various types. These proteolytic enzymes are zinc-dependent and play role in degradation of extracellular matrix (ECM). Various types of cells such as macrophages, fibroblasts, neutrophils, synovial cells and some epithelial cells secrete MMPs. According to previous studies on bronchiolitis and respiratory tract lesions in these patients and unknown pathophysiology mechanism up to date, this cross–sectional study was performed..
    Objectives
    The aim of this study was to compare the serum MMP level in patients with chemical injuries and normal people and also determine the role of these parameters in pulmonary disorders. .
    Materials And Methods
    In this cross–sectional study, 25 Iranian patients exposed to the sulfur mustard and 25 unexposed participants as the control group were enrolled. Serum samples were collected from two groups and stored at -70˚C until the measurement of MMPs and TIMPs. ELISA kit was used for measurement of MMP and TIMP based on the kit''s instruction. For validations in measurement, all samples were analyzed duplicate and in some cases triplicate..
    Results
    The mean level of MMP-9 in serum of chemically-injured group was 1592.42 and this amount in normal group was 679.72. So there was a significant difference between two groups (P = 0.001) and the mean level of MMP-8 in serum of patients group was 49.10 and in normal group was 35.53. Then there was no significant difference between two groups (P = 0.197). The mean levels of MMP-1 and MMP-2 was not significantly different (P value > 0.05) in the patient and normal groups. And also the mean levels of TIMP-1 and TIMP-2 was not significantly different (P > 0.05) in the patients and normal groups..
    Conclusions
    In summary, serum MMPs in chemically-injured has shown no significant difference with normal people except for the MMP-9..
    Keywords: Matrix Metalloproteinase, Tissue Inhibitor of Metalloproteinases, Mustard Gas
  • Mohsen Bahrami, Reza Mastery Farahani, Esmail Nazem, Mohammad Kamalinejad, Mansoor Keshavarz, Alireza Nikbakht Nasrabadi, Mohammad Yousofpoor, Farshad Amini Behbahani Page 15193
  • Marjan Khazan, Mehdi Hedayati, Farzad Kobarfard, Sahar Askari, Fereidoun Azizi Page 15344
    Background
    Adulterated herbal weight loss products with containing undeclared synthetic drugs are common and responsible for many serious health damages..
    Objectives
    The purpose of the study was to determine five synthetic adulterants in eight common herbal weight loss supplements, which are currently sold in Iran markets, to verify their presence in supplements, without mentioning on the labels..
    Materials And Methods
    Eight common herbal weight loss samples were obtained from the Iran pharmaceutical market after advertising in the Persian language on satellite channels and internet. Five pharmacological classes of drugs used for weight loss, namely sibutramine, phenolphthalein, phenytoin, bumetanide and rimonabant, were investigated and quantified by GC-MS for the first three and LC-MS for the last two medications..
    Results
    The most undeclared ingredients, which were illegally added include sibutramine, phenolphthalein, bumetanide, and phenytoin in the original super slim, herbaceous essence, super slim green lean, and fat loss, supplements, respectively. Rimonabant was not found. Caffeine, pseudoephedrine, theobromine and amfepramone were also found in the supplements using GC-MS assay..
    Conclusions
    Adulterated synthetic substances were detected in the herbal weight loss products. Health care professionals should make people aware of the risks of taking herbal weight-loss supplements..
    Keywords: United States Food, Drug Administration, Herbal Medicine, Weight Loss, Gas Chromatography, Mass Spectrometry
  • Kaveh Behaeen, Mansour Soltanzadeh, Sholeh Nesioonpour, Ahmad Ebadi, Alireza Olapour, Seyed Mohammad Mehdi Aslani Page 15506
    Background
    Pain is considered as an importantissue after cesarean section. Multimodal approach to post cesarean pain management may not only enhance analgesia but also reduce side effects after the surgery..
    Objectives
    This study was aimed to evaluate the clinical efficacy of subcutaneous injection of low dose ketamine at the incision site to reduce cesarean section pain..Patients and
    Methods
    Sixty patients, aged between 18 and 25 years old, scheduled for elective cesarean section, were enrolled to this double-blind randomized controlled trial study. Patients were divided into three groups of 20 patients each group one (k-pre) received 0.5 mg/kg ketamine before skin incision and normal saline after skin closure, group two (k-post) received normal saline before skin incision and 0.5 mg/kg ketamine after skin closure and group three (C) received normal saline before skin incision and after skin closure; subcutaneously at the incision site. The first analgesic request, the amount of analgesic and the pain intensity were evaluated for 24 hours..
    Results
    The first time analgesic requested was longer and the amount of analgesic used during the first 24 hours was significantly lower in groups K-pre and K-post compared with group C (P < 0.05). Pain intensity was significantly lower at 2, 4, 6 and 12 hours in groups K-pre and K-post compared with group C (P < 0.05). Nevertheless, pain intensity was not significantly different at 18 and 24 hours in group C (P > 0.05). The first requested time, total used amount of analgesicand pain intensity were not meaningfully different in K-pre and K-post groups (P > 0.05)..
    Conclusions
    Patients who were given ketamine before or after cesarean section subcutaneously at incision site had lower pain intensity and less analgesic consumption than patients who were given placebo..
    Keywords: Ketamine, Caesarean Section, Pain, Postoperative, Diclofenac
  • Zohreh Karimi, Tahereh Ashktorab, Easa Mohammadi, Heidar Ali Abedi Page 15532
    Background
    Professionalism in nursing is critical for creating credibility and a positive image..
    Objectives
    This study was carried out to explain the use of hidden curriculum in teaching professionalism in nursing students..
    Materials And Methods
    This qualitative study was conducted through purposeful sampling strategy by the participation of 32 nursing students. The data were collected by using semi-structured interviews, and this process was continued until achieving data saturation and themes’ emergence. Content analysis method was used for data analysis..
    Results
    Data analysis revealed three main themes: Development of understanding the professionalism elements, Variety of influenceability strategies, and Influenceability to various resources. Each theme consisted of some subthemes..
    Conclusions
    The nursing students learnt the professionalism elements by different methods from different resources through the hidden curriculum. Therefore, exploration of the currently administered hidden curricula is suggested..
    Keywords: Curriculum, Education, Nursing, Students, Nursing
  • Morteza Mojahedi, Mohsen Naseri *, Reza Majdzadeh, Mansoor Keshavarz, Mohammad Ebadini, Esmaeil Nazem, Mohsen Saberi Isfeedvajani Page 15924
    Background
    In Iranian Traditional Medicine, mizaj (temperament) plays a key role in preventive, therapeutic and lifestyle recommendations. A reliable self-reported scale for mizaj identification is critically needed to introduce ITM into the official medical and health care system especially in the case of designing national preventive protocols..
    Objectives
    The present study aimed to design a preliminary self-administered mizaj questionnaire and assessed its reliability and validity in Iran..Patients and
    Methods
    In this cross-sectional study, a questionnaire with 52 items was designed based on mizaj-related indices. Subsequent to content and face validity assessment, using qualitative and quantitative method, 47 items remained. Based on the non-randomly sampling, the test-retest reliability of each question and internal consistency of the questionnaire was examined by the participation of 35 volunteers. The reliable version questionnaire was filled up by 52 volunteers wherein they were divided into warm/cold and wet/dry groups based on their mizaj which was predetermined by a team of expert practitioners. Logistic regression analysis was performed for validity process between the experts’ assessment of mizaj and each of the items in the questionnaire that resulted to the final ten-item questionnaire divided into two subscales. By using ANOVA and post Hoc with Dunnet statistics, the optimum cut-off points were defined and their sensitivity and specificity was assessed..
    Results
    The weighted kappa coefficients of the 39 items were between 0.40 and 0.82 showing their acceptable reliability and the Cronbach’s α coefficient was 0.71 showing the internal consistency. The sensitivity and specificity of the final questionnaire cut-off points were 65% and 93% for the warm group, 52% and 97% cold group, 53% and 67% dry group and finally 53% and 76% wet group..
    Conclusions
    Our results suggested that many of the designed questions according to the literature’s mizaj identification indices had satisfactory reliability and the final ten-item questionnaire could discriminate the different groups of mizaj, therefore, this can be used as the first version of a brief self-report mizaj estimating scale..
    Keywords: Medicine, Medicine, Unani, Temperament, Questionnaires, Reproducibility of Results
  • Zohre Feyzabadi, Farhad Jafari, Parvin Sadat Feizabadi, Hassan Ashayeri, Mohammad Mahdi Esfahani, Shapour Badiee Aval Page 15981
    Context: Insomnia is one of the most prevalent sleep disorders characterized by sleep difficulty that impairs daily functioning and reduces quality of life. The burden of medical, psychiatric, interpersonal, and societal consequences of insomnia expresses the importance of diagnosing and treatment of insomnia. The aim of study was to investigate causes of insomnia from the viewpoint of Iranian traditional medicine..Evidence Acquisition: In this review study, we searched insomnia in a few of the most famous ancient textbooks of Iranian traditional medicine from different centuries. This books includeThe Canon of Medicine by Avicenna (the first version of Beirut), Zakhire Kharazmshahi by Jurjani (the scanned version of Bonyade Farhang-e Iran), Malfaregh by Razes (the first version of Iran University of Medical Sciences), and Aqili’s cure by Aqili (the first version of Iran University of Medical Sciences)..
    Results
    This study found that in Iranian traditional medicine manuscripts, insomnia was called sahar and even though many factors induce insomnia, most of them act through causing brain dystemperament..
    Conclusions
    The brain dystemperament is considered one of the main causes of insomnia and insomnia can be well managed with an organized line of treatment, by correcting the brain dystemperament through elimination of causes. This study helps to find new solutions to treat insomnia..
    Keywords: Sleep Initiation, Maintenance Disorders, Brain, Medicine, Traditional
  • Mohammad Alipour, Masoomeh Tabari, Masoomeh Alipour Page 16086
    Background
    Propofol is a most widely used intravenous anesthetic drug. One of its most common complications is the pain upon injection; therefore, different methods, with various effects, have been proposed in order to alleviate the pain..
    Objectives
    This study investigates the effects of paracetamol, ondansetron, granisetron, magnesium sulfate and lidocaine drugs on reducing the pain of propofol injection during anesthetic induction. Also, the hemodynamic changes will be analyzed..Patients and
    Methods
    This is an interventional study containing 336 patients underwent elective or thopedic surgeries in Educational Hospitals of Mashhad University, using systematic sampling, the patients were divided into six groups. A 20-gauge needle was inserted into a venous vessel in the back of the hand and 100 cc of Ringer serum was injected into the vein, which was applied proximal to the injection site. Afterwards, paracetamol 2 mg/kg (group p), magnesium sulfate 2 mmol (group M), ondansetron 4 mg (group O), granisetron 2 mg (group G), lidocaine 40 mg (group L) and 5cc saline (group S) were injected into the vessel, after 60 seconds, the tourniquet was opened. One quarter of the total dose of propofol (2.5 mg/kg) was injected with a flow rate of 4 mg/sec and then the injection pain was measured. Finally, the fentanyl (2 µg/kg), atracurium 0.5 mg/kg, and the remaining dose of propofol were injected and the vital signs were recorded before the administration of propofol and 1, 3, 5 and 10 minutes after the propofol injection..
    Results
    The six groups did not significantly differ, regarding their gender, weight or age. Propofol injection pain was less in L and G groups, in comparison with the others (P ≤ 0.001). By analyzing the hemodynamic changes, it was observed that the least amount of change in mean arterial pressure was observed in the paracetamol group..
    Conclusions
    The reduction of propofol injection pain was observed by using medications (in comparison with normal saline), but it was more significant in groups G and L. Moreover, Hypotension was higher in groups S and G and it was lessened in group P..
    Keywords: Acetaminophen, Magnesium Sulfate, Ondansetron, Granisetron, Lidocaine
  • Mohammad Gharavi, Alireza Sabzevari, Ehsanolah Ghorbanian *, Rasoul Sajadi, Mohsen Akhondi Page 16099
    Background

    Propofol is one of common anesthetic drugs used in anesthesia. The most common side effects of propofol are local pain. Pretreatment with lidocaine can reduce propofol injection pain..

    Objectives

    The aim of the present study was to assess and compare the efficiency of lidocaine 0.4% and 2% in reducing the incidence and severity of propofol injection pain..Patients and

    Methods

    This was a double blind prospective clinical trial on children 4-8 years old with class ASA I and II candidates who were referred to Dr. Shaikh Hospital in Mashhad for elective surgery. Sample size calculated 50 patients in each groups based on pilot study. 100 children''s were randomly divided equally in two groups, who were injected with lidocaine solutions 2% and 0.4% respectively. patient''s pain evaluation based on VSD (verbal descriptor scale) and NRS (Numeric Rating Scale) using patient''s verbal reaction and behavior namely fretting, hand drag and tearing. The collated data was analyzed..

    Results

    There was nosignificant difference as to the first three variables (age, gender and weight P > 0.2). The significant difference regarding pain experience in both groups was noteworthy (P > 0.2)..

    Conclusions

    Most of the studies compared lidocaine with other drugs or its efficiency at different doses. Our study is different in that we applied a constant dose of lidocaine in various volumes and concentration. This result shows that lidocaine with the same does but lower concentration and higher volume is more effective in preventing propofol injection pain. Using diluted lidocaine with the dosage of 1 mg/kg and a concentration of 0.4% is an effective way to relieve pain caused by propofol injection in children.

    Keywords: Propofol, Lidocaine, Injections, Pain
  • Roshanak Ghods, Manouchehr Gharooni, Gholamreza Amin, Esmaeil Nazem, Alireza Nikbakht Nasrabadi Page 16449
    Background
    Nowadays, hypertension is considered as a global public health issue and in recent decades, it has shown a growing trend due to changes in lifestyle..
    Objectives
    The purpose of this investigation was to compare symptoms of hypertension with known diseases in ancient medical texts and to find a disease that had the maximum overlap of symptoms with hypertension..
    Materials And Methods
    In this qualitative study, reliable sources of traditional medicine such as The Canon of Medicine by Avicenna, The Complete Art of Medicine (Kitab Kamil as-Sina’aat-Ṭibbiyya) by Haly Abbas, Facilitating Treatment and a letter for Health preservation (Tahsil Al-Elaj and Resale Hafez Al-Sehha) by Mohammad Taghi Shirazi, and some reliable resources of conventional medicine such as Harrison’s principles of internal medicine and databases such as Pubmed, Scopus, SID, and Magiran were probed base on keywords to find a disease that had the most overlapping symptoms with hypertension. By taking notes from the relevant materials, the extracted texts were compared and analyzed..
    Results
    Findings showed that hypertension has the most overlap with Imila (accumulation of normal or abnormal fluid in the body) symptoms in Iranian traditional medicine. Although this is not a quietly perfect overlap and there are other causes and reasons including dry dystemperament of vessel wall (atherosclerosis), hot dystemperament of heart or damages to other organs like liver, kidney and nervous system that could also lead to hypertension according to Iranian traditional medicine..
    Conclusions
    Finding the equivalent disease to HTN based on Iranian traditional medicine, could suggest a better strategy for preventing, treating and reducing debilitating its complications in the future. In conclusion, we can approach to hypertension with recommendations for reducing Imtila when we are dealing with a kind of hypertension that corresponds to Imtila. Therefore, if patient is suffering from another type of hypertension like dry dystemperament of vessel wall, it surely requires another treatment approach for reducing vessel wall dryness..
    Keywords: Hypertension, Medicine, Traditional, Iran
  • Giti Ozgoli, Saeideh Ziaei, Fazlollah Ahmadi, Mahyar Azar Page 16594
    Background
    No study has been conducted yet on the process of adjustment of wives with their husbands’ erectile dysfunction in the transitional stages, and there is lack of understanding of this process in Iran..
    Objectives
    A qualitative, grounded-theory study was designed to examine the process of adjustment of wives with their husbands’ erectile dysfunction in transitional stages..
    Materials And Methods
    Purposive sampling was carried out in Tehran, Iran. Data collection occurred until the theoretical saturation was reached. A total of 16 semi structured in-depth interviews were conducted with 15 woman participants. The constant comparative method of data analysis was used..
    Results
    The women were 29-53 years old and duration of marriage was 2-40 years. They had different educational status ranging from Illiterate to Master’s degree. The present study showed the process of adjustment of wives with husbands’ erectile dysfunction in categories of husband broken role, ups and downs in woman’s sexual life, passing through failure, and end of transition. Following erectile dysfunction (event) and the man’s reaction, broken role occurs (change). In response to this change, reactions due to loss of intimacy occur in the ups and downs of woman’s life. Some women, unable to get through the failure, continue low quality life with sexual and communicational problems (limbo). By the end of transition, some women manage to overcome this unpleasant state of limbo, and begin to experience a new life, with increased intimacy, with or without sexual intercourse (new beginning)..
    Conclusions
    If the process of transitional adjustment occurs in women, it will be effective in improving the relationship and increased intimacy, even sexual intimacy. With this understanding, better counseling and therapeutic interventions can be planned for these couples..
    Keywords: Erectile Dysfunction, Sexual Behavior, Population Dynamics, Family Characteristics
  • Mohammad Karim Bahadori, Seyed Mohsen Mohammadnejhad, Ramin Ravangard, Ehsan Teymourzadeh Page 16807
    Background
    Hospital pharmacy is responsible for controlling and monitoring the medication use process and ensures the timely access to safe, effective and economical use of drugs and medicines for patients and hospital staff..
    Objectives
    This study aimed to optimize the management of studied outpatient pharmacy by developing suitable queuing theory and simulation technique..Patients and
    Methods
    A descriptive-analytical study conducted in a military hospital in Iran, Tehran in 2013. A sample of 220 patients referred to the outpatient pharmacy of the hospital in two shifts, morning and evening, was selected to collect the necessary data to determine the arrival rate, service rate, and other data needed to calculate the patients flow and queuing network performance variables. After the initial analysis of collected data using the software SPSS 18, the pharmacy queuing network performance indicators were calculated for both shifts. Then, based on collected data and to provide appropriate solutions, the queuing system of current situation for both shifts was modeled and simulated using the software ARENA 12 and 4 scenarios were explored..
    Results
    Results showed that the queue characteristics of the studied pharmacy during the situation analysis were very undesirable in both morning and evening shifts. The average numbers of patients in the pharmacy were 19.21 and 14.66 in the morning and evening, respectively. The average times spent in the system by clients were 39 minutes in the morning and 35 minutes in the evening. The system utilization in the morning and evening were, respectively, 25% and 21%. The simulation results showed that reducing the staff in the morning from 2 to 1 in the receiving prescriptions stage didnt change the queue performance indicators. Increasing one staff in filling prescription drugs could cause a decrease of 10 persons in the average queue length and 18 minutes and 14 seconds in the average waiting time. On the other hand, simulation results showed that in the evening, decreasing the staff from 2 to 1 in the delivery of prescription drugs, changed the queue performance indicators very little. Increasing a staff to fill prescription drugs could cause a decrease of 5 persons in the average queue length and 8 minutes and 44 seconds in the average waiting time..
    Conclusions
    The patient's waiting times and the number of patients waiting to receive services in both shifts could be reduced by using multitasking persons and reallocating them to the time-consuming stage of filling prescriptions, using queuing theory and simulation techniques..
    Keywords: Queuing Theory, Patient Simulation, Pharmacy, Hospitals