فهرست مطالب

  • Volume:28 Issue:1, 2014
  • تاریخ انتشار: 1392/11/28
  • تعداد عناوین: 159
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  • Nader Roushan, Hossein Froutan, Reza Taslimi, Mohammad Kalani, Azita Ganji, Sodaif Darvish Moghaddam, Mohammad Jafar Farahvash, Zahra Khazaeipour Page 1
    Background
    Approach to the small intestine has been difficult even with newer methods. Double-balloon enteroscopy (DBE) has been created for diagnostic and therapeutic interventions in diseases of the small intestine. Small intestinal diseases have different etiologies in each country. The DBE has been introduced in recent years in Iran. Our aim was to study the indications and results of DBE in some academic centers in Iran.
    Methods
    Fifty-five patients with symptoms and signs related to small intestine without definitive diagnosis but with previous workup were enrolled in the study. The DBE was performed in three different medical universities in Iran.
    Results
    The mean age of the patients that underwent the DBE was 47.2 ± 17.3 years. Abdominal pain (54.5%) and occult gastrointestinal bleeding (23.6%) were the most common presentations. Small bowel lesions were detected in 26 patients (47.3%); the most common lesions were ulcer (46.2%) and polyps (19.2%). Crohn’s disease (12.7%) was the commonest diagnosis found in DBE procedure. Patients presenting with abdominal pain or lower hemoglobin level were more likely to be diagnosed (both p≤ 0.05). Small intestinal diseases were ultimately diagnosed in 47.3% of the patients. Twenty percent of the patients had another disease outside the small bowel.
    Conclusions
    DBE is an effective and relatively safe diagnostic and therapeutic option for small bowel evaluations. Accurate selection of patients and more experience technicians and physicians will improve the efficacy of this procedure in Iran.
    Keywords: Double, balloon enteroscopy, Small intestinal disease, Crohn's disease
  • Bahaadin Siroos, Zahra Ahmadinejad, Mohammad Tabaeizadeh, Mojtaba Hedayat Yaghoobi, Alireza Torabi, Majid Ghaffarpour Page 2
    Sarcoidosis is a multisystem noncaseating granulomatous disease with a propensity for lung, eye, and skin which recently have been proposed that mycobacterium tuberculosis may contribute in its pathogenesis, and rarely involves central nervous system (CNS). Despite CD4+ lymphocytopenia, sarcoidosis by itself does not increase risk of opportunistic infections other than cryptococcosis. Nonetheless, simultaneous association of CNS cryptococcosis and tuberculosis infection remains extremely rare event in immunocompetent states, and has not been reported in sarcoidosis yet. We here presented such a case in a 42 years old man, a known case of sarcoidosis with diagnostic and therapeutic difficulties were encountered in a fourteen-month-long hospitalization period.
    Keywords: Sarcoidosis, ventriculomeningitis, hydrocephalus, cryptococcosis, Tuberculosis
  • Shahnaz Miri, Esmaeil Ghoreyshi, Gholam Ali Shahidi, Mansour Parvaresh, Mohammad Rohani, Mehdi Saffari Page 3
    Background
    Deep brain stimulation (DBS) of the globus pallidus internus (GPi) is recommended as a promising technique for the management of the primary generalized dystonia (PGD) with DYT1 gene mutation. We present the first report of DBS results in Iranian patients with DYT1 positive PGD.
    Methods
    Nine patients who suffered from severely disabling DYT1 positive PGD consecutively were recruited for the study between 2008 and 2010. The patients underwent bilateral deep brain stimulation of the GPi in a single procedure. The mean follow up duration was 8.8 ± 2.2 months. The efficacy of the intervention was evaluated by comparing pre- and post operative scores of patients with Burke-Fahn-Marsden''s dystonia Scale (BFMDS). Statistical analysis was performed using SPSS 11.0 software.
    Results
    Of 9 patients six were female with the mean age of 15.2 ± 5.5 years old (range: 8- 25 years old). The mean for Burke-Fahn-Marsden''s Dystonia Rating Scale (BFMDRS) score was 47.22 ± 14.1 before surgery and 12.3 ± 8.2 after follow up, which significantly improved (P=0.0001).The mean stimulation parameters at the last visit were at a frequency of 152.2 ± 32.4 Hz (range 130- 230 Hz), a voltage of 2.6 ± 0.7 V (range 1.1- 4), and a pulse width of 60 μsec. No complication was observed during follow up.
    Conclusion
    Bilateral DBS of the GPi has an encouraging result for the management of DYT1 positive PGD and is recommended as a safe technique for the treatment of these patients. Shorter pulse width in stimulation parameters is suggested for DYT1 dystonia patients.
    Keywords: Deep brain stimulation, Globus pallidus internus, DYT1 dystonia
  • Arezoo Yari, Haidar Nadrian, Hamideh Rashidian, Saharnaz Nedjat, Nader Esmaeilnasab, Rajabali Doroudi, Haydeh Hoursan Page 4
    Background
    The aim of this study was to investigate the psychometric properties of Social Capital Questionnaire (SCQ) developed by Onyx and Bullen (2000) among a sample of medical science students in Tehran University of Medical Sciences, Iran and to compare the factor analysis with findings from two previous studies in Australia and the United States.
    Methods
    Multistage cluster sampling was employed to recruit 293 medical science students (Male: 95/Female: 198) from 7 faculties in Tehran University of Medical Sciences. After translating SCQ into Persian applying back-translation technique and three-stage consensus panel, the questionnaires administered to the respondents and they were asked to complete them. Statistical Analysis was performed using SPSS version 16.0 for Windows.
    Results
    Exploratory Factor Analysis (EFA) was conducted to evaluate factor structure of the Persian SCQ (PSCQ), which showed a moderate replicability, validity, and reliability (Cronbach alpha=. 79) to those found in previous studies. Twelve factors extracted with eight values greater than 1 which altogether accounted for 76.23% of the total variance. Applying Cattell''s scree test, it was indicated that between seven and eight factors extracted. The correlations between factors were detected in the low (at the lowest 0.002) to modest (at the highest 0.614) range.
    Conclusion
    The differences found in the factor analysis between the studies may be ascribed to the various types of populations studied. Despite the difference in populations studied, our findings support the meaningfulness of P-SCQ as an instrument that is worthy of further attention for use in social health researches, although more studies are recommended to help researchers in comparing its variety in dimensions of different communities.
    Keywords: Social Capital, Factor Analysis, Construct Validity, Iran
  • Azam Sharifi, Mohammad Kamali, Ali Chabok Page 5
    Background
    Cerebral palsy (CP) describes a group of disorders regarding the development of movement and posture, which causes limitations in activity. In fact, it is attributed to non-progressive disturbances that occur during brain development in fetus or infant. CP disorders may accompany by speech, auditory, visual abnormality, seizure, learning disorder, mental retardation and etc. Due to the variation in disorders and ultimately the needs that are made in the wake of the diseases, understanding the needs of these patients is essential.
    Methods
    This research was a qualitative study, with phenomenology method and sampling was purposeful. The participants were 17 cerebral palsy people (6 female and 11 male, with aged 15 to 43). Data were collected by deep interview with open-end questions and analyzed by collaizi method.
    Results
    During the interview sessions, notes and ideas were classified and assorted, so that, the rehabilitation needs of people with CP were understood according to the statements of participants. The results of this study were placed in four domains, 3 themes and 22 subthemes. The domains included social, emotional needs, economic, and therapeutic needs.
    Conclusion
    The requirements studies in this research were particularly introduced by patients with CP. People in the society, who might have contact with these patients, are responsible to help them to overcome their problems and disabilities.
    Keywords: Cerebral palsy, Rehabilitation needs, Qualitative study, Phenomenological method
  • Sanaz Soltanparast, Zahra Jafari, Seyed Jalal Sameni, Masoud Salehi Page 6
    Background
    The purpose of the present study was to evaluate the psychometric properties (validity and reliability) of the Persian version of the Sustained Auditory Attention Capacity Test in children with attention deficit hyperactivity disorder.
    Methods
    The Persian version of the Sustained Auditory Attention Capacity Test was constructed to assess sustained auditory attention using the method provided by Feniman and colleagues (2007). In this test, comments were provided to assess the child’s attentional deficit by determining inattention and impulsiveness error, the total scores of the sustained auditory attention capacity test and attention span reduction index. In the present study for determining the validity and reliability of in both Rey Auditory Verbal Learning test and the Persian version of the Sustained Auditory Attention Capacity Test (SAACT), 46 normal children and 41 children with Attention Deficit Hyperactivity (ADHD), all right-handed and aged between 7 and 11 of both genders, were evaluated.
    Results
    In determining convergent validity, a negative significant correlation was found between the three parts of the Rey Auditory Verbal Learning test (first, fifth, and immediate recall) and all indicators of the SAACT except attention span reduction. By comparing the test scores between the normal and ADHD groups, discriminant validity analysis showed significant differences in all indicators of the test except for attention span reduction (p< 0.001).
    Conclusion
    The Persian version of the Sustained Auditory Attention Capacity test has good validity and reliability, that matches other reliable tests, and it can be used for the identification of children with attention deficits and if they suspected to have Attention Deficit Hyperactivity Disorder.
    Keywords: Sustained Auditory Attention Capacity Test, Validity, Reliability, Attention deficit hyperactivity disorder, Children
  • Mahdie Golchin, Mirsaeed Attarchi, Elham Mirzamohammadi, Mostafa Ghaffari, Saber Mohammadi Page 7
    Background
    Severe upper extremity injuries can affect the quality of life in patients and cause multi-factorial and long-term costs of disease. The aim of this study was to assess quality of life in patients with upper extremity injuries caused by work-related accidents.
    Methods
    In this study cross-sectional method was used in patients referred to the Occupational medicine Clinic of Rasoul Akram Hospital to determine their impairments. Patient''s information including demographic variables, calculation of the impairment rate based on AMA Guide book (in terms of WPI), returning to work, and location of injury, work experience and type of injury. Then the quality of their life was assessed and interpreted using SF36 questionnaire.
    Results
    203 patients were evaluated. Different aspects of the patients’ life were not associated with age, gender and education of patients based on The SF-36 questionnaire. There was an inverse relationship between the percentage of patients’ impairment and different aspects of life quality; there were also a significance correlation between impairment rate and physical performance of patients (p<0.001, r= -0.26), social performance of patients (p= 0.001, r= -0.24), pain (p= 0.005, r= -0.2), emotional health of patients (p= 0.006, r= -0.29), energy / fatigue in patients (p<0.001, r= -0.29) and the patient''s general health (p<0.001, r= -0.27).
    Conclusion
    This study shows that upper extremity impairment due to occupational injuries has an inverse and significant association with various aspects of quality of life.
    Keywords: Quality of life, Upper extremity, Occupational injuries, Impairment
  • Masih Tajdini, Sona Akbarloo, Seyed Mohammadreza Hosseini, Banafsheh Parvizi, Somaye Baghani, Vajiheh Aghamollaii, Abbas Tafakhori Page 8
    Brucellosis is an infectious disease with high incidence in Iran. Neurobrucellosis is a focal complication of brucellosis affecting both central and peripheral nervous system presenting with a varieties of signs and symptoms. The most reported manifestations are meningitis and meningoencephalitis. In this report, we will describe a case of a young woman affected by neurobrucellosis presenting with chronic progressive headache and papilledema.
    Keywords: Brucellosis, Headache, Papilledema
  • Farid Najd Mazhar, Mohammad Taghi Ghazavi, Davod Jafari, Kaveh Gharanizadeh Page 9
    Habitual dislocation of the hip (HDH) in children is a rare entity and can be a causative factor for popping or snapping hip which is a common problem in children with good prognosis. We report a case of HDH in a 9 year old girl who was suffering from frequent snapping hip at night, its course and treatment process.
    Keywords: Dislocation, Hip, Child
  • Maryam Abolhasani, Mashaallah Babashahi, Tina Shooshtarizadeh, Mojgan Asgari, Hossein Shahrokh, Pejman Shadpour, Maryam Emami Page 10
    Spermatic cord liposarcomas are very rare tumors. Patients usually present with painless growing scrotal swellings which are clinically misdiagnosed as hernia. The correct diagnosis is not common and usually they present as operative or histological surprises. To our knowledge, there are about 186 similar cases reported in the literature. Herein we report three cases of spermatic cord liposarcoma with clinical presentation of scrotal bulging, mimicking inguinal hernia in one case and resembling a testicular tumor in the other two cases. The patients were operated and all of them underwent radical orchiectomy and tumor resection.
    Keywords: Spermatic cord, Liposarcoma, Hernia, Pathology
  • Shadi Ghourchian, Babak Zamani, Kosar Poorkosary, Seyed Kazem Malakouti, Mohammad Rohani Page 11
    Background
    Major depression is a common disorder with great social and individual burdens. Transcranial sonography (TCS) is a useful and noninvasive measure for assessment of normal and impaired brain parenchyma. The brainstem raphe nuclei are in close association with dorsocaudal limbic system and plays an important role in depression. In this study we compared the echogenicity of the raphe nuclei in patients with major depressive disorder and the control group.
    Methods
    Thirty patients suffering from depression, diagnosed by a psychiatrist, and 30 cases of similar age and sex were entered into the case and control groups respectively. Semi-structural clinical conversation was done according to the DSM IV-TR in order to confirm the depression by the psychiatrist member of the group. Echogenicity of the brainstem raphe nuclei was assessed by a trained neurologist using TCS. To compare the mean echogenicity between the two groups independent sample t-test was used. In order to assess the strength of association between the disease and the echogenicity, odds ratio was also calculated.
    Results
    The echogenicity of the brainstem raphe nuclei was significantly decreased in depressed patients (36.7%) in comparison with the control group (10%) (p= 0.015, OR= 5.21).
    Conclusion
    Echogenicity of the brainstem raphe nuclei in patients with depression is significantly lower than normal population. To confirm the results, we recommend a meta analysis considering previous articles'' results.
    Keywords: Major depressive disorder, Transcranial sonography (TCS), Raphe nuclei echogenicity
  • Narges Shafaroodi, Mohammad Kamali, Soroor Parvizy, Afsoon Hassani Mehraban, Giyn Otoole Page 12
    Background
    Clinical reasoning is generally defined as the numerous modes of thinking that guide clinical practice but little is known about the factors affecting how occupational therapists manage the decision-making process. The aim of this qualitative study was to explore the factors influencing the clinical reasoning of occupational therapists.
    Methods
    Twelve occupational therapy practitioners working in mental and physical dysfunction fields participated in this study. The sampling method was purposeful and interviews were continued until data saturation. All the interviews were recorded and transcribed. The data were analyzed through a qualitative content analysis method.
    Results
    There were three main themes. The first theme: socio-cultural conditions included three subthemes: 1- client beliefs; 2- therapist values and beliefs; 3- social attitude to disability. The second theme: individual attributions included two subthemes 1- client attributions; 2- therapist attributions. The final theme was the workplace environment with the three subthemes: 1- knowledge of the managers of rehabilitation services, 2- working in an inter-professional team; 3- limited clinical facilities and resources.
    Conclusion
    In this study, the influence of the attitudes and beliefs of client, therapist and society about illness, abilities and disabilities upon reasoning was different to previous studies. Understanding these factors, especially the socio-cultural beliefs basis can play a significant role in the quality of occupational therapy services. Accurate understanding of these influential factors requires more extensive qualitative and quantitative studies.
    Keywords: Occupational therapy, Decision, making, Qualitative research
  • Asghar Elmi, Ali Tabrizi, Alireza Rouhani, Fardin Mirzatolouei Page 13
    Background
    Malunion is the most common complication following distal radius fractures. Aim of this study was to evaluate the results of distal radius corrective osteotomy and plate fixation by dorsal approach in the malunion.
    Methods
    In this retrospective study, 14 patients with neglected distal radius malunion from 2005 to 2011 were studied. All patients were treated with an opening wedge osteotomy with a dorsal plate and cancellous bone grafting. Radiological and clinical measurements were performed pre and postoperatively. All patients were followed at least for two years.
    Results
    Fourteen patients with a mean age of 42.5±10.2 years including 2 females (14.2%) and 12 males (85.8%) were studied. Radiological healing was achieved in all osteotomies at a mean of 11.5 (range: 11 to 14) weeks. There were significant differences between wrist function and radiological findings before and after treatment. Following the operation, all patients were relieved of pain. There were not any complications.
    Conclusion
    Based on our findings, dorsal approach for osteotomy and plate insertion is an effective approach with good final results and no major complication for the treatment of distal radius malunion.
    Keywords: Osteotomy, Radius Fracture, Malunited fractures
  • Hamid Alizadeh, Behzad Bazgir, Farhad Daryanoosh, Maryam Koushki, Vahid Sobhani Page 14
    Background
    Exercise has positive and negative effects on immune system. Herein, we would like to investigate the effects of incremental aerobic training and fish oil supplementation on the plasma levels of CRP, CPK and IL-17 in trained mice. One of the major roles of immune system is to produce soluble or cellular components that provide the immunity against inflammatory agent. The purpose of this study is to investigate distinct and combine effects of incremental aerobic training and fish oil supplement on plasma levels of IL-17, CPK and CRP in trained male mice.
    Methods
    Totally, 54 healthy male mice (2 months old, weight= 34±1 grams) were selected. At first 10 mice were killed to determine base line values, the rest of them were randomly divided into four groups, control group (C, n=11), supplement group (S, n=11), training group (T, n=11) and supplement-training group (ST, n=11).The supplement and supplement-training groups were fed with 0.2cc/day fish oil for 8 weeks. Training and supplement-training groups underwent exercise for 5 sessions per week for a period of 8 weeks on animal treadmill. SPSS 16.0 software and multivariate analysis of variance were used for statistical analysis of data.
    Results
    Exercise and fish oil supplement lead to a decrease in CRP levels and subsequently causing a reduction in plasma levels of IL-17 and CK in mice (p<0.05).
    Conclusion
    Combination of exercise and fish oil can reduce regulate inflammatory response caused by incremental exercise.
    Keywords: Fish oil supplement, Inflammation, IL, 17, CRP, CPK
  • Zahra Jafari Page 15
    Background
    Team-based learning (TBL) is a structured type of cooperative learning that has growing application in medical education. This study compares levels of student learning and teaching satisfaction for a neurology course between conventional lecture and team-based learning.
    Methods
    The study incorporated 70 students aged 19 to 22 years at the school of rehabilitation. One half of the 16 sessions of the neurology course was taught by lectures and the second half with team-based learning. Teaching satisfaction for the teaching methods was determined on a scale with 5 options in response to 20 questions.
    Results
    Significant difference was found between lecture-based and team-based learning in final scores (p<0.001). Content validity index of the scale of student satisfaction was 94%, and external and internal consistencies of the scale were 0.954 and 0.921 orderly (p<0.001). The degree of satisfaction from TBL compared to the lecture method was 81.3%.
    Conclusion
    Results revealed more success and student satisfaction from team-based learning compared to conventional lectures in teaching neurology to undergraduate students. It seems that application of new teaching methods such as team-based learning could be effectively introduced to improve levels of education and student learning.
    Keywords: Lecture, Learning, Satisfaction
  • Seyed Ali Javad Mousavi, Seyed-Mohammad Fereshtehnejad, Neda Khalili, Malihe Naghavi, Hooman Yahyazadeh Page 16
    Background
    Asthma is a common condition in general medical practice, and it accounts for about 1% of all ambulatory hospital visits. Nowadays, hospitalization rates for asthma have actually been increased in some demographic subgroups despite recent advances in treatment. Understanding the underlying factors that contribute to hospitalization and especially duration of the hospitalization of asthmatics could help elucidate the recent rise in morbidity and also reduce the high demand on health care systems of the disease. The aim of this study was to evaluate factors affecting the duration of hospitalization for Iranian patients with asthma.
    Methods
    This study was conducted on 55 asthmatic patients (diagnosis of asthma was in accordance with the criteria of the American Thoracic Society). The study was performed on patients hospitalized in Rasoul-e-Akram hospital in Tehran, Iran during the period 2005-2006. During hospitalization, the patients’ most common complaints were recorded as the symptoms and signs of the medical condition, results of physical examinations, spirometry, arterial blood gas analysis (ABG), and ICU admission.
    Results
    There were 18(32.7%) male and 37(67.3%) female patients with a mean age of 54.96 (SD=17.54) years. The mean duration of hospitalization was 8.31(SD=4.69) days that ranged between 2 and 23 days. The mean baseline arterial PH (p=0.039, RPearso = -0.362), baseline arterial [HCO3] (p=0.042, RPearson = 0.361), changes of FEV1 after bronchodilator (p=0.041, RPearson= -0.363) and patient''s age (p=0.002, RPearson=0.0433) were determined as factors affecting duration of hospitalization.
    Conclusion
    Our results showed that more attention needs to be given to the findings of arterial blood gas and spirometry which can potentially affect the duration of hospitalization of asthmatic patients.
    Keywords: Asthma, Hospitalization, Length of Stay
  • Yasser Labbafinejad, Saber Mohammadi, Elham Mirzamohammadi, Mostafa Ghaffari, Mirsaeed Attarchi, Azadeh Amiri Page 17
    Background
    Organic solvents are known as a group of organic compounds, widely used in industry and to which many workers are exposed. Neurotoxicity is one of the most important complications of the chronic exposure to the solvents and may causes neurobehavioral disorders in workers. We have studied the frequency of neurobehavioral disorders in workers exposed to organic solvents in one of the publishing houses in Tehran.
    Methods
    In this cross-sectional study, 510 workers of a publishing house, having been employed at least a year before the research, were selected to be studied. Among them, 345 workers had been exposed to organic solvents and the other (165 workers) had not. Data were collected using a questionnaire. This questionnaire included demographic and occupational information, and the Swedish Q16 questionnaire. Variables included age, duration of employment, working shift, and smoking. Then we compared both groups in terms of neurobehavioral disorders, using statistical methods.
    Results
    The mean score of the Swedish Q16 questionnaire in the exposed group (4.8±4.4) was significantly higher than the non-exposed group (3.2±3.1) (p=0.001). According to the questionnaire score, the frequency of neurobehavioral disorders in the exposed group was 38% and in the non-exposed group was 22% (p=0.001). We estimated that the frequency of neurobehavioral disorders in the exposed group was significantly higher than the non-exposed group (p<0.05) using regression analysis and removal of the confounding factors.
    Conclusion
    This study shows that the frequency of the neurobehavioral disorders in the exposed group is significantly higher than the non-exposed group.
    Keywords: Neurobehavioral manifestations, Occupational exposure, Solvents
  • Kambiz Abachizadeh, Battol Tayefi, Abbas Ali Nasehi, Nadereh Memaryan, Maryam Rassouli, Soheila Omidnia, Leila Bagherzadeh Page 18
    Background
    Social health is considered as a significant dimension of health and, hence, its assessment is vital in health planning. Within this context, this study aimed to develop a valid and reliable scale for measuring individual’s social health in Iran. To do so, an exploratory sequential mixed method was used.
    Methods
    To establish the item pool and primary scale, 30 interviews with experts and other stakeholders, and a primary review of relevant literature and similar questionnaires were conducted. Then, a survey with 800 respondents from three cities in Iran was undertaken to assess the validity and reliability of the scale.
    Results
    In the qualitative stage of this study, after careful consideration, forty questions were remained for the next step. Considering the correlation of the score of each question with the total score of the questionnaire, seven questions were omitted. For this questionnaire with 33 remaining questions, Cronbach''s alpha for internal consistency was estimated to be 0.86. The reliability coefficient for 100 samples (taken after 7 to 10 days from the first round of sampling) was 0.91. Considering the factor analysis, three factors were recognized. These factors were named as “family”, “community” and “friends and relatives”. Cronbach''s Alpha for internal consistency of community, friends and relatives, and family factors were estimated to be 0.91, 0.77 and 0.78 respectively. The corresponding value of the reliability indicator, intraclass correlation coefficient (ICC), for community, friends and relatives, and family were calculated 0.69, 0.80 and 0.67 respectively.
    Conclusion
    We developed a measurable scale for social health at an individual level in the Iranian community with an acceptable level of validity and reliability. The new developed scale is able to provide an opportunity to measure Iranians’ social health at an individual level. Such an indicator of individual health can be used in evaluating the performance of social health policies and providing a platform for evidence-based policy-making in the social health context.
    Keywords: Social health, Iran, Scale development, Measure
  • Zahra Raoofi, Anahita Jalilian, Mansorah Shabani Zanjani, Seyedeh Paniz Parvar, Seyedeh Pegah Parvar Page 19
    Background
    To investigate thyroid function in preeclamptic patients in comparison with normal pregnant women.
    Methods
    In this analytical cross-sectional study free Thyroxine (T4), and Thyroid Stimulating Hormone (TSH) levels were measured in 100 preeclamptic patients and were compared with Free T4 and TSH levels in 101 normal pregnant women in their third trimester of pregnancy. Patients with thyroid or other systemic disorders were excluded from this study.
    Results
    A significant difference in concentration of free T4 levels (0.729 ±0.324 ng/ dl versus 0.929± 0.314 ng/dl, p <0.001) was observed in the preeclamptic group compared with the normotensive group, but the mean TSH level was not significantly different (2.935±1.16 mIU/L versus 2.339±1/15 mIU/L, p = 0.170).
    Conclusion
    Women who develop preeclampsia are more likely to have lower normal limits of thyroid function during their final weeks of pregnancy.
    Keywords: Thyroxin, Hypothyroidism, Preeclampsia, Thyroid stimulating hormone
  • Najmeh Haseli, Firooz Esmaeelzadeh, Fariba Fariba Ghahramani, Yousef Alimohamadi, Ramin Hayati, Mohammad Mahboubi Page 20
    Background
    HIV/AIDS is known to affect an individual not only physically but also mentally, socially, and financially. It is a syndrome that builds a vacuum in a person affecting his/her life as a whole. Nowadays, using anti-viral medication delays the onset of the disease cycle and increases the patients’ life time. From the psychological point of view, however, such patients are faced with a great number of social and cultural limitations which affect various dimensions of their health as well as quality of life. Therefore, the present study aimed to investigate the quality of life and its related factors in HIV patients in Shiraz Behavioral Counseling Center.
    Methods
    The present analytical cross-sectional study was conducted on 129 HIV patients in Shiraz Behavioral Counseling Center who were selected through convenience sampling. The data were gathered using demographic as well as SF-36 questionnaires and analyzed through T-test, ANOVA, X2, and Schiff''s post hoc test.
    Results
    In this study, the patients’ mean score of quality of life was 48.8+14. In addition, the mean scores of males’ and females’ life quality were 47.7+16.2 and 59.5+20.4, respectively and the difference was statistically significant (p<0.05). The mean difference of the patients’ quality of life was also found to be significant based on employment status, marital status, and history of drug abuse (p<0.05), while it was not significant regarding age, level of education, length of disease, and the distance between the house and the service providing center.
    Conclusion
    In comparison to the physical dimension, the HIV-positive individuals’ quality of life mean score was lower in the mental dimension. In addition, the mean difference revealed to be significant based on marital as well as employment status. These findings show such patients’ needs for psychological support, more psychological interventions, and creation of appropriate job opportunities.
    Keywords: HIV, AIDS, Quality of life, SF, 36, Behavioral counseling center
  • Shahnaz Miri, Esmaeil Ghoreyshi, Gholam Ali Shahidi, Mansour Parvaresh, Mohammad Rohani *, Mehdi Saffari Page 21
    Background
    Deep brain stimulation (DBS) of the globuspallidusinternus (GPi) is recommended as a promising technique for the management of the primary generalized dystonia (PGD) with DYT1 gene mutation. We present the first report of DBS results in Iranian patients with DYT1 positive PGD.
    Methods
    Nine patients who suffered from severely disabling DYT1 positive PGD consecutively were recruited for the study between 2008 and 2010. The patients underwent bilateral deep brain stimulation of the GPi in a single procedure. The mean follow up duration was 8.8 ± 2.2 months. The efficacy of the intervention was evaluated by comparing pre- and post operative scores of patients with Burke-Fahn-Marsden''s dystonia Scale (BFMDS). Statistical analysis was performed using SPSS 11.0 software.
    Results
    Of 9 patients six were female with the mean age of 15.2 ± 5.5 years old (range: 8- 25 years old). The mean for Burke-Fahn-Marsden''s Dystonia Rating Scale (BFMDRS) score was 47.22 ± 14.1 before surgery and 12.3 ± 8.2 after follow up, which significantly improved (P=0.0001).The mean stimulation parameters at the last visit were at a frequency of 152.2 ± 32.4 Hz (range 130- 230 Hz), a voltage of 2.6 ± 0.7 V (range 1.1- 4), and a pulse width of 60 μsec. No complication was observed during follow up.
    Conclusion
    Bilateral DBS of the GPi has an encouraging result for the management of DYT1 positive PGD and is recommended as a safe technique for the treatment of these patients. Shorter pulse width in stimulation parameters is suggested for DYT1 dystonia patients.
    Keywords: Deep brain stimulation, Globus pallidusinternus, DYT1 dystonia
  • Ali Ahmadi, Seyed Saeed Hashemi Nazari, Mahmoud Mobasheri Page 22
    Background
    The present study compared the differences between survivals of patients with colorectal cancer according to their ethnicity adjusted for other predictors of survival.
    Methods
    In this prospective cohort study patients were followed up from definite diagnosis of colorectal cancer to death. Totally, 2431 person-year follow-ups were undertaken for 1127 colorectal cancer patients once every six months. The data were analyzed by stata software using bivariate analysis, multivariate analysis, and Cox regression.
    Results
    The age at diagnosis was significantly different between men and women (p<0.03). 61.2% were male and the rest were female. Most patients were Fars (51.2%), followed by Turciks (21.5%), Kurds (8.2%), and 7.5% Lurs. Of the patients, 75% had a survival of more than 2.72 years, 50% a survival of 5.83 years, and 25% longer than 13.1 years after diagnosis. Risk ratio was significantly different among ethnics (p<0.05). The variables of ethnicity, being non married, tumor grade, family history of cancer, and smoking were considered as determinants of the patients’ survival in Cox regression model. The median survival time in Fars, Kurds, Lurs, Turks and other ethnics was 5.83, 2.44, 5.49, and 8.52 years, respectively.
    Conclusion
    Ethnicity and access to healthcare are predictors of survival of patients with colorectal cancer which may define priorities in controlling cancer and implementing interventional and prevention plans.
    Keywords: Colorectal cancer, Disparity, Ethnicity, Mortality, Survival time
  • Alireza Jalili, Farid Najd Mazhar Page 23
    Radial polydactyly, the most common digital duplication in Asian and white populations, has a wide range of manifestations. Its classification is useful for planning and assessing surgical treatment. Our patient had four thumbs, duplicated radial carpal bones, and a bifurcated radius. This presentation is not covered by any of the current classifications. To the best of our knowledge, this is the first case of such characteristics reported to date. Consequently, we propose some modifications in the nomenclature and classification of radial polydactyly.
    Keywords: Radial polydactyly, Triphalangeal thumb, Tetraplication of the thumb
  • Haidar Nadrian, Saharnaz Nedjat, Mohammad Hossein Taghdisi, Davoud Shojaeizadeh Page 24
    Background
    Traffic and transport is a substantial part of a range of economic, social and environmental factors distinguished to have impact on human health. This paper is a report on a preliminary section of a Health Impact Assessment (HIA) on urban traffic and transport initiatives, being conducted in Sanandaj, Iran. In this preliminary study, the psychometric properties of Urban Traffic related Determinants of Health Questionnaire (UTDHQ) were investigated.
    Methods
    Multistage cluster sampling was employed to recruit 476 key informants in Sanandaj from April to June 2013 to participate in the study. The development of UTDHQ began with a comprehensive review of the literature. Then face, content and construct validity as well as reliability were determined.
    Results
    Exploratory Factor Analysis showed optimal reduced solution including 40 items and 8 factors. Three of the factors identified were Physical Environment, Social Environment, Public Services Delivery and Accessibility. UTDHQ demonstrated an appropriate validity, reliability, functionality and simplicity.
    Conclusion
    Despite the need for further studies on UTDHQ, this study showed that it can be a practical and useful tool for conducting HIAs in order to inform decision makers and stakeholders about the health influences of their decisions and measures.
    Keywords: Urban traffic, Health Impact Assessment, Social Determinants of Health, Factor Analysis, Questionnaire, Psychometric Properties
  • Faranak Aliabadi, Mohammad Kamali, Leili Borimnejad, Mehdi Rassafiani, Mehdi Rasti, Narges Shafaroodi, Foroogh Rafii, Reihaneh Askari Kachoosangi Page 25
    Background
    This study aimed to understand the confront strategies of parents of premature infants hospitalized in NICU.
    Methods
    This study was performed using qualitative content analysis approach. Twelve participants including nine parents whose infants were hospitalized in NICU, two nurses and one physician, all selected by purposive sampling method were interviewed by a female expert occupational therapist. Data were gathered by semi-structured interviews. Data were analyzed by inductive content analysis approach.
    Results
    One category, six subcategories and twenty one themes emerged from data analysis expressed confront strategies of parents of premature infants admitted in NICU. These categories were: taking assurance, stop thinking to bad things, diverting mind, taking supports, emotional expression, complaining from staff.
    Conclusion
    Premature infant''s parents announced that they do not receive adequate formal support to manage their feelings and needs. So, they seek for other informal resources of support and apply some special strategies including self-support.
    Keywords: Strategies, Parents, Premature Infants, Content Analysis, Descriptive
  • Azar Moezy *, Saeed Sepehrifar, Masoud Solaymani Dodaran Page 26
    Background
    Dysfunction in the kinetic chain caused by poor scapula stabilization can contribute to shoulder injuries and Shoulder Impingement Syndrome (SIS). The purpose of this study was to compare the effectiveness of two treatment approaches scapular stabilization based exercise therapy and physical therapy in patients with SIS.
    Methods
    The study is a randomized clinical trial in which 68 patients with SIS were randomly assigned in two groups of exercise therapy (ET) and physical therapy (PT) and received 18 sessions of treatment. Pain, shoulders'' range of abduction and external rotation, shoulder protraction, scapular rotation and symmetry as well as postural assessment and Pectoralis minor length were evaluated pre and post intervention. The paired-sample t test and the independent sample t test were applied respectively to determine the differences in each group and between two groups.
    Results
    Our findings indicated significant differences in abduction and external rotation range, improvement of forward shoulder translation and increase in the flexibility of the involved shoulder between the two groups (respectively; p=0.024, p=0.001, p<0/0001, p<0/0001). No significant difference was detected in pain reduction between the groups (p=0.576). Protraction of the shoulder (p<0.0001), forward head posture (p<0/0001) and mid thoracic curvature (p<0.0001) revealed a significant improvement in the ET group. Apparent changes occurred in scapular rotation and symmetry in both groups but no significant differences were observed between the two groups (respectively; p=0.183, p=0.578).
    Conclusion
    The scapular stabilization based exercise intervention was successful in increasing shoulder range, decreasing forward head and shoulder postures and Pectoralis minor flexibility.
    Keywords: Shoulder Impingement Syndromes, Posture, Exercise Therapy, Physical Therapy
  • Yaser Mokhayeri, Mahmood Mahmoudi, Ali Akbar Haghdoost, Hassan Amini, Mohsen Asadi-Lari, Kourosh Holakouie Naieni* Page 27
    Background
    There is substantial lack of knowledge about the role of socioeconomic status (SES) indicators on life expectancy (LE) within-cities, especially within mega-cities. We aimed to investigate the disparities of LE within city districts of Tehran, Iran, and specify how SES inequalities play role on LE.
    Methods
    The death and population data for 2010 by different age, gender, and residency district were obtained from the main cemetery of Tehran and statistical centre of Iran, respectively. Age-specific mortality rates and consequently LE were calculated for all 22 districts by different genders. Finally, based on the results of first Tehran''s Urban Health Equity Assessment and Response Tool (Urban HEART) project in 2008, the influence of social classes (SCs), total costs, and education indicators were analyzed on LE at birth (e0).
    Results
    The e0 for total males and females in Tehran were calculated as 74.6 and 78.4 years for 2010, respectively. The maximum LE of 80 years was observed in females of northern part with higher SES, and the minimum e0 of 72.7 years observed in males of southern part with lower SES. The e0 gender gap among districts was 5.5 years for females and 3.7 years for males. The highest and lowest mean of e0 observed in SC1 (highest class) and SC5 (lowest class), were 77.6 and 76.0 years, respectively. The lowest mean of e0 observed in the first group of total costs indicator and was 76.2 years. In addition, the lowest observed mean of e0 was in the first category of education indicator (illiterate) and was 76.0 years.
    Conclusion
    Results indicate substantial disparities in LE within city districts. This confirms that SES disparities within-cities would have direct influences on LE.
    Keywords: Disparities, Education level, Expenditure, Inequality, Iran, Life expectancy, Longevity, Social class, Socioeconomic situation (SES), Tehran, Urban HEART, Within, city health metrics
  • Pedram Golnari, Faezeh Sodagari, Hamid Reza Baradaran Page 28
    Background
    Research in medical education has been paid more attention than before; however the quality of research reporting has not been comprehensively appraised.To evaluate the methodological and reporting quality of Iranian published medical education articles.
    Methods
    Articles describing medical students, residents, fellows or program evaluation were included. Articles related to continuing medical education or faculty development, review articles and reports, and studies considering both medical and nonmedical students were excluded. We searched MEDLINE through PubMed in addition to major Iranian medical education search engines and databases including Scientific Information Database (SID) from March 2003 to March 2008. The Medical Education Research Quality Index (MERSQI) scale and the Consolidated Standards of Reporting Trials (CONSORT 2001) were used for experimental studies and the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) was utilized for observational studies.
    Results
    Ninety five articles were found to be related to the medical education research in Iran including 16 (16.8%) experimental studies. Total MERSQI scores ranged between 3.82 and 13.09 with the mean of 8.39 points. Mean domain scores were highest for data analysis (1.85) and lowest for validity (0.61). The most frequently reported item was background (96%) and the least reported was the study limitations (16%).
    Conclusion
    The quality of published medical education research in Iran seems to be suboptimal.
    Keywords: Systematic review, Medical education, Iran
  • Nahid Shahbazian, Taghi Razi, Shima Razi, Leila Yazdanpanah* Page 29
    Background
    Gestational trophoblastic neoplasia (GTN) refers to malignant lesions that arise from abnormal proliferation of placental trophoblast. Even in its metastatic forms GTN is curable with a cure rate of 90-100 %. Currently، methotrexate with or without folic acid، andactinomycin D is recommended for low risk GTN. The aim of this study is to compare the efficacy of methotrexate and actinomycin D as the first-line single chemotherapeutic agents for women with low-risk gestational trophoblastic neoplasia (LR-GTN).
    Methods
    A total of 30 women with LR-GTN were randomized to receive a weekly pulsed dose of 40 mg/m (2) of methotrexate intramuscularly (n=15) or a pulsed intravenous bolus of 1. 25 mg/m (2) of actinomycin D every 2 weeks (n=15). An additional cycle was administered as consolidation treatment following normalization of the serum level of beta-human chorionic gonadotropin (˂10 IU/L).
    Results
    Complete remission was achieved in 53. 3% of patients in the methotrexate group and 86. 7% in the actinomycin D group (p˂0. 04). The mean number of treatment cycles needed to achieve response was lower in the actinomycin D group (4. 3 vs. 6. 5). The mean duration from beginning of treatment till achieving complete remission was 9. 6 weeks for the Act group and 13 weeks for the MTX group.
    Conclusion
    Actinomycin D may be a better option than methotrexate as a first-line chemotherapy agent for patients with LR-GTN but larger multicenter randomized controlled trials should be conducted to establish the most appropriate regimen for these patients.
    Keywords: Actinomycin D, Methotrexate, Gestational Trophoblastic Disease (GTD)
  • Azar Darvishpour*, Soodabeh Joolaee, Mohammad Ali Cheraghi Page 30
    Background
    Prescribing represents a new aspect of practice for nurses. To make qualitative results more accessible to clinicians, researchers, and policy makers, individuals are urged to synthesize findings from related studies. Therefore this study aimed to aggregate and interpret existing literature review and systematic studies to obtain new insights on nurse prescription.
    Methods
    This was a qualitative meta synthesis study using Walsh and Downe process. In order to obtain data all Digital National Library of Medicine''s databases, search engines and several related sites were used. Full texts with «review and nurs* prescri*» words in the title or abstract in English language and published without any time limitation were considered. After eliminating duplicate and irrelevant studies, 11 texts were selected. Data analysis was conducted using qualitative content analysis. Multiple codes were compared based on the differences and similarities and divided to the categories and themes.
    Results
    The results from the meta synthesis of the 11 studies revealed 8 themes namely: leading countries in prescribing, views, features, infrastructures, benefits, disadvantages, facilitators and barriers of nursing prescription that are discussed in this article. The results led to a schematic model.
    Conclusion
    Despite the positive view on nurse prescribing, there are still issues such as legal, administrative, weak research and educational deficiencies in academic preparation of nurses that needs more effort in these areas and requires further research.
    Keywords: Nurse prescribing, Meta, synthesis, Review
  • Afshin Shafaghi, Fariborz Mansour-Ghanaei, Maryam Rostamnejad, Alireza Amir Maafi *, Asghar Haji-Abbasi, Hossein Froutan Page 31
    Background
    Ulcerative colitis an inflammatory bowel disease (IBD) and chronically idiopathic immune related that associates with extraintestinal manifestations such as arthritis. Despite of the highly specificity ofanti-cyclic citrullinated peptide (CCP) antibodies for rheumatoid arthritis, their role in IBD remains unclear. There are only a few studies on the prevalence of anti-CCP antibodies in patients with IBD.This study aimed to assess the prevalence of anti- CCP antibodies in ulcerative colitis and to investigate possible associations with their clinical and laboratory characteristics.
    Methods
    In this cross-sectional study, 93 consecutive patients with ulcerative colitisreferred to gastroenterology clinics in Razi referral hospital of Rasht, Iran, from September 2010 to September 2011. Rheumatologic examination, demographic data and clinical presentation of patients were recorded on specially prepared data sheets. Blood sample was collected for assessment of anti-CCP and other laboratory tests. Data were analyzed by the Chi square test, Fisher Exact test and student t test, using the SPSS 20 software for Windows, and P value less than 0.05 was considered significant.
    Results
    Of 93 patients, anti-CCP antibodies detected in 10.8% of cases (CI 95%: 4.5-17.1%). There were a significant relation between the prevalence of anti CCP positivity and aphthous ulcers and ocular manifestations whereas other parameters were not significantly related.
    Conclusion
    Anti CCP may have a possible role in some ulcerative colitis manifestations but there was no association between the presence of these antibodies and activity or extension of inflammatory colitis. We suggest other studies especially molecular studies to investigate other aspects of these antibodies in IBD patients.
    Keywords: Anti, CCP, Inflammatory bowel disease, Ulcerative colitis, Extra, intestinal manifestation
  • Zahra Eshaghi, Zahra Jafari *, Abdolreza Shaibanizadeh, Shohreh Jalaie, Azizeh Ghaseminejad Page 32
    Background
    Preterm birth is a significant global health problem with serious short- and long-term consequences. This study examined the long term effects of preterm birth on vestibular evoked myogenic potentials (VEMPs) among preschool-aged children.
    Methods
    Thirty-one children with preterm and 20 children with term birth histories aged 5.5 to 6.5 years were studied. Each child underwent VEMPs testing using a 500 Hz tone-burst stimulus with a 95 dB nHL (normal hearing level) intensity level.
    Results
    The mean peak latencies of the p13 and n23 waves in the very preterm group were significantly longer than for the full-term group (p≤ 0.041). There was a significant difference between very and mildly preterm children in the latency of peak p13 (p= 0.003). No significant differences existed between groups for p13-n23 amplitude and the interaural amplitude difference ratio. The tested ear and gender did not affect the results of the test.
    Conclusion
    Prolonged VEMPs in very preterm children may reflect neurodevelopmental impairment and incomplete maturity of the vestibulospinal tract (sacculocollic reflex pathway), especially myelination. VEMPs is a non-invasive technique for investigating the vestibular function in young children, and considered to be an appropriate tool for evaluating vestibular impairments at the low brainstem level. It can be used in follow-ups of the long-term effects of preterm birth on the vestibular system.
    Keywords: Vestibular evoked myogenic potential, Vestibulospinal tract, Sacculocollic reflex, Preterm birth, Term birth
  • Afsun Nodehi-Moghadam*, Morteza Taghipour, Razie Goghatin Alibazi, Hamzeh Baharlouei Page 33
    Background
    Falls have been strongly associated with decreased physical activity and impaired mobility. Reduced range of motion, as a consequence of muscle stiffness, has been indicated to assume a positive relationship to fall incidence. Also clinical observations suggest that maintaining the normal spinal curves is associated with the prevention of spinal, knee and hip disorders. Thus, the aim of this study was to compare hip and ankle range of motions and thoracic and lumbar curves between young and old persons
    Methods
    Using a nonprobability sampling 30 elderly persons at average of 68.14 ±4.03 years of age and 30 young people (age 23.37 ± 2.31 years) through a case – control design participated in the study. Maximal hip extension and ankle dorsiflexion range of motions were measured by a standard goniometer. Thoracic and lumbar curvatures were measured by a flexible ruler in both groups. Independent t test were used to statistically analyze differences between groups.
    Results
    Compared with the young group, the elderly group had decreased hip extension and ankle dorsiflexion motions (p<0.01). The result of independent t test showed that the mean of lumbar curve was higher in young group (31.29± 6.37)than elderly subjects (27.93±8.11), however, no significant difference was found between two groups(p=0.08). The result also showed increasing thoracic curvature with aging (young group=34.43±13.27, old group= 36.19±8.97), however, no significant difference was found between two groups(p=0.55).
    Conclusion
    Findings suggest decreased ankle and hip joint range of motions should be considered in rehabilitation of elderly people.
    Keywords: Elderly, Muscle length, Rehabilitation, Spinal curves
  • Atefeh Ghanbari Jolfaei, Alena Makvandi, Abdolreza Pazouki Page 34
    Background
    Sleep disturbances have negative effects on medical conditions, mental health and cognitive performance. It was shown that about 60% of inpatients suffer from sleep problems. The aim of this study was to assess the correlation between sleep quality and other factors in the inpatients of Rasoul-e-Akram hospital.
    Methods
    In this cross-sectional study, all the hospitalized patients in twelve wards of Rasoul-e-Akram hospital during September 2012, were examined. Sleeping habits of 209 inpatients of different wards were assessed through the Persian version of Pittsburgh Sleep Questionnaire (PSQI). A self-designed 18- question questionnaire was conducted for all patients in order to assess their attitude to interior and atmosphere of wards. Content validityand test retest reliability were evaluated. The pain level was also measured by the visual analog scale (VAS) and scores analyzed by the statistical methods of frequency, percentage, chi-square and logistic regression.
    Results
    The mean of the total scores in PSQI was 8.8 ±4.8 and 70.8% of the patients were ''poor sleepers''(global PSQI>5). Age and gender had no effect on the PSQI total score, but the number of roommates, type of the ward, hospitalization period, presence and severity of pain, taking sleep medication and attitude toward the overall atmosphere and interior of wards have caused deviation in scores.
    Conclusion
    Sleep problems are quite frequent in medical inpatients. Pain management and modification of the ward interior and atmosphere can impact inpatients sleep quality.
    Keywords: Sleep quality, hospitalized patients, Pittsburgh Sleep Questionnaire
  • Mashaallah Kazemzadeh, Maryam Kashanian*, Bita Baha, Narges Sheikhansari Page 35
    Background
    Hyperemesis gravidarum (HEG) is one of the many problems during pregnancy; its etiology has not been clearly understood. Inflammatory factors like helicobacter pylori infection has been considered as a risk factor in some studies. The purpose of the present study is to find a relationship between Helicobacter Pylori (H.P) infection and hyperemesis gravidarum (HEG).
    Methods
    A case control study was performed on two groups of pregnant women who were in the first trimester of their pregnancies. Case group were pregnant women with hyperemesis gravidarum and control group were pregnant women with the same gestational age but without hyperemesis gravidarum. In both groups, IgG for H.P was measured and compared between the 2 groups.
    Results
    Totally, 175 pregnant women were evaluated; 78 women with HEG and 97 without. Both groups had no statistically significant difference according to age, gestational age, gravidity, and body mass index (BMI). 51 women out of 78 (65.4%) in HEG group and 43 women (44.3%) in the control group were IgG positive for HP, which showed a significant difference (p=0.005); OR= 2.37, CI 95%= 1.28-4.38. Also, mean serum level of IgG was higher in the HEG group (42.1 ± 3.75 VS 32.6 ± 3.65, p= 0.05). Between the different variables of age, gestational age, gravidity and HP infection, only HP infection was found as a risk factor for HEG using logistic regression model (p=0.011); OR= 2.522, CI 95%= 1.23-5.14.
    Conclusion
    HP infection is higher in HEG cases and may be considered as its risk factor.
    Keywords: Pregnancy, Hyperemesis gravidarum, Helicobacter pylori
  • Jamshid Ayatollahi *, Ali Fattahi Bafghi, Seyed Hossein Shahcheraghi Page 36
    Cutaneous Leishmaniasis may present with clinical presentation such as zosteriform, sporotrichoid and erysipeloid. The eczema variant has rarely been reported. We report a 27- year- old patient with atypical cutaneous leishmaniasis resembling eczema on the hand of a man in Yazd province in the central of Iran.
    Keywords: Cutaneous Leishmaniasis, Eczema, Iran
  • Vitorino Modesto Dos Santos *, Nayanne Lays Dos Santos Pereira, Renata Faria Silva, Fabio Henrique De Oliveira Silva, Cacilda Joyce Ferreira Da Silva Garcia, Maria Aparecida Alves De Figueiredo Sousa Page 37
    Dowling-Degos disease is a rare sporadic or autosomal dominant pigmentary entity, in which clusters of papules and reticulate macules slowly develop with predominance in flexural regions. This entity is due to mutations in the keratin 5 gene, and is related with other cutaneous disorders. We report the sporadic form of Dowling-Degos disease in an elderly man with multiple seborrheickeratosis in a “Christmas tree” pattern.Worthy of note in this case study is the lesions evolved for over than 30 years. The aim is to describe the association of these keratoses with Dowling-Degos disease in a healthy man.
    Keywords: Dowling, Degos disease, Reticular pigment anomaly of flexures, Seborrheic keratosis
  • Mehrdad Solati, Elham Ouspid, Saeedeh Hosseini, Nepton Soltani *, Mansoor Keshavarz, Mohsen Dehghani Page 38
    Background
    Magnesium is the second most abundant intracellular cation. It plays an important role in insulin homeostasis and glucose metabolism through multiple enzymatic reactions. With increasing data on magnesium deficiency in diabetic patients and epidemiological studies demonstrating magnesium deficiency as a risk factor for diabetes, it is logical to search for its possible beneficial effects on diabetes control and prevention. We aimed to determine whether oral magnesium supplementation improves metabolic control, lipid profile and blood pressure in patients with type II diabetes.
    Methods
    Fifty four patients with type II diabetes were included in a randomized double blind placebo-controlled clinical trial.Patients received either placebo or 300 mg elemental magnesium (as magnesium sulfate -MgSo4-) daily, for 3 months. Metabolic control, lipid profile, blood pressure, magnesium status, hepatic enzymes, hemoglobin concentration, and anthropometric indices were determined in the beginning and at the end of the study.
    Results
    Daily administration of 300 mg elemental magnesium for 3 months, significantly improved fasting blood glucose (183.9±15.43 to 125.8±6.52 vs. 196.5±28.12 to 136.5±7.94, p< 0.0001), 2-hour post prandial glucose (239.1±74.75 to 189.1±60 mg/dl vs. 246.4±97.37 to 247.8±86.74 mg/dl, p< 0.01), lipid profile, blood pressure and hepatic enzymes.
    Conclusion
    Oral magnesium supplementation with proper dosage has beneficial effects on blood glucose, lipid profile, and blood pressure in patients with type II diabetes.
    Keywords: Magnesium, Diabetes, Blood glucose, Lipid profile, Blood pressure
  • Behzad Foroutan*, Reza Foroutan Page 39
    Background
    The use of antibiotic prior to surgery is widely accepted. The WHO has recommended the use of ATC/DDD (Anatomical Therapeutic Chemical / Defined Daily Dose) for the analysis of drug utilization.The aims of the present study are 1) to analyze the assessment of prophylactic antibiotic usage prior to surgery, 2) to assess the drug administration based on antibiograms and 3) to compare the results with the national and international standards.
    Methods
    The present study used ATC/DDD, in a retrospective manner. Cefazolin, ceftazidime, gentamicin, ciprofloxacin, metronidazole, vancomycin, imipenem and penicillin G from 21st March to 21st June 2011 were analyzed in a hospital. Out of 516 medical records, 384 patients had received prophylactic antibiotics.
    Results
    In comparison, the orthopaedic ward had used more antibiotics. The results showed that antibiotics were not selected based on the antibiogram antibiotic programs. Patients in the age range of 20-30 years were the most recipients of the antibiotics. Men had received more antibiotic in comparison with women. About 75% (384 out of 516) of patients in the study received antibiotics as prophylaxis. Cefazolin was the most frequently prescribed antibiotic.
    Conclusion
    Our findings showed differences in comparison with national and international studies, but insignificant differences. Data on in-hospital antibiotic usage are varying widely not only due to different antibiotic policies but also due to different methods of mesurement. These differences make the comparison difficult.
    Keywords: Antibiotic prophylaxis, Elective surgery, Hospital
  • Mehdi Nasr Esfahani *, Mojgan Behzadipour, Amirhossein Jalali Nadoushan, Seyed Vahid Shariat Page 40
    Background
    Studies have shown a gradual decline in empathy of medical trainees with increasing years of education. Methods to augment empathy show some promise, but the most effective methods are both expensive and time consuming.To assess effectiveness of communication skills training program as a distant learning method in improving empathy. Method s: Fourteen first year residents of psychiatry were randomly allocated to either participate in a two day workshop on communications skills (attending group) or to watch the videotape of the first day and participate in the second day (distance learning group). Assessments included Jefferson Scale of Empathy (JSE) and objective assessment of empathy (OAE) during a simulated interview, before and 3 months after the training.
    Results
    The empathy was significantly increased in the attending group as measured by OAE. The score of JSE also increased in the attending group but did not reach a significance level. No increase in empathy was seen in the distance learning group.
    Conclusion
    Watching the videotape of the workshop is not effective in improving empathy of residents. More interactive methods should be sought if we plan to use distance learning methods in enhancement of empathy.
    Keywords: empathy, medical education, medical student
  • Peymaneh Alizadeh Taheri, Mandana Sadeghi, Negar Sajjadian* Page 41
    Background
    Severe neonatal hyperbilirubinemia is associated with significant morbidity and mortality. This study was conducted to investigate the causes of severe hyperbilirubinemia leading to Exchange Transfusion (ET) from March 2009 to March 2011 in Bahrami children hospital, Tehran, Iran in order to establish guidelines to prevent profound jaundice & ET.
    Methods
    94 neonates underwent ET for severe hyperbilirubinemia data for demographic data, and onset of jaundice, history of severe hyperbilirubinemia in siblings, blood group of both mother and neonate, G6PD activity, hemoglobin, hematocrite, reticulocyte count, peripheral blood smear, total and direct bilirubin before and after ET, direct and indirect Coombs, times of transfusion and the cause of hyperbilirubinemiawere all recorded for analysis.
    Results
    Ninety four neonates (56.4% boys and 43.6% girls) underwent ET with a mean birth weight of 1950±40 g and a mean gestational age of 35.2±1.4 weeks. Premature labor, breastfeeding jaundice, ABO incompatibility and G6PDD with the frequency of 59(63%), 33(35%), 25(24/5%) and 12(12.8%) were of major causes of ET.
    Conclusions
    Predisposing factors for severe hyperbilirubinemia in this study were premature labor, breastfeeding jaundice, ABO incompatibility and G6PDD. The authors recommend prevention of premature labor, reevaluation of successful breastfeeding education for mothers and screening infants for blood group and G6PD In the first of life. Arranging earlier and continuous visits in neonates with these risk factors during the first four days of life is also recommended.
    Keywords: Severe hyperbilirubinemia, Neonatal jaundice, Exchange transfusion
  • Mohammad-Reza Sohrabi*, Mohammad Rahmati-Roodsari, Saeid-Reza Rahmdar Page 42
    Background
    This study aimed to assess the effect of new package of interventions on scientific productions rate in ShahidBeheshti University of Medical Sciences.
    Methods
    Through a health system research, we extracted policies from the strategic plan of the university and 10 interventions were developed to increase the scientific productions in terms of quality, quantity and commercialization and to develop infrastructure for research in health service provision and education. For evaluating the effectiveness of interventions, citation and publication indicators for individuals and schools were analyzed using descriptive statistics and t-test. They were extracted from Scopus and ISI web of knowledge during period of 1/1/2009 to 30/5/2012.
    Results
    There was an increasing trend in scientific productions from 2009 to mid-2012. We found 60 percent of total scientific productions of the university were published during last 3.5 years. During this 3.5 years, 10 more percentile of faculty members involved in research. Schools of pharmacy, Medicine and Health had the highest scientific products. Mean for h-index was 1.5 (SD=2.49) in ISI and 1.9 (SD=2.89) in Scopus database (p< 0.001).
    Conclusion
    Effective policies and interventions lead to 46% increase in scientific productions from 2009 to 2010 and 56% increase from 2010 to 2011.
  • Seyed Mohammad Seyedmehdi, Mohammad Reza Masjedi, Faezeh Dehghan, Rahim Roozbahani, Zargham Sadeghi, Baharak Bahadori, Mirsaeed Attarchi* Page 43
    Background
    Asthma is the most common respiratory disease with an increasing prevalence. On the other hand, obesity is also a challenging disease compromising health in human communities. This study sought to assess the correlation of asthma and body mass index (BMI) in occupational setting.
    Methods
    This study was conducted in a cable manufacturing company in 2012. A total of 551 workers from the production (exposed group) and non-production (unexposed group) units were studied. A questionnaire specifically designed for this purpose was filled out for study subjects and then all workers with respiratory symptoms suggestive of asthma thoroughly examined by a physician and medical history was taken from them. Complementary diagnostic tests were also carried out.
    Results
    A total of 11.6% of our understudy subjects had asthma. The prevalence of asthma in exposed subjects with BMI ³ 25 kg/m2 was found to be significantly higher than in exposed workers with BMI< 25 kg/m2 (p< 0.01). However, no significant differences existed in prevalence of asthma between the two subgroups of BMI ³ 25 kg/m2 and BMI< 25 kg/m2in the unexposed group (p>0.05). After adjusting for confounding factors significant associations were observed between BMI and asthma at cut points of 30 kg/m2 and 25 kg/m2 (OR: 8.53 and 2.41, respectively).
    Conclusion
    Our study results showed that prevalence of asthma might be higher in workers with higher BMI who are exposed to occupational asthmogens. This finding highlights the necessity of offering weight loss recommendations in periodic examinations to workers with exposure to occupational asthmogens.
    Keywords: Asthma, BMI, Occupational exposure
  • Saeed Abbasi, Davood Farsi, Maryam Bahrani, Saeed Davari, Elham Pishbin, Nahid Kianmehr, Mahdi Rezai, Reza Yazdanpanah, Mani Mofidi* Page 44
  • Jalil Koohpayehzadeh, Akram Hashemi, Kamran Soltani Arabshahi, Shoaleh Bigdeli, Maryam Moosavi *, Kamran Hatami, Hamid Reza Baradaran Page 45
    Background
    If an institute is looking for improvement of its learning environment, a reliable and valid assessment tool is needed for measurement of the educational environment. The Dundee Ready Educational Environment Measure (DREEM) has been used in various studies to evaluate the educational environment. However, psychometric evaluations of the instrument seem necessary, for all known versions of the instrument.The aim of this study was to investigate the reliability and validity of Persian version of the DREEM in the major clinical wards in teaching hospitals affiliated to Iran University of Medical Sciences.
    Methods
    This descriptive - analytical study, involved medical students (clinical stagers and interns) in 4 major clinical wards. In this study, DREEM questionnaire was reviewed in content, face validity and construct validity through confirmatory factor analysis. The reliability was calculated according to test - retest and the internal consistency was measured using Cronbach''s alpha coefficient.
    Results
    A total number of 267 questionnaires were completed by medical stagers (60%) and interns (40%) including 181 females and 82 males. The mean age of stagers and interns were 23.60 ± 1.27 and 25.45 ± 1.22 years, respectively. The total mean of the questionnaire was calculated as 96.15 (93.5375, 98.7547) out of 176, with 95% confidence interval. The face validity of the questionnaire was confirmed. The mean of content validity ratio (CVR) was calculated as 0.35, and 6 questions were omitted in this step. The content validity index (CVI) was 0.39. The reliability coefficient mean was 0.71. In confirmatory factor analysis five factors were confirmed that changed the orientation of some questions. The Cronbach''s alpha coefficient of the whole questionnaire was obtained as 0.914.
    Conclusion
    The modified and validates DREEM questionnaire in Persian language with 44 items and appropriate psychometric attributes is capable of being used in assessment of clinical education environments in Iran.
    Keywords: Validity, Reliability, DREEM, Educational environment
  • Mohammad Reza Dayer*, Maysam Mard-Soltani, Mohammad Saaid Dayer, Sayed Mohammad Reza Alavi Page 46
    Background
    Type 2 diabetic mellitus patients are amongst the most susceptible groups to vascular abnormalities, which predominantly lead to myocardial disease. The hypercoagulable state has been widely studied by researchers as being the major suspicious mechanism facilitating the consecutive chain of molecular events leading to these complications. However, there is no consensus on the definition of the hypercoagulable state with respect to coagulation quantities, their interrelations and basic factor(s) initiating this pathogenic event, by which the prognosis of myocardial complications could be determined.
    Methods
    Path analysis was used to study the interactions between coagulation factors as well as other factors beyond coagulation factors in relation with pathogenic events in both diabetics and healthy subjects. In the present work, coagulation factors of 40 healthy and 40 type 2 diabetics were determined experimentally. The data were then analyzed using SPSS and AMOS software. Multivariate regression analysis was done to draw path diagrams.
    Results
    Our results show that FII, as the main cause for hypercoagulable state, is directly induced by FX and FVIII in normal individuals and by FX, FXI, FV and VWF cofactors in diabetic patients.
    Conclusion
    In general, our findings showed complicated relationship between coagulation factors and their effects either separately or combined.
    Keywords: Hypercoagulable State, Path analysis, vascular Complication, Myocardial Infarction, Coagulation Factors
  • Seyed Behnamedin Jameie*, Masoumeh Masoumipoor, Atousa Janzadeh, Farinaz Nasirinezhad, Mahdieh Kerdari, Maryam Soleimani Page 47
    Background
    Neuropathic pain (NP) is one of the most suffering medical conditions that often fail to respond to certain pain therapy. Although its exact etiology is still unknown the role of reactive oxygen species (ROS) and oxidative stress were explored by many researchers. Neuropathies either central or peripheral lead to painful condition as well as social and economic isolation, thus various therapies were used to treat or reduce the pain. Laser therapy and antioxidant drugs have separately considered as treatment for NP, but the combination of them have not been used yet. In order to study the combination effects of Low Level Laser Therapy (LLLT) and Coenzyme Q10 (CoQ10) the present study was designed.
    Methods
    Sixty adult male rats (230-320g) were used in this experimental study that divided into six groups (n=10). Chronic constriction injury (CCI) was used to induce neuropathic pain. The CoQ10 or vehicle, a low level laser of 980nm was used for two consecutive weeks. Thermal and mechanical paw withdrawal thresholds were assessed before and after surgery on 7th and 14th days.
    Results
    As we expected CCI decreased the pain threshold, whereas CoQ10 administration for two weeks increased mechanical and thermal threshold. The same results obtained for laser therapy using the CCI animals. Combination of laser 980nm with CoQ10 also showed significant differences in CCI animals.
    Conclusion
    Based on our findings the combination of CoQ10 with LLLT showed better effects than each one alone. In this regard we believe that there might be cellular and molecular synergism in simultaneous use of CoQ10 and LLLT on pain relief.
    Keywords: Low Level Laser Therapy, Neuropathic pain, Chronic Constriction Injury, Coenzyme Q10
  • Eshagh Bahrami, Sahar Bakhti, Seyed-Mohammad Fereshtehnejad *, Mansour Parvaresh, Mohammad Reza Khani Page 48
    Medulloblastoma is quite uncommon in the adult population and even rarer in extra-axial site in cerebello- pontine (CP) angle. In this report, a 23-year-old male patient with a two month history of deafness, nausea, vomiting and ataxia is presented. Clinical and radiological findings demonstrated a heterogeneously enhanced extra-axial lesion in the right CP angle. Total excision was performed and the histopathological features of medulloblastoma were confirmed. After surgery, the patient had no neurological deficit and the audiometric findings were improved. In addition, he underwent adjuant radiotherapy and no sign of metastatic mass was observed in follow-up spinal cord MRI. Although extremely rare, medulloblastoma must be considered in the differential diagnosis of extra-axial CP angle lesions.
    Keywords: Medulloblastoma, Extra, axial, Cerebello, pontine (CP) angle, Adult
  • Ali Mirsadeghi, Farid Farrokhi, Azadeh Fazli-Shahri, Bahareh Gholipour Page 49
    Bronchogenic cysts are among developmental disorders of the primitive foregut which are typically found above the diaphragm. Bronchial cysts discovered in the abdominal cavity or retroperitoneum are extremely rare. We present a rare case of a retroperitoneal bronchogenic cyst which was incidentally detected after a wrestling injury in a 23-year-old man who had a negative medical history. Although initial imaging studies suggested an adrenal tumor, histopathological analysis provided a definite diagnosis of bronchogenic cyst. Though rare, bronchogenic cysts must be considered in the differential diagnosis of retroperitoneal cystic lesions. This is the first case of a retroperitoneal bronchogenic cyst reported in Iran.
  • Soheila Aminimoghaddam *, Mohammad Hossein Badakhsh, Farrokh Taftachi, Forough Nejadisalami, Fatemeh Mahmoudzadeh Page 50
    Condyloma acuminatum, is a rare sexually transmitted disease. The virus responsible for condyloma is human papillomavirus. HPV-6 and HPV-11 are the most commonly detected HPV genotypes, but at least 20 other HPV genotypes have occasionally been found in genital wart tissue specimens. In fact genital HPV infection is common among sexually active populations. This disease may occur at any age after puberty and always seen in the mucosal area. It is characterized by slow growth. We reported here a case of a 42-year-old female patient with a 12 year history of a condyloma acuminatum lesion in her genitalia area without any medical treatment.
    Keywords: Genital wart, Condyloma acuminatum, Human papilloma virus, Typing
  • Nader Roushan*, Abolfazl Zolfaghari, Mehrnaz Asadi, Reza Taslimi Page 51
    Here, we present a case of a 78-year-old man that underwent gastrointestinal endoscopy because of one- month history of dysphagia to liquids and solid foods with accompanying weight loss. On endoscopy, there was distal esophageal stenosis. Multiple biopsies were obtained. Histologic examination of the samples revealed normal tissue. The stenosis was treated by dilatation and abdomino pelvic computed tomography scanning was performed to search for an underlying malignant lesion that showed a mass adjacent to distal esophagus. We did endosonography- guided fine needle aspiration of the mass. It was a squamous cell carcinoma (SCC). Malignancy is a challenging diagnosis in patients with dysphagia and near normal endoscopy. To our knowledge, there are a few reports of SCC to cause it.
    Keywords: Achalasia, Dysphagia
  • Mohammad Reza Motie*, Majid Ansari, Hamid Reza Nasrollahi Page 52
    Background
    The present study was conducted to establish the patterns and risk factors of surgical site infections in our institution between 2006 and 2011.
    Methods
    This was a retrospective cross-sectional study. The surgical site infection (SSI) was identified based on the presence of ICD-10-CM diagnostic code in hospital discharge records. By using a standardized data collection form predictor variables including patient characteristics, preoperative, intra-operative and postoperative data were obtained.
    Results
    Ninety five patients fulfilled the inclusion criteria. The patients were admitted for various procedures including both elective (62.1%) and emergency (37.9%) operations. Colectomy (13.7%) was the leading procedure followed by umbilical herniation (12.6) and appendix perforation (12.6%). The mean age was 47.13 years with standard deviation of 19.60 years. Twenty percent were addicted to opium. Midline incision above and below the umbilicus (40%) had the highest prevalence of infection. Most patients (46.3%) had clean-contaminated wounds and 30.5% had contaminated one. The quantitative variables which were also measured include duration of surgery, pre-operative and post-operative hospital stay with the mean of 2.9±1.45 hours, 1.02±1.42 and 7.75±6.75 days respectively.The most antibiotics prescribed post-operatively were the combination of ceftriaxone and metronidazole (51.6%).
    Conclusion
    The contaminated and clean-contaminated wounds are associated with higher rate of SSIs. Also, there was a converse relation between length of surgical incision and rate of SSIs. In overall, we found type of surgery as the main risk factor in developing the SSIs.
    Keywords: Risk factor, Surgical Wound Infection, Contamination, International Classification of Diseases
  • Mohammad Vaziri *, Saadat Molanaei, Zeinab Tamannaei Page 53
    Solitary Fibrous Tumors (SFTs) are rare primary pleural neoplasms which have recently been reported in extra-thoracic sites. In this report, solitary fibrous tumor arising in an intra-thoracic goiter with no evidence of cervical mass in a 74-year-old obese man who was found to have a large superior mediastinal mass with tracheal deviation on Chest X-Ray is presented.
    Keywords: Thyroid, Solitary Fibrous Tumor, Intrathoracic Goiter
  • Mohammad Vaziri, Fahimeh Ehsanipour, Abdolreza Pazouki, Zeinab Tamannaie*, Tamannaieroohollah Taghavi, Mohaddese Pishgahroudsari, Fatemeh Jesmi, Shahla Chaichian Page 54
    Background
    Delay in diagnosis and treatment of acute appendicitis (AA) results in an increased rate of perforation, postoperative morbidity, mortality and hospital length of stay. Several biochemical parameters including white blood cell (WBC) count, C-reactive protein (CRP), interleukin-6 (IL6) and Procalcitonin (PCT) have been used to further improve the clinical diagnosis of AA. The aim of this study was to assess the value of procalcitonin as a predictor of diagnosis and severity of appendicitis in order to improve the clinical decision making, since other studies have been unable to demonstrate a diagnostic value for PCT elevation in acute appendicitis.
    Methods
    One-hundred patients who underwent open appendectomy, including 75 men and 25 women with a mean age of 28 years were included in this study. Procalcitonin values were measured by an immunofluorescent method). Serum PCT>0.5 ng/ml was considered positive. The PCT serum values were measured in four different categories, including ˂0.5ng/ml, 0.5-2 ng/ml, 2-10ng/ml and more than 10ng/ml.
    Results
    The sensitivity and specificity of PCT level measurement for acute appendicitis diagnosis were 44% and 100% respectively. The value of PCT increased with the severity of appendicitis and also with the presence of peritonitis and infection, at the site of surgery.
    Conclusions
    Procalcitonin measurement cannot be used as a diagnostic test for adult patients with acute appendicitis and its routine use in such patients is not cost effective and conclusive. Procalcitonin values can be used as a prognostic marker and predictor of infectious complications following surgery and it can help to carry out timely surgical intervention which is highly recommended in patients with PCT values more than 0.5ng/ml.
    Keywords: Appendicitis, Procalcitonin, Diagnosis, Prognosis
  • Alimohamad Asghari, Shahin Rajaeih*, Fatemeh Hassannia, Negah Tavakolifard, Hamed Fattahi Neisyani, Seyed Kamran Kamrava, Maryam Jalessi, Parisa Omidian Page 55
    Background
    Soft tissue profile can be widely different in various populations. Furthermore, this profile can be also continues to change throughout life. However, there are few studies that quantitatively evaluate the soft tissue profile in Iranian population. In order to determine normal reference values of facial parts in our populations, we aimed to measure standards for facial soft tissue parameters in Iranian young population.
    Methods
    The study samples included 155 medical students at the Firouzgar hospital in winter 2011. The soft tissue facial profiles were digitally analyzed using linear measurements and angles made with standardized photographic records, taken in a natural head position, to determine the average soft tissue facial profile for males and females.
    Results
    There was a statistically significant difference between males and females in 21 of our 26 measurements. The most prominent differences between the genders were observed in the measurements taken from the face region. Minimum frontal breadth and supraorbital breadth were larger in males than in females. Except for middle face height measurement, other horizontal and vertical measurements for the face were larger in males than in females, indicating wider and higher faces in men than in women. Some measurements of facial angles are discrepant between the two genders.
    Conclusion
    Due to the specific features of Iranian facial soft tissue values and also observable differences in facial measurements and angles between men and women, the Iranian standard values on facial measurements and angles should be given more attention, especially by plastic and cosmetic surgeons.
    Keywords: Anthropometry, Measurements, Face, Analysis, Iranian
  • Ali Jangjoo, Mohammad Reza Darabi Mahboub, Mostafa Mehrabi Bahar, Monavvar Afzalaghaee, Ali Najib Jalali, Mohsen Aliakbarian Page 56
    Background
    This study was performed to evaluate the effect of Stoppa hernia repair on sexual function of the patients with bilateral inguinal hernia.
    Methods
    In a prospective follow-up study, 50 patients with bilateral inguinal hernia were investigated to assess sexual function before and 1 and 6 months after standardized Stoppahernioplasty using the International Index of Erectile Function (IIEF) questionnaire. The mean scores obtained on pre- and postoperative visits for all domains of sexual function were analyzed and compared with the Friedman and paired Wilcoxon tests.
    Results
    The mean score of IIEF at the first month after surgery was significantly declined compared to that before surgery and 6 months after surgery (P< 0.001), while the difference between preoperative score and the score at 6 months after surgery was not significant.
    Conclusion
    Bilateral inguinal mesh repair with Stoppa technique can decreased sexual activity of the patients at one month after surgery, nevertheless it returns to its initial condition at 6 months after surgery. This suggests that the Stoppa technique does not affect the sexual function of patients with bilateral inguinal hernia.
    Keywords: Hernia, Inguinal, Herniorrhaphy, Sexual Behavior
  • Mohsen Adib-Hajbaghery *, Ali Abasi, Rahman Rajabi-Beheshtabad Page 57
    Background
    Patients admitted in coronary care units face various stressors. Ambiguity of future life conditions and unawareness of caring methods intensifies the patients’ anxiety and stress. This study was conducted to assess the effects of whole body massage on anxiety and vital signs of patients with acute coronary disorders.
    Methods
    A randomized controlled trial was conducted on 120 patients. Patients were randomly allocated into two groups. The intervention group received a session of whole body massage and the control group received routine care. The levels of State, Trait and overall anxiety and vital signs were assessed in both groups before and after intervention. Independent sample t-test, paired t-test, Chi-square and Fischer exact tests were used for data analysis.
    Results
    The baseline overall mean score of anxiety was 79.43±29.34 in the intervention group and was decreased to 50.38±20.35 after massage therapy (p=0.001). However, no significant changes were occurred in the overall mean anxiety in the control group during the study. The baseline diastolic blood pressure was 77.05±8.12 mmHg and was decreased to 72.18±9.19 mmHg after the intervention (p=0.004). Also, significant decreases were occurred in heart rate and respiration rate of intervention group after massage therapy (p=0.001). However, no significant changes were occurred in vital signs of the control group during the study.
    Conclusion
    The results suggest that whole body m assage was effective in reducing anxiety and stabilizing vital signs of patients with acute coronary disorders.
    Keywords: Massage therapy, Anxiety, Vital signs, Acute coronary disorder
  • Marziyeh Aghahosseini, Homa Asgharifard*, Ashraf Aleyasin, Arash Tehrani Banihashemi Page 58
    Background
    Subclinical hypothyroidism may adversely affect In Vitro Fertilization (IVF) outcomes. However the cutoff of thyroid-stimulating hormone (TSH) for diagnosis and treatment is controversal. The aim of this study was to find the association of clinical pregnancy rate with regard to TSH levels in women undergoing IVF.
    Methods
    A historical cohort study of 816 infertile patients who underwent IVF in 2011 and 2012 was conducted. The study subjects were categorized in two groups according to their baseline TSH level; one with 0.5 ≤TSH< 2.5 mIU/L and other with 2.5 ≤TSH< 4.5 mIU/L. All patients were followed up for 6 weeks after embroyonic transfer. The outcomes of the study were consisted of rates for Human Chorionic Gonadotropin (HCG) and evaluation of their clinical pregnancies.
    Results
    About 60% of the study subjects had serum TSH level < 2.5 mIU/L and 40% ≥ 2.5 mIU/L. There were no statistically significant differences in age, years of infertility, BMI, baseline FSH and estradiol level of patients and the type of induction protocols between the study groups. The HCG rise was occurred in 30.4% of the subjects with TSH level < 2.5 mIU/L versus 26.3% of the subjects with TSH ≥ 2.5 mIU/L (p value= 0.2). The clinical pregnancy rates in the group of patients with TSH < 2.5 mIU/L and those with ≥ 2.5 mIU/L were 27.1% and 23.9% respectively (p value= 0.3).
    Conclusion
    Our results were similar to various studies in which reported lack of association between TSH level in the range of 0.5- 4.5 mIU/L and IVF outcomes. It seems that lowering the upper limit of normal TSH should be still considered as a scientific debate.
    Keywords: Thyroid stimulating hormone, clinical pregnancy, In Vitro Fertilization. Subclinical hypothyroidism
  • Bina Eftekharsadat, Tannaz Ahadi*, Gholam Reza Raissi, Saied Kazem Shakoory, Seyed Mohammad Fereshtehnejad Page 59
    Background
    Determining the validity of current median sensory nerve conduction techniques for diagnosis of carpal tunnel syndrome (CTS).
    Methods
    Eighty five patients with clinical diagnosis of CTS were compared with the same number of healthy people. The validity of electrodiagnostic tests were compared in a case-control manner. These electrodiagnostictechniques included long-segment, short-segment, 2-segment and relative slowing studies; as well as disto-proximal ratio. Receiver Operating Characteristic (ROC) curve employed for comparison, determining the optimal cut-off points for each test. Validity was evaluated with likelihood ratio.
    Results
    Likelihood ratio (LHR) for Radial-median sensory latency difference was ∞, while LHR for ulnar-median sensory latency difference was 16.9. Sensitivity of Two-segment method was 98.8% and mixed palm-wrist median Nerve Conduction Velocity (NCV) study showed a sensitivity and specificity of 97.6%, 83.5% respectively.
    Conclusions
    Radial-median latency difference study (optimal cut-off point ≥0.5) and study of wrist-segment NCV (optimal cut-off point <50.45) were the most valuable techniques in diagnosis of CTS, respectively. Median-ulnar latency difference study and disto-proximal ratio study had more diagnostic implication than long and short (mixed) segment technique in this regard.
    Keywords: Carpal Tunnel Syndrome, Electrodiagnosis, ROC curve
  • Soheila Aminimoghaddam, Fariba Yarandi *, Forough Nejadsalami, Farrokh Taftachi, Fereshteh Noorbakhsh, Fatemeh Mahmoudzadeh Page 60
    Background
    Gestational trophoblastic neoplasia (GTN) disease is excessive and inappropriate proliferation of trophoblast after termination of the pregnancy. Many attempts have been made to improve follow-up procedures, but no studies have evaluated Human Chorionic Gonadotrophin (HCG) as a post treatment indicator. Thus we aimed to know β-HCG variability in post treatment pregnancies.
    Methods
    40 Molar affected pregnancies were followed post-surgical treatment by serum β-HCG level in a tertiary level hospital. All subjects were treated by evacuation and followed by β-HCG every week for three weeks, then every month for six months.
    Results
    30 women were normal (group I) and 10 (group II) diagnosed as GTN cases. Serum β-HCG which obtained serially shown significant differences between two groups (p=0.001). The quantity of β-HCG/week had significantly higher level than normal females (p<0.001)
    Conclusion
    Our results suggested that β-HCG serum level could be used as a strong indicator for identifying affected patients at early stage.
    Keywords: Gestational trophoblastic neoplasia, Molar pregnancy, ?, HCG, Chemotherapy
  • Arezou Mirfazeli, Maliheh Sedehi *, Mohammad Jafar Golalipour Page 61
    Background
    Reduction of neonatal mortality rate can improve health and newborn status of the society. This study was done to evaluate the prevalence and patternof causes for neonatal mortality in Gorgan, North of Iran.
    Methods
    this descriptive, cross-sectional study was carried out on all birth in the maternity Dezyani hospital in Gorgan, North of Iran during 1 September 2008 -31 March 2011. Causes of mortality were evaluated in newborns that admitted and died in the NICU. Died newborns were screened for primary and final causes of death. The final causes of the mortality in majority of neonates were extracted according to the International Coding of disease Ver10 (ICD10).
    Results
    The total number of births was14785. The leading primary obstetric causes of death were: spontaneous preterm labor 36(25.7%), fetal abnormality 31(22.1%), hypertensive disorders 21(15%), unexplained intrauterine death 21(15%), maternal disease 12(8.6%), intra-uterine growth restriction (IUGR) 10(7.1%), oligo-hydroamnios 5(3.6%) and ante partum hemorrhage 4(2.9%). Mortality rate was 76.8% during the first week of life. General final causes of death were; pulmonary bleeding17.9%, septic shock16.8%, IVH15.8%, congenital anomalies and pnomotorax 13.7% in fourth grade.
    Conclusion
    The risk factors, main associated reason and procedures for prevention of spontaneous preterm labor and fetal abnormality should be includes as the main themes in perinatal research. In addition, there should be emphasized on necessity of genetic consultations and health care before and during pregnancy.
    Keywords: Neonatal, Prenatal, Causes of death
  • Shiva Rafati, Mohammad Niakan*, Mohsen Naseri Page 62
    Background
    The development of microbial resistance to the existing anti-microbial agents has become a real challenge and a serious problem facing patients suffering from skin infections. Seeds of Nigella sativa have been used for a long time in folk medicine for the treatment of skin infections. Production of new potent agents is urgently needed, especially for hospitals and health care centers. This study is designed to explore anti-microbial effect of extract from the Nigella sativa seeds against skin pustules infection.
    Methods
    The in vivo anti-microbial effect of the Nigella sativa seeds extract at a concentration of 33% on pustules staphylococcal Skin Infections was assessed and compared with standard drug mupirocin on 40 neonates. All neonates were divided and examined into two experimental and control groupsrandomly. Recovery times were compared between two groups.
    Results
    The mean of recovery time in experimental group was 75/1 with SD= ± 12, and the mean of recovery time in control group was 69/4 with SD = ± 8/7.There was no significant difference in recovery time between two groups (p value = 0/131).
    Conclusion
    In clinical practice, the agent of Nigella Sativa recovered as pustular from tissues of all patients. While the extract was as nearly effective as the standard drug, mupirocin, no side effect was observed.
    Keywords: Nigella sativa, Saphylococcal skin infection, Neonate
  • Jalil Koohpayehzadeh, Maryam Haji Ahmadi *, Afsaneh Dehnad, Seyed Kamran Soltani Arabshahi, Shoaleh Bigdeli, Sohrab Yadollahi Page 63
    Background
    Learning in a clinical environment is an inseparable part of a training program in medical education. To evaluate the quality of training in a clinical environment, a comprehensive questionnaire which is adjusted for local purposes is essential. This study was conducted to determine the validity and reliability of Activities Coaching Context (ACC)-questionnaire from the perspective of residents and students in a clinical learning environment.
    Methods
    This was a cross-sectional study conducted with 65 residents and students of Semnan University of Medical Sciences. The Content Validity of the questionnaire was confirmed by the judgment of a panel of ten experts in medical education. The construct validity of the questionnaire was determined by factor analysis. Data were collected and analyzed by SPSS16.
    Results
    The ratio and index of content validity calculated by experts’ view were quite acceptable (0.31 and 0.7, respectively). Construct validity was examined by factor analysis which confirmed seven first order factors. Cronbach’s Alfa coefficient revealed a high degree of internal consistency (0.932). The reliability of the questionnaire was measured by test - retest (0.9).
    Conclusions
    The ACC questionnaire appeared to be a valid, reliable and also appropriate tool to evaluate the educational quality of a clinical learning environment.
    Keywords: Validity, Reliability, Questionnaires, Clinical, Learning
  • Azar Nickavar *, Seyyed Javad Nasiri, Arash Lahouti Harahdashti Page 64
    Background
    Hydronephrosis (HN) or calycial dilatation is the most common prenatal urologic abnormality. The aim of this study was to identify the possible changes in demographic and clinical manifestations of infantile HN in previously and recently diagnosed patients.
    Methods
    193 children with infantile HN admitted to Ali-asghar Children''s Hospital in two different periods (group 1; 1997-2003, and group 2; 2005-2011) were evaluated in this cross-sectional study. Variables such as time at diagnosis, gender, clinical manifestations, etiology, laterality, grade, and associated anomalies were also evaluated.
    Results
    The mean age at diagnosis was 32.3± 42.6 (group 1) and 21.4± 36.4 (group 2), respectively. 69.8% of patients were males. 75% of prenatally diagnosed patients were asymptomatic. Urinary tract infection was the most common symptom, followed by pain, hematuria, and decreased renal function. Obstruction in ureteropelvic junction was the most common etiology, accounting for 39.6% of all patients. Neurogenic bladder, vesicoureteral reflux, nephrolithiasis, and ureterovesical junction obstruction were the other common etiologies. 55.5% of all patients had unilateral HN, which was more common on the left side. No significant difference documented between two groups of patients, except for mild HN (23.7% vs. 39%), which was more common in newly diagnosed patients (p= 0.001).
    Conclusion
    There was no changing trend in demographic and clinical manifestations of infantile HN. However, the severity of infantile HN has been decreased significantly in recently diagnosed patients.
    Keywords: Hydronephrosis, Children, Epidemiology
  • Shahnaz Miri, Gholam Ali Shahidi, Mansour Parvaresh, Mohammad Rohani* Page 65
    Little is known about the results of pallidal deep brain stimulation (DBS) in DYT6 dystonia. This will be the first report of DYT6 dystonia treated with pallidal DBS from Iran. A 21 years old male patient with DYT6 dystonia underwent bilateral deep brain stimulation. The target of DBS was the sensorimotor region of the posteroventralglobuspallidusinternus (GPi). DBS parameters included an amplitude of 2.7 V, frequency of 160 Hz, and pulse width of 90 μs which were adjusted according to the patient''s response 12 months after surgery. Treatment outcome was measured by the patient’s Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) score. Before surgery, the patient''s BFMDRSscore was 32. However, BFMDRS score reduced to 7 at one year follow up after surgery(78% improvement of total score). Dystonic symptoms of extremities and mouth completely resolved. Also speech and swallowing function significantly improved. Although previous observations reported a poor to moderate response in speech, we found DBS as an effective treatment not only for dystonic features, but also for speech improvement of DYT6 dystonia.
    Keywords: Deep brain stimulation, DYT6 dystonia, Globus pallidusinternus
  • Alireza Merrikhi, Hojatollah Raji Asadabadi, Ali Akbar Beigi, Sayed Mahdi Marashi, Hafez Ghaheri *, Zohre Nasiri Zarch Page 66
    Background
    This research compares the outcomes of percutaneous technique and open surgical peritoneal dialysis catheter placement in children.
    Methods
    In this randomized controlled trial, between 2010 and 2011,a total of 35 pediatric uremic patients were enrolled and randomized into two study groups. Follow up data included duration of operation (minute), duration of hospitalization (days) and onset time of peritoneal dialysis. Complications were considered as mechanical and infectious.
    Results
    The percutaneous procedure was significantly faster than the open surgical technique (9.5 ± 1.81 versus 27.00 ± 2.61 minutes, p= 0.0001). The onset of dialysis was earlier in percutaneous insertion. There were no cases of hollow viscous perforation, early peritonitis and exit site infection at the 3rd, 7th, and 14th day in both groups. Complications in open surgical group were include wrapped omentum in 4 (23.5%), catheter malposition in 3 (17.6%),delayed exit site infection in 2 (11.7%), Incisional hernia in 1 (5.8%)and hemoperitoneum in 2 (11.7%)cases. Complications in percutaneous insertion group were include catheter malposition and wrapped omentum each in one case.
    Conclusion
    Percutaneous method with secure insertion of the catheter reduced the rate of some complications.Although they were not statistically significant, this technique reduces the time of hospitalization and operation without need to general anesthesia. The onset of dialysis was earlier significantly. Trial registry code: IRCT2013091514670N1
    Keywords: Surgical Procedures, Peritoneal dialysis, Catheters, Complications
  • Alireza Moghisi *, Reza Mohammadi, Leif Svanstrom Page 67
    Background
    Three studies were conducted aiming to design specific interventions regarding motorcyclist''s safety using Haddon matrix in 14 cities of Iran.
    Methods
    Motorcyclists'' fatality data was extracted in 14 cities (5 safe community practicing and 9 safe community non practicing cities) during 2006-2007. As the next step a cross sectional study on Knowledge, Attitude, Practice (KAP) of motorcyclists about helmet was performed. A range of variables relevant to motorcyclists'' injury and prevention were developed and organized according to the Haddon matrix. The risky behaviors, including over speeding, acrobatic movement, no helmet or not properly wearing helmet were considered. Data were analyzed with chi-square and ANOVA method using STATA software.
    Results
    The highest mortality rate was revealed in Niriz city (NSC) and the least was reported from Arsanjan city (SC) in Fars Province. In Busher province, the highest death rate was detected in the Busher city (SC) and the least was in the Genaveh city (NSC). In Khorasan, the highest death rate was reported from Torbat-e-hydarieh city (NSC) and the lowest was from Bardscan (SC). Male drivers of 19-39 years old were the most affected age groups. The rate of helmet usage in overall was 13% while 97% owned a helmet. Embarrassing of wearing helmet was mentioned by 70% of participants as a reason for not wearing helmet. Participants believed that public education and re-enforcement of mandatory helmet law are two important ways to raise the helmet usage.
    Conclusions
    Constant public education in addition to attention to traffic rules are two important factors to promote helmet wearing rate.
    Keywords: Helmet, Safety, Motorcycle, Iran
  • Mohsen Saberi Isfeedvajani *, Ali Akbar Karimi Zarchi, Abbas Musavi Heris, Fatema Sajjadi, Ali Mehrabi Tavana Page 68
    Background
    Hypertension is a risk factor for life threatening diseases such as cerebrovascular accidents, coronary artery diseases, congestive heart failure and chronic renal failure. The prevalence of non-communicable diseases such as hypertension and diabetes including obesity has increased over the past few years in Iran. The first step for modification of cardiovascular diseases in a defined population is to assess the prevalence of their risk factors. This study was conduceted to assess personnel blood pressure and its risk factors in one of the medical universities of Tehran in the Health Day of 2013.
    Methods
    This cross sectional study was performed from May 19, 2013 to May 24, 2013 (I.R. of Iran’s Health Weak) in one of the medical universities of Tehran. Participants completed voluntarily a researcher-made questionnaire which composed of demographic characteristics and variables about risk factors and preventive factors of cardiovascular diseases such as smoking, history of diabetes, history of hypertension, physical exercise status and so on. Blood pressure was measured by mercury sphygmomanometer and weight and height were measured by a ground analogue scale.
    Results
    Of 195 persons participated in this study, 180 persons (92.3%) were male. The mean age of participants was 33.75 (±9.87) yr. The mean of systolic and diastolic blood pressure was 114.44 (±8.67) mmHg and 73.06 (±8.45) mmHg, respectively. The prevalence of overweight, obesity, prehypertension and hypertension was 41.7%, 17.8%, 40.4% and 11.7% respectively. Only 8 persons (5.6%) were cigarette smokers.
    Conclusion
    Despite the low prevalence of hypertension in our samples, the high prevalence of pre-hypertension and overweight need great attention. Interventions like life style modification could be effective in prevention of hypertension.
    Keywords: Heart, Blood Pressure, Risk Factors, Hypertension
  • Manzoor Ahmad Bhat *, Bashir Ahmad Laway, Farhat Mustafa, Mohammad Shafi Kuchay, Idrees Mubarik, Nazir Ahmad Palla Page 69
    Distal renal tubular acidosis is a syndrome of abnormal urine acidification and is characterized by hyperchloremic metabolic acidosis, hypokalemia, hypercalciurea, nephrocalcinosis and nephrolithiasis. Despite the presence of persistent hypokalemia, acute muscular paralysis is rarely encountered in males.Here, we will report an eighteen year old male patient who presented with flaccid quadriparesis and was subsequently found to have rhabdomyolysis, severe short stature, skeletal deformities and primary distal renal tubular acidosis.
    Keywords: Nephrocalcinosis, Hypokalemia, Rhabdomyolysis, Short stature, Renal tubular acidosis
  • Sara Mortaz Hejri, Mohammad Jalili* Page 70
    The process of determining the minimum pass level to separate the competent students from those who do not perform well enough is called standard setting. A large number of methods are widely used to set cut-scores for both written and clinical examinations. There are some challenging issues pertaining to any standard setting procedure. Ignoring these concerns would result in a large dispute regarding the credibility and defensibility of the method. The goal of this review is to provide a basic understanding of the key concepts and challenges in standard setting and to suggest some recommendations to overcome the challenging issues for educators and policymakers who are dealing with decision-making in this field.
    Keywords: Student assessment, Standard setting, Reliability, Validity
  • Sadegh Izadi, Sina Karamimagham, Maryam Poursadeghfard* Page 71
    Chronic Inflammatory Demyelinating Polyneuropathy is an autoimmune disease with progressive and relapsing courses. The main clinical presentations are diffuse deep tendon hyporeflexia or areflexia and symmetric proximal-distal muscles weakness. Myasthenia gravis is also an immune mediated disease with fluctuating ocular and bulbar symptoms and sometimes weakness. Although both myasthenia gravis and chronic inflammatory demyelinating polyneuropathy are immune mediated disorders, clinical presentations are obviously different in the two diseases. Herein, we will report a case of chronic inflammatory demyelinating polyneuropathy who presented with isolated unilateral ptosis. Initially, the patient was managed as ocular type of myasthenia gravis, but after progression to general limb weakness and areflexia, the diagnosis of chronic inflammatory demyelinating polyneuropathy was made. Although unilateral ptosis is a typical feature of myasthenia gravis, it may be seen as the first presentation of chronic inflammatory demyelinating polyneuropathy as well which mimics myasthenia gravis disease.
    Keywords: Blepharoptosis, Chronic Inflammatory Demyelinating Polyradiculoneuropathy, Myasthenia gravis
  • Laleh Ghadirian, Azadeh Sayarifard*, Reza Majdzadeh, Fatemeh Rajabi, Masoud Yunesian Page 72
    Background
    Conduction of thesis by the students is one of their major academic activities. Thesis quality and acquired experiences are highly dependent on the supervision. Our study is aimed at identifing the challenges in thesis supervision from both students and faculty members point of view.
    Methods
    This study was conducted using individual in-depth interviews and Focus Group Discussions (FGD). The participants were 43 students and faculty members selected by purposive sampling. It was carried out in Tehran University of Medical Sciences in 2012. Data analysis was done concurrently with data gathering using content analysis method.
    Results
    Our data analysis resulted in 162 codes, 17 subcategories and 4 major categories, «supervisory knowledge and skills», «atmosphere», «bylaws and regulations relating to supervision» and «monitoring and evaluation».
    Conclusion
    This study showed that more attention and planning in needed for modifying related rules and regulations, qualitative and quantitative improvement in mentorship training, research atmosphere improvement and effective monitoring and evaluation in supervisory area.
    Keywords: Dissertation, Research, Supervision, Iran
  • Seyed Mansour Razavi, Saman Mohazzab Torabi, Payman Salamati* Page 73
    Background
    Respiratory diseases/syndromes are the most common causes of referring to physicians among pilgrims in Hajj. They lead to high morbidity, impose high costs on the health system and are among the major obstacles for pilgrims to perform Hajj duties. The main aim of our study was to determine types, frequencies, etiologies, and epidemiologic factors of respiratory diseases among Iranian Hajj pilgrims and to suggest some preventive and treatment strategies.
    Methods
    To determine the types and frequencies of respiratory syndromes, we implemented a syndromic surveillance method in Iranian health care system for Hajj during 5 consecutive years. To achieve the etiology of these diseases, we performed 4 concurrent before and after studies. We also evaluated efficacy of the flu and pneumovax vaccines among Iranian Hajj pilgrims in 2 studies. T o determine some other epidemiological factors, we conducted 4 additional studies.
    Results
    The most common problem was common cold like syndrome. Origin s of the most upper respiratory problems were infections, and allergies were less involved. Among infectious agents, viruses were the most common agents and their frequencies were as follows respectively: Adenoviruses 38 (36.2 %), Rhinoviruses 31 (30%), Influenza type B virus 21 (20%). Bacteria were often the secondary causes and their frequencies were as follows respectively: Intestine bacillus 69 (19.4%), Chlamydia pneumonia 20(15.8%), Haemophiluses 32 (9.1%) and Streptococcus (A,C and G) 30 (8.5%). We introduced some epidemiological factors as effective in creating respiratory diseases.
    Conclusion
    In this paper, we suggested some applied points for prevention, treatment, and correction of common malpractices in the treatment of respiratory diseases of the pilgrims.
    Keywords: Respiratory tract infections, Prevention, control, Islam, Iran, Saudi Arabia
  • Nader Roushan*, Fateme Zali, Hamidreza Abtahi, Mehrnaz Asadi, Reza Taslimi, Najme Aletaha Page 74
    Background
    Sulfur mustard (SM) has acute and chronic effects on skin and mucosal surfaces. The aim of the study was to evaluate the frequency of esophagitis in a historical cohort of veterans who had been exposed to SM in Iran-Iraq war nearly 25 years ago.
    Methods
    One hundred two veterans with dyspepsia and/or heartburn underwent esophago-gastro-duodenoscopy. Of them, 52 cases had been exposed to SM and had chronic mustard lung disease. Controls included 50 veterans without SM exposure. Esophagitis was defined according to standard criteria.
    Results
    81.6% of cases and 70.6% of controls had heart burn and/or regurgitation (p= 0.224). Esophagitis was seen in 40% of cases and 26.5% of controls (p= 0.155).
    Conclusion
    Based on our findings, SM exposure seems not to be associated with increased esophagitis.
    Keywords: Sulfur mustard, Esophagitis, Gastroesophageal reflux
  • Mohammad Jafar Golalipour*, Mohammad Ali Vakili, Nafiseh Kaviani Page 75
    Background
    Several studies have examined the effects of folic acid fortification on the occurrence of orofacial clefts. This study was carried out to evaluate the impact of flour fortification with folic acid on oral clefts in Northern Iran.
    Methods
    In this hospital based study from March 2006 to September 2009, we screened the total number of live births at all hospitals in Golestan province in North of Iran, as well as the number of pregnancies affected by non syndromic oral clefts, per 100000 births during the periods before (March 2006 –June 2007), during (July2007-March 2008) and after (May 2008- September 2009) folic acid fortification of flour was implemented. Non syndromic Oral clefts were defined in accordance with the International Classification of Diseases, 10th revision (ICD-10).
    Results
    The prevalence of oral clefting reduced from 64.2 per 100000 births before fortification to 32.2 per 100000 after flour fortification with folic acid. The preventive fraction rate of oral clefting after fortification period in comparison with before period was 49.8% (OR=0.502 95% CI 0.26-0.97, p=0.036).
    Conclusion
    This study showed that flour fortification with folic acid is associated with a significant reduction in the rate of oral clefting in Golestan province in Northern Iran.
    Keywords: Oral clefts, Folic acid, Flour, Fortification, Iran
  • Faranak Aliabadi, Mohammad Kamali *, Leili Borimnejad, Mehdi Rassafiani, Mehdi Rasti, Narges Shafaroodi, Foroogh Rafii, Reihaneh Askary Kachoosangy Page 76
    Background
    Having an infant in the neonatal intensive care unit (NICU) is a stressful and painful experience. Unlike to normal births, this birth is associated with admission and separation of infant from parents. The aim of this study was to compile the supporting-emotional needs of Iranian parents who have a premature infant admitted in (NICU).
    Methods
    This study was performed using qualitative research approach. Twelve participants including 9 parents whose infant had been hospitalized in NICU; two nurses and one physician were also selected for sampling purposes. Data were gathered using semi-structured interview. Data were analyzed by inductive content analysis approach.
    Results
    Four subcategories emerged from data analysis expressed supporting-emotional needs of parents of premature infants admitted in NICU. These subcategories were: Need for interaction with infant, Need to medical team’s empathy, need to exchange support with spouse, and Need to get help from others.
    Conclusion
    In order to develop mutual bonding with infant and attain parental roles, parents need to be close their neonate, also receive empathy and support to find a way to meet their needs. Participants in this study announced that resolving these needs can help parents to feel more confidence in infant''s care and reduce their negative feelings.
    Keywords: Emotions, Parents, Premature infant, Content, Neonatal intensive care unit
  • Nasim Vahabi *, Mahmood Reza Gohari, Ali Azarbar, Masoud Salehi Page 77
    Background
    Quality of life evaluates the general well-being of individuals and it can be considered as one of the important aspects in programming and giving service to disabled people. Blindness is one of the most important kinds of physical disability that has a direct effect on quality of life, so t his study aimed to explore how war blindness influences the quality of life.
    Methods
    In this cross-sectional study, data from 71 blind war (Iran-Iraq) veterans in 2010 were collected using the Short Form Health Survey instrument (SF36). Rasch model was fitted by running WINSTEPS software and then item parameter (), i.e. difficulty of items, and person parameter (), i.e. the ability or attainment level of respondents, were estimated.
    Results
    In a total of 71 cases, 69 cases(97 %) were male with a mean () age and blindness duration range of 48.97 () yrs and 25.74 () yrs, respectively. Item difficulty ranged from 2.962 to 4.441. Comparison of the SF36 scores and Rasch measurements showed that standard error of Rasch model estimates in physical and total scores are less than SF36 scores.
    Conclusion
    Due to the advantages and higher accuracy of the Rasch model, using this model can be a good alternative for the traditional models. With due regard to the relative low quality of life of blind war veterans in this study and other similar study, further investigation are recommended to be carried out to this group of society.
    Keywords: Rasch model, Quality of life, Blind war veterans
  • Majid Naderi, Shadi Tabibian, Akbar Dorgalaleh, Zahra Kashani Kahtib, Shaban Alizadeh* Page 78
  • Parisa Nejati, Sara Lotfian *, Azar Moezy, Mina Nejati Page 79
    Background
    Office workers spend a long period of time behind a computer during working hours. The relation between the posture of sitting during work with computer and neck pain is still debatable. Even though some researchers claim a significant difference in head posture between patients with neck pain and pain-free participants, the FHP (forward head posture) has not always been associated with neck pain in literature. So, the purpose of this study was to discover the relationship between neck pain and improper posture in the head, cervicothoracic spine and shoulders.
    Methods
    This was a cross-sectional study to explore the relationships between neck pains, sagittal postures of cervical and thoracic spine and shoulders among office workers in two positions, straight looking forward and working position. 46 subjects without neck pain and 55 subjects with neck pain were evaluated using a photographic method. Thoracic and cervical postures were measured by the HT (High Thoracic), CV (Craniovertebral) angles respectively. Shoulder’s posture was evaluated in the sagittal plane by the acromion protrusion.
    Results
    HT and CV angles were positively correlated with the presence of neck pain only in working position (p< 0.05). In straight looking forward position there was no significant difference between the two groups statistically (p>0.05). The difference of shoulder protrusion between symptomatic and asymptomatic groups was not significant.
    Conclusion
    FHP and thoracic kyphosis were accompanied with neck pain. But shoulder posture was not correlated with neck pain.
    Keywords: Neck Pain, Posture, Shoulder
  • Afsoon Hassani Mehraban*, Yasamin Soltanmohamadi, Malahat Akbarfahimi, Ghorban Taghizadeh Page 80
  • Ali A. Asadi-Pooya*, Nahid Ashjazadeh, Ahmad Kamgarpour, Mousa Taghipour, Seyed Mohammad Rakei, Mohsen Farazdaghi, Soroor Inaloo, Mohammad Hadi Bagheri, Ali Razmkon, Zahra Zare Page 81
    Of about 40 million people with epilepsy, who live in developing countries, the majority do not receive appropriate treatment. Nonetheless, there are striking disparities among the so called developing countries, however generally speaking, access to and availability of epilepsy management programs in developing countries are very limited and therefore, the issue of developing epilepsy centers in resource-limited settings in a large scale is very essential. The surgery for epilepsy, including temporal lobotomy, lesionectomy and corpus colostomy, for patients with medically-refractory seizures, defined as failure of adequate trials of two tolerated, appropriately chosen and using antiepileptic drug to achieve sustained freedom, from seizure has been proved to be feasible and cost-effective in developing countries. However, the success of epilepsy surgery depends upon the accurate identification of good surgical candidates based on the available resources and technologies without jeopardizing safety. In the current paper, we will share our experiences of establishing an epilepsy surgery program in Iran, despite all short-comings and limitations and try to provide some answers to those challenges, which helped us establish our program.
    Keywords: Epilepsy surgery, Developing country, Limited resources, Iran
  • Ali Cheraghvandi, Saeid Fallah Tafti, Firouzeh Talischi, Seyed Mohammad Seyedmehdi *, Elham Ghazanchaei, Beheshteh Jebelli, Mihan Pourabdollah Page 82
    Silicosis is considered to be among the occupational lung diseases and associated with sandblasting, mining, quarrying and tunneling. Acute silicosis is usually progressive diseaseand despite treatment with corticosteroids it leads to cardio-respiratory failure and death. Alveolar silicoproteinosis is one of it’s acute presentations due to exposure to silica dust and lungs filling with proteinaceous material. Here, we have presented a 29 year old male sandblaster with the three conditions of acute silicosis, secondary alveolar proteinosis and pulmonary tuberculosis on four anti tuberculous medications who presented with respiratory distress.
    Keywords: Silicotuberculosis, Silicosis, Pulmonary Alveolar Proteinosis, Tuberculosis, Drug, Resistant
  • Farzad Izadi, Ehsan Parvas *, Vita Derakhshandeh Page 83
    Primary non-Hodgkin lymphoma of the larynx is rare, accounting for less than 1% of all laryngeal neoplasms. Fewer than 100 cases have been reported in the literatureand to our knowledge this may be the first reported case of laryngeal non Hodgkin lymphoma presented with hoarseness, aortic aneurysm, hepatitis B and skin rashes.
    Keywords: Lymphoma, Larynx, Subgluttic mass, Hepatitis B
  • Mohammad Reza Guity, Shaharam Akhlaghpour, Reza Yousefian* Page 84
    Background
    Glenoid bone damages consisting of anterior rim erosion and bony avulsion are very important in decision making for treatment of recurrent dislocation in shoulder joint. This study was aimed to determine the prevalence of these damages in patients with anterior recurrent shoulder dislocation.
    Methods
    The study was a cross-sectional study evaluating patients with unstable shoulder joint. Glenoid bone damage was assessed using three dimensional (CT) scan implementing either glenoid width index or by Pico method.
    Result
    Ninety two patients were assessed by glenoid width index and 19 by PICO. Among the first group, 6 patients (6%) had intact shoulder joint and 86 patients (93%) had glenoid lesion including 56 (60.9%) erosions and 30 (32.6%) with bony Bankart. In this group, 60 (65%) patients had Hill-Sachs lesion. Using Pico evaluation, 8 (42%) had bony Bankart, 9 (47%) erosion and 2 (10%) no lesion, and 8 (42%) Hill-Sachs.
    Conclusion
    There was no significant correlation between severities of glenoid bone loss with patients''frequency of dislocations. Patients with convulsion-induced shoulder dislocation had the most severe bone loss. The CT scan should be done early in recurrent dislocation because severe bony damage could occur even after few dislocations. The overall prevalence of glenoid bone damage including bony Bankart and erosion are high in recurrent anterior dislocation. This is particularly emphasized in patients with seizure.
    Keywords: Glenoid lesions, Recurrent shoulder dislocation, 3 dimensional CT scan, Pico
  • Amir Houshang Mehrparvar, Mohammad Heydari, Seyyed Jalil Mirmohammadi, Mehrdad Mostaghaci*, Mohammad Hossein Davari, Mahmoud Taheri Page 85
    Background
    Musculoskeletal disorders are among the most prevalent occupational disorders in different jobs such as office work. Some interventions such as ergonomic modifications and workplace exercises are introduced as the methods for alleviating these disorders. In this study we compared the effect of ergonomic modifications and workplace exercises on musculoskeletal pain and discomfort in a group of office workers.
    Methods
    In an interventional study on office workers, the effect of two interventions was compared. Ergonomic modification consisted of correcting the arrangement of workstation and changing some equipment; workplace exercises included stretching exercises focusing on neck, shoulders, low back, and hand and wrist. Musculoskeletal complaints were assessed and compared before and after 1 month interventions.
    Results
    The frequency of musculoskeletal complaints was high before the study. Both interventions significantly reduced complaints in a similar manner except for low back pain which was reduced in exercise group more than the other group.
    Conclusion
    In this study we found a beneficial short-term effect for both ergonomic modifications and stretching work-place exercises on reducing musculoskeletal pain in office workers.
    Keywords: Musculoskeletal diseases, Ergonomic modification, Stretching exercises, Office worker
  • Masoud Mehrpour, Narges Sadat Shams-Hosseini*, Saeed Rezaali Page 86
    Background
    There is not any data available about the effect of high bar pressure condition on intracranial pressure. In this study, the effect of diving on the optic nerve and sheath diameters as non-invasive markers of intracranial pressure has been investigated.
    Methods
    Twenty professional male divers from twenty one volunteers were chosen for this cross-sectional study. Only one person who had a history of barotraumas was excluded. Each diver then completed a questionnaire on demographic data, medical and diving history. Nineteen other volunteers were selected to represent a control group. A 10-MHz linear ultrasonic probe was used to measure the optic nerve sheath diameters of both eyes in closed and supine position and its relationship with diving history of divers was determined.
    Results
    It was found that divers have a higher mean optic nerve sheath diameter compared to the normal population as previously reported by other studies. The mean diameter of the left and right optic nerve sheaths were 6.4±0.7, 6.5±0.9 mm respectively and a significant relationship between optic nerve sheath diameter and diving history was found.
    Conclusion
    Results showed that divers have a higher optic nerve diameter than the general population. However, our result cannot yet be considered as a marker of intracranial pressure in divers as it was conducted on an limited number of subjects and so a bigger study should be undertaken for this purpose.
    Keywords: Optic nerve, Ultrasound, Diving, Pressure
  • Mahboobeh Hajiabdolbaghi, Sirous Jafari, Sedighe Mansouri, Mojtaba Hedayat Yaghoobi* Page 87
    Background
    HIV/AIDS patients are mainly hospitalized for HIV-related diseases and opportunistic infections. This study was performed to determine the causes of hospitalization and its related factors in HIV/AIDS patients in Tehran’s Imam Khomeini Hospital during 2009-2012.
    Methods
    This study was a descriptive cross-sectional study. HIV patients admitted to the Imam Khomeini Hospital were included in the study through census method, during the study. Demographic variables, hepatitis co-infection, CD4 count, history of receiving anti- retroviral therapy (ART), cause of admission, length of hospitalization and patient''s outcome were recorded. Data were analyzed by SPSS software and by means of Chisquare and Mann Whitney U tests.
    Results
    During the study, 555 HIV patients were included in, 84.9% of whom were male, with the mean age of 36.59±8.51 years and the average length of hospitalization for 16.04±18.82 days. Opportunistic infections were the most common cause of hospitalization (46.5%) with prevalent of which was pulmonary tuberculosis being the most prevalent (37.6%). Patients suffering from opportunistic infections had significantly lower CD4 count and longer hospitalization than the other diseases. A significant difference was detected between patients outcome and the history of ART.
    Conclusion
    Low CD4 count may contribute to an increase in number and length of hospitalization in HIV/AIDS patients. Accordingly, it appears to affect outcome of their treatment and ART was accompanied by a drop in the death rate of hospitalized patients.
    Keywords: HIV Infection, AIDS, Hospitalization, Opportunistic infections, ART
  • Fatemeh Mohamadkhah, Farkhondeh Amin Shokravi*, Mahmood Karimy, Sograt Faghihzadeh Page 88
    Background
    Despite the efforts, the level of dental caries remains prevalent in developed countries; It has increased in developing countries due to dietary changes. The aim of this study was to assess the effect of an educational intervention on the oral health of students in Chabahar city.
    Methods
    This quasi-experimental study carried out on 200 students selected with systematic cluster sampling from schools located in Chabahar city, (100 students in each case and control groups). The data was collected using a questionnaire before the intervention, that was lecturing on oral health, and immediately and 3 months later. Data were analyzed using the SPSS software version 11.
    Results
    The mean age of participants was 11.3 ± 1.3 years. The findings indicated that rate of oral self-care behaviors were significantly increased in the case group compared to the control group after the intervention (tooth brushing for twice a day 69%, Flossing tooth 34%, mouthwash 69%, and regular visiting a dentist 6% in case group versus 47% (p< 0.002), 14% (p< 0.001), 57% (p< 0.03) and 5% (p< 0.007) in the control group (,, , respectively.
    Conclusion
    Lecturing is an effective and cheap method on the promotion of oral health preventive behaviors particularly in deprived areas like Chabahar city.
    Keywords: Education, Lectures, Oral health
  • Mojahede Salmani Nodoushan, Amir Houshang Mehrparvar, Ziba Loukzadeh, Masoud Rahimian, Mohammad Ali Ghove Nodoushan, Reza Jafari Nodoushan Page 89
    Background
    Despite the presence of many textile and dyeing plants in Iran, we couldn’t find similar studies in this country. Forthermore, considering progress in the dyeing process and engineering controls, assessment of respiratory system is important for these workers. The present study was performed to evaluate the respiratory system in dyeing workers.
    Methods
    In a cross-sectional study, 101 dyeing workers (all dyeing workers in yazd) and 90 workers without respiratory exposures (control group), were evaluated. A questionnaire was filled for each participant included Venables questionnaire and some other questions about age, work experience, personal or familial history of asthma or atopy, acute and chronic respiratory symptoms; Then spirometry was performed before and after the shift work
    Results
    The frequency of acute and chronic respiratory symptoms was significantly higher among dyeing workers than controls. According to the Venables questionnaire, 11.9% of the dyeing workers suffered from asthma. Means of FVC and FEV1 of pre-shift spirometry were lower than control (p< 0.001). Across-shift spirometry showed significant reduction of FVC (p< 0.001), FEV1 (p< 0.001), FEF25-75% (p= 0.05) and FEF25% (p= 0.007) in dyeing workers compared to the control group.
    Conclusion
    Evaluation of dyeing workers’ respiratory system in this study showed that despite development in dyeing processes and engineering controls, workers in this job show more prevalent acute and chronic symptoms, and across-shift changes in spirometric parameters were significantly higher in this work group than the control group. Therefore it is necessary to pay attention to the control of respiratory exposures in this job.
    Keywords: Respiratory symptoms, Spirometry, Textile insustryasthma
  • Reza Farid Hosseini, Farahzad Jabbari Azad, Hadis Yousefzadeh, Houshang Rafatpanah, Saeed Hafizi, Homan Tehrani, Masoud Khani* Page 90
    Background
    Chronic obstructive pulmonary disease (COPD) is a third leading cause of death.
    Methods
    In this case control study, we prepared 5 cc bloods from the antecubital vein of 100 COPD patients and 40 healthy individuals as control group. Vascular endothelial growth factor (VEGF) expression protein level was measured by ELISA in both groups.
    Results
    We found that concentration of VEGF in blood serum of patients with COPD 189.9±16pg/ml) was significantly higher than the control group (16.4±3.48pg/ml) (p<0.001). While VEGF serum level in emphysematous patients wasn’t significantly different with control group (p=0.07). Furthermore VEGF serum level in COPD patients was proportionally increased with severity of disease (p<0.001). Besides all COPD patients, regardless of their smoking status, were experienced significantly higher levels of VEGF than healthy ones (p=0.001; z=4.3).
    Conclusion
    Our results suggest VEGF serum concentration as the sensitive index for severity and activity of COPD and its prognosis.
    Keywords: Chronic obstructive pulmonary disease, Vascular Endothelial Growth Factor, Chronic bronchitis, Emphysema
  • Mahdi Shahriari, Sezaneh Haghpanah, Javad Dehghani, Javad Dehbozorgian, Peyman Eatemadfar, Asghar Bazrafshan, Mehran Karimi* Page 91
    Background
    High serum level of cancer antigen 15.3 (CA15.3) has been reported in some malignant and nonmalignant conditions including thalassemia major which could have been resulted from ineffective erythropoiesis. We aimed to evaluate the serum level of CA15.3 in carriers of beta-thalassemia by comparing them with cancer patients and healthy individuals.
    Methods
    This cross-sectional study was done from February to December 2011 in Southern Iran. Participants consisted of 32 subjects with beta-thalassemia minor, 49 with cancer and 25 healthy individuals. The serum levels of CA15.3 were measured and compared in different groups.
    Results
    The serum levels of CA 15.3 in all participants were in the normal range (<35 U/mL). Also it did not significantly differ among various groups of the participants (p=0.723). Age was not significantly correlated with the serum level of CA 15.3 (r= 0.039, p=0.702). The most frequent cancer in the group of patients with malignancies was hematologic malignancies (96%) with the highest frequency for acute lymphoblastic leukemia (37 patients). Frequency of thalassemia minor in patients with cancer was 11 (22.4%).
    Conclusion
    No correlation was found between CA 15.3 serum level with beta-thalssemia minor or with childhood malignancies. Compared to general population, a high proportion of beta thalssemia minor was observed in patients with cancer in our study. Future prospective studies are needed to evaluate the relationship between cancer and beta-thalassemia minor accurately.
    Keywords: Beta, thalassemia minor, Cancer, Cancer antigen 15.3
  • Azadeh Mazaheri Meybodi, Ahmad Hajebi, Atefeh Ghanbari Jolfaei* Page 92
    Background
    Co-morbid psychiatric disorders affect prognosis, psychosocial adjustment and post-surgery satisfaction in patients with gender identity disorder. In this paper, we assessed the frequency of personality disorders in Iranian GID patients.
    Methods
    Seventy- three patients requesting sex reassignment surgery (SRS) were recruited for this crosssectional study. Of the participants, 57.5% were biologically male and 42.5% were biologically female. They were assessed through the Millon Clinical Multiaxial Inventory II (MCMI- II).
    Results
    The frequency of personality disorders was 81.4%. The most frequent personality disorder was narcissistic personality disorder (57.1%) and the least was borderline personality disorder. The average number of diagnoses was 3.00 per patient.
    Conclusion
    The findings of this study revealed that the prevalence of personality disorders was higher among the participants, and the most frequent personality disorder was narcissistic personality disorder (57.1%), and borderline personality disorder was less common among the studied patients.
    Keywords: Personality disorder, Gender identity disorder
  • Arman Ahmadzadeh, Mohammadmehdi Emam, Alireza Rajaei*, Mohammad Moslemizadeh, Maryam Jalessi Page 93
    Background
    SCORE, OST and ORAI risk assessment tools could reduce the cost burden of BMD tests by selecting the high risk patients to osteoporosis. In this study we compared the ability of these risk assessment measures to assess probability of the osteoporosis among post-menopausal women.
    Methods
    211 post-menopausal women aged 45-88 years enrolled into the study. All of the patients underwent BMD test and divided into two groups according to T-Score level. 43 patients (20.4%) had T-Score ≤-2.5 (osteoporotic) (group-1) and 168 (70.6%) patients had T-Score of > -2.5 (non-osteoporotic). Among 168 nonosteoporotic cases, 88 had -2.5≤T-Score≤-2 in at least one bony area. These 88 cases in addition to the 43 cases with -2.5≤T-Score considered as high risk group to osteoporosis (group 2). Afterward, SCORE, OST and ORAI risk scores were calculated and sensitivity, specificity, likelihood ratio, accuracy index and area under the curve of each tool were determined in both groups and then compared with each other.
    Results
    SCORE had the highest sensitivity compared with others in both groups (95% and 88.2% respectively). Moreover, it had the highest diagnostic odds ratio and negative predictive value between the three methods. OST had the highest likelihood ratio and specificity in both groups (71.4% and 75.4%). There was significant difference between the sensitivity and specificity of the tests (p= 0.004 and 0.027).
    Conclusion
    OST with the highest specificity and positive LR had a special role in determining the osteoporotic patients and SCORE with the highest sensitivity and negative predictive value had an exceptional role in exclusion of the non- osteoporotic individuals. However, considering the area under the curve, there was no significant difference among these three methods in determining osteoporosis.
    Keywords: Osteoporosis, Bone density, Risk assessment, Sensitivity, Specificity, Predictive value
  • Ahmad- Reza Jamshidi, Arash Tehrani Banihashemi*, Shima Roknsharifi, Masoumeh Akhlaghi, Ahmad Salimzadeh, Fereydoun Davatchi Page 94
    Background
    To estimate the prevalence and characteristics of Rheumatoid Arthritis (RA) in an urban area of Tehran.
    Methods
    A total of 50 clusters were randomly selected in Tehran and 10291 subjects completed the COPCORD Core Questionnaire during 2004 and 2005. Patients with rheumatic complaints were examined and diagnosed by subspecialty fellows in rheumatology. Laboratory and radiology tests were also performed if required.
    Results
    A total of 35 subjects (5 men and 30 women) were diagnosed with RA, with a prevalence of 0.33% (95% CI: 0.22-0.46). Our results demonstrated that RA was six times more common in women than men. The mean age (± SD) of patients was 52.3 (± 17.6) years. Morning stiffness > 1 hour was reported in 37.1% of patients. Rheumatic signs were commonly found in wrist (60%), knee (60%), metacarpophalangeal (48.6%) and proximal interphalangeals of hand (40%). Approximately 46% of patients had difficulty carrying out daily activities.
    Conclusion
    According to our study, the prevalence of RA in Iran seems to be lower than western countries. However, the prevalence of RA in Iran seems to be approximately in the middle point comparing the APLAR region (from 0.7% in Australia (rural) to 0.12% in Thailand).
    Keywords: Rheumatoid Arthritis, Prevalence, Iran
  • Abolfazl Khoshdel, Soleiman Kheiri, Jafar Nasiri, Hoda Ahmari Tehran, Esfandiar Heidarian Page 95
    Background
    Many pregnant Muslim women choose to fast during Ramadan every year worldwide. This study aimed to examine the effect of Ramadan fasting on serum leptin, neuropeptide Y and insulin in pregnant women and find whether fasting during pregnancy could have a negative effect on the health of mothers and fetuses.
    Methods
    This cross-sectional study was conducted on 39 healthy volunteer fasting pregnant women. Serum leptin, neuropeptide Y, insulin levels, body mass index and weight were measured five times on 0, 7th, 14th and 28th days of Ramadan and on the 14th day post-Ramadan. The data were analyzed by SPSS software (version 11.5) using repeated measures ANOVA to find whether any changes occurred in the variables of interest during the study, and Pearson correlation coefficient was used to examine the relations among the variables.
    Results
    A significant change in fasting blood sugar, neuropeptide Y and leptin was observed during the study (p< 0.05). Fasting blood sugar decreased significantly during Ramadan and increased after Ramadan, with the lowest value at the end of Ramadan. Neuropeptide Y increased both during Ramadan and two weeks after Ramadan. Also, leptin decreased significantly two weeks after Ramadan compared to the end of Ramadan. No significant change was observed in insulin level during the study (p>0.05).
    Conclusion
    The result of this study revealed the important role of leptin and neuropeptide Y in the long term regulation of energy balance in pregnant women with chronic diurnal fasting, and it further revealed that Ramadan fasting did not significantly change the serum insulin level.
    Keywords: Leptin, Insulin, Neuropeptide Y, Pregnancy, Fasting
  • Kamran B. Lankarani*, Yaser Sarikhani, Seyed Taghi Heydari, Hasan Joulaie, Najmeh Maharlouei, Payam Peimani, Seyed Mehdi Ahmadi, Davoud Khorasani- Zavareh, Hamid Soori, Ali Davoudi-Kiakalayeh, Gholamreza Masoumi Page 96
    Iran has had incremental incidence of traffic accident mortality since introduction of mechanization about a century ago. But the newest data from Iran show decrease in the absolute number of deaths, death per 10,000 vehicles and death per 100, 000 populations. Despite its huge impact on health and economy, research in the field of traffic crashes is still scant and there are still deficiencies in problem oriented research on traffic accidents. Actual cooperation of policy makers, executive bodies and academician could build platform for intersectoral discussion of different aspects of traffic accidents and could reduce burden of traffic accidents.
    Keywords: Traffic accidents, Burden of Disease, Accident Mortality
  • Homeira Khoddam, Neda Mehrdad*, Hamid Peyrovi, Alison L. Kitson, Timothy J. Schultz, Asa Muntlin Athlin Page 97
    Background
    Although knowledge translation is one of the most widely used concepts in health and medical literature, there is a sense of ambiguity and confusion over its definition. The aim of this paper is to clarify the characteristics of KT. This will assist the theoretical development of it and shape its implementation into the health care system
    Methods
    Walker and Avant’s framework was used to analyze the concept and the related literature published between 2000 and 2010 was reviewed. A total of 112 papers were analyzed.
    Results
    Review of the literature showed that «KT is a process» and «implementing refined knowledge into a participatory context through a set of challenging activities» are the characteristics of KT. Moreover, to occur successfully, KT needs some necessary antecedents like an integrated source of knowledge, a receptive context, and preparedness. The main consequence of successful process is a change in four fields of healthcare, i. e. quality of patient care, professional practice, health system, and community. In addition, this study revealed some empirical referents which are helpful to evaluate the process.
    Conclusion
    By aiming to portray a clear picture of KT, we highlighted its attributes, antecedents, consequences and empirical referents. Identifying the characteristics of this concept may resolve the existing ambiguities in its definition and boundaries thereby facilitate distinction from similar concepts. In addition, these findings can be used as a knowledge infrastructure for developing the KT-related models, theories, or tools.
    Keywords: Knowledge translation, Concept analysis, Walker, Avant, Healthcare system
  • Seyed Mansour Kashfi, Ali Khani Jeihooni*, Abbas Rezaianzadeh, Shahnaz Karimi Page 98
    Background
    Growth retardation in children is a result of nutritional ignorance, inappropriate care, and inadequate monitoring of growth monitoring. This study was performed to assess the effect of mothers education program based on the precede model on the mean weight of children (6-12 months) at health centers in Shiraz, Fars Province.
    Methods
    This quasi experimental study was conducted on 120 mothers (60 in the experimental and 60 in the control group) with single child and exclusively on breast feeding who were cared by health centers in Shiraz, Fars province. The data were gathered through a questionnaire which included demographic characteristics, the components of the precede model (knowledge, attitude, enabling as well as reinforcing factors, and maternal function) and child weight. Educational intervention was performed during 6 sessions each of which lasted for 55 to 60 minutes. The questionnaire was completed by the experiment a land control group before and 4 months after the training program.
    Results
    The results showed that the educational intervention program in the experimental group caused significant increase in the means of knowledge (p<0.001) and attitude scores (p<0.001). This study showed that enabling and reinforcing factors (and training sessions), performance score of mothers as well as weight of children among experimental group were significantly higher than control group (p=0.01).
    Conclusion
    The results of this study can be used as a guideline prevents growth retardation in health centers and other related organizations.
    Keywords: Health education, Precede model, Growth retardation, Children
  • Nastaran Khosravi, Anahita Izadi, Samileh Noorbakhsh, Shima Javadinia*, Azardokht Tabatabaei, Sarvenaz Ashouri, Ramin Asgarian Page 99
    Background
    Lead elements have an adverse effect on human health. The most important complications of lead poisoning are disorders of nervous system particularly seizure. This study aimed to evaluate the blood lead levels and its association with convulsion in a group of hospitalized febrile children.
    Methods
    In this analytic cross-sectional study, 60 hospitalized febrile children with 1- 60 month old participated in the study via non-probability convenience sampling method. All of the information included sex, age, weight, blood lead levels and history of convulsion gathered in the questionnaire. Finally all of data were statistically analyzed.
    Results
    66.7% of samples were male and 33.3% were female. The mean age was 32.57±38.27 months and the mean weight was 13.04±9.61kg. The Mean and Standard deviation of Blood lead level was 4.83±3.50μg/dL. 10% of samples had lead levels greater than 10μg/dL. 53.3% of patients have convulsion and other don’t have it. Blood lead levels was 4.91±3.65μg/dL in children with convulsion and 4.73± 3.38μg/dL in children without it; the difference was not significant (p= 0.8).
    Conclusion
    Overall, no significant association was found between blood lead levels and convulsion.
    Keywords: Lead, Convulsion
  • Seyed Hamidreza Monavari*, Mohammad Javad Mirzaei Parsa, Bahram Bolouri, Soltan Ahmed Ebrahimi, Angila Ataei-Pirkooh Page 100
    Background
    Wide distribution and low half-life of acyclovir has led to a high dose consumption of the drug. Recent studies have shown that encapsulation of acyclovir in nano-carriers can increase effectiveness and decrease its side effects. We investigated the inhibitory effect of acyclovir loaded nano-niosomes against herpes simplex virus type-1 (HSV-1) in cell culture.
    Methods
    In-vitro cytotoxicity study of empty niosomes (E-N), acyclovir loaded niosomes (ACV-N) and ACV as a free drug against HeLa cell line was performed by MTT assay and the viral titers was tested by TCID50 assay.
    Results
    The results indicated that a significant higher antiviral activity for acyclovir loaded nano-niosomes of about 3 times in comparison with free drug.
    Conclusion
    The results of this study revealed ACV-N have a higher antiviral activity compared with free drug; it could be a suitable carrier for delivery of acyclovir in the treatment of HSV-1 infections.
    Keywords: Nano, niosomes, Herpes simplex virus, Cytotoxicity
  • Farzad Shidfar, Mitra Zarrati, Mohammad Ebrahim Khamseh, Neda Haghighat, Ali Rostami, Hamid Zolfaghari* Page 101
    Background
    Some results exist on fetuin-A as marker for vascular disease in type diabetes. We examined the relationship between serum fetuin-A with some factors, in patients with type 2 diabetes mellitus (T2DM).
    Methods
    From October 2012 to June 2013, a total of 131 T2DM patients were recruited and evaluated for various parameters including HOMA-IR, Apo-A1, Apo-B100, body fat percentage and waist circumference. Serum fetuin-A levels were measured by enzyme-linkedimmunosorbent assay (ELISA), and Serum glucose with a Cobas MIRA analyzer by enzymatic method. Apo-B100 and apo-A1 were measured by immunoturbidimetry with a Cobas MIRA analyzer. HOMA-IR was calculated by the following formula: [fasting insulin (uIU/mL) × fasting blood glucose (mmol/L)]/22.5.
    Results
    The mean levels of HOMA-IR were significantly increased progressively across fetuin-A tertiles (p for trend=0.04) in women but not men. Fetuin-A had just a significant positive correlation with Apo- A1(r=0.22, p=0.02).
    Conclusion
    This present study showed that levels of serum fetuin-A are significantly associated with insulin resistance in women with T2DM.
    Keywords: Fetuin, A, Apo, A1, Apo, B100, Body Fat Percentage, Insulin Resistance, Type 2 Diabetes
  • Shahrokh Karbalaie, Kaveh Hosseini, Ali Bozorgi* Page 102
    Background
    In addition to diagnosing the acute myocardial infarction (MI), stratifying high-risk patients and proper treatment strategies are important issues in managing patients complaining of chest pain and suspecting MI. Many studies have been conducted to predict the occlusion site by interpreting the ST segment deviations in Electrocardiogram (ECG).Additional posterior and right precordial leads are suggested in literature to increase the sensitivity of prediction. The goal of this study was to determine the relation of ST segment changes in ECG (conventional 12 leads ECG besides right and posterior leads) with the site of occlusion within the vessel.
    Methods
    Retrospectively, from total 138 patients, 76 of them were analyzed as single vessel acute Inferior ST elevation Myocardial infarction (I-STEMI)-ST which 56 (74%) had Right Coronary Artery (RCA) occlusion [22(29.3%) proximal RCA, 24(32%) middle RCA and 10(13.3%) distal occlusion of RCA], 19(25%) had Left Circumflex artery (LCx) lesion and one had middle Left Anterior Descending (LAD) artery occlusion. On admission ECGs and coronary artery intervention films, were reported within maximum time of 6 days in hospital stay, and re-evaluated by two cardiologists.
    Results
    Fiol’s algorithm was 93% sensitive and 50% specific for predicting RCA occlusion. The ST elevation in lead III was associated with RCA stenosis (Odds Ratio (OR): 12, Confidence Interval (CI): 2.2-68.9), the association between ST elevation in lead II with LCx involvement was not significant. The V4R was a good marker for RV involvement on-admission, (OR=8, CI: 1.6-37.5). Sum of ST deviation in posterior leads (V7 to V9) ≥ 2mm had positive and significant relation to LCx stenosis (OR=4, CI: 1.3-14).
    Conclusion
    Benefit of adding posterior and right leads to 12-lead ECG is shown to be noteworthy in present and prior studies, in identifying LCx stenosis and poor prognosis involvement.
    Keywords: ECG, Coronary Angiography
  • Gholamreza Pahnabi, Mohammad Akbari*, Noureddin Nakhostin Ansari, Mahmoud Mardani, Mehdi Ahmadi, Mohammad Rostami Page 103
    Background
    Rupture of the Anterior Cruciate Ligment (ACL) is a common knee injury. The purpose of this study was to determine the balance control in football players with and without ACL reconstruction in posture of injury.
    Methods
    Sway of the center of gravity of 15 patients with ACL reconstruction was compared with 15 healthy, age and sex-matched subjects as the control group. All tests were done unilaterally in the posture of injury, using a kistler force plate with the open and -closed eye conditions.
    Results
    The knee of the operated side of the case group showed more displacement of the center of gravity when compared to the non-operated side in the same subject for all variables of the force plate. The operated side of the case group showed more displacement of the center of gravity for all variables of the force plate in comparison with the dominant side of knees in control group. There were significant differences between the non-operated side in the case group and the dominant side of the control group.
    Conclusion
    All together, postural control in the operated side of the case group was weaker than the nonoperated side of the same group and the dominant limb of the control group, which might have resulted from poor proprioception. The postural control was even weaker in the non-operated side of the case group as compared with the dominant limb of the control group, which can justify the hypo mobility of limb for several months after the surgery.
    Keywords: Anterior cruciate ligament, Postural control, Reconstruction
  • Somayeh Shatizadeh, Jila Yavarian, Farhad Rezaie, Mahmood Mahmoodi, Maryam Naseri, Talat Mokhtari Azad* Page 104
    Background
    Respiratory viruses are the leading cause of respiratory tract infections among children and are responsible for causing morbidity and mortality worldwide. This study was performed to detect viruses in children with respiratory infections and describe their epidemiology and clinical characteristics.
    Methods
    In this descriptive cross sectional study, throat swabs and wash specimens from 202 children younger than six years of age with diagnosis of a respiratory tract infection from a total of 897 specimens were evaluated using multiplex PCR method.
    Results
    Respiratory viruses were detected in 92 children: respiratory synsytial virus, 16.8; influenza virus, 5.4%; parainfluenza virus, 8.4%; adenovirus, 14.4% and human metapneumo virus 0.49 with male predominance and higher distribution in children younger than 1 year of age with preference in the cold months of year. The clinical presentations of all detected viruses were almost similar.
    Conclusion
    In the present study, nine different respiratory viruses were detected. RSV causes the great majority of respiratory virus infections in children. There was no significant difference in epidemiologic patterns of these viruses in comparison to other studies.
    Keywords: Children, Epidemiology, Iran, Respiratory viruses
  • Hashem Fakhreyaseri*, Mehdi Shakaraby, Hamid Reza Bradaran, Seyed Kamran Soltani Arabshahi, Ali Mohammad Fakhre Yaseri Page 105
    Background
    The cag pathogenicity island includes a number of genes, including cytotoxin-associated protein A (cagA) and vacuolating cytotoxin (vacA) genotypes, which are associated with bacterial virulence. Although the role of cagA and vacA in the virulence of Helicobacter pylori (H. pylori) is well established in epidemiological studies, the relationship between the cagA and vacA genotypes in Iran has yet to be fully elucidated. This study compared the association between cagA and vacA genotypes between peptic ulcer disease (PUD) patients and non-ulcer dyspeptic (NUD) patients.
    Methods
    This case control study was done on 130 patients with positive H. pylori in histological and Giemsa reports. The case group comprised 65 PUD patients, and the control group included 65 NUD patients. The presence of the cagA and vacA genotypes was determined using polymerase chain reaction (PCR) on biopsy samples, taken via endoscopy.
    Results
    Both cagA and vacA genotypes were positive in 51.5% (17) of the PUD group and 20% (6) of the NUD group (p= 0.009), and both cagA and vacA genotypes were negative in 48.5% 16) and 80% (24) of the case and control groups, respectively (p= 0.03). CagA-positive H. pylori was detected in 41.5% (27) and 24.6% (16) of the case and control groups, respectively (p= 0.001), and vacA-positive H. pylori was found in 60% (39) and 46% (30) of the case and control groups, respectively.
    Conclusion
    Both cagA and vacA genotypes were more prevalent in the PUD patients than in their NUD counterparts among our Iranian samples. It is seems that the determination of these two genotypes in PUD patients is a good screening tool for patient selection for endoscopy and treatment.
    Keywords: Dyspepsia, Peptic ulcer, Genes
  • Abbas Shamsalinia, Kian Nourozi*, Masoud Fallahi Khoshknab, Ali Farhoudian Page 106
    Background
    Addiction is a global problem for which effective treatment is crucial. Stopping the consumption of abused substances in a camp is a strong predictor of the success for the recovery process. The present study employed a qualitative approach to explore the camp recovery experiences in individuals with substance addictions.
    Methods
    The research conducted in Iran’s northern cities with participants that included 17 men with a history of substance abuse, who were all engaged in the recovery process at the time of the study. They were invited to participate in the research based on a purposive and snowball sampling method. The data were collected by individual face-to-face and phone interviews using semi-structured questions. Data were then analyzed using conventional content analysis
    Results
    three main categories were identified: selecting a camp: an appeal for rescue, substance deprivation crisis, and out of the frying pan into the frying pan or into the fire.
    Conclusion
    Results showed that participants can be helped in the recovery process by the provision of public facilities and financial support for camps, by monitoring the performance of these centers and by attempting to address existing deficiencies. We concluded with three recommendations for improving services and preventing physical, psychological, and emotional damage to addicted individuals: remove unauthorized camps, establish camps with treatment designated to the needs of addicted individuals.
    Keywords: Addiction, Substance Abuse, Medium, term Residential Centers (Camps), Qualitative Study, Recovery
  • Fariba Almassinokiani*, Alireza Almasi, Peyman Akbari, Mahboubeh Saberifard Page 107
    Background
    To determine the role of Letrozole, an aromatase inhibitor, in the treatment of endometriotic pain.
    Methods
    In this prospective, randomized, controlled clinical trial in minimally invasive surgery research center, 51 women with pelvic endometriosis and endometriotic pain (dyspareunia, dysmenorrhea, pelvic pain) score of 5 or more (for at least one of these endometriotic pain), after laparoscopic diagnosis and conservative laparoscopic surgery were treated with either Letrozole plus OCP (n=25) or only OCP (n=26) for 4 months continuously.
    Results
    Using VAS test, the score of dyspareunia, dysmenorrhea and pelvic pain 4 months after the laparoscopic surgery declined significantly in both groups but the difference between results of the two groups was not significant.
    Conclusion
    Both treatment modalities showed comparable effectiveness in the treatment of pains related to endometriosis and in comparison with OCP, Letrozole did not affect the outcome.
    Keywords: Aromatase inhibitor, Endometriosis, Letrozole, Pelvic pain
  • Mandana Rezaei, Ismael Ebrahimi, Behnoush Vassaghi- Gharamaleki* Page 108
    Background
    This paper explores the gender-related bilateral differences of extensor and flexor torques of the knee joint at low and high angular velocities in Iranian healthy males and females.
    Methods
    70 healthy subjects (29 males (26.61±4.34 yrs and 41 females with average age of 23.07±3.70 yrs)) were participated in this study. Isokinetic peak torque values for knee extensors and flexors in concentric and eccentric contraction modes were measured and flexors and extensors strength ratios (HQR) computed among both dominant and non-dominant legs in lying position at 60 and 180°.s-1angular velocities.
    Results
    There was significant gender-velocity interactions detected for knee flexor to extensor strength ratios presenting that increasing velocity escaled this, ratios in females more than males (p 0.05). There was no gender- velocity-leg side interaction (p>0.05). Bilateral differences were found for eccentric flexor peak torques (p<0.05). By increasing velocity, peak torque values decreased and HQR was increased (p<0.05).
    Conclusion
    Measurement procedures including test position is an important factor when interpreting genderrelated and bilateral differences of isokinetic knee strength ratios in healthy individuals.
    Keywords: Knee, Isokinetic dynamometry, Strength ratio, Gender
  • Diana Matini, Atefeh Ghanbari Jolfaei*, Abdolreza Pazouki, Mohadeseh Pishgahroudsari, Mehdi Ehtesham Page 109
    Background
    Severe obesity is highly co-morbid with psychiatric disorders and may have effect on the quality of life. This study aimed to compare severity and prevalence rate of depression, anxiety and eating disorders and quality of life in severe obese patients before and 6 months after the gastric bypass surgery.
    Methods
    This was a prospective observational study which conducted at Hazarat Rasool-Akram Hospital in Tehran, 2012. Questionnaires included demographic questions, eating disorder Inventory (EDI), The Short Form Health Survey (SF-36) for quality of life, Structured Clinical Interview for DSM-IV Axis I disorders (SCID-I) and Hamilton Rating Scale for Depression (HRSD) and anxiety (HRSA). Participants were interviewed two times, before surgery and six months after, to determine changes of the disorders. Patients with the history of bariatric surgery, individuals younger than 18 year old and those who disagreed to join the study were excluded.
    Results
    In assessing the eating disorder inventory-3rd version (EDI-3), Significant reduction in drive for thinness (DT) (p= 0.010), bulimia (B) (p< 0.0001) and body dissatisfaction mean (BD) (0.038) was observed at the 6-month follow-up. At this period, the mean for physical component summary of SF36, significantly decreased (p< 0.0001), however mental component summary did not significantly differ (p= 0.368); Also differences in severity of anxiety (p= 0.852), and depression in HRSD (p= 0.311), prevalence of depression (p= 0.189) and prevalence of general anxiety disorder according to SCID (p=0.167) did not differ significantly, at this period.
    Conclusion
    Although weight loss after bariatric surgery improved the physical component of quality of life, this improvement did not affect the mental aspect of life, depression and anxiety and it seems that these psychopathologies need attention and treatment in addition to weight loss treatments in patients with obesity.
    Keywords: Bariatric surgery, Psychiatric disorders, Obesity
  • Bahman Cheraghian, Mohsen Asadi-Lari*, Mohammad Ali Mansournia, Reza Majdzadeh, Kazem Mohammad, Saharnaz Nedjat Page 110
    Background
    Hypertension is an important public-health challenge worldwide. The prevalence of hypertension greatly varies across countries. The aim of this study was to estimate the prevalence of self-reported hypertension and to determine related factors in a large random sample of Tehran population in 2011.
    Methods
    In this cross sectional study, 69173 individuals aged 25–64 years were selected using multistage cluster random sampling method. All participants were interviewed by trained personnel using standard questionnaires. Weighted prevalence and incidence rates were calculated and principle component analysis (PCA) was used to construct wealth index. Chi-square and odds ratio were used to assess associations in univariate analysis. Logistic Regression model was used in multivariate analysis.
    Results
    The prevalence of self-reported hypertension was 5.27% in total, 3.83% in men and 6.64% in women (p< 0.001). The annual incidence rate of self-reported hypertension was 6.87 per 1000; 5.26 in men and 8.43 in women (p< 0.001), obviously varied across various districts. In multivariate analysis, age, sex (woman), marital status (single), obesity and smoking were positively associated with prevalence of self reported hypertension. Education level was negatively associated to hypertension. On the other hand, wealth status was not associated to self-reported hypertension.
    Conclusion
    Our study findings highlighted low awareness rates of hypertension among Tehran adults especially in men and younger people. Hence, we recommend public health strategies to improve health education programs. Moreover, programs to develop the surveillance system and screening programs to early detection of undiagnosed cases are urgently needed particularly in high risk population subgroups.
    Keywords: Hypertension, Self, reporting, Prevalence, Tehran
  • Sima Nedjat, Saharnaz Nedjat*, Reza Majdzadeh, Mojgan Farshadi Page 111
    Background
    People are increasingly interested in health news. As a mass media, the ‘Islamic Republic of Iran Broadcasting’ (IRIB) has the highest number of target audiences. In Iran, some people follow health news via health programs on satellites and other means of communication. However, all of these programs do not live up to the standards of scientific evidence. In this study, we examined Tehran people’s trust in health news disseminated by the IRIB and other mass media outlets.
    Methods
    A cross-sectional study was conducted in Tehran. Through multistage sampling, 510 households proportional to size were randomly selected from five regions of Tehran including northern, eastern, western, southern and central regions. One person from each household completed the questionnaire through interviews. The questionnaire included questions on people’s level of trust in health news delivered by the IRIB, satellite programs, the internet and magazines. It also included demographic questions. The validity and reliability of the questionnaire was evaluated.
    Results
    Among the interviewees, 50.6% was female. The highest level of trust by the participants was observed in the IRIB (65.2%), and the lowest trust was observed in satellite news (43.4%); p< 0.001. The interviewees believed that the IRIB news broadcasters had more mastery over the subject than the ones in satellite channels (p< 0.001). The IRIB’s coverage of important and relevant health topics was also significantly perceived to be better than that of satellite news (p< 0.001). According to 83.5% of interviewees, the quality of health news had improved in the past 10 years. Fifty nine point eight percent of participants believed the quality and accuracy of the IRIB health news was monitored.
    Conclusion
    People’s higher level of trust in domestic news as compared to foreign sources and the better status of domestic sources in other areas such as precision in reporting, coverage of more important news, its delivery in lay language, the news broadcasters’ proficiency, and other cases - from the participants’ point of view - can highlight the significance of designing interventions for changing health behavior among domestic health news producers. Therefore, the results of this study can prove useful to health news policy makers in the IRIB.
    Keywords: Iran, News, Health
  • Mehdi Rezaee, Mehdi Rassafiani*, Hamidreza Khankeh, Mohammad Ali Hosseini Page 112
    Background
    Fieldwork education is a core part of all occupational therapy curriculums around the world to enable the students meet minimum competencies required for their professional life. Student experience is a valuable source to explore the nature of fieldwork training and plan more efficient curriculums in the future. This study aimed to explore the students'' experiences in the first fieldwork education.
    Methods
    Data were collected through a focus group and series of semi-structured interviews with 16 occupational therapy students who had passed the first semester of fieldwork education at three occupational therapy departments in Iran. The interviews were transcribed line by line and analyzed according to inductive content analysis.
    Results
    Following the analysis of the data, three main themes were identified including the importance of supervisors’ management, deficits in the current curriculum and challenges in the educational environment. Each theme included different categories to show students’ concerns and challenges in the first fieldwork education experience and their suggestions for more efficient trainings.
    Conclusion
    The research argues that several combined key factors determine the nature and utility of occupational therapy (OT) fieldwork experiences of the students. However, further studies are needed to clarify the experiences of the supervisors, department managers and others involved in the fieldwork education.
    Keywords: Clinical education, Occupational tTherapy student, Professional education, Qualitative research
  • Hamid Reza Aghayan, Babak Arjmand, Mohsen Yaghoubi*, Maziar Moradi-Lakeh, Homa Kashani, Farhad Shokraneh Page 113
    Background
    Cell-based therapies can be used to treat neurological diseases and spinal cord injuries. The aim of this study was to assess the clinical outcome of bone marrow derived mononuclear cells (BM-MNCs) transplantation in patients with spinal cord injuries.
    Methods
    Following a systematic review to detect clinical intervention studies, a meta analysis was done for pooling data to estimate the outcome of BM-MNCs transplantation. The percentage of the patients with improved ASIA scale from one grade to a higher grade was defined as the main outcome. By considering the study design and outcome measurement, two reviewers independently extracted the data.
    Results
    Eight relevant primary studies were found; seven qualified studies, with a combined total of 328 patients were assessed by meta-analysis, including 314 ASIA-A, 13 ASIA-B, 94 cervical, 227 thoracic and 60 acute injuries. The percentage of the patients’ improvement was tested by meta-analysis through random and fixed models. The overall percentage of all patients’ improved ASIA scale after a one- year follow-up (95% CIs) was 43 (0.27-0.59).
    Conclusion
    Data from published trials revealed that encouraging results were achieved by autologous BMMNCs for the treatment of spinal cord injury. However, the number of clinical trials included in the systematic review was too limited to reach a definite conclusion. More qualified clinical trials with standardized methods are needed to truly justify the outcome of this therapeutic modality in SCI patients.
    Keywords: Cell Transplantation, Bone Marrow Derived Mononuclear Cells, Spinal Cord Injury
  • Mina Doudkani-Fard, Vahid Ziaee*, Mohammad-Hassan Moradinejad, Mojtaba Sedaghat, Mohammad-Taghi Haghi-Ashtiani, Zahra Ahmadinejad Page 114
    Background
    Juvenile Idiopathic Arthritis (JIA) is one of the most common chronic rheumatic diseases in children with unknown etiology and pathogenesis. It also has no diagnostic test and its clinical diagnosis is made through ruling out other types of arthritis. The aim of this study was to evaluate the level of ADA (Adenosine Deaminase) in the serum of JIA patients and to compare it with that of patients with Reactive Arthritis (RA). Evaluation of sensitivity and specificity of serum ADA level in JIA was another objective.
    Methods
    The study included 120 children with JIA (mean age= 7.6 ± 4.3 years) and 40 children with RA (mean age= 5.5 ± 3.1 years). The ADA was measured in the active phase of both diseases.
    Results
    The mean ADA serum level was obtained as 15.8 ± 11.8 U/l in JIA patients and 14.3 ± 7.5 U/l in RA patients. The difference was statistically insignificant (p= 0.4). Another finding of this study was the significant specificity (77.5%) of this laboratory parameter for JIA in comparison with its low sensitivity (36.7%). Positive predictive value was 83% and negative predictive value 29%.
    Conclusion
    Determination of ADA serum levels is a noninvasive reliable and easy biomarker for diagnosis of JIA and it can be used as alternative parameters representing disease activity.
    Keywords: Juvenile idiopathic arthritis, Reactive arthritis, Adenosine deaminase, Chronic arthritis, Children
  • Yasser Labbafinejad, Mostafa Ghaffari, Baharak Bahadori, Saber Mohammadi, Alireza Abdi, Mohammad Namvar, Mirsaeed Attarchi* Page 115
    Background
    Work ability assessment and its affecting factors are important in the field of occupational health. One of the factors affecting work ability is sleep disorder, which is very common among workers. Therefore, the present study aimed to assess work ability and its relationship with sleep disorder in workers of a manufacturing plant.
    Methods
    This cross- sectional study was conducted in a manufacturing plant in Tehran in 2013. All the 931 male workers of this plant were enrolled in the study, and their work ability was assessed using the Work Ability Index (WAI). The scores of this index range from 7 to 49, and the higher work ability score indicates a better work ability status. In this study, sleep disorder was assessed using the MUSIC-Norrtalje Questionnaire.
    Results
    The average score of WAI was 42.81, ranging from 22 to 49. This score was significantly lower in the group with sleep disorder (41.28) than in the group without sleep disorder (44.10) (p< 0.001). The results of the logistic regression analysis revealed a significant relationship between work ability and sleep disorder even after adjustment for the confounding variables (OR= 2.52, 95% CI= 1.07 – 5.93, p= 0.033).
    Conclusion
    The results of this study found a relationship between sleep disorder and work ability. Therefore, it is recommended to identify workers with sleep disorder and attend to their problem in order to increase their work ability.
    Keywords: Work Ability, Sleep disorder, Worker
  • Asghar Dalvandi*, Hamidreza Khankeh, Saiedeh Bahrampouri, Abbas Ebadi, Hojjat Passandeh, Hassan Nouri Sari, Fardin Faraji, Mehdi Rahgozar Page 116
    Background
    The studies have shown that stroke morbidity and mortality could be decreased if early diagnosis and treatment is delivered faster for patients. This tool is designed based on all Pre hospital stroke scales across the world as well as experiences of the emergency medicine specialists and pre-hospital emergency technicians to improve the diagnostic accuracy of the stroke scale in Iran.
    Methods
    This study used mixed methods and was carried out in two main phases. In the first phase (items generating), concept elicitation was conducted based on the review of the literature related to stroke diagnosis and usual instruments in pre-hospital emergency stroke centers, and a series of semi- structured individual interviews with 35 neurologists, emergency medicine practitioners, and physicians working in hospitals and emergency technicians in the pre-hospital field participated. In the second phase (items reduction), the face and content validity, and reliability of the procedure were checked.
    Results
    According to results from the first phase of this study (items generation), three domains were introduced as the most important factors influence to detection of early signs and symptoms of stroke. In the second phase (items reduction), the face validity of this tool was based on the comments received from participants (the experts and EMS technicians), and changes were made for clarity of items. The content validity based on Lawshe index was identified. The S-CVI/Ave for Iranian Pre-Hospital stroke scale was calculated 89%). To determine the criterion validity of the instrument, he Iranian pre-hospital stroke scale scores were compared with the final diagnosis based on Brain CT scan result in hospital.
    Conclusion
    This study made an Iranian pre hospital stroke scale for emergency technicians in pre-hospital field which is dichotomous items, simple and very easy to use. For future this tool could be recommended and employed by emergency dispatch units as well as using it in the triage procedure in the hospital.
    Keywords: Psychometric properties, Pre, hospital emergency, Stroke Scale, Iran
  • Noushin Jalayer Naderi*, Farrokh Tirgari, Mohammad Javad Kharazifard, Fateme Farahani Parsa Page 117
    Background
    Cell proliferation is one of the most critical factors in metastasis and prognosis of the malignant tumors.Recent investigations show that the eosinophil granolosytes have an important role in developing of malignant tumors. The relation between cell proliferation and eosinophilic infiltration in oral squamous cell carcinoma (OSCS) with prognosis is unclear. The aim of this study was to investigate the relationship between the Ki67 expression and eosinophilic infiltration with the clinical features on OSCC.
    Methods
    This study was cross sectional in which 24 paraffined embeded block of OSCC selected from the Imam Khomeini hospital; cancer institute’s archive. 4 micron sections were prepared and studied for Ki67 antigen immunohistochemically. The labeling index (LI: positive epithelial cells/1000 epithelial cells) of Ki67 positive cells were obtained. In each section eosinophilic cells were counted in 10 fields with 400 (HPF). The relations between the eosinophil cells and Ki67 positive cells counts with clinical features and histopathological differentiation were achived by the linear regression and spirman statistical tests.
    Results
    There were no any significant relationship between gender, histopathological differentiation and the number of eosinophils and Ki67 positive cells counts (p= 0.33 and p=0.73). A significant relationship between lymph node involvement and the number of eosinophils and the Ki67 positive cells counts was found (p=0.04).There was a positive relationship between the number of Ki67 positive cells and the number of eosinophil cells (p= 0.05).
    Conclusion
    A significant relationship between lymph node involvement with eosinophilc cells and Ki67 positive cells counts were exist.
    Keywords: Eosinophil cells, Lymph node involvement, Oral squamus cell carcinoma, Ki67 antigen
  • Mehri Maleki, Zahra Jafari, Homa Zarrinkoob, Alireza Akbarzadeh Baghban Page 118
    Background
    Aging can cause loss of balance, which may lead to physical and psychological problems. As the role of the otolith organs in maintaining postural stability has been emphasized in recent years, the present study investigated the effect of aging on saccular function using cervical vestibular evoked myogenic potentials (cVEMP).
    Methods
    The participants were assigned into two groups; group one included 31 young adults with a mean age of 22.15 (range: 19-26 yr) and group two consisted of 31 old adults with a mean age of 69.76 years (range: 61-79 yr). All participants hearing sensitivity was normal with no history of balance problems. VEMP was recorded for all subjects using tone burst 500 Hz stimuli at the threshold level and 95 dB nHL intensity level through air-conduction stimulation via an insert receiver.
    Results
    There was a significant difference in the cVEMP response threshold (p< 0.001), 1 wave latency (p<0.001), P1/N1 amplitude (p< 0.001), and asymmetry ratio of P1/N1 amplitude (p< 0.05) between the two groups. No significant difference was found between the left and right ears or in N1 wave latency between the two groups.
    Conclusion
    VEMP abnormalities observed in healthy older adults showed the sensitivity of this test in identifying early signs of vestibular dysfunction. VEMP is an easy-to-use test that requires a short time to be performed. Therefore, it can be used as a selective objective screening test to detect vestibular disorders.
    Keywords: Saccular function, Vestibular evoked myogenic potentials, Aging
  • Omid Pournik*, Sara Dorri, Hedieh Zabolinezhad, Seyyed Moayed Alavian, Saeid Eslami Page 119
    Background
    Timely diagnosis of liver cirrhosis is vital for preventing further liver damage and giving the patient the chance of transplantation. Although biopsy of the liver is the gold standard for cirrhosis assessment, it has some risks and limitations and this has led to the development of new noninvasive methods to determine the stage and prognosis of the patients. We aimed to design an artificial neural network (ANN) model to diagnose cirrhosis patients with non-alcoholic fatty liver disease (NAFLD) using routine laboratory data.
    Methods
    Data were collected from 392 patients with NAFLD by the Middle East Research Center in Tehran. Demographic variables, history of diabetes, INR, complete blood count, albumin, ALT, AST and other routine laboratory tests, examinations and medical history were gathered. Relevant variables were selected by means of feature extraction algorithm (Knime software) and were accredited by the experts. A neural network was developed using the MATLAB software.
    Results
    The best obtained model was developed with two layers, eight neurons and TANSIG and PURLIN functions for layer one and output layer, respectively. The sensitivity and specificity of the model were 86.6% and 92.7%, respectively.
    Conclusion
    The results of this study revealed that the neural network modeling may be able to provide a simple, noninvasive and accurate method for diagnosing cirrhosis only based on routine laboratory data.
    Keywords: Liver cirrhosis, Non, Alcoholic Fatty Liver Disease (NAFLD), Neural Networks, Diagnosis
  • Fatemeh Kermanian, Mansoureh Soleimani, Bagher Pourheydar, Alireza Samzadeh-Kermani, Farzaneh Mohammadzadeh, Mehdi Mehdizadeh* Page 120
    Background
    Adenosine is an endogenous purine nucleoside that has a neuromodulatory role in the central nervous system. The amphetamine derivative (±)-3,4-methylenedioxymethamphetamine (MDMA or ecstasy) is a synthetic amphetamine analogue used recreationally to obtain an enhanced affiliated emotional response. MDMA is a potent monoaminergic neurotoxin with the potential of damage to brain neurons. The NF-kB family of proteins are ubiquitously expressed and are inducible transcription factors that regulate the expression of genes involved in disparate processes such as immunity and ingrowth, development and cell-death regulation. In this study we investigated the effects of the A2a adenosine receptor (A2a-R) agonist (CGS) and antagonist (SCH) on NF-kB expression after MDMA administration.
    Methods
    Sixty three male Sprague–Dawley rats were injected to MDMA (10 and 2 mg/kg) followed by intraperitoneal CGS (0.03 mg/kg) or SCH (0.03mg/kg) injection. The cerebellum were then removed forcresylviolet staining, western blot and RT- PCR analyses. MDMA significantly elevated NF-kB expression. Our results showed that MDMA increased the number of cerebellar dark neurons.
    Results
    We observed that administration of CGS following MDMA, significantly elevated the NF-kB expression both at mRNA and protein levels. By contrast, administration of the A2a-R antagonist SCH resulted in a decrease in the NF-kB levels.
    Conclusion
    These results indicated that, co-administration of A2a agonist (CGS) can protect against MDMA neurotoxic effects by increasing NF-kB expression levels; suggesting a potential application for protection against the neurotoxic effects observed in MDMA users.
    Keywords: N, Methyl, 3, 4, methylenedioxyamphetamine (MDMA), Adenosine, Nuclear factor, kB, Cerebellum
  • Nasrin Khalesi, Nastaran Khosravi, Mohammad Reza Rezaee, Leila Amini* Page 121
    Background
    Identification of α thalassemia (α thal) a common cause of microcytosis during neonatal periods is an important step prevent unnecessary interventions. Thus, low the mean corpuscular volume (MCV) and the mean corpuscular hemoglobin (MCH) may consider as α-thalassemia key detection points. The present study aimed to determine the prevalence of microcytosis among neonates who born in Tehran, Iran.
    Methods
    Cord blood samples were collected from 1001 newborns after birth in labor room and their red blood cell parameters were investigated.
    Results
    MCV was 114.2 fl (95% CI: 113.5-114.9) and twenty three neonates (2.3%) had MCV less than 94 fL that classified as microcytosis and 4 (0.40%) had both low MCH and MCV.
    Conclusion
    Low MCV especially in normal Hb newborns may hints for α thal detection.
    Keywords: Thalassemia, mean corpuscular hemoglobin, microcytosis, Hb Barts
  • Hamid Reza Javadi, Abbas Allami*, Navid Mohammadi, Rezvan Alauddin Page 122
    Background
    Impact of substance abuse on outcome of hospitalized patients with acute myocardial infarction (MI) is a frequent question. Available studies show disagreements over its impact, thus we performed this study to find a clear answer.
    Methods
    In a cross sectional study, 304 patients (include 152 consecutive opium dependents and equal number of independents) with acute MI admitted to coronary care units (CCU) in Bou-Ali Sina Hospital of Qazvin University of Medical Science were enrolled. Data on demographics (e.g. age, sex and education), identified MI risk factor (smoking and diabetes), clinical findings (e.g. Killip class and in-hospital mortality), ECG findings (e.g. localization of infarction and arrhythmia), echocardiographic examinations (e.g. ejection fraction and regional wall motion abnormality) and laboratory findings (lipid profile, glycemic situation) were gathered.
    Results
    The mean age was 63.01±12 years for opium users and 64.3± 10 for non-users. Educational level was higher in patients who used opium. No significant differences were found between opium users and non-users in rate of hypertension, diabetes mellitus, hyperlipidemia, and cigarette smoking. The mean duration of experienced chest pain in hospital stay was significantly higher in non-opium users compared to opium users (1.78± 0.63 vs.1.52±0.54) (p< 0.001). Higher Killip class and arrhythmia have been identified as the most important independent predictors of early in-hospital mortality (in both groups).
    Conclusion
    The higher Killip class and age identified as the most important independent predictors of early in-hospital mortality and addiction do not act as a major risk or protecting factor in this context. Nevertheless, we believe that a more comprehensive study with follow up of patients should be carried out for evaluation of opium addicted patients, their outcome after MI, and a better decision making for their treatment.
    Keywords: Opium dependence, Myocardial infarction, Outcome
  • Mahmoud Jabalameli, Khodamorad Jamshidi*, Mehran Radi, Hosseinali Hadi, Abolfazl Bagherifard Page 123
    Background
    Pigmented villonodular synovitis (PVNS) is characterized by the presence of inflammation and hemosiderin deposition in the synovium. Two forms of PVNS distinguished in the literature are diffused and localized involvements. There are controversies in the literature about the surgical management of PVNS. We report our experience in the management of knee PVNS at a mean follow-up of 4 years. We also introduce our preferred method of treatment for these patients.
    Methods
    A number of 26 patients (26 knees) with histologically proven PVNS of the knee in the pathology department at Shafa Yahyaeyan hospital were identified between January 1996 and February 2012. Annual clinical follow-up was conducted in all patients and a follow-up MRI scans was ordered for symptomatic cases. All patients were examined according to the Knee Society Score (KSS) in which the knees were graded from excellent to poor.
    Results
    Mean age of the patients was 28.08±12.5. A number of 15 patients (58%) had diffused involvement of the knee joint and 11 (42%) had a localized form of involvement. Mean follow up was 4 years. The mean duration of symptoms prior to presentation was 44.40±38.69 months. In five cases (23%) subtotal synovectomy and in 21 cases (77%) total synovectomy was performed. Two cases (7.7%) had recurrence. In a comparison between new methods vs. routine methods, after adjusting the pre-operation KSS scores, there was a significant difference between both methods in their post-op results. There were no complications in the form of knee instability, infection or neurovascular injury.
    Conclusion
    The PVNS of knee joint; especially the diffused form should be carefully observed and managed using appropriate investigations. Staged open total synovectomy with a posterior and then an anterior approach seems to be a superior method for surgical treatment of diffused forms.
    Keywords: Knee joint, Pigmented Villonodular Synovitis, Synovectomy, Recurrence
  • Farzad Omidi-Kashani*, Ebrahim Ghayem Hasankhani, Hamid Reza Noroozi Page 124
    Background
    The incidence of recurrence in patients undergoing primary discectomy due to lumbar disc herniation (LDH), is regularly reported as 5-15%. In this study we aimed to evaluate surgical outcome of instrumented transforaminal lumbar interbody fusion (TLIF) in the patients suffering from recurrent LDH.
    Methods
    We retrospectively studied 51 patients (30 female, 21 male) from August 2007 to October 2011. The mean age and follow-up of the patients was 46.4±14.8 (ranged; 29-77 years old) and 31.4±6.8 (ranged; 25-50 months), respectively. Clinical improvement was assessed by Oswestry Disability Index (ODI), visual analogue scale (VAS), and subjective satisfaction rate, while fusion was appraised radiologically. Data analysis was by one sample Kolmogorov-Smirnov, paired t, and Mann-Whitney tests.
    Results
    Surgery could significantly improve mean leg and lumbar VAS and ODI from preoperative 7.4±2.5, 7.8±3.1, and 72.1±21.5 to postoperative 3.4±3.6, 3.5±2.6, and 27.5±18.0, respectively at the last follow-up visit. Subjective satisfaction rate was excellent in 24 patients (47.1%), good in 14 (27.5%), fair 11 (21.6%), and poor in two (3.9%). We had one patient with iatrogenic partial L5 nerve root injury and one with unknown late onset refractory postoperative back pain. Fusion rate was 100% and instrument failure was nil.
    Conclusion
    In surgical treatment of the patients with recurrent LDH, bilaterally instrumented TLIF is a relatively safe and effective procedure and can be associated with least instrument failure and highest fusion rate while no postoperative bracing is also needed.
    Keywords: Transforaminal lumbar interbody fusion, Recurrent disc herniation, Treatment outcome
  • Mandana Shirazi*, Amir Hosein Emami, Seyed Jamal Mirmoosav, Seyed Mohammad Alavinia, Hadi Zamanian, Faezeh Fathollahbeigi, Italo Masiello Page 125
    Background
    Effective leadership is of prime importance in any organization and it goes through changes based on accepted health promotion and behavior change theory. Although there are many leadership styles, transformational leadership, which emphasizes supportive leadership behaviors, seems to be an appropriate style in many settings particularly in the health care and educational sectors which are pressured by high turnover and safety demands. Iran has been moving rapidly forward and its authorities have understood and recognized the importance of matching leadership styles with effective and competent care for success in health care organizations. This study aimed to develop the Supportive Leadership Behaviors Scale based on accepted health and educational theories and to psychometrically test it in the Iranian context.
    Methods
    The instrument was based on items from established questionnaires. A pilot study validated the instrument which was also cross-validated via re-translation. After validation, 731 participants answered the questionnaire.
    Results
    The instrument was finalized and resulted in a 20-item questionnaire using the exploratory factor analysis, which yielded four factors of support for development, integrity, sincerity and recognition and explaining the supportive leadership behaviors (all above 0.6). Mapping these four measures of leadership behaviors can be beneficial to determine whether effective leadership could support innovation and improvements in medical education and health care organizations on the national level. The reliability measured as Cronbach’s alpha was 0.84.
    Conclusion
    This new instrument yielded four factors of support for development, integrity, sincerity and recognition and explaining the supportive leadership behaviors which are applicable in health and educational settings and are helpful in improving self –efficacy among health and academic staff.
    Keywords: Contextualization, Socio, cognitive Theory, Standardization, Supportive Leadership Behavior Questionnaire
  • Atosa Dorudinia, Masoud Shamaei, Shirin Karimi, Alireza Javadi, Leila Mohammadi Ziazi, Mihan Pourabdollah* Page 126
    Background
    Polymerase chain reaction (PCR) assay has widely used for the detection of tuberculosis (TB). This study tried to compare in-house PCR with some well-known commercial PCR kits for detection of TB agent.
    Methods
    Clinical samples obtained from 620 TB suspected patients were analyzed for the diagnosis of Mycobacterium tuberculosis complex (MTC) by in-house PCR. All samples were obtained through pulmonary specimens consisted of 384 sputum, 148 bronchial aspirates and 88 pleural effusions.
    Results
    Considering culture as a golden criterion, in which its diagnostic sensitivity and specificity of PCR assay were 87.7% and 85.6%, respectively. The findings of this study also indicate 22.1 (137/620) of the specimens were detected as MTC by PCR. Both PCR and culture confirmed presence of MTC in 57 of the samples. In comparison to culture, the diagnostic sensitivity of PCR for sputum was 87.5% 42/48), bronchial aspirates 100% (12/12), and 60% (3/5) for pleural effusions. The sensitivity of in-house PCR method is comparable with the sensitivity of Amplicor and Cobas TaqMan for MTC.
    Conclusion
    The study illustrates the in-house PCR assay for detection of MTC has high sensitivity and specificity versus approved commercial kits. This could be reliable test in the diagnosis of MTC in resource-limited countries.
    Keywords: Mycobacterium tuberculosis, Polymerase chain reaction, Culture
  • Raheel Mushtaq*, Sheikh Shoib, Tabindah Shah, Sahil Mushtaq Page 127
    Background
    5HTTLPR polymorphism (5- Hydroxy tryptamine transporter linked promoter region polymorphism) is the most widely studied genetic variant in psychiatry. The present study is a modest effort at ascertaining the role of 5HT transporter linked promoter region polymorphism (5HTTLPR) in anxiety and depressive disorders in Kashmir (India).The aim of this study was to examine 5-Hydroxy tryptamine transporter (5HTT) gene promoter region polymorphism in anxiety and depressive disorders.
    Methods
    Thirty patients with unipolar depressive disorders, 30 patients with anxiety disorders and 40 healthy volunteers (controls) were studied on a case control design, using polymerase chain reaction (PCR) and agarose gel electrophoresis after digestion with endonuclease enzyme. Genotypes and allele frequencies were compared using chi square tests, and p value of < 0.05 was considered as statistically significant.
    Results
    The mean (±sd) HAM-A (Hamilton rating scale for anxiety) scores for anxiety and depressive groups were 28.2±5.14 and 17±5.61, respectively (P < 0.001). The mean (±sd) HAM-D (Hamilton rating scale for depression) scores for depressive and anxiety groups were 25±5.58 and 15±6.13, respectively. (p< 0.001). The frequency of S allele was significantly high (83.3% vs 60%) in the group with anxiety (p< 0.05) compared to the control group (p> 0.05).
    Conclusion
    The genetic studies are still evolving as pathogenesis of anxiety and depressive disorders and involve the interaction of environmental factors with various genes. Genetic variation in different populations and hence different environments is important for elucidation of the mechanisms of these disorders. However, the study concludes that the locus under study is not shared between the two disorders.
    Keywords: 5HTTLPR, Anxiety disorder, Depressive Disorder
  • Mahmood Nazarpoor* Page 128
    Background
    Inversion recovery (IR) pulse sequences can generate T1-weighted images with a different range of inversion time (TI) to suppress or null the signal intensity (SI) for a specified tissue. In this study, we aimed to investigate the effect of TI values on the concentration of the contrast agent, which leads to a minimum signal intensity, using an inversion recovery T1-weighted 3-dimensional fast-gradient echo imaging sequence.
    Methods
    A phantom was designed to hold 25 vials which contained different (between and 19.77mmol/L of (Gd-DTPA)) concentrations of the contrast agent. We used the vials of different concentrations to measure SI using IR sequences with different inversion times (TI, 100-3000ms).
    Results
    The results of this study revealed that the T1 recovery curve did not cross the x axis for the lower TI. Therefore, a minimum SI can be observed from the concentration of the contrast agent versus SI curves. The findings of this study also revealed that the concentration of the contrast agent, which leads to a minimum SI, is dependent on the TI and the minimum SI will be increased at higher TI concentrations.
    Conclusion
    In conclusion, when the TI parameter is used to suppress the SI of the specified tissues in clinical studies (e.g., fat suppression or blood suppression in perfusion measurements), it should be chosen with great caution.
    Keywords: Inversion Time, T1, Weighted, Signal Intensity, Concentration of Contrast Agent, Null Point
  • Achmad Fauzi Kamal*, Ismail Hadisoebroto Dilogo, Errol Untung Hutagalung Diah Iskandriati, R. Susworo, Nurjati Chaerani Siregar, Achmad Aulia Yusuf, Adang Bachtiar Page 129
    Background
    Delayed union, nonunion, and mechanical failure is still problems encountered in limb salvage surgery (LSS) using extracorporeal irradiation (ECI). This study aimed to determine whether bone marrow mesenchymal stem cells (MSC) and recombinant human bone morphogenetic protein-2 (rhBMP-2) improve hostgraft union after osteotomy and also increase its mechanical strength.
    Methods
    Thirty Sprague Dawley rats were randomly divided into five groups. Group I (control) underwent LSS using ECI method with 150 Gy single doses. Similar procedures were applied to other groups. Group II received hydroxyapatite (HA) scaffold. Group III received HA scaffold and MSC. Group IV received HA scaffold and rhBMP-2. Group V received HA scaffolds, MSC, and rhBMP-2. Radiograph were taken at week-2, 4, 6, and 8; serum alkaline phosphatase and osteocalcin were measured at week-2 and 4. Histopathological evaluation and biomechanical study was done at week-8.
    Results
    The highest radiological score was found in group IV and V Similar result was obtained in histological score and ultimate bending force. These results were found to be statistically significant. There was no significant difference among groups in serum alkaline phosphatase and osteocalcin level.
    Conclusion
    Combination of MSC and rhBMP-2 was proven to accelerate union and improve mechanical strength of ECI autograft.
    Keywords: Extracorporeal irradiation, Limb salvage surgery, Mesenchymal stem cell, Bone morphogenetic protein, Scaffold, Hydroxyapatite
  • Hossein Talebi*, Abdollah Moossavi, Soghrat Faghihzadeh Page 130
    Background
    Older adults with cerebrovascular accident (CVA) show evidence of auditory and speech perception problems. In present study, it was examined whether these problems are due to impairments of concurrent auditory segregation procedure which is the basic level of auditory scene analysis and auditory organization in auditory scenes with competing sounds.
    Methods
    Concurrent auditory segregation using competing sentence test (CST) and dichotic digits test (DDT) was assessed and compared in 30 male older adults (15 normal and 15 cases with right hemisphere CVA) in the same age groups (60-75 years old). For the CST, participants were presented with target message in one ear and competing message in the other one. The task was to listen to target sentence and repeat back without attention to competing sentence. For the DDT, auditory stimuli were monosyllabic digits presented dichotically and the task was to repeat those.
    Results
    Comparing mean score of CST and DDT between CVA patients with right hemisphere impairment and normal participants showed statistically significant difference (p=0.001 for CST and p 0.0001 for DDT).
    Conclusion
    The present study revealed that abnormal CST and DDT scores of participants with right hemisphere CVA could be related to concurrent segregation difficulties. These findings suggest that low level segregation mechanisms and/or high level attention mechanisms might contribute to the problems.
    Keywords: Older adults, Cerebrovascular accident (CVA), Auditory attention, Auditory segregation
  • Akram Azad, Afsoon Hassani Mehraban*, Masoud Mehrpour, Babak Mohammadi Page 131
    Background
    Fear of falling may be related to falling during stroke onset. The Fall Efficacy Scale- International (FES-I) with excellent psychometric properties, is an instrument developed to assess patients’ concerns about fallings. The aim of this study was to determine validation of this scale in Iranian patients with stroke.
    Methods
    The “forward-backward” procedure was applied to translate the FES-I from English to Persian. One hundred-twenty patients who had suffered stroke, aged 40 to 80 years (55% male) completed the Persian FES-I, Geriatric Depression Scale-15 (GDS-15), General Health Questionnaire-28 (GHQ-28), Berg Balance Scale(BBS) and Timed up and Go (TUG) questionnaires. The interval time for the test-retest of the Persian scale was 7-14 days.
    Results
    The test-retest and inter-rater reliabilities of the Persian FES-I were excellent (IC 2,1=0.98, p<0.001) and the internal consistency was high (Cronbach’s alpha=0.78). Factor analysis of the 16 items in the Persian scale showed only one significant factor. The total Persian FES-I score had a significantly negative correlation (p<0.001) with the BBS, but it had significantly positive correlation with the TUG, GHQ 28, and GDS-15. The difference in responsiveness scores across fallers and non-fallers yielded a large effect size 0.46), which indicated a good discriminating validity.
    Conclusion
    The Persian FES-I proved to be an effective and valuable measurement tool to assess stroke patients’ fear of falling in practice and research setting.
    Keywords: Fall Efficacy Scale, International (FES, I), Stroke, Reliability, Validity, Psychometric properties
  • Mahdieh Shojaa, Mehrdad Aghaie, Mostafa Qorbani*, Patricia Khashayar, Mahsa Amoli, Abbas Ali Keshtkar, Ramin Mohebi, Hossein Ansari, Hamid Asayesh, Shima Roknsharifi Page 132
    Background
    Cytotoxic T lymphocyte-associated antigen-4 (CTLA-4) is an important negative regulator of Tcell responses. The -1722TC polymorphism of the CTLA-4 gene may be associated with systemic lupus erythematosus (SLE) risk, but related results from previous studies have been inconsistent. We carried out a metaanalysis to assess this association more precisely.
    Methods
    A systematic search through PubMed, Science Direct, and OVID, Iran doc, Iranmedex and SID (Scientific Information Database) databases was performed with the last search updated on December 30, 2011. The odds of ratio (OR) and its 95% confidence interval (95%CI) were used to assess the strength of the association. We evaluated both fixed and random effect models, depending on the presence of between-study heterogeneity. The analyses were conducted using STATA software, version 11.0.
    Results
    A total of 9 independent studies on the CTLA-4 gene -1722TC polymorphism and SLE, including 1422 cases and 1417 controls were used in this meta-analysis. In the present meta analysis, we found a significant association between -1722TC polymorphism and SLE risk in the overall analysis (TT versus TC/CC: OR=1.18, 95%CI 0.84-1.66, p= 0.32; TT/TC versus CC: OR = 2.06, 95%CI 1.07–3.99, p= 0.03; TT versus CC: OR = 2.32, 95%CI 1.62–3.32, p< 0.001; TC versus CC: OR = 1.99, 95%CI 1.42–2.78, p<0.001; TT versus TC: OR = 1.2, 95%CI 0.86–1.66, p= 0.28; T versus C: OR = 1.22, 95%CI 0.91–1.64, p= 0.16). In the subgroup analysis by ethnicity, -1722TC polymorphism was significantly associated with SLE risk in Asian population.
    Conclusion
    This meta-analysis suggests a significant association between -1722TC polymorphism and SLE susceptibility. Large-scale and well-designed case-control studies are necessary to validate the risk identified in the present meta-analysis.
    Keywords: Systemic lupus erythematosus (SLE), 1722TC polymorphism, CTLA, 4, Meta analysis
  • Babak Mostafazadeh*, Esmaeil Farzaneh, Maryam Moshfegh, Seyed Ali Mohtarami Page 133
  • Mohammad Razi, Mohammad Mahdi Sarzaeem*, Gholam Hossein Kazemian, Farideh Najafi, Mohammad Amin Najafi Page 134
    Background
    Disruption of anterior cruciate ligament (ACL) is a common ligamentous injury of the knee. The choice of graft for (ACL) reconstruction remains controversial. This prospective, randomized clinical trial aimed to compare clinical results of bone-patellar tendon-bone (BPTB) grafts and four-strand semitendinosus-gracilis (ST) grafts for ACL reconstruction over a 3-year follow-up interval.
    Methods
    Seventy-one patients with an average age of 29± 4.5yearswere treated for torn ACL between 2008 and 2009. Forty-sixpatients underwent reconstruction with BPTB autograft, and 41 were treated with ST autograft. At the time of final follow-up, 37 patients in patella group and 34 patients in hamstring group were evaluated in terms of return to pre-injury activity level, pain, knee stability, range of motion, IKDC (International Knee Documentation Committee) score and complications.
    Results
    At 36thmonth of follow-up, 34 (92%) and 28 (82%) patients in BPTB and ST group, respectively had good-to-excellent IKDC score (p > 0.05). The activity levels were higher in BPTB group (p> 0.05). At 3rd yearof follow up, the Lachman test was graded normal, for 23 (62%) and 11 (32%) patients in BPTB and ST group, respectively (p=0.019). Regarding the pivot-shift test, 29 (79%) and 15 (44%) patients in patella and hamstring group, respectively had normal test at the latest follow-up (p=0.021).There were no significant differences in terms of thigh circumference difference, effusion, knee range of motion, pain and complications.
    Conclusion
    The results indicate a trend toward increased graft laxity and pivot-shift grades in patients undergoing reconstruction with hamstring autograft compared with patella tendon. However, the two groups had comparable results in terms of activity level and knee function.
    Keywords: Anterior Cruciate Ligament (ACL), Reconstruction, Bone, Patellar Tendon, Bone (BPTB) graft, Semitendinosus, gracilis graft, Outcome
  • Ebrahim Shafiei, Ahmad Baratimarnani, Salime Goharinezhad, Rohollah Kalhor, Mohammad Azmal* Page 135
    Background
    Evidence-based practice (EBP) provides nurses a method to use critically appraised and scientifically proven evidence for delivering quality health care and the best decision that leads to quality outcomes. The purpose of this study was to measure the practice, attitude and knowledge/skill of evidence-based practice of nurses in a teaching hospital in Iran.
    Methods
    This cross-sectional study was conducted in 2011.The study sample was composed of 195 nurses who were working at the Fatemeh Zahra Hospital affiliated to Bushehr University of Medical Sciences (BPUMS). The survey instrument was a questionnaire based on Upton and Upton study. This tool measures Nurses'' perceptions in the three sub-scales of practice, attitude and knowledge/skill of evidence-based practice. Descriptive statistical analysis was used to analyze the data. Pearson correlation coefficients were used to examine the relationship between subscales.
    Results
    The overall mean score of the evidence-based practice in this study was 4.48±1.26 from 7, and the three subscales of practice, attitude and knowledge/skill in evidence-based practice were, 4.58±1.24, 4.57±1.35 and 4.39±1.20, respectively. There was a strong relationship between knowledge and performance subscale (r=0.73, p< 0.01).
    Conclusion
    Findings of the study indicate that more training and education are required for evidence-based nursing. Successful implementation of evidence-based nursing depends on organizational plans and empowerment programs in hospitals. Hence, hospital managers should formulate a comprehensive strategy for improving EBP.
    Keywords: Evidence, based practice, Nurses, Teaching hospital, Busherhr University of Medical Sciences
  • Rita Mojtahedzadeh, Aeen Mohammadi, Amir Hossein Emami*, Samaneh Rahmani Page 136
    Background
    Comparing computer and internet based instruction with traditional giving lecture would provide enough evidence to identify best teaching practice. In this study, we compared lecture, interactive internet based and computer based learning regarding medical students'' knowledge acquisition and satisfaction in teaching pathophysiology of hematology and oncology.
    Methods
    Eighty four medical students were randomized into three groups and an identical faculty member conducted the instructions through the above mentioned methods. Students'' knowledge was assessed one week before and immediately after the interventions by pre and posttest. Students'' satisfaction was assessed using a validated 5-point Likert scale.
    Results
    The results showed that students'' satisfaction was significantly higher in interactive internet based group than other ones (p= 0.05). There were a significant increase between pre and posttest scores in all groups (p= 0.000). We used ANCOVA to compare score changes in the study groups, with posttest scores as the dependent factor and pretest scores as covariate and knowledge acquisition was significantly higher in interactive internet based group than other two groups (p= 0.026).
    Conclusion
    The study showed that although interactive internet based instruction is a difficult and time consuming method, it is recommended to integrate this method to medical curricula.
    Keywords: Internet based teaching, Computer based learning (CBL), Traditional instruction, Medical students
  • Mahmoud Mobasheri*, Soleiman Kheiri, Elham Mardanpour, Seifollah Bakhshi Page 137
    Background
    Being informed of new methods of teaching and comparing their outcome help teachers use more effective and efficient methods in developing and implementing new training courses. The aim of this study was to examine the efficacy of epidemiology learning software on learning epidemiology courses.
    Methods
    This quasi-experimental study included 101 nursing and midwifery students taking epidemiology course in two separate classes. One of the classes was selected as intervention group (taught via software) and another one as the control group. At the end of the semester, scores of the courses were analyzed using covariance analysis.
    Results
    After adjusting the effect of grade point average, covariance analysis indicated a significant difference in epidemiology scores between the two groups (p<0.001). The students taught through the software obtained significantly higher scores compared to the students in traditional group.
    Conclusion
    By means of this training software, teachers can use several strategies for presenting lessons and increasing training efficacy, leading to active learning in students.
    Keywords: Software, Learning, Nursing students, Education
  • Fatemeh Ehsani, Afsun Nodehi- Moghadam*, Hakimeh Ghandali, Zahra Ahmadizade Page 138
    Background
    Many studies have reported the increase in strength of the untrained contralateral limb after unilateral training. The aim of this study was to compare the cross education effect in the young and elderly persons.
    Methods
    In this quasi-experimental and pre-post study, 12 young people aged 28.25 ±3.11 years and 12 elderly persons (aged 73.08 ± 5.3 years) participated. The subjects had no history of strength training and upper limb movement impairments. Maximal isometric flexion strength in the dominant limb and the contralateral side before and after training were measured by tensiometer. Subjects performed elbow flexion exercises in the dominant side, using 3 sets of 10 repetition of the 60-70% maximal force for two weeks. Independent and paired t test were used to analyze between and within groups differences.
    Results
    The results showed that short-term isometric resistive exercise led to a significant increase of strength in trained and untrained limbs in both groups (p<0.05). There was not a significant difference between the two groups in the rate of strength increase, both in the upper limb that was exercised and also in the opposite side (p> 0.05).
    Conclusion
    The increased muscle strength observed during training indicates positive effect of training in old adult. The increased muscle strength in untrained limb suggests the capacity of neuromuscular adaptation among old adults, suitable to be used in cases of limb immobility or unilateral impairment.
    Keywords: Elderly, Maximal isometric muscle strength, Cross training, Cross education, Elbow flexors
  • Ali A. Asadi-Pooya*, Mohammad Hossein Dabbaghmanesh, Nahid Ashjazadeh Page 139
    Background
    Reproductive endocrine disorders and sexual dysfunction are common among men with epilepsy. We investigated sexual hormone serum levels among men with newly diagnosed epilepsy, before starting any antiepileptic drug (AED), and then after starting carbamazepine (CBZ), to determine the role and effects of epilepsy versus CBZ in creating reproductive endocrine disorders.
    Methods
    In this prospective study, male patients 20 to 40 years of age who due to new onset seizure(s) were referred to the outpatient epilepsy clinic at Shiraz University of Medical Sciences from 2009 through 2012 were studied. A blood sample was obtained to evaluate the serum levels of follicle stimulating hormone, luteinizing hormone, prolactin, testosterone, free-testosterone, dehydroepiandrosterone sulfate and sex hormone binding globulin. CBZ was started after blood works. After at least three months of taking CBZ, another blood sample was obtained to determine the serum levels of those hormones again.
    Results
    Twenty patients were included. Their mean age (± standard deviation) was 28 years (± 5). The statistical analysis with paired sample tests did not show any significant changes in serum levels of sex hormones before and after CBZ therapy.
    Conclusion
    Despite the fact that, sexual dysfunction and reproductive disorders are common among men with epilepsy, the exact pathophysiology of these problems is not clear yet. Further studies are required to determine the exact role of epilepsy itself, AEDs, and other possible determinants.
    Keywords: Carbamazepine, Epilepsy, Sex hormone, Men
  • Hamzeh Rahimi, Mohammad M. Farajollahi*, Arshad Hosseini Page 140
    Background
    The CCR5 is a chemokine receptor that serves as a co-receptor for HIV-1 attachment and entryto T lymphocytes. A 32bp deletion (Δ32) in this gene is believed to be associated with resistance to infection and delay disease progression. The aim of this study was to determine the Δ32 allele frequency in healthy ind ividuals and HIV-infected individuals with AIDS.
    Methods
    In this experiment, 530 normal individuals from healthy Iranian population and 40 HIV-infected samples from Western Clinic of Tehran were examined for Δ32 in CCR5 gene using polymerase chain reaction (PCR) techniques followed by agarose gel electrophoresis.
    Results
    Allele frequencies of the CCR5Δ32 in normal individuals were calculated to be 1.1% for heterozygous genotype and 0.19% for homozygous genotype. None of the co-receptor gene in HIV cases was found to be mutated in this study.
    Conclusion
    Based on the findings of this study and the literature in Iran, we could conclude that Iranian people similar to neighbor countries such as Arabs are susceptible to HIV virus infection.
    Keywords: CCR5Δ32, Chemokine receptor, HIV, 1, AIDS, Iran
  • Ali Hassanpour-Dehkordi, Nahid Jivad Page 141
    Background
    The pathophysiology of multiple sclerosis (MS) is characterized by fatigue, motor weakness, and spasticity, to name a few. MS symptoms may lead to physical inactivity associated with the development of secondary diseases. This study was to investigate the effect of regular aerobic and yoga on the quality of life of patients with MS.
    Methods
    The present quasi-experimental study was conducted on 90 patients with chronic MS chosen randomly and divided into two test and one control groups. Data were analyzed using SPSS software (version 11.5) through paired t-test, ANOVA, and Tukey’s post hoc.
    Results
    There were no significant differences among the scores of quality of life in the three groups prior to investigation. Although they were significant after intervention. The mean score of yoga group was higher than that of aerobic group, and aerobic group showed a higher mean score compared with the control.
    Conclusion
    Yoga and aerobic exercises may improve quality of life in patients with MS. It is highly recommended that the governor along with MS societies and other organizations servicing and supporting patients start to develop sport-regulated programs to help improve quality of life for these patients.
    Keywords: Multiple sclerosis (MS), Yoga, Aerobic exercises, Quality of life
  • Saba Jafarpour, Vafa Rahimi, Movaghar* Page 142
    Road traffic crashes (RTCs) account for great mortality and morbidity rates worldwide, resulting in substantial global burden. Factors contributing to RTC generally fall into three categories: environmental, vehicle, and human, with the human factor being by far the leading determinant. Obtaining an in-depth exploration of driving behavior and factors underpinning risky driving could be of particular importance to facilitate the establishment of effective policies. The present article provides insight to different aspects of risky driving behavior, at micro and macro levels, from individual attitudes, and psychological factors like personality, temperament, mood and emotions, to socioeconomic context, social norms, cultural backgrounds, level of law enforcement, and internalization of legality in the society. Risky driving behavior is a multidimensional issue and any effort to design and establish modification policies should be based on a comprehensive understanding of its determinants in different aspects.
    Keywords: Road traffic crash (RTC), Car crash injury, Driving behavior, Psychological distress, Risky behavior, RTC determinants
  • Mojtaba Sedaghat Siyahkal, Farnaz Khatami* Page 143
    Background
    There are challenges ahead of short-term hospitalization of low risk patients hospitalized only for monitoring of severe disease who may die soon after admission. The purpose of this study was to suggest strategies for the management of ICU stay lengths and to ensure optimal use of ICU resources.
    Methods
    The study was conducted retrospectively on 246 patients admitted to 9 general ICUs in Tehran, from September 2011 to March 2012. Patients staying for ≤2 days in the ICU were compared to each other after being categorized into two medical and surgical groups.
    Results
    Of 129 patients with ≤2 days ICU stay (52.4%), 88.4% survived. Of these, 25 19.4%) were placed in the medical and 104 (80.6%) to surgical groups. Survival rates were significantly greater in surgical group; only 7.7% of them were in need of mechanical ventilation in the first 24 hours of admission (p<0.001). In contrast to medical group, the average Acute Physiology and Chronic Health Evaluation (APACHE) II score in the surgical group was significantly lower (9.8±3.6 and 17.3±5.8) (p<0.001).
    Conclusion
    The majority of patients with ≤2 days LOS in the surgical group hospitalized for monitoring after surgery had low mortality rate and APACHE-II score. Therefore, it would seem that transferring such patients to the intermediate care unit leads to more efficient and optimal use of ICU resources.
    Keywords: Short Stay, General Intensive Care Units, Medical, surgical group
  • Mohammad Rezapour, Morteza Khavaninzadeh* Page 144
    Background
    Chronic Kidney Disease (CKD) is a complicated kidney problem causing permanent renal failure in progressive stages. The final stage of CKD is called ESRD in which most accepted management is Hemodialysis (HD). Arterio-Venus Fistula (AVF) is the most practical way of making proper access to the blood circulatory system; however, maturation of the AVF is a challenge, since there are number of variables interfering with the whole process. The purpose of this study was to evaluate potentially modifiable factors associated with Maturation Time (MT) after creation of a Vascular Access (VA).
    Methods
    In this cross-sectional study, a total of 87 patients referred to the Hasheminejad Kidney Center for AVF creation in 2010 were evaluated. Patients were evaluated before and after the AVF creation and risk factors such as history of blood pressure abnormalities, diabetes and congestive heart failure, as well as the successive development of AVF was studied and finally processed using ‘data mining’ technology.
    Results
    The “Decision Trees” indicated the significant impact of the systolic blood pressure (SBP) in the delay of the patient’s AVF maturation. Also, prediction of AVF maturation was made with 70.59% of precision in regard to their BP condition.
    Conclusion
    This study demonstrated that monitoring the SBP is one of the important steps in management of the cardiovascular variables producing any delay in the process of the patient’s HD. Also the data mining method can discover the hidden relationship between the patient’s medical conditions in order to predict the potential disorders.
    Keywords: Data Mining, ArterioVenus fistula, Blood pressure, Hypertension
  • Mohammad Reza Motamed, Seyed-Mohammad Fereshtehnejad, Maryam Abbasi, Mastaneh Sanei, Mina Abbaslou, Somayeh Meysami Page 145
    Background
    The sporadic cases of radiation-activated multiple sclerosis (MS) has been previously described, with a few studies focused on the relationship between radiation and the risk of MS. The aim of our study was to evaluate the association between history of X-ray radiation and MS.
    Methods
    This case-control study was conducted on 150 individuals including 6 MS patients and 85 age- and sex-matched healthy controls enrolled using non-probability convenient sampling. Any history of previous Xray radiation consisted of job-related X-ray exposure, radiotherapy, radiographic evaluations including chest Xray, lumbosacral X-ray, skull X-ray, paranasal sinuses (PNS) X-ray, gastrointestinal (GI) series, foot X-ray and brain CT scanning were recorded and compared between two groups. Statistical analysis was performed using independent t test, Chi square and receiver operating characteristics (ROC) curve methods through SPSS software.
    Results
    History of both diagnostic [OR=3.06 (95% CI: 1.32-7.06)] and therapeutic [OR=7.54 (95% CI: 1.59- 35.76) X-ray radiations were significantly higher among MS group. Mean number of skull X rays [0.4 (SD=0.6) vs. 0.1 (SD=0.3), p=0.004] and brain CT scanning [0.9 (SD=0.8) vs. 0.5 (SD=0.7), p 0.005] was higher in MS group as well as mean of the cumulative X-ray radiation dosage [1.84 (SD=1.70) mSv vs. 1.11 (SD=1.54) mSv; p=0.008].
    Conclusion
    Our study was one of the first to show higher history of X-ray radiation in patients with MS compared to healthy controls. A possible association was also found between the dose and the site exposed to X-ray radiation and risk of developing MS.
    Keywords: Multiple Sclerosis, Radiation, X-ray, Association, Risk factor
  • Feridoun Sabzi, Reza Faraji* Page 146
    Multiple aorto-cardiac cavity communications is very rare but important complication of prosthetic aortic valve endocarditis. The case below illustrates multiple aorto-cardiac cavity fistula formation following prostethic aortic valve endocarditis presented with slowly progressive symptoms of heart failure. A brief review of surgical reconstruction and the existing literature are presented, including emphasis on pre and intra operative echocardiographic diagnosis and treatment.
    Keywords: Aorto, cardiac, Aortic valve endocarditis, Fistula
  • Yousef Alimohamadi, Hamidreza Tabatabaee, Parvin Afsarkazerooni, Sajad Vahedi, Meysam Enaami, Abedin Teimourizad Page 147
    Background
    Acquired immune deficiency syndrome (AIDS) was firstly reported from California and soon became a pandemic in the world. This disease poses serious threats to humans’ health. In this study, we intended to examine the characteristics of HIV-positive patients who referred to the Behavioral Diseases Consultation Center (BDCC) in Shiraz, Iran.
    Methods
    This was a cross-sectional descriptive study. HIV-positive patients, referring toBDCC of Shiraz University of Medical Scienceswere the population under the study. The data, collected through a checklist, were encoded and entered in to the SPSS 19. Then descriptive statistics such as mean, median, standard deviation and range were used to describe the variables. Also, the relationships between the variables were tested using X2 test.
    Results
    The mean and median age of the HIV-positive patients were 39 + 8.7 and 3 years, respectively. Nearly327 (65.4%) of the studied population were male and 173 (34.6%) were female. With respect to marital status, 225 (45%) participants were married, 133 (27%) were single, 91 (18.2%) were divorced and 49 (9.8%) were widowed. Also, 265(53%) of the participants were infected through injection drug use, 198 (39.6%) through sexual route, 7 (1.4%) through blood and blood products, 6 (1.2%) through tattoos and 21 (4.2%) by other routes. Most of the participants had a HIV-positive history in their family, and 145 (29%) mentioned that their wives were HIV-positive. Moreover, 320 (62.7%) of the participants had a positive history of drug use, 176 (35.2%) did not have a history of drug abuse, and the status of 10 (2%) participants was not recognized.
    Conclusion
    Although the results of this study highlighted that injection addiction remains the major transmission route in Iran, the role of sexual transmission should be acknowledged in the future.
    Keywords: HIV, AIDS, Descriptive study, Epidemiologic Characteristics, Shiraz, Iran
  • Maryam Rasoulian, Mina Shirazi, Marzieh Nojomi* Page 148
    Background
    Primary health care physicians (PHCPs) are the first in the clinic to detect and help victims of intimate partner violence (IPV). Therefore, their attitude and practice toward domestic violence (DV) are important to manage this problem. The aim of current study was to compare the behavior and attitude of PHCPs about DV versus other health risk factors in Tehran, Iran.
    Methods
    A convenience sample of 220 PHCPs was evaluated. The study was carried out in April 2012. Two self-administered questionnaires were used to identify physicians’ beliefs and behaviors on screening and intervention of DV and other health risk factors. All analyses were performed using SPSS version 18.0 (SPSS, Inc. Chicago, IL).
    Results
    One hundred and ninety eight questionnaires were analyzed. PHCPs’ mean age was 39.06 (±7.5) years. Participants were just reported 10% screening of regular patients for DV compared with 29% to 48% for other health risk factors. Mean age of PHCPs was not associated with their approach toward the DV. Compared to male physicians, females spared more time for DV victims. Major of physicians (96%) believed that DV is not a private problem and is something that needs to be addressed cautiously.
    Conclusion
    The results of this study indicated that DV screening occurs less than that of other health risk factors. Attitude of majority of PHCPs was positive for addressing this problem.
    Keywords: Attitude, Domestic violence, Primary health care physicians (PHCPs), Screening
  • Mina Moradi, Neda Mehrdad*, Soghra Nikpour, Hamid Haghani, Maryam Aalaa, Mahnaz Sanjari, Farshad Sharifi Page 149
    Background
    Sleep disorders are common among patients with chronic heart failure (HF), and it can have a significant effect on patients’ daily activities as well as their health. The purpose of this study was to assess sleep quality and its predictors in Iranian patients with chronic HF.
    Methods
    This cross-sectional study was conducted on a sample of 200 patients with HF in two hospitals of Tehran University of Medical Sciences from June to November 2009. These patients completed a demographic questionnaire, and their sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI). One-way analysis of variance (ANOVA), Kruskal-Wallis test, t-test and Linear regression were used for data analysis.
    Results
    Seventy-nine percent of patients (n = 158) reported poor sleep quality (PSQI > 5). The range of global PSQI scores was 3–20. Also, a significant relationship was found between PSQI scores and patients’ age (p<0.004), gender (p< 0.042), educational level (p< 0.001), occupational status (p< 0.038), number of hospitalizations (p< 0.005), type of referral (p< 0.001), non-cardiac diseases (p< 0.001), diuretic use (p< 0.021) and left ventricular ejection fraction (p< 0.015). Three predictors were identified using regression analyses with stepwise methods, and included age, type of referral and educational level.
    Conclusion
    The high prevalence of poor sleep quality highlighted the importance of sleep disorders in HF patients. There are many factors associated with sleep quality and sleep disorders that health providers should recognize for improved and effective management.
    Keywords: Sleep Quality, Heart Failure, Sleep Disorder
  • Abbas Zoalfaghari, Najmeh Aletaha, Nader Roushan, Reza Taslimi, Hossein Foroutan, Bita Faridnia Page 150
    Background
    Currently, non-invasive methods for screening atrophic gastritis and gastric cancer are lacking. The purpose of this study was to evaluate the value of serological parameters including serum pepsinogen I (PGI), pepsinogen II (PGII) and pepsinogen I: II ratio for the screening atrophic gastritis and gastric cancer.
    Methods
    The study population consisted of 132 dyspeptic patients who had undergone upper endoscopy with biopsy. Blood samples for ELISA assays of serum PGI, PGII and IgG antibodies against Helicobacter pylori were drawn. Comparison between the two groups was done by Student’s t- test, and Mann Whitney test. Cut-off points were calculated using receiver operating curves (ROC).
    Results
    Mean (±SD) age of the study population was 51.4 (±15.5) years. Values of PGI and PG ratio decreased significantly in the atrophic gastritis as compared with the control group (p<0.05). Values of PG and PG ratio didn’t show any significant difference between the gastric cancer and control group (p>0.05). For patients with atrophic gastritis, the area under the ROC for PGI was 0.639 (95% CI:0.538-0.741, p=0.008) in which the best cut-off value was 40μg/L (sensitivity 90%, specificity 67%, accuracy 69%, negative predictive value 92%, YI: 0.429). The area under the ROC for PG ratio was 0.711 (95% CI: 0.617–0.806, p 0.0001) and the best cutoff value was 8 (sensitivity 71%, specificity 71%, accuracy 71%, negative predictive value 86%,YI: 0.431).
    Conclusion
    It seems that PGI, PGI: PGII ratio is potential biomarkers for screening atrophic gastritis with high sensitivity, specificity, accuracy and negative predictive value. Serology could be used as a screening method for the detection of precancerous states due to its convenience, relative low cost and safety.
    Keywords: Pepsinogens, Atrophic gastritis, Gastric cancer, Biomarkers
  • Behnam Heidari, Patricia Khashayar, Mohsen Rezai Homami, Atieh Pajouhi, Akbar Soltani*, Bagher Larijani Page 151
    Background
    Dual-energy X-ray Absorptiometry (DXA) is considered the gold standard for non-invasive measurement of bone mass. T-scores and Z-scores are used to present the results of bone mass. The present study was designed to evaluate the discordance between T-scores and Z-scores calculated at a same level and its relation with age, gender and body mass index (BMI) in a representative sample of normal population.
    Methods
    This cross-sectional study was conducted as a part of a comprehensive survey, Iranian Multicenter Osteoporosis Study (IMOS), designed to assess bone health among healthy adults. Each individual underwent both L1–L4 antero-posterior lumbar spine and hip DXA scan. The difference between the T- and Z-scores measured at each of the four skeletal sites was then calculated.
    Results
    A -1.21 to 1.21 point difference was noted in the Z- and T- scores measured at each site. While the difference between the T- and Z-scores was less than 0.5 SD in most of the cases, the difference was higher than 1 SD in about 5% of the subjects.
    Conclusion
    Standardization of Z-score definition and calculation techniques as well as developing an ethnicity- matched reference population is needed to improve the reliability of DXA-generated Z scores.
    Keywords: Osteoporosis, Bone Mineral Density, T, scores, Z, scores, Iran
  • Zohre Sheikhan*, Giti Ozgoli, Mahyar Azar, Hamid Alavimajd Page 152
    Background
    Millions of men and women suffer from infertility worldwide. In many cultures, infertile women are at risk of social and emotional problems. Infertility may affect the public health in many countries. Domestic violence is the intentional use of physical force, power or threat against oneself, another person or another group or community which leads to injury, death, mental harm, lack of development or deprivation. This study aimed to assess the prevalence of domestic violence against infertile women who referred to the infertility centres of Tehran, Iran in 2011.
    Methods
    This was cross- sectional descriptive study conducted on 400 infertile women who were selected through convenient sampling method. The questionnaire used in this study included two sections: a demographic section with questions about demographic characteristics of the infertile women and their husbands; and the domestic violence questionnaire with questions about physical, emotional and sexual violence. Data were analysed by SPSS16; descriptive statistics, Spearman’s test, t- test, one-way analysis of variance (ANOVA) and logistic regression were used for data analysis.
    Results
    Four hundred women with the average age of 30.50 ± 6.16 years participated in the study; of whom, 34.7% experienced domestic violence physical violence (5.3%), emotional violence 74.3%) and sexual violence (47.3%). Domestic violence was significantly associated with unwanted marriage, number of IVFs, drug abuse, emotional status of the women, smoking and addiction or drug abuse of the spouse, mental and physical diseases of the husband (p< 0.05).
    Conclusion
    Many of the current problems in this society, particularly in families are due to the transition of the society from a traditional model to a modern one. The majority of the infertile women experience violence in Iran. Domestic violence against infertile women is a problem that should not be ignored. Clinicians should identify abused women. Providing counseling services to women in infertility treatment centers is suggested to prevent domestic violence against infertile women.
    Keywords: Infertile Women, Domestic Violence
  • Mandana Rezaei, Ismael Ebrahimi- Takamjani*, Ali A. Jamshidi, Behnoush Vassaghi-Gharamaleki, Nosratollah Hedayatpour, Naser Havaei Page 154
    Background
    The aim of this study was to investigate muscle damage indicators and electromyography activities of quadriceps muscles at 25° of hip flexion in untrained healthy females after an eccentric exercise induced muscle fiber damage.
    Methods
    A total of 14 healthy females participated in this pre-experimental study. The subjects performed maximal eccentric quadriceps contractions at 25˚ of hip flexion. Maximum voluntary extensor isometric and concentric moments, angle of maximum moment for concentric contractions, perceived pain intensity, and pain pressure threshold were examined before, immediately, 48 hours, 120 hours and 14 days after eccentric exercise. Additionally, electromyography of three parts of quadriceps muscle, knee flexion range of motion and thigh circumference were measured before and after eccentric exercise.
    Results
    Significant reductions in maximum isometric moment and maximum concentric moment were observed at angular velocity of 60˚ per sec immediately after eccentric exercise (p<0.05). Both maximum isometric moment and maximum concentric moment recovered to the baseline 48 hours after eccentric exercise. Increased pain intensity and decreased knee joint range of motion manifested 48 hours after eccentric exercise. Pain pressure threshold for the quadriceps was higher 14 days after exercise as compared to 48 and 120 hours (p<0.05). No significant changes observed in electromyography and thigh circumference (p>0.05).
    Conclusion
    Eccentric exercise performed at 25˚ of hip flexion resulted in muscle fiber injuries within the quadriceps muscle. However, electromyography of quadriceps muscle was not significantly different than the baseline. The result indicates that hip joint position may modify the effect of eccentric exercise on muscle activation.
    Keywords: Muscles, electromyography, hip, muscle soreness, exercise
  • Zahra Fotoukian, Farahnaz Mohammadi Shahboulaghi*, Masoud Fallahi Khoshknab, Eesa Mohammadi, Hamid Reza Baradaran Attar Moghaddam Page 155
    Background
    Empowerment of elderly people with chronic obstructive pulmonary disease (COPD) can increase their quality of life and feeling of well-being. However, few researches focused on the obstacles and factors facilitating empowerment in elderly people with COPD; and an adequate determining of these factors need an in-depth understanding of the meaning of these factors which influences empowerment. The objective of this study was to explore the barriers to and factors facilitating empowerment in elderly people with COPD.
    Methods
    This study was conducted with a qualitative approach using content analysis. Twenty- four participants were selected based on purposeful sampling. Data were collected through conducting in depth semistructured interviews and making filed notes. Data analysis was performed according to the proposed steps by Granhym & Lund man (2004).
    Results
    The potential to empower the elderly with COPD was influenced by mediating factors; the nature of aging, the difficult nature of COPD, fear and hopelessness, the cultural values and beliefs, poor formal support systems and poor economic status were found to be the barriers; and incentive, trust to health care providers, the educable status of the elderly and increased experience were found to be facilitating factors.
    Conclusion
    It seems that empowerment of the elderly with COPD was affected by many factors which mainly rooted in social factors, health care systems and personal resources.
    Keywords: Empowerment, COPD, Elderly People, Barriers, Facilitating Factors
  • Somayeh Hassan, Mohammad Namvar, Maryam Ghoreishvandi, Mirsaeed Attarchi, Majid Golabadi, Seyed Mohammad Seyedmehdi*, Mahshad Khodarahmian Page 156
    Background
    Chemicals are among risk factors that can affect women''s reproductive system. This study is aimed to investigate the association of occupational exposure to a mixture of organic solvents with menstruation disturbances and hormonal changes among female workers.
    Methods
    Female workers of a pharmaceutical company were divided into three groups of non-exposed, lowexposed and highly-exposed to a mixture of organic solvents (formaldehyde, phenol, N-hexane, and chloroform) based on workplace measurements. Menstrual disturbances (in terms of short cycles, long cycles, irregular cycles, and bleeding or spotting between periods) and mean of hormone levels (including follicle stimulating hormone, luteinizing hormone, thyroid stimulating hormone, prolactin, estrogen and progesterone levels) were compared between these three groups. For investigating associations, logistic regression was performed.
    Results
    Our study showed that mean length of cycles, duration of bleeding, and amount of flow and also prevalence of long cycles, irregular cycles, and bleeding or spotting between periods were higher in exposed groups (p≤0.05). Odds ratio for prevalence of menstrual disturbances in the low exposure group and high exposure group were 9.69 (p=0.001) and 3.40 (p=0.002) respectively compared to the reference group. Estrogen and progesterone levels were not affected (p> 0.05), but other hormones levels were significantly disturbed in the exposed groups compared with the non-exposed group (p=0.001).
    Conclusion
    Occupational exposure to the mixture of organic solvents may be associated with the increase of menstrual disorders and hormonal changes in female workers. Based on our findings, periodic evaluation of reproductive system of female workers in pharmaceutical companies is recommended.
    Keywords: Women, Occupational exposure, Solvents, Menstruation disturbances, Hormones
  • Alireza Olyaeemanesh, Shila Doaee*, Mohammadreza Mobinizadeh, Mina Nedjati, Parisa Aboee, Seyed Hassan Emami-Razavi Page 157
    Background
    Various decisions have been made on technology application at all levels of the health system in different countries around the world. Health technology assessment is considered as one of the best scientific tools at the service of policy- makers. This study attempts to investigate the current challenges of Iran’s health technology assessment and provide appropriate strategies to establish and institutionalize this program.
    Methods
    This study was carried out in two independent phases. In the first, electronic databases such as Medline (via Pub Med) and Scientific Information Database (SID) were searched to provide a list of challenges of Iran’s health technology assessment. The views and opinions of the experts and practitioners on HTA challenges were studied through a questionnaire in the second phase which was then analyzed by SPSS Software version 16. This has been an observational and analytical study with a thematic analysis.
    Results
    In the first phase, seven papers were retrieved; from which, twenty- two HTA challenges in Iran were extracted by the researchers; and they were used as the base for designing a structured questionnaire of the second phase. The views of the experts on the challenges of health technology assessment were categorized as follows: organizational culture, stewardship, stakeholders, health system management, infrastructures and external pressures which were mentioned in more than 60% of the cases and were also common in the views.
    Conclusion
    The identification and prioritization of HTA challenges which were approved by those experts involved in the strategic planning of the Department of Health Technology Assessment will be a step forward in the promotion of an evidence- based policy- making and in the production of comprehensive scientific evidence.
    Keywords: Evidence Based Policy Making, HTA, Challenges, Iran
  • Salman Khazaei, Shahab Rezaeian*, Mokhtar Soheylizad, Behzad Gholamaliee Page 158
    Background
    Although the incidence of animal bite is increasing in Iran, there is no sufficient knowledge about delayed Post-Exposure Prophylaxis (PEP). Hence, the aim of this study was to evaluate delayed PEP and its associated factors in bitten people.
    Methods
    This cross-sectional study was conducted in Tuyserkan district of Hamadan Province (West of Iran) from February 2011 to February 2012 and included 425 cases of animal bites recorded in the Rabies Treatment Center (RTC) using the census method. The associations between delayed PEP and each of the potential risk factors were investigated using Chi-square test.
    Results
    Of 425 registered cases, 71.8% were male and 81.2% were from rural areas. The mean age of the subjects was 32.4 years (±21.3). Dogs were the most frequent source of exposure (69.4%), and the most common bitten part of the body was legs (49.4%). With respect to the wounds, 16.2% of the cases had deep injuries. Overall, 37.2% of the cases received timely PEP (less than 6 hours). Delayed PEP was associated with sex (p= 0.001), type of animal (p= 0.020), injury status (p<0.001), place of residence (p= 0.006) and distance from RTC (p<0.001).
    Conclusion
    Although all victims of animal bite injuries suspected to be rabid, they received complete PEP. However, delayed time of PEP was still very high. The factors associated with delayed PEP may help health care workers to prevent adverse disease outcomes. Furthermore, considering the results of this study, it is highly recommended that proper attention and emphasis be given to public educational programs on dog behavior, dogchild interaction, the risk of dog bites and bite wound management for the general population, particularly children.
    Keywords: Post, Exposure Prophylaxis, Vaccination, Animal bites, Rabies
  • Fatemeh Nayeri, Firozeh Nili, Bita Ebrahim*, Zohreh Olomie Yazdi, Zahra Maliki Page 159
    Background
    Although transfusion is a common procedure for treating anemia of prematurity, there is no specific protocol for blood transfusion in premature newborns. So in this study we investigate whether application of a strict protocol has any statistically significant effect on reduction of blood transfusion.
    Methods
    In this study, first group admitted in NICU during 2005 - 2006 and the second group admitted during 2006 - 2007. Whereas in the first group the blood transfusion performed based on neonatologists'' opinion following consultations with a pediatric hematologist, blood transfusion in the second group was based on the Shannon''s protocol.
    Results
    During 2005-2006, out of 206 cases, 71 cases (%34.5) underwent blood infusion. During 2006-2007, out of 211 cases, 56 (%26.5) received blood transfusion based on the Shannon''s strict protocol. Although the number of cases decreased, no significant difference was found betweenthe two groups (p= 0.07).Conculsion: Applying strict criteria alone is not effective in reducing the frequency of transfusion in infants.
    Keywords: Blood transfusion, Premature infants, Anemia