Iranian Red Crescent Medical Journal
Volume:16 Issue: 7, Jul 2014

Received: February 3, 2013; Revised: March 4, 2014; Accepted: April 12, 2014 Coronary artery disease (CAD) as a chronic disease can affect physical, mental, and social aspects of health as well as the perception of wellbeing. Advanced treatments of the disease emphasize on functionality and quality of life (QOL). The present study aimed to investigate the QOL and its related factors among women with CAD.Patients and This was a descriptive cross-sectional study conducted on 200 women with CAD, referring to the Heart Clinic of Shahid Rajaei Cardiovascular Center in Tehran, Iran. The participants were selected by convenient sampling method. Data were collected using the Persian version of Ferrans and Powers QOL index (QLI) cardiac version and then analyzed using descriptive statistics and statistical tests (independent t-test, one-way ANOVA, and Scheffe’s test). The mean score of overall QOL was 16.91 ± 3.54, ranging between 7.17-27.63. Regarding the instrument subscales, the mean scores were as follows: health and functioning: 15.48 ± 4.32, social and economic: 16.18 ± 3.65, psychological/spiritual: 18.04 ± 4.36, and familial: 20.12 ± 4.57. There was a significant relationship between QOL and marital status (P = 0.004), education (P = 0.007), income (P < 0.001) and disease duration (P = 0.047). However, there was no significant association between QOL and age, job and comorbidity. Based on the findings, participants had average levels of overall QOL. Some domains showed the need to improve QOL of women with CAD. Results of the present study revealed the necessity of designing and performing educational and supportive interventions to improve the QOL in women with CAD, especially among patients with low socio-economic status.

Human society has witnessed disasters and wars that left many consequences on families as well as social and individual life of the victims. In this research, we compared the psychological health and marital adjustment in Iranian employed veterans with veterans receiving disability pension.Patients and The study participants were all of the veterans of Isfahan city registered in Veterans and Martyr Foundation who were receiving disability pension, were still working, or had not received any disability pension yet. A total of 330 veterans were selected by randomized systematic sampling. The Symptom Checklist-90-Revised (SCL-90-R) questionnaire and Dyadic Adjustment Scale (DAS) were completed by the participants. The data were analyzed by Chi square test, independent samples t test, and Mann-Whitney U test. Almost half of the veterans did not demonstrate any psychopathology and half of them were diagnosed with borderline or serious psychopathology. Veterans receiving disability pension had more mental problems in comparison with the employed veterans. Veterans receiving disability pension had higher scores in psychosomatic disorders, obsessive-compulsive disorder, depression, anxiety, phobias, psychoticism, and total scales (general symptom index, GSI) in comparison with the employed veterans. Employed veterans and veterans receiving disability pension did not differ significantly regarding DAS scores. Occupational condition has an important effect on mental health of veterans.

One of the most obvious forms of violence in today''s society is violence against women. In Iran, along with other countries, violence against women has become a problematic issue. The present research aims to investigate the impact of educational intervention based on empowerment model in preventing violent behaviors against women.Patients and The present study is an intervention research done through the random selection of 91 women under the aegis of Imam Khomeini Relief Foundation in Gorgan. Tools for data gathering included demographics checklist, Rosenberg Self-Esteem, general self-efficacy, awareness and attitude questionnaires. Three ninety-minute educational sessions were held for each group to enhance their awareness, change their attitudes, and train them life skills to increase self-esteem so that they can express their vicarious experiences to increase their self-efficacy toward violent behavior. Following the post-test, data were analyzed with SPSS software (version 20). Tests for analyzing data included descriptive and analytical tests (chi-square, Pearson''s correlation, independent samples t-test, One-way ANOVA and paired t test). Results indicated that the frequency of domestic violence against participating women was significant after educational intervention, as compared to pre-intervention period. Paired t-test showed that average scores of awareness, attitude, self-esteem, and self-efficacy constructs, and total power were statistically higher after educational intervention as compared to the period prior to intervention. As one of the manifestations and the moving force of empowerment, education is the first major strategy in codifying, designing, and implementing empowerment programs. For women to be empowered, the active participation of all people in education is required.

Emergence Agitation (EA) is a common problem in pediatric anesthesia. The current study evaluated the effect of intravenous lidocaine combined with propofol or thiopental sodium to control EA by sevoflurane in children. The current study aimed to compare the effectiveness of two anesthesia regimen propofol–lidocaine and thiopental sodium lidocaine to control sevoflurane-induced emergence agitation in children.Patients and The study enrolled 120 children aged 12 to 36 months with retinoblastoma who underwent induction of anesthesia with sevoflurane for Eye Examination Under Anesthesia (EUA). Sampling was done at Rasoul-Akram Hospital in Tehran, Iran. The subjects were randomly assigned into four groups including: group one (thiopental sodium-lidocaine [TL]), group two (thiopental sodium-saline [TS]), group three (propofol-lidocaine [PL]), and group four (propofol-saline [PS]). Emergence agitation was assessed by using a five-point scoring scale, every 10 minutes during the first 30 minutes after admission to the recovery room. EA occurred in 24 cases (20%) of children. Incidence of EA in the TS, TL, PS, and PL groups were 21 (70%), 2 (6.7%), 1 (3.3%), and 0 (0%), respectively (P < 0.001). Nausea and vomiting after anesthesia did not occur in any of the patients. After removal of the endotracheal tube, laryngospasm complication occurrence in the TS group (10 cases) was higher than the other groups and no statistically significant difference was observed (P = 0.1). Propofol–lidocaine anesthesia regimen was more effective to control the pediatric emergence agitation than the other combinations.

Applying utilization review programs is an appropriate solution to decrease the expenditure, and to increase the efficiency of healthcare systems. This paper presents an instrument to measure the level of appropriate admissions and days of stay (DOS) in the pediatric public hospitals of Iran. The American version of the Pediatric Appropriateness Evaluation Protocol (PAEP) was modified and adjusted by our group of physicians. They carried out a retrospective study over 100 randomly selected patients. The reliability of the instrument was tested based on the consensus of reviewers using PAEP. In addition, the external validity of the instrument was studied by comparing the evaluations of the reviewers using PAEP and the individual judgments of three clinicians in two public teaching hospitals. Finally, reliability and validity were also calculated by the kappa statistic. With respect to the inter-reliability testing, there was a high level of agreement between reviewers applying the instrument in the admissions criteria and days of stay. Overall agreement was > 77%; also specific inappropriate agreement and specific appropriate agreement were > 61%, and > 72%, respectively. Regarding the validity of the testing, the instrument had a sensitivity of > 0.75, specificity of > 0.67, as well as positive and negative predictive values of > 0.93, and > 0.55, respectively. The kappa statistic for the reviewers (using the instrument for admission and days of stay criteria) were substantial (k = 0.75.5 and 0.71). They were also substantial for clinicians (k = 0.73 and 0.66). These results showed that the modified PAEP is a reliable and valid instrument to study the appropriateness of admission and days of stay in Iran hospitals. As the developing countries, particularly, Middle East countries have the same status and culture, the result of this study (with minor changes) could be applied in these countries too.

Esophageal, stomach, and colorectal cancers are commonly lethal gastrointestinal tract (GIT) neoplasms, causing almost two million deaths worldwide each year. some environmental risk factors are acknowledged; however, genetic defects can significantly contribute to predisposition to GIT cancers. Accordingly, recent works have shown that single-nucleotide polymorphisms (SNPs) within miRNAs coding sequence (miR-SNPs) and miRNA target sites (target-SNPs) may further contribute to increased risk of developing cancer. In this study, we comprehensively identified miRNA-target gene pairs implicated in GIT cancers and catalogued the presence of potentially functional miR-SNPs and target-SNPs that impair the correct functional recognition. Using bioinformatics tools, manual literature review, and a highly accurate dataset of experimentally validated miRNA-target gene interactions, we compiled a list of miRNA-target genes pairs related to GIT cancers and prioritized them into different groups based on the levels of experimental support. Functional annotations (gene ontology) were applied to these pairs in each group to gain further information. We identified 97 pairs in which both miRNAs and target genes were implicated in GIT cancers. Several pairs, denoted as highly polymorphic pairs, had both miR-SNPs and target-SNPs. In addition, more than 5000 miRNA-target gene pairs were identified in which, according to the previous reports, either the miRNAs or the target genes had a direct involvement in GIT cancers. More than 800 target-SNPs are located in regulatory regions that were extracted from the ENCODE project through the RegulomeDB database. Of these, 20 were classified as expression quantitative trait loci (eQTLs). Our work provided a comprehensive source of prioritized and annotated candidate polymorphisms inside miRNAs and their target sites in GIT cancers, which would facilitate the process of choosing right candidate miRNA-target genes and related polymorphisms for future association or functional studies.

Experimental studies have demonstrated that angiotensin II (ANG-II)-induced oxidative stress contributes to the pathogenesis of I/R injury. This study was aimed to investigate the protective effects of co-administration of losartan, as a selective ANG-II type 1 receptor (AT1R) blocker, and vanillic acid (VA), as an antioxidant, in I/R-induced oxidative stress in isolated rat heart. Adult male Wistar rats were randomly divided to sham, control, and five treatment groups (n = 10). Two doses of VA (5 and 10 mg/kg), one dose of losartan (20 mg/kg) alone, and one dose of losartan in combination with either doses of VA were administered orally for 10 days. The hearts were isolated and exposed to 30 minutes ischemia and 60 minutes reperfusion, using Langendorff apparatus. I/R-induced myocardial injury was assessed by estimating the release of lactate dehydrogenase (LDH), creatine phosphokinase (CPK) and myocardial creatine kinase (CK-MB) in coronary effluent at 5, 15, and 60 minutes of reperfusion. The oxidative stress in the hearts was assessed by estimating malondialdehyde (MDA). The effects of treatments on endogenous antioxidant enzymes were assessed by measuring superoxide dismutase (SOD), glutathione peroxidase (GPx) and catalase (CAT). There was a more significant decrease in the levels of LDH, CPK, CK-MB, and MDA as well as increase in the levels of SOD, CAT and GPx in groups that had received combined treatment in comparison to VA or losartan alone. It may be concluded that combination of losartan with higher dose of VA decreases ischemic markers and lipid peroxidation and augments endogenous antioxidant and hence, protects myocardium against I/R-induced oxidative stress injuries.

Epidemiology, the study of patterns of disease distribution in time and space, can help to improve mental health services for children and adolescents by increasing understanding of causes, development, and course of psychiatric disorders. To describe the prevalence of DSM-IV TR psychiatric disorders and comorbidities in students of Paveh, one of the western cities in Iran. The participants of this cross sectional survey were 379 children and adolescents aged 6-18 years old that were selected by multistage cluster sampling method. They were screened in the first phase of the study by two screening tools. In the second phase, 141 students were assessed by K-SADS-PL psychiatric interview. The overall prevalence of DSM-IV TR disorders in this population according to psychiatric interview was 24.4%. The most common disorder was attention deficit hyperactivity disorder (11.9%) and then generalized anxiety disorder (11.3%), social phobia (6.2%), and separation anxiety disorder (6.2%). There was no significant difference between two sex and age groups except enuresis. The prevalence of psychiatric disorders in Paveh is comparable to other areas of Iran and the world. The high prevalence of attention deficit hyperactivity disorder needs more consideration and treatment plans.

Recurrent pregnancy loss (RPL) is a serious problem for pregnancy. There is evidence that vascular complications play a principal role in RPL. Methylenetetrahydrofolate reductase (MTHFR) is a key enzyme in folate metabolism. Polymorphisms (C677T, A1298C) of MTHFR gene are associated with decreased MTHFR activity. The aim of this study was to determine the association between MTHFR polymorphisms (C677T and A1298C) and recurrent pregnancy loss (RPL) in Iranian women. In this case-control study, blood samples were obtained from patients who had three or more consecutive pregnancy losses before the 22nd week of pregnancy (n = 204). The control group consisted of 116 age-matched women with at least one alive child and without any history of pregnancy loss or other gestational complications (n = 116). Following DNA extraction, samples were tested for MTHFR C677T and A1298C polymorphisms using the reverse hybridization method. The prevalence of 677TT mutation was 8.8% (18/204) in the patient group and 8.6% (10/116) in the control group (P = 0.434). The prevalence of 1298CC mutation was 12.3 % (25/204) in the patient group and 8% (9/116) in the control group (P = 0.155). Investigation of the distributions of various genotypes of MTHFR C677T and A1298C did not indicate a significant difference between patients with RPL and healthy control subjects. The results suggest that MTHFR mutations might not be associated with RPL in the examined population.

Unknown etiology and pathophysiology of prostate pain syndrome (PPS) has led to a lack of proper and competent treatment in modern medicine. According to the guidelines of European Association of Urology (EAU), use of complementary treatments is recommended for PPS. In this preliminary study, analyzing the signs and symptoms of PPS from the viewpoint of Iranian traditional medicine (ITM) was helpful in selecting the appropriate alternative treatment. Two male patients diagnosed with PPS were evaluated and treated according to the ITM. Each patient took 15 mL oxymel 45 minutes after lunch and dinner. For each patient, four clinical visits were made with one week intervals and the validated Farsi version of international prostate symptom score (IPSS) and numeric pain rating score (NPRS) were completed for them. Considering the fact that other major pathological causes are ruled out, many of the symptoms and signs observed in these patients were similar to those associated with flatulency-related diseases in ITM. Selecting treatment with oxymel was based on this view and led to improvements in the digestive and urinary symptoms according to Farsi version of the IPSS and NPRS.

Cytokines are secreted signaling proteins which play essential roles in immune responses during experimental autoimmune encephalomyelitis (EAE), a demyelinating model that mimics many features of multiple sclerosis (MS). Interleukin 6 (IL-6) is a multifunctional cytokine produced by different cells, mediating inflammatory reactions and immune-mediated processes. Several studies have described immunosuppressive potentials of several herbal medicines. MS14 as an Iranian marine herbal medicine has anti-inflammatory and immunomodulatory activities. The present study investigated the immunosuppressive potential of MS14 as an herbal drug as well as the IL-6 level in EAE model. We hope it will be a new approach for neurologic diseases and autoimmune originated diseases therapy.Patients and The present experimental study was a collaboration between Department of Anatomical Sciences of Tabriz University of Medical Sciences and Shefa Neuroscience Research Center of Tehran. We used 30 C57BL/6 mice. The animals were immunized with myelin oligodendrocyte glycoprotein (MOG) to induce EAE and treated with MS14-containing (30%) diets. Subjects were selected by simple random sampling and then they were randomly allocated to two groups. EAE symptoms were assessed using the standard 10–point EAE scoring system from the seventh to the 35th day after immunization. Afterwards, the spleen was removed and its cells were cultured with or without MOG 35-55; then, the IL-6 level was analyzed by ELISA. In addition, histopathological studies were carried out for demyelination lesion evaluation in the spinal cord. MS14 significantly improved clinical symptoms of EAE compared with the control (P < 0.05). It also suppressed proliferative responses of T cells and decreased IL-6 expression (16.93 ± 2.7 vs. 21.4 ± 3.33) (P < 0.05). Our results strongly suggested that IL-6 as a potential molecule could have a role in neuroimmunology and neuroinflammation, which is in congruent with previous studies. Therefore, it can be a clear target in strategic therapies and support effective properties of phytotherapy in EAE and MS treatment.

Orthopedic injuries are the most common types of injuries. To identify the main causes of injuries, collecting data in a standard manner at the national level are needed, which justifies necessity of making a minimum data set (MDS). The aim of this study was to develop an MDS of the information management system for orthopedic injuries in Iran. This descriptive cross-sectional study was performed in 2013. Data were collected from hospitals affiliated with Tehran University of Medical Sciences that had orthopedic department, medical documents centers, legal medicine centers, emergency centers, internet access, and library. Investigated documents were orthopedic injury records in 2012, documents that retrieved from the internet, and printed materials. Records with Random sampling by S22-S99 categories from ICD-10 were selected and the related internet-sourced data were evaluated entirely. Data were collected using a checklist. In order to make a consensus about the data elements, the decision Delphi technique was applied by a questionnaire. The content validity and reliability of the questionnaire were assessed by expert’s opinions and test-retest method, respectively. An MDS of orthopedic injuries were assigned to two categories: administrative category with six classes including 142 data elements, and clinical category with 17 classes including 250 data elements. This study showed that some of the essential data elements included in other country’s MDS or required for organizations and healthcare providers were not included. Therefore, a complete list of an MDS elements was created. Existence of comprehensive data concerning the causes and mechanisms of injuries informs public health policy-makers about injuries occurrence and enables them to take rationale measures to deal with these problems.

Severe depression may be accompanied by immune dysregulation and is also associated with increased risk of coronary artery disease (CAD). We investigated serum levels of 10 cytokines and their relationship with depression in patients with cardiovascular diseases as well as healthy subjects in northeast of Iran.Patients and The study was carried out on 462 subjects (120 healthy subjects and 342 candidates undergoing angiography). The healthy subjects were referred for routine annual checkups or pre-employment examinations; they did not have clinically evident CAD. A questionnaire was used to obtain demographic data and the Beck depression inventory (BDI) was applied to assess depression. The Evidence Investigator® platform was used for cytokines assays for IL-1α, IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, TNF-α, MCP-1 and IFN-γ, using sandwich chemiluminescent method. The statistical analysis was performed using SPSS version 11.5. The mean age was 53.3 ± 11.5, 54.8 ± 11.3, and 59.5 ± 11.3 in healthy, angiography (-), and angiography (+) subjects, respectively (P < 0.05). There were significant differences in serum levels of IL-4, IL-6, IL-10, and MCP-1 cytokines, comparing subjects with CAD and healthy persons (P < 0.05). When all subjects were divided to with and without depression regardless of their cardiovascular status, there was a significant difference in serum levels of IL-8 and IL-6 between the groups (P < 0.05). When the subgroup with features of CAD was selected and divided to those with and without depression, there was also a significant difference in serum levels of IL-8 and TNF-α (P < 0.05). The positive interaction between depression and CAD was probably mediated by inflammatory mechanisms.

Sleep disorders are considered as one of the most important problems in hemodialysis patients, making their everyday life a serious hazard. Sleep quality of hemodialysis patients and consequences of sleep disorders on other aspects of health such as spiritual well-being are important issues. This study examined the relationship between spiritual well-being and quality of sleep in hemodialysis patients in Isfahan, Iran.Patients and This study was a correlation research, carried out on 190 hemodialysis patients. Data collection Questionnaires included demographic forms, Pittsburgh sleep quality index (PSQI), and Ellison and Paloutzian spiritual well-being scale. Data were analyzed using descriptive and inferential statistics (Pearson correlation and linear regression analysis) at P < 0.05 significance level, by SPSS software version 18. Of 190 study participants, 163 (85.78%) with scores more than five index had sleep disturbances and 27 (14.12%) had no sleep disturbance; 3 (1.52%) had mild, 163 (85.78%) moderate, and 24 (12.30%) good spiritual health conditions. Pearson correlation test showed significant relationship between the sleep quality items of Pittsburg and spiritual well-being (P < 0.04, r = 0.149). Through the regression analyses of spiritual health, family, education, financial status, marital status, occupation, and use of sleep medication, the predictive power of these variables was found 0.417% and prediction of spiritual well-being was more than others (ß = 0.209). Considering bed as one of the most vital physical, mental, and emotional needs, it is very important in mental and spiritual well-being of hemodialysis patients as an influencing factor in mental relaxation and reducing disease tensions. Paying attention to sleep quality and spiritual well-being components of hemodialysis patients in formulating and promoting healthcare programs is recommended.

Multiple population-based human studies have established a strong association between increasing levels of serum C-reactive protein, uric acid and subsequent development of hypertension. We aimed to investigate the association between mental well-being with presence of hypertension, hyperuricemia and hs-CRP levels.Patients and This was a cross sectional study of 801 individuals aged 35-85 years old in Broujerd, Iran, included by randomized cluster sampling. General Health Questionnaire (GHQ-12) for assessing mental health/distress level, MONICA standard questions for evaluating hypertension history, serum hs-CRP and Serum Uric Acid (SUA) were evaluated Data were analyzed by appropriate statistical test such as chi-square, T-test and correlation. One hundred eighty five patients (23.1%) had high distress/minor psychiatric disorders. SUA had significant association with hypertension (r = 0.64, P = 0.034). No significant relation was observed between hs-CRP and hypertension. The correlation between GHQ and hs-CRP was not significant but a weak and negative correlation was found between GHQ and SUA SUA (P = 0.012, r = -0.089). The weak and strong correlation among these parameters indicate that mental wellbeing relays on physical wellness and interact with each other; therefore, controlling hypertension along with uric acid control may effect mental health of any kind of patients.

Evidence Acquisition: Studies conducted on post-cardiac arrest cares, history of induced hypothermia, and therapeutic hypothermia for patients with cardiac arrest were included in this study. We used the valid databases (PubMed and Cochrane library) to collect relevant articles. According to the studies reviewed, induction of mild hypothermia in patients after cardiopulmonary resuscitation would lead to increased survival and better neurological outcome; however, studies on the complications of hypothermia or different methods of inducing hypothermia were limited and needed to be studied further. This study provides strategic issues concerning the induction of mild hypothermia, its complications, and different ways of performing it on patients; using this method helps to increase patients’ neurological survival rate.

Bacterial meningitis is still considered as one of the most dangerous infectious diseases, which causes numerous complications and high mortality if not diagnosed and treated timely. This study was performed to determine antimicrobial resistance patterns of bacterial pathogens isolated from acute bacterial meningitis at Tabriz Children Educational-Health Care Center in Iran.Patients and In a retrospective study (from 2003 through 2013), all patients with bacterial meningitis were identified by cerebrospinal fluids with positive results in culture (107 cases). Patients'' necessary data was recorded in a questionnaire. Furthermore, the results of simultaneous blood culture were also examined. Ultimately, antimicrobial susceptibility of isolates was determined using the disc diffusion method. One hundred and seven patients with bacterial meningitis were identified by cerebrospinal fluids with positive results in culture. All of patients (100%) had fever (male/female = 1.27/1). The most prevalent pathogens isolated from CSF culture were Streptococcus pneumoniae (34.5%), Haemophilus influenzae type b (23.36%), Neisseria meningitidis (6.54%), Serratia spp. (6.54%), and Klebsiella pneumoniae (5.6%), respectively. Moreover, the patients'' blood culture had positive results in 36.44% of cases with H. influenzae type b (20.65%) and S. pneumoniae (6.54%) as the main bacteria isolated from blood. Meningitis occurred mostly in children under two years (P = 0.001). According to antimicrobial susceptibility test, a relatively high resistance was reported against some conventional cephalosporins and other antibiotics. S. pneumoniae and H. influenzae type b were the main pathogens of bacterial meningitis in children in the area under study. Most species had relatively high resistance to conventional antibiotics as compared to the past.

Sarcoidosis is a multisystem disease affecting different organs with different frequency rates depending on geographical location. Musculoskeletal abnormalities includes osseous lesions (small and large bone sarcoidosis), sarcoidal arthropathy, and sarcoidal myopathy. Musculoskeletal involvement is reported in a significant number of patients. This study aimed to determine the prevalence and clinical picture of musculoskeletal sarcoidosis in Iranian cohort of patients with sarcoidosis.Patients and We designed a descriptive cross-sectional study including 30 patients with sarcoidosis who had hospitalized in the Rheumatology Department at Ghaem Hospital, Mashhad, Iran. The patients were evaluated for musculoskeletal symptoms using history, physical examination, and paraclinical data. Of the 30 studied patients, 24 were female (80%) and six were male (20%). The mean age at diagnosis was 38 years. Sarcoidal arthropathy (arthritis and periarthritis) was observed in 26 patients (86.6%). Furthermore, the initial presentation was associated with joint symptoms in 19 cases (63.3%); acute arthritis developed in 17 (65%) while bone and muscle involvements each occurred in 2 (6.6%). Sarcoidosis is a common disease in women aged 20 to 40 years. The most common involved joint were consecutively ankles, knees, and wrists, reaching a accumulated frequency of 86.6%; however, bone and muscle involvements were uncommon.

Identification of a normal range for biomarkers, based on pregnancy outcomes (caused by their high or low values) is of special importance in clinical studies. As some pregnancy outcomes can happen in both high and low levels of biomarkers, the receiver-operating characteristic (ROC) curve is unsuitable for identifying these levels separately; rather, a statistical method is preferable which identifies both levels simultaneously. To this effect, our research introduces a generalization of ROC curve (by using a number of related consequences) to identify a normal range for the biomarker. Practically, the study intends to identify a normal range of hemoglobin in the first trimester of pregnancy to prevent adverse outcomes that can be caused by high and low levels of hemoglobin.Patients and The current article introduces an ROC generalization curve to determine a normal range for biomarkers based on a number of pregnancy outcomes, which may occur in high and low levels of biomarkers. Simulated data were also used to compare the current method with the ROC curve method. Our data collected from a cohort study carried out on 600 pregnant women referring to Milad Hospital in Tehran, Iran in 2010. The data comprised hemoglobin level in the first trimester of pregnancy as well as pregnancy outcomes such as preterm delivery, low birth weight, preeclampsia, and gestational diabetes. We calculated an estimation of the normal range of hemoglobin for the study population. Statistical analysis was carried out by R software, version 3.0.2. Results from the simulation study indicated that, the new method was better than the methods which used two ROC curves separately with regard to sensitivity and specificity. In this method, the level of normal hemoglobin in the first trimester ranged from 10 to 12.4 with sensitivity and specificity levels of 76.2% and 48% respectively, which is higher than previous studies. With regard to the normal range of biomarkers, our method yielded greater sensitivity and specificity levels than methods using the ROC curve, which separately analyzes the data, particularly in occasions with common consequences in high and low levels of the biomarker.

Recent studies regarding the effect of hydroxyurea (HU) in thalassemia have revealed favorable effects on the reduction of ineffective erythropoiesis. The aim of the current study was to evaluate whether or not HU can have an effect on the gallstone formation rate in patients with beta-thalassemia intermedia (BTI).Patients and In this case control cross-sectional study, from a total of 250 transfusion-independent BTI patients, 51 patients who were taking HU, participated in the study. Patients were registered in the Thalassemia clinic of Shiraz University of Medical Sciences, Shiraz, which is a referral center located in southern Iran, during 2011-2012. Mean dose of HU consumption in the case group was 10 ± 2.5 mg/kg/day (range of 8-15 mg/kg/day), with a mean duration of consumption of 7.5 ± 3.8 years (range 1-14 years). In addition, 41 age- and sex-matched BTI patients who did not use HU were randomly selected as a control group. All patients underwent abdominal ultrasound by a radiologist for evaluation of gallstones. Mean age of the participants was 21.4 ± 6.5 years (10-40 years). There was no statistically significant difference regarding the frequency of cholelithiasis between the two groups of patients (P = 0.822). Our study showed significantly lower hemoglobin levels and a higher percentage of nucleated red blood cells in the HU group compared with the control group (P = 0.001 and P = 0.005, respectively). It seems that taking HU for long periods can reduce hemolysis and bone marrow suppression, and that decreases the rate of cholelithiasis. We believe that if these patients had not been treated with HU, we would probably have observed a significantly higher frequency of cholelithiasis, due to more hemolysis compared with patients not taking HU. Further studies with larger sample sizes are suggested.

Bacterial vaginosis (BV) is one of the most common gynecological infections during reproductive age. Although metronidazole is one of the most effective medications recommended as the first-line treatment, it has various side effects. Because of the side effects and contraindications of some chemical medicines, using herbs has been investigated in treating BV. The aim of this study was to compare the effect of garlic tablet (Garsin) and oral metronidazole in clinical treatment of the BV in women referred to Resalat Health Center, affiliated with Mazandaran University of Medical Sciences, in 2013.Patients and This randomized clinical trial was conducted on 120 married women aged 18 to 44 years who were diagnosed with BV by Amsel’s clinical criteria and Gram staining. Enrolled women were randomly allocated to two groups of 60 patients and were treated with either garlic tablet or oral metronidazole for seven days. Amsel’s criteria and Gram stain were assessed seven to ten days after beginning the treatment period and side effects were registered. Amsel’s criteria were significantly decreased after treatment with garlic or metronidazole (70% and 48.3%, respectively; P < 0.001). Therapeutic effects of garlic on BV were similar to that of metronidazole (63.3% and 48.3%, respectively; P = 0.141). There were significant differences between the two treatment groups in terms of side effects; metronidazole was associated with more complications (P = 0.032). This study reveals that garlic could be a suitable alternative for metronidazole in treatment of BV in those interested in herbal medicines or those affected by side effects of metronidazole.

In previous studies, the bronchodilator and antitussive effects of Nigella sativa have been demonstrated on guinea pigs. In the present study, the effect of the hydroethanolic extract of N. sativa on tracheal responsiveness in guinea pigs exposed to cigarette smoke was examined. Three groups of guinea pig models of COPD were given drinking water alone (COPD group), drinking water containing vitamin C (COPD + VC group), and N. sativa (COPD + NS group). Tracheal responses to methacholine were measured as effective concentration causing 50% of maximum response (EC50 M) in control animals (group C) and three groups of guinea pigs with COPD (n = 7, for all groups). Tracheal responses to 0.1% ovalbumin in comparison to contraction obtained by 10 μM methacholine were also examined. The tracheal responsiveness to both methacholine and ovalbumin in guinea pigs with COPD were significantly higher than those of controls (P < 0.001 for both cases). The tracheal responsiveness in the COPD + VC and the COPD + NS groups to both methacholine and ovalbumin were significantly decreased in comparison to the COPD group (P < 0.05 and P < 0.001, respectively). These results showed the preventive effect of hydroethanolic extract of N. sativa on tracheal responsiveness of guinea pig model of COPD, which was as effective as vitamin C.

Sleep is considered as one of the most important factors, directly influencing mental and physical health components. In the last decade, low sleep quality - i.e. poor sleep - has become one of the major problems of the individuals, especially in middle-aged women. Low quality sleep also directly influences memory, functional components, nutrition, and mood. This study aims to detect the effect of selected aerobic exercises on sleep quality in non-athlete middle-aged women. Fifteen non-athlete middle-aged women participated in this study, all of them suffered from insomnia. Pittsburgh questionnaire was used for determining sleep quality in this sample. Four indices including sleep duration, sleep disturbance, sleep latency, and sleep efficiency have been investigated through this. The period of exercises included eight weeks, three one-hour sessions each week. The sample group was trained during eight weeks through performance of selected aerobic exercises including three groups: sequential movements equip mental movement and movements on the pad. The selected protocol included performance of exercises: 10 minutes for warm up, 10 minutes for sequential movements, 20 minutes for movements by using equipment, 15 minutes for movements performed on the pad, and 5 minutes for cooling down. The exercises during the first four weeks have been presented with 60% increase of the heart rate, and 75% increase during the second four weeks. The sample group was provided with Pittsburgh questionnaire at the beginning of the exercises and the end of each week. The information of each person was registered. The results showed that the mean of sleep duration, sleep disturbance, sleep latency, and sleep efficiency indices significantly reduced 32%, 22%, 30%, 14% and 36%, respectively. The results also showed that the trend of changes in sleep duration, sleep disturbance, sleep latency, and sleep efficiency indices had significant descending trend. We concluded that eight weeks of aerobic exercises can significantly increase sleep quality in middle-aged women.

Women during the postpartum period experience many physiological, psychological, and social changes. Quality of life (QOL) is a sense of well-being and arises from satisfaction or dissatisfaction with various aspects of life including health, employment, socioeconomic state, psychological-emotional state, and family. Moreover, QOL is an important criteria for assessing healthcare system. The purpose of this study was to compare the postpartum QOL between six to eight and 12 to 14 weeks after delivery in women referred to public health centers in Dezful City, Iran, in 2011. This study was a longitudinal study. The study participants were 150 postpartum women referred to public health centers. Quota method was used for sampling. Data collection tools in this study were demographic questionnaire, Edinburgh Postnatal Depression Scale (EPDS), short form health survey questionnaire (SF-36), and Specific Quality of Life after Delivery Questionnaire. Data were analyzed using SPSS. The results showed that the mean scores of various dimensions of the SF-36 were significantly higher at 12 to 14 weeks than at six to eight weeks (P < 0.001). The postpartum mean depression score was significantly higher at six to eight weeks than at 12 to 14 weeks (P < 0.001). The mean score of QOL questionnaires at 12 to 14 weeks were increased in all dimensions in comparison with six to eight weeks; however, this increase was significant only in dimension of the mother''s feelings toward herself, her husband, and others (P < 0.001). Because enormous changes develop in postpartum women, we suggest supportive measures for mother by her mother-in-law, family, and caregivers to improve the QOL and health status of the mother and her child.

The patients receiving hemodialysis spend a lot of their lifetime in the hemodialysis departments, which is an unpleasant experience. Therefore, some interventions are necessary to relieve this experience. The current study aimed to explore the hemodialysis patients'' perceptions of comfort facilitators during the hemodialysis procedure.Patients and This study was conducted by a qualitative content analysis approach. Twenty four patients receiving hemodialysis participated in this study by purposive sampling. The sampling was over when the data saturation occurred. The semi-structured interviews were applied as the main data gathering tool. The data analysis was conducted by conventional qualitative content analysis in eight phases. Three themes emerged: The presence of competent nurses, the delightful presence of the others, and coping with comfort obstacles. Each theme consisted of some categories. It seems that to achieve the patients'' comfort during the hemodialysis procedure, the health care teams, hospitals in charge and the patients themselves have to do their best to provide the patients'' comfort.

Healthcare-seeking behavior is one of the factors determining the uptake and outcome of healthcare. However, few studies have discussed how and why diabetics seek healthcare assistance before meeting a physician.

In this study, we explored the subjective experiences of healthcare-seeking behavior among Iranian patients with type 2 diabetes mellitus.Patients and

A qualitative approach was adopted using a conventional content analysis of semi-structured interviews carried out in the Diabetes Association in Tabriz (Iran) with 15 participants suffering from type 2 diabetes. Participants were recruited by the purposeful sampling method.

Five themes emerged from the study: 1) warning by physical signs; 2) personal processing; 3) self-remedy and its outcomes; 4) seeking information, and; 5) diagnosis and verification of information by healthcare staff.

Individual social context plays an important role in the decision-making process when seeking healthcare for diabetes. The results of this study can be utilized by healthcare providers to facilitate interventions to increase diabetics’ active involvement in their healthcare, and encourage a wider knowledge of its symptoms and outcomes to facilitate appropriate healthcare-seeking and service use.

A mucocele is an epithelial-lined, mucus-containing sac that can fill the sinus completely and expand gradually. Mucopyocele is an infected mucocele.Case Report: We presented a case of left maxillary mucopyocele in a 58-year-old man that developed after radiotherapy for nasopharyngeal carcinoma. Computed tomography scan showed opacification of the left maxillary sinus expanding through the medial wall of the antrum with thinning and destruction of the adjacent structures. Endoscopic marsupialization of the lesion and left partial maxillectomy were performed. The cystic mass had yellowish thick mucopurulent fluid that was completely drained.

A few cases of sphenoid sinus mucocele as a late complication of radiation therapy have been reported. Maxillary mucocele and mucopyocele can be considered as one of the late complications of radiotherapy to head and neck as a result of occlusion of sinus ostia by scarred mucosa.