فهرست مطالب
Iranian Red Crescent Medical Journal
Volume:16 Issue: 9, Sep 2014
- تاریخ انتشار: 1393/07/10
- تعداد عناوین: 33
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Page 1BackgroundStudies in higher education indicated that students’ expectation for their educational services are not provided sufficiently, particularly in developing countries that implies on gap between the students perception on current situation and their expectations from educational services.ObjectivesThe aim of this study was to determine the gap between student perception and expectations of students in various levels of the undergraduate educational courses at Urmia University of Medical Sciences, Iran.Patients andMethodsThis is a longitudinal study, which was conducted in academic year 2007-2008 at the Urmia University of Medical Sciences. In total, 173 students were selected as sample size, among various courses. SERVQUAL questionnaire was used as instrument. Descriptive statistics following by Friedman and Wilcoxon tests were used to determining significance of quality gap between five dimensions and to evaluate significant gap between student perceptions and their expectations, respectively. Spearman test was also used to determine the relationship between dimensions.ResultsIn overall, 80% of educational expectations were not meet; there was a negative gap at all phrases and dimensions and the gap was more negative for educational experts (-1.45 ± 0.89) compared to teachers (-0.97 ± 0.97). The highest gap for teachers was in empathy dimension (-1.11 ± 1.51), while for experts it was in assurance dimension (-1.58 ± 1).ConclusionsExistences of gap in dimensions indicated that expectations of students are not met and it indicates their dissatisfaction, and thus it is a necessity for improvement in all dimensions.Keywords: Student, Perception, Education, Consumer Satisfaction, Medical Students
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Page 2BackgroundThere is an increasing trend in the prevalence of coronary artery disease (CAD) in Iran.ObjectivesThe present study aimed to investigate the relationship of anxiety, depression, diabetes and coronary artery disease among patients undergoing angiography in Ghaem Hospital, Mashhad, Iran.Patients andMethodsThis case-control study was conducted between September 2011 and August 2012 among 200 patients undergoing coronary angiography for symptoms of coronary disease at Ghaem Hospital, Mashhad, Iran. The control group consisted of 697 healthy adults recruited from the individuals who attended the clinic for routine medical checkups or pre-employment examinations. The Beck anxiety and depression inventory scores and fasting blood glucose results were assessed in all the subjects. Data were analyzed using SPSS version 16. P < 0.05 was regarded as statistically significant.ResultsThe mean age of patients was 57.52 ± 9.33 years old and for the control group it was 55.35 ± 8.45 years; there was no significant difference between the subjects (P = 0.647) regarding age. There was also no significant difference in gender distribution between the patients and control groups (P = 0.205). There was however a significant difference in anxiety and depression scores between the patients and healthy controls (P < 0.001). There was a significant positive correlation between anxiety score and depression score in both groups when data were analyzed by Pearson test. (P < 0.001, r = 0.604 and r = 0.521). Moreover, there was a significant positive linear correlation between the depression/anxiety scores and fasting blood glucose concentrations in the patients group (r = 0.3, P < 0.001) and a weak negative correlation in the healthy controls (r = -0.096, P < 0.05).ConclusionsDepression and anxiety are potentially important factors among patients with angiographically-defined CAD. There appear to be significant associations between glucose tolerance and anxiety and depression in these patients.Keywords: Coronary Artery Disease, Anxiety, Depression, Angiography
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Page 3IntroductionPyometra is an accumulation of purulent material or pus in the uterine cavity. Spontaneous perforation of uterus by pyometra is rare. This is a clinical presentation and management of a spontaneous perforation of uterine caused by pyometra.Case PresentationThis is a case report on spontaneously perforated associated with pyometra secondary to cervical malignancy. The patient underwent exploratory laparotomy with total hysterectomy and bilateral salpingo-oophorectomy.ConclusionsSpontaneous rupture of pyometra duo to cervical cancer in cases of acute abdomen in elderly patients should be considered.Keywords: pyometra, Uterine Perforation, Acute Abdomen, Postmenopause
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Page 4BackgroundAnxiety is the most common emotional response in women during delivery, which can be accompanied with adverse effects on fetus and mother.ObjectivesThis study was conducted to compare the effects of aromatherapy with rose oil and warm foot bath on anxiety in the active phase of labor in nulliparous women in Tehran, Iran.Patients andMethodsThis clinical trial study was performed after obtaining informed written consent on 120 primigravida women randomly assigned into three groups. The experimental group 1 received a 10-minute inhalation and footbath with oil rose. The experimental group 2 received a 10-minute warm water footbath. Both interventions were applied at the onset of active and transitional phases. Control group, received routine care in labor. Anxiety was assessed using visual analogous scale (VASA) at onset of active and transitional phases before and after the intervention. Statistical comparison was performed using SPSS software version 16 and p < 0.05 was considered significant.ResultsAnxiety scores in the intervention groups in active phase after intervention were significantly lower than the control group (P < 0.001). Anxiety scores before and after intervention in intervention groups in transitional phase was significantly lower than the control group (P < 0.001).ConclusionsUsing aromatherapy and footbath reduces anxiety in active phase in nulliparous women.Keywords: Aromatherapy, Warm Foot Bath, Anxiety, Active Phase, Nulliparous
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Page 5IntroductionBasidiobolomycosis is a rare disease that, unlike other fungal infections, affects immunocompetent individuals. It is caused by an environmental saprophyte named the fungus Basidiobolus ranarum. Basidiobolomycosis usually appears as a subcutaneous infection. GI basidiobolomycosis is an emerging disease, and the colon is the most frequent involved part of the GI tract.Case PresentationThe present study presents a middle-aged lady suffered from basidiobolomycosis with concomitant lesions in the cecum and liver involvement. This disease is extremely rare in adults and only a few cases have been reported so far.ConclusionsGI basidiobolomycosis is a very rare disease which resembles as an infiltrative, infectious, or inflammatory process. Concomitant liver and bowel involvement is extremely rare too. It is an aggressive disease which has a high mortality rate despite treatments like surgical resection and prolonged antifungal therapy.Keywords: Fungal Infections, Basidiobolomycosis, Granuloma
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Page 6BackgroundNowadays drug dependence has become one of the main concerns worldwide. Indeed, drug dependence and abuse have become personal, social and, health problems that intensively threat human resources.ObjectivesThis study aimed to examine the effect of mindfulness-based stress reduction (MBSR) on health-related quality of life (HRQOL) in drug-dependent males.Patients andMethodsAn experimental research with pretest/posttest design and a control group was conducted on 49 drug-dependent males. The selected individuals were randomly allocated to the study groups (24 to the experimental and 25 to the control groups). Afterwards, the Short Form Health Survey for HRQOL (SF-36) questionnaire was completed by participants. Subsequently, the experiment group experienced eight 90-minute sessions of training in MBSR. At the end of the training, the subjects were evaluated once again by SF-36. The independent-samples t test and analysis of covariance (ANCOVA) were used to analyses data.ResultsThe results suggested that the mean differences between groups regarding scales of role emotional, vitality, mental health, social functioning, and bodily pain were statistically significant (P < 0.05).ConclusionsUsing MBSR is recommended for improving HRQOL in drug-dependent males who are undergoing treatment for their drug dependence in addiction treatment center; however, more studies concerning different drugs as well as drug dependence in women must be performed.Keywords: Drug Addiction, Mindfulness, Based Stress Reduction, Health, Related Quality of Life
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Page 8BackgroundAwareness during general anesthesia in different types of surgery is an important described adverse event. Bispectral (BIS) monitoring is one of the recent techniques proposed to monitor the depth of anesthesia.ObjectivesThe present study tested the hypothesis that the awareness rate and changes in hemodynamic parameters within anesthesia would be lower in patients allocated to BIS-guided management than those allocated to routine monitoring.Materials And MethodsIn total, 333 adult patients with the American Society of Anesthesiologists (ASA) physical status I-III, aged between 18 and 65 years scheduled for elective abdominal surgery under general anesthesia were included in this randomized double-blind placebo controlled trial. Patients were randomly allocated to BIS monitoring (n = 163) or routine monitoring (n = 170). BIS values and hemodynamic parameters including systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and SPO2 were marked before induction (control value), after intubation and laryngoscopy, at intubation, after incision, and also during the operation every 15 minutes until extubation.ResultsThe overall incidence of awareness in the BIS and routine monitoring groups were 5.5% and 4.1%, which was not significantly different. There were no significant differences in hemodynamic indices including SBP, DBP, HR, and SPO2 before induction of anesthesia between the two groups. These between-group differences in the studied indices remained insignificant at different time points after anesthesia induction as well as post ICU hospitalization. Furthermore, the trend of changes in hemodynamic parameters was comparable in the two groups.ConclusionsBIS-guided management may not be superior to routine monitoring protocols to prevent awareness as well as hemodynamic changes during general anesthesia in patients undergoing abdominal surgeries.Keywords: Anesthesia, Awareness, Consciousness Monitors
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Page 9BackgroundAs individuals live a longer life, health-promoting lifestyle (HPL) becomes even more essential, particularly with regard to maintaining functional independence and improving quality of life (QoL).ObjectivesThis study aimed to determine the association between QoL and HPL in the Iranian elderly living in Shiraz.Materials And MethodsThis analytical cross-sectional study was conducted in 2013 at retirement centers of Shiraz City, Iran. The sample included 500 elderly who aged > 60 years. Proportional stratified random sampling was used to select the elderly from retirement centers. QoL was assessed by the Farsi version of Short Form Health Survey questionnaire (SF-36) and HPL was measured by health-promoting lifestyle profile (HPLP II). Data were analyzed using independent-samples t test, one-way ANOVA, Pearson’s correlation, and stepwise multiple regression using SPSS 21.ResultsThere were significant differences in QoL in terms of sex, age, education, and marital status. There were significant differences in HPL in terms of gender, age and education (P < 0.05) There was a statistically significant association between QoL and HPL in the elderly (r = 0.42, P < 0.05). Based on HPLP II constructs, the significant predicting factors of QoL in the elderly consisted of spiritual growth, stress management, and physical activity (P < 0.05).ConclusionsHealth providers should improve the QoL in the elderly by facilitating HPL through health-promoting interventions, which will maintain and increase physical activity, stress management, and spiritual growth.Keywords: Quality of Life, Health, Promoting Lifestyle, the Elderly
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Page 10BackgroundStachys pilifera Benth has long been used to treat infectious diseases as well as respiratory and rheumatoid disorders in Iranian folk medicine. Antioxidants, antitumor, and antimicrobial properties of the plant have been reported.ObjectivesThis experimental study was designed to evaluate systemic and topical anti-inflammatory effects of the hydro-alcoholic extract from aerial parts of Stachys pilifera (HESP).Materials And MethodsAnti-inflammatory effects of HESP was studied in four well-known animal models of inflammation, including carrageenan- or formalin-induced paw edema in rat (thirteen groups, 6 rats per each group), and 12-O-tetradecanoylphorbol-13-acetate (TPA)- or xylene-induced ear edema in mouse (ten groups, 6 mice per each group). The rats received HESP (50-400 mg/ kg) orally 45 minutes before the subplantar injection of carrageenan or formalin. In TPA or xylene tests, HESP (1, 2.5, and 5 mg/ear) was applied topically simultaneous with these phlogistic agents on the ear mice. Finally, pathological examination of the inflamed tissues (paw and ear) was carried out.ResultsAcute toxicity study of the extract showed that no rats were killed at 5000 mg/kg (LD50 > 5000 mg/kg). The extract (100 and 200 mg/ kg) significantly suppressed carrageenan-induced paw edema 1, 2, 3, and 4 hours after carrageenan challenge in comparison with the control group (P < 0.001). The HESP (100 and 200 mg/ kg) also produced a considerable antiedematogenic effect in the formalin test over a period of 24 hours (P < 0.01). Furthermore, topical administration of the HESP (1, 2.5, and 5 mg/ear) inhibited TPA- and xylene-induced ear edema in comparison with the control group (P < 0.001). The pathological analysis of the paws and ears revealed that HESP was capable of reducing tissue destruction, cellular infiltration, and subcutaneous edema induced by the indicated phlogistic agents.ConclusionsThe present data confirmed systemic and topical anti-inflammatory effects of Stachys pilifera which is comparable to indomethacin.Keywords: Anti, inflammatories, Carrageenan, Formalin, Stachys, 12, O, Tetradecanoylphorbol, 13, Acetate
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Page 11BackgroundCommon carotid artery (CCA) ultrasound with measurement of intima-media thickness (IMT) is a safe and noninvasive technique for assessing subclinical atherosclerosis and determining cardiovascular risks. Moreover, the pattern of wall thickening in the brachial artery (BA) is rather diffuse compared to the carotid artery and may be a more sensitive indicator of long-term systemic exposure to risk factors. Therefore noninvasive evaluation of mechanical parameters changes of both arteries has gained the attention of researchers.ObjectivesThe aim of this study was to compare different edge detection techniques with speckle reducing anisotropic diffusion (SRAD) de-noising filter in ultrasound images of both arteries.Patients andMethodsIn a cross-sectional design, an examination was performed on ten men with mean age of 40 ± 5 years from September 2012 to March 2013 through random sampling. An ultrasonic examination of the left CCA and BA was performed. The program was designed in the MATLAB software to extract consecutive images in JPEG format from the AVI. Another program was designed in the MATLAB software to apply regions of interest (ROI) on the IMT of the posterior wall of common carotid and brachial arteries. Next, different edge detections and SRAD filter were applied to the ROI, separately. Finally, the program measured mean-squared error (MSE) and peak signal to noise ratio (PSNR).ResultsThe lowest values of MSE and highest values of PSNR were achieved by Canny edge detection with de-noising SRAD filter for IMT of left CCA and BA in 90 frames.ConclusionsBased on the result, by measuring the MSE and PSNR, this study showed Canny edge detection with SRAD filter is better than other edge detections in terms of speckle suppression and details preservation in CCA and BA ultrasound images.Keywords: Carotid Artery, Brachial Artery, Immature Thymocyte, Specific Antigen (IMT), Edge Detection, De, Noising Filter
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Page 12BackgroundDeep vein thrombosis (DVT) is a well-recognized complication in patients with cancer. Chemotherapy and cancer surgery increase the risk of DVT in these patients. There are a few reports about the prevalence of DVT in patients with cancer regarding different managing modalities.ObjectivesThis study aimed to assess the prevalence of DVT in patients with cancer, who were hospitalized in teaching hospitals, according to their treatment intervention.Patients andMethodsA cross-sectional retrospective study was conducted on 602 patients with cancer in Kerman, Iran, during years 2006-2007. Among the subjects, 301 had been operated and the rest had received chemotherapy. The prevalence of DVT was determined based on patients’ variables, cancer factors, and therapeutic modalities.ResultsTotally, 349 subjects (58%) were male. DVT incidence was 19.9%, most of the cases were over 40 years of age (82.2%), and 21.2% of males and 18.2% of females had developed DVT. The prevalence of DVT in chemotherapy group was higher than that in surgery group (21.9% and 17.9%, respectively); however, this difference was statistically insignificant. DVT developed more frequently in lung cancer (42%) with small cell carcinoma being the most common pathologic finding (42.9%) in those with lung cancer (P = 0.0001).ConclusionsDVT occurs frequently in patients with malignancies. In this study, there was no association between DVT prevalence and age as well as sex; nonetheless, the prevalence was significantly higher in some sites and in patients with certain pathologies. Although DVT prevalence was higher in chemotherapy than in surgery, the difference was insignificant. Informing patients with cancer about symptoms of DVT and prophylactic interventions are warranted.Keywords: Chemotherapy, Deep Vein Thrombosis, Malignancy, Surgery Copyright
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Page 13IntroductionHydatid cyst is a significant health problem in underdeveloped and developing countries, particularly among sheep breeders. Although cardiac involvement is seen only in 0.2% to 3% of the cases, early diagnosis and treatment are important.Case PresentationA 13-year-old boy with dyspnea and atypical pericardial type chest pain for three months was referred to us. Chest X-ray revealed linear calcification in the left side of the heart. Computed tomography demonstrated a cyst with peripheral calcification and without internal septation in the lateral left ventricle (LV) myocardium. Serologic IgG test was positive for Echinococcosis. No other cyst was seen in the other organs such as the lungs and liver. By midline sternotomy on pump, an incision was made 2-cm lateral to the left ascending artery through the LV myocardium and without entering any cardiac chamber. After injecting hypertonic (5%) saline, the cyst was punctured and its fluid contents were aspirated, the cyst was enucleated, and the cavity marsupialization was done for protection of the myocardium. LV ejection fraction before operation was 40% but after operation and repairing LV myocardium, ejection fraction increased to 50% in. Histopathologic examination confirmed a hydatid cyst.ConclusionsIn myocardial hydatid cysts, we recommend a direct approach without entering the cardiac chambers to avoid dissemination of the infection. We recommend excision of the germinative membrane without capitonnage to avoid impairment of myocardial contraction.Keywords: Echinococcosis, Myocardium, Heart, Cysts
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Page 14BackgroundTuberculosis is still a public health concern in Iran. The main challenge in monitoring epidemiological status of tuberculosis is to estimate its incidence accurately.ObjectivesWe used a newly developed approach to estimate the incidence of tuberculosis in Sistan, an endemic area in southeast of Iran in 2012-13.Patients andMethodsThis cross-sectional study was conducted on school children aged 6-9 years. We estimated a required sample size of 6350. Study participants were selected using stratified two-stage cluster sampling method and recruited in a tuberculin skin test survey. Indurations were assessed after 72 hours of the injection and their distributions were plotted. Prevalence and annual risk of tuberculosis infection (ARTI) were estimated using the Bayesian mixture model and some traditional methods. The incidence of active disease was calculated using the Markov Chain Monte Carlo technique.ResultsWe assumed weibull, normal and normal as the best distributions for indurations due to atypical reactions, BCG (Bacillus Calmette–Guérin) reactions and Mycobacterium tuberculosis infection, respectively. The estimated infection prevalence and ARTI were 3.6% (95%CI: 3.1, 4.1) and 0.48%, respectively. These estimates were lower than those obtained from the traditional methods. The incidence of active tuberculosis was estimated as 107 (87-149) per 100000 population with a CDR of 54% (40%-68%).ConclusionsAlthough the mixture model showed slightly lower estimates than the traditional methods, it seems that this method might generate more accurate results for deep exploration of tuberculosis endemicity. Besides, we found that Sistan is a high endemic area for tuberculosis in Iran with a low case detection rate.Keywords: Tuberculosis, Infection, Survey
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Page 15Context: Keeping in mind the burden of psychotherapy can play a crucial role concerning chronic pain (CP). Psychotherapy techniques are widely used to relief Chronic Pain (CP) worldwide. Appling psychotherapy needs to consider both individual and popular cultures. In addition to international requirements; nation-wide legitimacy should be regarded too. Psychological methods have provided a lot of articles in Iran, but they were neglected by the reviewers because the documents only have abstracts in English. The current study aimed to assess all Farsi Randomized Control Trials (RCTs) addressing psychotherapy to relieve chronic pains.Evidence Acquisition: Six nation-wide medical databases were investigated in 2012 using the keyword chronic pain in the Abstracts, systematically. Appling PICO question format (patient problem or population, intervention, comparison, and outcomes) all the interventional studies were reviewed for eligibility. Retrieving full text (in Farsi) and making the articles indistinguishable, two native reviewers assessed the quality of the articles independently using Jadad scale.ResultsInclusion criteria met 1542 abstracts. After refining and excluding, seventeen experimental studies were retrieved and evaluated. Mean quality score of Jadad was 1.53 ± 1.37 (median = 1.0). Cognitive Behavior Therapy (CBT) was the dominant approach (11 out of 17) and the majority (6 out of 17 studies) of the treated cases was Low Back Pain (LBP). Patient-therapist gender adjustment has clearly reported in most of the studies, based on the requirements.ConclusionsCognitive Behavior Therapy was more effective than the other psychotherapy approaches relieving chronic pain in the studies. Well-designed studies and comprehensive clarification of the studies demonstrating groups, intervention, follow-up and drop outs can improve the quality of the RCTs.Keywords: Psychotherapy, Chronic Pain, Quality Assessment
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Page 16Context: Cleft palate is the second most common birth defect and is considered as a challenge for pediatric plastic surgeons. There is still a general lack of a standard protocol and patients often require multiple surgical interventions during their lifetime along with disappointing results.Evidence Acquisition: PubMed search was undertaken using search terms including 'cleft palate repair', 'palatal cleft closure', 'cleft palate + stem cells', 'cleft palate + plasma rich platelet', 'cleft palate + scaffold', 'palatal tissue engineering', and 'bone tissue engineering'. The found articles were included if they defined a therapeutic strategy and/or assessed a new technique.ResultsWe reported a summary of the key-points concerning cleft palate development, the genes involving this defect, current therapeutic strategies, recently novel aspects, and future advances in treatments for easy and fast understanding of the concepts, rather than a systematic review. In addition, the results were integrated with our recent experience.ConclusionsTissue engineering may open a new window in cleft palate reconstruction. Stem cells and growth factors play key roles in this field.Keywords: Cleft Palate, Cleft Lip, Platelet, Derived Growth Factor, Transforming Growth Factor, Mesenchymal Stem Cells, Embryonic Stem Cells, Platelet, Rich Plasma
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Page 17BackgroundBioflavonoids are well known for their multi directional biologic activity including antidiabetic effect. It has been demonstrated that flavonoids can act as insulin secretagogue or insulin mimetic agents.ObjectivesThis experimental study was designed in Arak University of Medical Sciences, Arak, Iran, to investigate the effects of biochanin A (a bioflavonoid) on fasting blood glucose (FBG), body weight, glycosylated hemoglobin (HbA1c), lipid profile, serum enzymes, and visfatin of streptozocin-induced diabetic rats.Patients andMethodsWe used 24 male Wistar rats and randomly allocated them to four groups of six rats. One group was randomly assigned as control and diabetes was induced in three other groups by administration of streptozocin (35 mg/kg of body weight) intraperitoneally. The groups received the following treatments: group 1 (control), 5% DMSO; group 2 (diabetic control), 0.5% DMSO; and group 3 and 4, respectively 10 and 15 mg/kg biochanin A for 30 days. Body weight and biochemical parameters including FBG, HbA1c, lipid profile, aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), and visfatin were measured in all rats.ResultsFBG level was significantly reduced in treated diabetic rats (139.8 ± 9.3 and 206 ± 11 mg/dL in groups 3 and 4, respectively) in comparison to the diabetic control (295.1 ± 14 mg/dL) (P < 0.05). Administration of biochanin A significantly decreased HbA1c in group 3 (6.66 ± 0.33) and group 4 (7.11 ± 0.31) in comparison to the diabetic control group (8.26 ± 0.44) (P < 0.05). Levels of serum visfatin were improved to near normal levels in the treated rats (249 ± 35.5 and 161.33 ± 13.07 in groups 3 and 4, respectively) in comparison to the diabetic control (302.17 ± 19.4) (P < 0.05). Furthermore, biochanin A showed a protective effect against weight loss in diabetic rats (P < 0.05). In treated rats, serum total cholesterol, triglyceride, and low-density lipoprotein cholesterol (LDL-c) were significantly decreased and high-density lipoprotein (HDL-c) was increased in comparison with the diabetic control group. In addition, biochanin A restored the altered plasma enzymes (AST, ALT, and ALP) activities to near normal. Histopathologic examination of the pancreas also indicated that biochanin A had protective effects on β-cells in streptozocin-induced diabetic rats.ConclusionsThis study demonstrated that biochanin A possessed hypoglycemic and antilipemic activities and could increase visfatin expression, which suggests its beneficial effect in the treatment of diabetes.Keywords: Visfatin, Biochanin A, Diabetic Rats
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Page 18BackgroundAcupuncture has recently received considerable attention around the world due to its cost-effectiveness, few side effects, and well-established analgesic properties.ObjectivesThe present study aimed to identify the factors that might lead to using acupuncture for pain relief.Patients andMethodsThis qualitative study was conducted using conventional content analysis method. The study population included eight patients and six highly experienced acupuncturists, who were able to express their opinion and were willing to take part in the study. The inclusion criteria for patients were being under treatment with acupuncture for pain relief or a history of treatment during the last year and age > 18 years. All highly trained acupuncturists with minimum of one-year active experience were included. The data were collected via semi-structured in-depth interviews. Categories were extracted through inductive analysis and codes and eventually, themes emerged. Data rigor was assured by data collection triangulation, participants’ variety, and external and members’ check.ResultsInitially, 1311 primary codes were extracted, then the related codes were divided into 127 subcategories according to their similarities, and after reduction and integration process, 16 categories were developed from subcategories and eventually five themes were determined, including conventional medicine limitation, efficacy of acupuncture, external promoters, internal promoters, and acupuncture inhibitors.ConclusionsThe important factors that affect choosing acupuncture for pain relief included conventional medicine limitations, external promoters, internal promoters, acupuncture efficacy, and acupuncture inhibitors. More interest can be drawn to this technique by basic planning to enhance some of the underlying factors and eliminate obstacles to its further applicability.Keywords: Acupuncture, Analysis, Pain Relief
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Page 19IntroductionSialolithiasis is the most common disease of salivary glands. Sialography is particularly important for the assessment of the outflow tract and in diagnosing obstructive salivary gland lesions including calculi.Case PresentationWe report on a 38-year-old female with sialolithiasis whom had Wharton’s duct perforation, complicating the sialography. She was treated conservatively with a course of co-amoxiclav, oral prednisolone for three days and pain-killers. The patient was clinically well on follow-up reassessments at the end of the first week and three weeks post procedure.ConclusionsPerforation of salivary duct complicating the sialography is rare. Awareness of this potential complication and utilizing a good sialography technique need to be advocated amongst radiologists. Response to treatment by conservative management is preferred as illustrated in this case.Keywords: Salivary Gland Calculi, Sialography, Salivary Ducts, Rupture
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Page 20BackgroundBreast cancer is the most common malignancy in women. Global statistics indicate increasing rates of this cancer. Nutrition, diet, and healthy behaviors are among influential factors in prevalence of breast cancer, and possibly affect its incidence through inflammatory and immune system responses.ObjectivesThis study was designed to compare nutritional and unhealthy behaviors in women with and without breast cancer referred to Mahdieh Imaging Center in Hamadan in 2013. Patients andMethodsThis cross-sectional study is conducted on 232 women with r and without breast cancer referred to Mahdieh Imaging Center of Hamadan, Iran) in 2013 using random sampling method. Data were collected using nutritional and unhealthy behaviors questionnaires, and analyzed with SPSS-17 software using descriptive statistics and Mann-Whitney, independent t, and chi-square tests.ResultsThe mean scores of feeding type in the patients with and without breast cancer was 56.14 and 66.25, respectively. Results obtained from data analysis showed that there was statistically significant difference between the two groups in terms of nutrition (P < 0.001), but no relationship was observed between breast cancer and unhealthy behaviors.ConclusionsGiven the results, improving skills, training and awareness is necessary for women and emphasis on modified diet is recommended as a non-medical option for prevention of breast cancer.Keywords: Breast cancer, Nutrition, Lifestyle
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Page 21BackgroundThe 12-Item General Health (GHQ-12) questionnaire is one of the most commonly used instruments in screening studies on mental health.ObjectivesThe current study aimed to examine the factor structure of the GHQ-12 questionnaire among the students in Iran.Materials And MethodsIt was a cross-sectional study in which 428 university students were recruited and completed the GHQ-12. Reliability of the GHQ-12 was evaluated using the Cronbach's alpha and the split-half method by applying the Spearman-Brown coefficient. Factor structure of the questionnaire was extracted by exploratory factor analysis (EFA). Confirmatory factor analysis (CFA) was conducted to assess how well the EFA extracted model fitted the observed data.ResultsThe mean age of the participants was 22.83 years (SD = 3.09). Most of them were female (56.1%) and 81% were unemployed. The Cronbach’s alpha coefficient for the Iranian version of GHQ-12 was 0.85. Using the split-half method, the alpha for the social dysfunction was found to be 0.77; it was 0.76 for the psychological distress. The principal component analysis revealed a two-factor structure for the questionnaire including social dysfunction and psychological distress that explained 48% of the observed variances. The confirmatory factor analysis was showed fit for the data.ConclusionsThe current study findings confirm that the Iranian version of GHQ-12 has a good factor structure and is a reliable and valid instrument to measure psychological distress and social dysfunction.Keywords: General Health Questionnaire, Mental Health, Construct Validity
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Page 22BackgroundOral health plays a vital role in people’s general health and well-being. With regard to the costly treatments of oral diseases, preventive programs need to be designed for dental caries based on children’s perspectives.ObjectivesThe purpose of this study was to describe and explore challenges for caring dental health based on children’s perspectives. Patients andMethodsA qualitative design with content analysis approach was applied to collect and analyze the perspectives of students about factors influencing oral and dental care. Eighteen Iranian students in 8 guidance schools were chosen through the purposive sampling. Semi-structured interviews were held for data gathering. In order to support the validity and rigor of the data, different criteria such as acceptability, confirmability, and transferability were utilized.ResultsDuring data analysis, four main themes developed: “barriers to dental health,” “maintaining dental health,” “uncertainty in decision-making” and “supportive factors”. “Uncertainty in decision-making” and “barriers to dental health” were the main challenges for preventing dental caries among adolescents.Conclusions“Certainty in decision-making” to maintain dental health depends on overcoming the barriers of dental health. Further research is needed to confirm the findings of this study.Keywords: Qualitative Research, Student, Dental Caries, Dental Health
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Page 23BackgroundSmoking is the most preventable risk factor for non-communicable diseases and its alarming trend.ObjectivesThe aim of this study was to explore and determine facilitating factors for smoking in young males, who participated in the Tehran Lipid and Glucose Study (TLGS), from their own perspective.Patients andMethodsThis qualitative study was conducted within the framework of the TLGS. Participants were young males with 15 to 25 years of age and various levels of education. The inductive content analysis approach was used to analyze data on the participants’ perceptions with regard to smoking facilitators. Data collection was conducted through discussions by six semi-structured focus groups consisted of five to seven people. All the interviews were transcribed after being recorded and analyzed through constant comparative analysis.ResultsTwo main categories derived from the analysis of the data: I) personal needs and features; and II) environmental facilitators. The former concept included three subcategories: 1) fulfilling essential needs; 2) search for identity; and 3) lack of life skills. Environmental facilitators were also divided into two subcategories: 1) social patterns; and 2) ease of access.ConclusionsTendency towards smoking is influenced by different factors. Clarifying these influential factors for smoking from the perspective of young males can be important in designing effective preventive programs.Keywords: Qualitative Research, Smoking, Youth, Glucose
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Page 24BackgroundOne much needed tool to assist with the monitoring and evaluation of Human Immunodeficiency Virus (HIV) prevention programs is to provide a valid instrument to measure protective sexual behavior and related factors.ObjectivesThe current study aimed to design a valid and reliable instrument to predict the protective sexual behaviors of women at risk of HIV in Iran. Patients andMethodsThe current study was a sequential mixed cross-sectional and methodological research. Initially, via a qualitative research, constructs and factors associated with sexual protective behavior of women at risk were identified through 25 in-depth interviews. The questionnaire on predictors of protective sexual behaviors in women at risk of HIV (PSPB) was designed based on a qualitative study, and then its qualitative validity, content, and construct validity were evaluated. Exploratory factor analysis was performed and 200 women at risk participated.ResultsSeven concepts emerged after exploratory factor analysis of the 48 items. The content validity ratio (CVR) of the questionnaire constructs were 0.55 to 0.76, and content validity index (CVI) structure was 0.86 to 0.95. Cronbach's alpha coefficient for the entire questionnaire was 0.78, and correlation coefficient of the test-retest reliability for the constructs was from 0.73 to 0.89.ConclusionsThe current study proved the capability of the predictors of sexual protective behavior in women at risk for HIV questionnaire as a valid and reliable instrument for the Iranian community.Keywords: Vulnerable Populations, Women, Questionnaires
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Page 25IntroductionMalignant Mixed Mullerian Tumor (MMMT) is a very rare tumor, accounting for less than 1% of all ovarian cancers.Case PresentationWe present a 64-year-old woman with stage III MMMT of ovary that was treated with platinum-based chemotherapy after optimal cytoreductive surgery. After 25 months of being disease free, she had a pelvic recurrence and a good response to chemoradiotherapy.ConclusionsOptimal cytoreductive surgery and chemotherapy may be the best treatment in MMMT but more discussion and experiences are needed regarding the effectiveness of radiotherapy.Keywords: Mixed Tumor, Mullerian, Cytoreductive Surgery, Chemoradiotherapy, Chemotherapy, Ovary
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Page 26BackgroundSedation is a condition of reduced level of consciousness (LOC) for a patient that is created to decrease irritability, anxiety, and restlessness.ObjectivesIn this study, we compared the sedative effect of oral administration of ketamine, midazolam, and atropine cocktail with diphenhydramine in the referent children to the emergency department.Patients andMethodsBased on the double-blind randomized clinical trial in this investigation, 80 children, who needed to repair their wounds with suture were randomly divided into two groups: group 1 and group 2, who have received oral diphenhydramine and oral ketamine, midazolam, and atropine cocktail, respectively. Behavioral changes were collected and recorded before, during intervention and two weeks after intervention. Statistical data were analyzed by SPSS-16 software and chi-square and Mann-Whitney U tests were employed to study the relations among variables. P < 0.05 was considered statistically significant.ResultsThere was no significant difference between two groups in terms of drug acceptance and anxiety degree in children before intervention. Group 2 had achieved better and deeper sedation than group 1 during 45-minute post-medication (P < 0.05, P = 0.01). Regarding pediatric general behavior such as crying or interruptive moves, there was also a significant statistical difference between group 2 and group 1 (P = 0.009) based on Houpt Classification. The mean recovery times in groups 1 and 2 were 34.37 ± 14.23 min and 27.25 ± 5.14 min, respectively (P = 0.003). In terms of behavioral changes, the rate of cumulative frequency was computed for behavioral changes two weeks after the discharge from emergency department in which there were less behavioral changes in group 2 than in group 1 (P = 0.04).ConclusionsOral administration of ketamine, midazolam, and atropine cocktail induces better sedation than diphenhydramine with respect to its limited mood changes in children, who need a medical procedure at emergency department.Keywords: Conscious Sedation, Children, Emergency Service, Oral Drug Administrations
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Page 27Context: Halogenated inhalational anesthetics are currently the most common drugs used for the induction and maintenance of general anesthesia. Postoperative hepatic injury has been reported after exposure to these agents. Based on much evidence, mechanism of liver toxicity is more likely to be immunoallergic. The objective of this review study was to assess available studies on hepatotoxicity of these anesthetics.Evidence Acquisition: We searched PubMed, Google Scholar, Scopus, Index Copernicus, EBSCO and the Cochrane Database using the following keywords: “inhalational Anesthetics” and “liver injury”; “inhalational anesthetics” and “hepatotoxicity”; “volatile anesthetics” and “liver injury”; “volatile anesthetics” and hepatotoxicity for the period of 1966 to 2013. Fifty two studies were included in this work.ResultsAll halogenated inhalational anesthetics are associated with liver injury. Halothane, enflurane, isoflurane and desflurane are metabolized through the metabolic pathway involving cytochrome P-450 2E1 (CYP2E1) and produce trifluoroacetylated components; some of which may be immunogenic. The severity of hepatotoxicity is associated with the degree by which they undergo hepatic metabolism by this cytochrome. However, liver toxicity is highly unlikely from sevoflurane as is not metabolized to trifluoroacetyl compounds.ConclusionsHepatotoxicity of halogenated inhalational anesthetics has been well documented in available literature. Halothane-induced liver injury was extensively acknowledged; however, the next generation halogenated anesthetics have different molecular structures and associated with less hepatotoxicity. Although anesthesia-induced hepatitis is not a common occurrence, we must consider the association between this disorder and the use of halogenated anesthetics.Keywords: Anesthesiology, Liver Injury Drug, Induced, Inhalation Anesthesia, Halothane, Sevoflurane
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Page 28BackgroundThere has been no data on population based dietary patterns during the Ramadan fasting month.ObjectivesThe purpose of this study was to detect Ramadan major dietary patterns among those who fast in Tehran.Materials And MethodsThis cross-sectional study included 600 subjects, aged 18-65 with body mass index (BMI) of 18.5-40, who had decided to fast during Ramadan. Anthropometric measurements, usual physical activity level and educational status were collected two weeks before Ramadan. Information on Ramadan dietary intakes was obtained using a food frequency questionnaire and factor analysis was used to identify major dietary patterns.ResultsWe identified four major dietary patterns: 1) Western-like pattern; high in fast foods, salty snacks, nuts, potato, fish, poultry, chocolates, juices; 2) high cholesterol and high sweet junk food pattern; high in pickles, sweets and condiments, butter and cream, canned fish, visceral meats and eggs; 3) Mediterranean-like pattern; high in vegetables, olive oil, dates, dairy, dried fruits, fruits, red meats, tea and coffee and 4) Ramadan-style pattern; large consumption of Halim, soups, porridges, legumes and whole grains, soft drinks, Zoolbia and Bamieh. Age was positively and inversely associated with Mediterranean-like (P = 0.003; r = 0.17) and Ramadan style (P = 0.1; r = -0.13) dietary pattern, respectively. Pre-Ramadan physical activity level was associated with a Mediterranean-like dietary pattern (P < 0.0001; r = 0.20).ConclusionsThis study showed a Ramadan-specific dietary pattern has unique characteristics, which has not yet been identified as a model of dietary pattern. Also, among identified dietary patterns, Mediterranean-like was the healthiest.Keywords: Ramadan, Fasting, Diet
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Page 30BackgroundLower vitamin D status has been reported in diabetic patients. Serum 25-hydroxyvitamin D and adiponectin were inversely associated with type 2 diabetes and insulin resistance. Vitamin D may involve in regulation of the adiponectin levels, which is directly related to insulin sensitivity.ObjectivesThe aim of this study was to investigate the effect of therapeutic dose of vitamin D on serum adiponectin and insulin resistance in vitamin D-insufficient or deficient type 2 diabetic patients.Materials And MethodsThis double-blind, randomized, clinical trial was conducted on 81 type 2 diabetic patients with vitamin D level of 10-30 ng/mL. Intervention was 50000 IU vitamin D or placebo once a week for 8 weeks. At the beginning and end of the study, blood samples were collected after 12 hours of fasting and serum glucose, insulin, 25-hydroxyvitamin D, and adiponectin were measured. Insulin resistance was calculated by homeostasis model assessment (HOMA-IR).ResultsAfter 8-week intervention, serum 25-hydroxyvitamin D significantly increased and reached the normal levels in patients receiving vitamin D (P < 0.001) and the levels of fasting serum glucose, insulin, and HOMA-IR were significantly decreased (P = 0.04, 0.02 and 0.007, respectively). No significant changes were observed in these levels in the placebo group. Significant differences were observed in mean changes in the above-mentioned variables between the two groups (P = 0.01, 0.04 and 0.006, respectively). No significant changes were found in serum adiponectin in the vitamin D and placebo groups (P = 0.83).ConclusionsTherapeutic dose of vitamin D can improve vitamin D status and glycemic indicators. But it seems that an 8-week intervention period was not sufficient to reveal the possible effects of vitamin D on serum adiponectin levels.Keywords: Diabetes Mellitus, Vitamin D, Insulin Resistance, Adiponectin
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Page 31BackgroundNasal carriage of Staphylococcus aureus is a substantial source of human infections. Detection and treatment of nasal carriage in children with methicillin-resistant and multidrug resistant S. aureus (MRSA and MDRSA, respectively) may be an important modality in prevention of infections.ObjectivesThis study determined the prevalence, antibiotic resistance patterns and risk factors for nasal carriage of MDRSA among healthy children.Patients andMethodsThis cross-sectional study was carried out on 350 one-month to 14-year-old healthy children in Kashan city, Iran. From all health-care centers, four were chosen by simple random sampling. Nasal samples were cultured in blood agar medium for S. aureus and antibiotic susceptibility profile was determined by disc diffusion and E-test. Risk factors for nasal carriage of MDRSA were also determined.ResultsA total of 92 (26.3%) S. aureus isolates were obtained, of which 33 (35.9%) were MRSA and 27 (29.3%) were MDRSA. Of MRSA strains, 19 (70.4%) were MDRSA. S. aureus isolates showed 52.2% resistance to cephalothin, 33.7% to co-trimoxazole, 26.1% to clindamycin, 26.1% to ciprofloxacin, 4.3% to vancomycin, and 35.9% to oxacillin. The risk factors for nasal carriage of MDRSA were antibiotic usage during the last three months (P = 0.006), family size of more than four members (P = 0.044), and parental smoking (P = 0.045).ConclusionsMDRSA was not uncommon among healthy children in Kashan and prevention of its spread in the population is judicious.Keywords: Staphylococcus aureus, Nasal, Carriers, Multidrug Resistance, Healthy, Child
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Page 32BackgroundHappiness is one of the most important factors affecting women's mental health. Several factors contribute to happiness in different societies.ObjectivesThe aim of this study was to investigate the level of happiness in married women and its related factors.Materials And MethodsThis was a cross-sectional study with stratified sampling proportional to different age groups of married women in selected health centers (based on socioeconomic status). Subjects were 379 married women. The Oxford Happiness Inventory (scale: 0-87) was used to measure happiness. The Enrich Marital Satisfaction Inventory including 47 questions (scale: 47-235) and demographic information questionnaires were also used. Descriptive statistics, correlation, T-test, One-way ANOVA and Regression were used to analyze data.ResultsThe mean of happiness was 45.11 ± 14.40. Marital satisfaction was 164.68 ± 28.33 and 64% of the participants had a relative marital satisfaction. Univariate analysis of happiness showed significant effects of husband and wife education, husband job, economic status, stress in past six months, marital satisfaction and having social activates, but was not statistically significant for other factors (P < 0.05). Adjusting for the confounding effect of other variables, multiple linear regressions showed significant association of happiness with marital satisfaction, economic status and social activity.ConclusionsRegarding lower level of happiness of married women in Shahroud comparing to some other studies in Iran and abroad, leisure time programs, training life skills especially stress management skills, increasing marital satisfaction and improving economic status should be considered.Keywords: Happiness, Women, Satisfaction
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Page 33BackgroundTo current knowledge, different oocyte''s recovery method and various seasons have profound impact on in vitro embryo production (IVEP).ObjectivesThe aim of this study was to define an efficient recovery method for oocytes harvesting from slaughterhouse material in different seasons, and their effects on IVEP yield.Materials And MethodsOvaries from slaughtered ewes in breeding season (BS) and non-breeding season (NBS) were collected from a local abattoir. The oocytes were recovered through aspiration, centrifugation (ORC), puncture and slicing, and categorized into three classes (I, oocytes with more than three layers of cumulus cells; II, less than three layers with damaged cumulus cells; III, denuded oocytes). After cultivation in TCM 199 for 24 hours, matured oocytes were subjected to in vitro fertilization (IVF) and in vitro culture (IVC). The oocyte recovery using ORC in BS and NBS was significantly higher (P < 0.05) compared with other recovery methods.ResultsNo significant dissimilarities in the proportion of oocytes reaching M-II stage were recorded when using different oocyte recovery methods in different seasons. Aspiration resulted in lower (P < 0.05) proportion of class I (BS, 60.0 ± 2.1; NBS, 51.1 ± 2.1) compared to ORC (BS, 82.0 ± 1.2; NBS, 70.0 ± 1.2), slicing (BS, 80.0 ± 2.1; NBS, 71.0 ± 1.4) and puncture (BS, 80.0 ± 1.5; NBS, 72.0 ± 2.0). Monospermy and blastocyst development rates were significantly higher using ORC than other recovery techniques in both BS and NBS. More oocytes with high quality, greater blastocyst development and oocyte recovery rates were achieved in BS.ConclusionsThe results revealed that oocytes harvesting technique and season are effective in the rate of cleavage and blastocysts’ development, and suggest that despite same meiotic resumption rate in all treatments, it would be better to use ORC.Keywords: In Vitro Oocyte Maturation Techniques, Fertilization in Vitro, Embryo Production, Sheep, Oocytes