Iranian Red Crescent Medical Journal
Volume:17 Issue: 3, Mar 2015

Squamous cell carcinoma is the most common type of lip and oral cavity cancers. In majority of cases it follows quite common course, and after the surgery it does not produce any harm. This case presents unusual and unexpected growth of upper lip squamous cell carcinoma with severe cosmetic problems, and possible health threats. A 46-year-old woman noticed on her upper lip “a spot, the size of a wheat grain”, which grew rapidly and reached the size of 0.6 cm during a two-week period. The lesion was red, hard and painful, attached to the skin. It was surgically removed, and primary histopathological finding was follicular keratosis. Recurrent tumor appeared seven days after the operation, with the extreme swelling of the upper lip. The patient was sent to a tertiary hospital, where fungal or bacterial infection was excluded. The change on the patient’s upper lip reached the size of 5 × 2 cm, as soft, reddish nodular tumor. Squamous cell carcinoma was diagnosed after the histopathological audit. With the second surgical intervention the tumor was removed and the defect reconstructed. Prognosis of this type of tumor, apart from its size and differentiation level, depends on infiltration in tumor-surrounding tissue, perineural and perivascular spread. Therefore, it is always necessary to analyze the removed skin especially on margins.

Results of arterial blood gas analysis can be biased by pre-analytical factors, such as time interval before analysis, temperature during storage and syringe type. To investigate the effects of samples storage temperature and time delay on blood gases, bicarbonate and PH results in human arterial blood samples.Patients and 2.5 mL arterial blood samples were drawn from 45 patients via an indwelling Intraarterial catheter. Each sample was divided into five equal samples and stored in multipurpose tuberculin plastic syringes. Blood gas analysis was performed on one of five samples as soon as possible. Four other samples were divided into two groups stored at 22°C and 0°C. Blood gas analyses were repeated at 30 and 60 minutes after sampling. PaO2 of the samples stored at 0°C was increased significantly after 60 minutes (P = 0.007). The PaCO2 of the samples kept for 30 and 60 minutes at 22°C was significantly higher than primary result (P = 0.04, P < 0.001). In samples stored at 22°C, pH decreased significantly after 30 and 60 minutes (P = 0.017, P = 0.001). There were no significant differences in other results of samples stored at 0°C or 22°C after 30 or 60 minutes. In samples stored in plastic syringes, overestimation of PaO2 levels should be noted if samples cooled before analysis. In samples stored in plastic syringes, it is not necessary to store samples in iced water when analysis delayed up to one hour.

Violence is the cause of death for 1.5 million people in a year.. Our study aimed to estimate the incidence rate of self-reported interpersonal violence related physical injury (VRPI) and its associated factors in Iran..Patients and The sample included people ranged from 15 to 64 years old who were residing in Iran. A total of 1525 clusters were selected from the whole country. Six families were selected from each cluster via a systematic random sampling method. Then, the residential units were identified and the interviewers contacted the inhabitants. In the next step, one of the family members was selected by using Kish grid method. The instrument was a researcher-made questionnaire and consisted of two sections; demographics and project related data. Face validity and content validity of our questionnaire were investigated based on expert opinions and the reliability was confirmed by a pilot study, as well. The inclusion criteria were considered for choosing the interviewers. An interviewer was assigned for each 42 participants (7 clusters). An educational seminar was held for the administrative managers (54 persons) and interviewers (230 persons) for a week. The field work was distributed among all 46 Medical Sciences universities in Iran. In each university, administrative issues were related to an executive director. Mann-Whitney U test and odds ratio were used to analyze the data with 95% confidence interval. α value was considered less than 5%.. The frequency of VRPI among 7886 participants was 24 during the last three months. The incidence rate of interpersonal VRPI was estimated at 3.04 per 1000 population (95% CI: 2.66-3.42) during a three-month interval in Iran. The incidence was 4.72 per 1000 population (95% CI: 4.01-5.43) for males and 1.78 per 1000 population (95% CI: 1.39-2.17) for females during a three-month interval. The mean (SD) of age of the participants with and without a history of VRPI were 26.5 (7.21) and 33.05 (12.05) years, respectively (P = 0.008). Considering the participants’ gender, 66.7% were males (OR = 2.66, 95% CI: 1.14-6.23). Khuzestan Province had the most VRPIs (25% of all VRPIs). Streets and roads were the places with the highest frequency of injury (50%). The most frequent injured organ was the upper limb (54.17%). The most prevalent type of injury was a superficial wound (50%). Finally, the most common place of treatment was home (45.83%).. We determined the incidence rate of self-reported interpersonal VRPI for the first time in Iran based on a national survey. The injuries were more common among young men. We suggest consecutive national surveys with different data gathering methods and more sample sizes.

One of the highly toxic mushrooms that are common in the northwest region of Iran is Amanita phalloides, which might result in renal or liver failure. This is a case report of a patient referred a few days after consumption of wild mushrooms to emergency department having gastrointestinal complaint whose experiments indicated liver and renal failure. The supportive treatment was given to the patient prescribing N-acetyl cysteine (NAC) and Livergol (silymarin) along with hemodialysis. A few days after admission to the hospital, the patient died due to severe clinical symptoms. The patient was poisoned by A. phalloides complaining gastrointestinal symptoms including nausea; vomiting and watery diarrhea about six hours after consumption and then, amatoxin in the mushroom caused damage to hepatocytes and renal cells and finally led to hepatorenal failure. Deaths caused by this type of mushroom are extremely high and necessary trainings should be provided to the people by the health system not to consume wild mushrooms, especially in spring and summer.

New resuscitation guidelines that were proposed by the European Resuscitation Council in 2010 have introduced a new method of cardiopulmonary resuscitation (CPR) by chest compressions only for untrained individuals. We conducted this study to evaluate differences in attitudes towards CPR among medical doctors, surgeons and anesthesiologists in Osijek University Hospital. A call for help, chest-compression-only resuscitation, mouth-to-mouth ventilation and team-work were recognized as critical points that may influence the outcome. Unfamiliarity with these methods may be indicative of a lack of education in resuscitation and may result in poor outcomes for victims.Patients and An anonymous survey was conducted on 190 medical professionals: 93 medical doctors, 70 surgeons, and 27 anesthesiologists during year 2012 (mean age 41.9 years). The questions were related to previous education in resuscitation, current resuscitation practices and attitudes towards cardiopulmonary resuscitation. Data were analyzed using ANOVA and Fisher exact test. A P value of < 0.05 was considered statistically significant. The only difference between groups was regarding the male and female ratio, with more male surgeons (45, 55, and 11, P < 0.001). All surgeons considered CPR as important, but only anesthesiologists knew how often guidelines in CPR change. Approximately 45% of medical doctors, 48% of surgeons and 77% of anesthesiologists reported that they have renewed their knowledge in CPR within the last five years, whereas 34%, 25% and 22% had never renewed their knowledge in the CPR (P = 0.01 between surgeons anesthesiologists). Furthermore, chest-compression-only was recognized as a valuable CPR technique by 25.8% of medical doctors, 14.3% of surgeons and 59.3% of anesthesiologists (P < 0.001). Anesthesiologists estimated a high risk of infection transmission (62%) and were more likely to refuse mouth-to-mouth ventilation when compared to surgeons (25% vs.10%, P = 0.01). Anesthesiologists are most often called for help by their colleagues, only rarely doctors call their departmental colleagues and nurses to help in CPR. An insufficient formal education in CPR was registered for all groups, reflecting the lack of familiarity with new CPR methods. A team education, involving doctors and nurses may improve familiarity with CPR and patient outcomes.

Disease preventing methods focus mostly on lifestyle factors such as physical activity, healthy diet and not smoking. Previous studies verified using theory and models to change unhealthy behaviors, so that health belief model (HBM) is a useful framework for describing the healthy nutrition behavior. This study aimed to predict factors related to unhealthy nutrition and inactive life in students of Tehran University, Tehran, Iran based on the Health Belief Model (HBM).Patients and In this cross sectional study, proportional quota sampling from three different educational levels was conducted from October to December 2012. A self-administered validated instrument based on the Health Belief Model (HBM) with 69 items and four sections was used to collect data. In this study through using linear and logistic regression, the effect of body mass index, age, gender, marriage, self-efficacy, cues to action, knowledge, perceived severity, susceptibility, benefits and barriers on nutrition and physical activity behavior were assessed. SPSS version 18 was used to analyze data. Totally, 368 students including 318 female students (86.4%) and 50 male students (13.6%) with a mean age of 24.9 years (SD = 4.55) took part in the study. Among all independent variables, gender (P < 0.001), knowledge (P = 0.023) and perceived barriers (P = 0.004) predicted nutrition behavior. In case of physical activity, knowledge (P = 0.011), perceived severity (P = 0.009), perceived barriers (P = 0.019) and self-efficacy (P = 0.033) had significance association with physical activity behavior. This study indicated that health belief model contrasts could predict the risky behavior of university students due to heart disease. However, more researches are needed to verify the predictors of high risky behaviors in students.

Context: Menopause is described as a period of psychological difficulties that changes the lifestyle of women in multiple ways. Menopausal women require more information about their physical and psychosocial needs. Empowerment during the menopause can contribute to improving the perception of this stage and the importance of self-care. It is essential to increase women’s awareness and adaptation to menopause, using empowerment programs. The aim of this study was to review the empowerment and coping strategies in menopause women. Evidence Acquisition: In this review, PubMed, EMBASE, ISI, and Iranian databases were scanned for relevant literature. A comprehensive search was performed, using the combinations of the keywords «empowerment, menopause, coping with» to review relevant literature and higher education journals. Most interventions for menopause women have focused on educational intervention, physical activity/exercise, healthy diet, stress management, healthy behaviors, preventing certain diseases and osteoporosis. Health education intervention strategy is one of the alternative strategies for improving women''s attitudes and coping with menopause symptoms, identified as severalof the subcategories of health promotion programs. Empowerment of menopausal women will guarantee their health during the last third of their life. It will also help them benefit from their final years of reproductive life. The results of the present study can pave the way for future research about women’s health promotion and empowerment.

Employment of utilization review instruments is a method for managing costs and efficiency in the healthcare systems. This study developed an instrument for measuring the level of inappropriate acute hospital admissions and days of care in Iran.Patients and The American version of the Appropriateness Evaluation Protocol (AEP) was modified, using the agreement method, by a multidisciplinary group of physicians. We conducted a retrospective descriptive study of 273 randomly selected patients admitted to Imam Khomeini Hospital of Tehran University of Medical Sciences in Tehran, Iran. For the reliability study, two nurses were asked to review patients’ medical records using the instrument. Validity was appraised by pairs of clinicians, including two general surgeons, two internists and two gynecologists. The degree of consensus between the three pairs of clinicians was compared with that of the nurses. Inter-rater and intra-rater reliability testing revealed an excellent level of consensus between the two nurses employing the AEP in all the studied departments. Overall agreement was > 92%, while the specific appropriate agreement and specific inappropriate agreement were > 88% and > 83%, respectively. External validity testing of the instrument yielded a sensitivity > 0.785, specificity > 0.55, and positive and negative predictive values > 0.775 and > 0.555, respectively. The kappa statistic for the nurses who applied the AEP and clinicians using personal judgment were perfect (k > 0.85) and substantial (k > 0.68), respectively. The results illustrate that the Iranian version of the AEP (IR-AEP) could be a reliable and valid instrument for assessing the level of inappropriate acute hospital admissions and days of care in the Iranian context.

Midline cleft of mandible, classified as Tessier 30 clefts is extremely rare, with less than 100 reported cases in the latest studies. Variations in severity and associated malformations have been reported before. In this report, we present the first documented Iranian case of Tessier 30 with median cleft of lower lip and bifid tongue concomitant with congenital heart defects. We explain embryologic origin, differential diagnosis, other associated anomalies and its treatment by reviewing literature.

Osteoporosis is a disease, which causes bone loss and fractures. Although glucocorticoids effectively suppress inflammation, their chronic use is accompanied by bone loss with a tendency toward secondary osteoporosis. This study took into consideration the importance of cortical bone in the entire bone's mechanical competence. Hence, the aim of this study was to assess the effects of different protocols of glucocorticoid administration on the biomechanical properties of tibial bone diaphysis in rats compared to control and low-level laser-treated rats. This experimental study was conducted at Shahid Beheshti University of Medical Sciences, Tehran, Iran. We used systematic random sampling to divide 40 adult male rats into 8 groups with 5 rats in each group. Groups were as follows: 1) control, 2) dexamethasone (7 mg/week), 3) dexamethasone (0.7 mg/week), 4) methylprednisolone (7 mg/kg/week), 5) methylprednisolone (5 mg/kg twice weekly), 6) dexamethasone (7 mg/kg three times per week), 7) dexamethasone (0.7 mg/kg thrice per week), and 8) low-level laser-treated rats. The study periods were 4-7 weeks. At the end of the treatment periods, we examined the mechanical properties of tibial bone diaphysis. Data were analyzed by statistical analyses. Glucocorticoid-treated rats showed weight loss and considerable mortality (21%). The biomechanical properties (maximum force) of glucocorticoid-treated rats in groups 4 (62 ± 2.9), 6 (63 ± 5.1), and 7 (60 ± 5.3) were comparable with the control (46 ± 1.5) and low-level laser-treated (57 ± 3.2) rats. In contrast to the findings in humans and certain other species, glucocorticoid administration caused anabolic effect on the cortical bone of tibia diaphysis bone in rats.

Preeclampsia is one of the most serious complications during pregnancy with important effects on health of mother and fetus that causes maternal and fetal morbidity and mortality. This study was performed to evaluate whether high levels of hemoglobin may increase the risk of preeclampsia. The present study aimed to predict preeclampsia by the hemoglobin profiles through longitudinal discriminant analysis and comparing the error rate of discrimination in longitudinal and cross sectional data.Patients and In a prospective cohort study from October 2010 to July 2011, 650 pregnant women referred to the prenatal clinic of Milad Hospital in Tehran were evaluated in 3 stages. The hemoglobin level of each woman was measured in the first, second, and third trimester of pregnancy by an expert technician. The subjects were followed up to delivery and preeclampsia was the main outcome under study. The covariance pattern and linear-mixed effects models are common methods that were applied for discriminant analysis of longitudinal data. Also Student t, Mann-Whitney U, and chi-square tests were used for comparing the demographic and clinical characteristics between two groups. Statistical analyses were performed using the SAS software version 9.1. The prevalence rate of preeclampsia was 7.2% (47 women). The women with preeclampsia had a higher mean of hemoglobin values and the difference was 0.46 g/dL (P = 0.003). Also the mean of hemoglobin in the first trimester was higher than that of the second trimester, and was lower than that of the third trimester and the differences were significant (P = 0.015 and P < 0.001, respectively). The sensitivity for longitudinal data and cross-sectional data in three trimesters was 90%, 67%, 72%, and 54% and the specificity was 88%, 55%, 63%, and 50%, respectively. The levels of hemoglobin can be used to predict preeclampsia and monitoring the pregnant women and its regular measure in 3 trimesters help us to identify women at risk for preeclampsia.

Communication competence in nursing students is one of the nursing education requirements, especially during the internship period, the final stage of the bachelor nursing education in Iran. Several factors can influence this competence and identifying them could help provide safe care by nursing students in the future. This study aimed to investigate factors that influence nursing student's communication competence.Patients and A purposeful sampling technique was used to select 18 nursing students who had completed their internship. Semi-structured interviews were conducted and data were analyzed by the conventional qualitative content analysis method. After data analysis, three main categories were achieved: organizational factors, humanistic factors and socio-cultural factors. The main and latent theme that affected the student's communication competence was not being accepted as a caregiver in the clinical environment. With regards to students not being accepted in health care environments, it is recommended to plan special programs for empowering students to acquire better social state and acceptance by the health care team.

Despite all the progress in surgical science, bleeding caused by traffic accidents is still one of the challenges surgeons face in saving patients’ lives. Therefore, introducing an effective method to control external bleeding is an important research priority. This study aimed to compare the hemostatic effect of aluminum chloride versus simple suturing in controlling external bleeding. This experimental study was conducted in Kashan, Iran. In this study, 60 male Wistar rats were randomly allocated into six groups. An incision, two centimeters (cm) long and half a cm deep, was made on each rat’s shaved back skin and the hemostatic time was measured once using aluminum chloride with different concentrations (5%, 10%, 15%, 25%, and 50%) and then using the control method (controlling hemorrhage by simple suturing). The skin tissue was assessed for pathological changes. The hemostatic time of aluminum chloride 50%, 25%, 15%, 10% and 5% were 8.20 ± 0.919, 14.10 ± 1.37, 21.20 ± 1.31, 30.80 ± 1.68 and 42.00 ± 4.19 seconds, respectively. Also, the mean hemostasis time in the control group (suture) was 84.00 ± 4.05 seconds. The hemostatic times of different concentrations of aluminum chloride were significantly less than that of the control group. There was a statistically significant difference between every two hemostatic time. The pathologic examination showed the highest frequency of low-grade inflammation based on the defined pathological grading. The aluminum chloride method needs less time to control external hemorrhage compared to the control method (controlling external hemorrhage by simple suturing). Aluminum chloride is an effective agent in controlling external hemorrhage in an animal model.

Most women spend more than one-third of their lives after menopause. Due to physiologic changes in that period, menopause can cause a series of symptoms such as vasomotor symptoms, psychologic problems, and sexual dysfunction, which can affect the women’s quality of life (QoL) and other family members, especially their spouse. The present study aimed to determine the association between the QoL of postmenopausal women and their husbands.Patients and This descriptive-inferential cross-sectional study was conducted according to the census of 2006 in Iran. A total of 400 postmenopausal women aging 50 to 59 years and their spouses in 80 cluster heads of Ilam City residents were selected and studied in collaboration with the Statistical Center of Iran. The required data were gathered using the short-form health survey (SF-36) questionnaire and demographic questionnaire developed by the researcher-trained interviewers. Data were analyzed by SPSS 18 through Kruskal Wallis test, Wilcoxon signed ranks test, and correlation. The participants’ mean age was 54.2 ± 2.8 years for women and 61.1 ± 6.1 years for their spouses. More than half of the women (57%) and about one-third of men (32.8%) were illiterate. The employed educated women aging 50 to 54 years had a higher mean score of SF-36 domains. The difference in education was significant in all domains except for mental health. There was a significant difference in age in all domains except in general health. The mean score of all domains of QoL was significantly less in the illiterate men than in the literate ones (P < 0.05). The results of the present study showed a significant correlation (P < 0.05) between the couples’ QoL, vasomotor symptoms, and aging. Spearman test showed a significant positive correlation in all domains of QoL between postmenopausal women and their spouses (correlation coefficient, 0.48-0.63). Based on the results of the present study and other performed studies in this regard, menopause, aging, vasomotor symptoms, and education had significant association with the QoL of postmenopausal women. The reduced QoL in postmenopausal women could eventually lead to the reduced QoL of their spouses. Therefore, it is necessary to plan for the education of these women and their husbands to broaden their understanding of the changes of menopause and ways to improve their QoL.

Trichomoniasis, caused by Trichomonas vaginalis, is the most common sexually transmitted disease (STD) in the world with estimates of 7-8 million infections annually in the United States and 180 million globally. This study aimed to determine the prevalence and risk factors for T. vaginalis infection in women who attended the Clinic of Obstetrics and Gynecology in Kermanshah, Iran.Patients and This cross-sectional study was performed on all women aged 15 to 65 years who attended the clinic of obstetrics and gynecology, Imam Reza Hospital, Kermanshah, west of Iran, between September 2011 and July 2012. Vaginal secretion samples were examined by the Dorset culture medium and wet-mount methods. Demographic and personal information were also collected via questionnaires and the data were analyzed using chi-square and Fisher exact tests. A total of 600 women were screened for T. vaginalis infection and this infection was diagnosed in 9 (1.5%) and 13 cases (2.1%) using the wet mount and culture methods, respectively. The age and husband occupation were significantly associated with an increased risk of trichomoniasis in the infected cases (P < 0.05 and P < 0.001, respectively); other variables, including the patient's occupation and education level appeared to be positively (but not significantly) correlated with infection (P > 0.05). The prevalence of T. vaginalis infection in the study population was low. Diagnosis of trichomoniasis based on only clinical symptoms is not efficient for treatment decision. Based on our results, we suggest using the culture method on all the suspected cases even if the wet smear is negative.

Today, pregnant women are treated as individuals requiring medical care. Every day, more and more technologies, surgical procedures and medications are used even for low-risk childbirths. These interventions can save mothers’ lives in threatening situations, although they might be risky for mothers and neonates in low-risk deliveries. Despite the increasing interest in medical care for childbirth, our knowledge about underlying factors for development of medicalized childbirth is limited in Iran. The purpose of this study was to provide a broad description of medicalized childbirth in Iran. In this study, a qualitative approach was applied and data was gathered via in-depth interviews. The subjects were selected via purposive sampling. Overall, 27 pregnant and postpartum women were enrolled in this study. Participants were selected from public health centers, hospitals and offices. Data analysis was performed using conventional qualitative content analysis. As the results indicated, mothers preferred medicalized childbirth under the supervision of obstetricians. The subjects mostly opted for elective cesarean section; this choice led to an increase in physicians’ authority and restricted midwives’ role in childbirth. Consequently, mothers’ preference for cesarean section led to the expansion of medicalization and challenged the realization of natural childbirth. Mothers also had a strong tendency toward natural childbirth. Generally, many Iranian mothers choose the medicalized approach, despite their inclination to comply with the natural mode of delivery. It seems that mothers have an ambivalent attitude toward childbirth. Health authorities can prevent the adverse effects of medicalized birth and encourage natural childbirth among women using the obtained findings.

Ultrasound measurement of carotid Intima-Media Thickness (IMT) is a suitable method to evaluate subclinical arteriosclerosis. The current study aimed to present a new computerized algorithm to detect instantaneous changes of the IMT to Common Carotid Artery (CCA) of IMT in sequential ultrasound images by applying the maximum gradient and the dynamic programming.Patients and In a cross-sectional design, an examination was performed on thirty healthy human subjects with the mean age of 44 ± 6 years from April 2013 to June 2013 in Beheshti Hospital, Kashan, Iran. In all individuals, the instantaneous changes of the far wall IMT on the CCA were extracted. Local measurements of vessel intensity, intensity gradient, and boundary continuity were extracted for all of the sequential ultrasonic 2D-frames throughout three cardiac cycles. The Pearson correlation coefficients and Bland-Altman analysis were performed to assess the relationship and agreement between IMT measured by the proposed and conventional manual methods. There was no significant difference between the proposed and manual methods with paired t-test analysis (in systole: 0.57 ± 0.10 vs. 0.56 ± 0.10 mm; P = 0.188 and in diastole: 0.63 ± 0.16 vs. 0.62 ± 0.10 mm; P = 0.122 for the manual and proposed methods, respectively). The Pearson correlation coefficients were r = 0.94 and r = 0.93 for IMTs and IMTd, respectively (both P < 0.001). Limit of agreements were narrow and considerable agreement was found between the two methods. The present study demonstrated that the proposed computerized analyzing method can provide accurate measurements of the IMT of the CCA in sequential 2D ultrasonic images.

Episiotomy, a common surgical practice in midwifery, is accompanied with high levels of pain and discomfort for mothers. The importance of medicinal herbs and traditional medicine in wound healing cannot be neglected. Considering the positive effects and easy accessibility of Equisetum arvense, this study examined the effectiveness of topical application of Equisetum arvense ointment in wound healing, reduction of inflammation and pain relief after episiotomy in nulliparous mothers.Patients and This double-blind clinical trial was performed on 108 postpartum nulliparous mothers (54 women in horsetail group and 54 women in placebo group) in Alzahra Educational-Medical Center (Tabriz, Iran). About 5 ± 1 and 10 ± 1 days after the childbirth, the primary outcomes of episiotomy, i.e. wound healing and pain intensity, were assessed based on redness, edema, ecchymosis, discharge and approximation of the edges (REEDA) scale and a visual analogue scale (VAS), respectively. The secondary outcomes evaluated in the current research were the number of used painkillers and the adverse events during the 10-day period of the study. Data was analyzed using independent t and Mann-Whitney U tests. The case and control groups had no significant differences in for the mean wound healing score (5.0 ± 1.6 vs. 4.1 ± 1.6) and mean pain intensity (5.7 ± 2.4 vs. 5.3 ± 2.2) at baseline. During both follow-up sessions (5 ± 1 and 10 ± 1days after delivery), the mean scores were significantly lower in the case group than the control group. The adjusted pain score difference (MD) after 5 ± 1 and 10 ± 1 days was -2.3 (95% CI: -3.2 to -1.3) and 3.8 (95% CI: -4.7 to -3.0), respectively. The mean numbers of acetaminophen pills used in the control and case groups during the 10-day period of the study were 6.8 ± 4.4 and 11.6 ± 7.1, respectively (P < 0.001). According to our findings, 3% Equisetum arvense ointment promoted wound healing and relieved pain during the 10-day period after episiotomy. Since this study was the first to assess the effects of Equisetum arvense ointment on wound healing and pain intensity following episiotomy in humans, further research is warranted to fully clarify the beneficial effects of prepared ointment.

Although male circumcision is a surgical intervention that is frequently performed in children, there is no consensus about the age at which it should be performed. The purpose of this study was to determine the best age range for routine male circumcision with respect to a child’s health and the cost.Patients and This clinical trial was conducted in the affiliated hospital of the Erzincan University of Medical Sciences, Turkey, in 2014. The circumcised children were evaluated in 3 groups: < 1 year old (Group 1), 1-7 years old (Group 2), and > 7 years old (Group 3). To obtain a satisfactory Wilton sedation score, midazolam 0.1 mg/kg IV was administered first. If adequate sedation was not achieved, ketamine 2 mg/kg IV was also administered. If adequate sedation was still not achieved, general anesthesia was administered via a laryngeal mask. At the end of the surgery, the groups were compared in terms of post-anesthesia recovery duration, complications, discharging duration, and cost. A total of 603 children were circumcised, 374 in Group 1, 94 in Group 2, and 135 in Group 3. Midazolam was sufficient for sedation in 364 Group 1 patients (97.3%), 6 Group 2 patients (6.3%), and 38 Group 3 patients (28.1%). The shortest post-anesthesia recovery duration after surgical intervention and time until discharge, the lowest cost, and the fewest anesthesia complications were observed in Group 1 (P < 0.05 for all). Although almost all of the < 1 year-old children could be sedated with midazolam alone, most of the > 1 year-old children required ketamine or general anesthesia. Performing circumcision when children are less than 1 year old decreases the risk of complications due to anesthesia and lowers the costs compared with performing the procedure on older children.

The rate of exclusive breastfeeding in Iran is decreasing. The breastfeeding attrition prediction tools (BAPT) have been validated and used in predicting premature weaning. We aimed to translate the BAPT into Farsi, assess its content validity, and examine its reliability and validity to identify exclusive breastfeeding discontinuation in Iran. The BAPT was translated into Farsi and the content validity of the Farsi version of the BAPT was assessed. It was administered to 356 pregnant women in the third trimester of pregnancy, who were residents of a city in northeast of Iran. The structural integrity of the four-factor model was assessed in confirmatory factor analysis (CFA) and exploratory factor analysis (EFA). Reliability was assessed using Cronbach’s alpha coefficient and item-subscale correlations. Validity was assessed using the known-group comparison (128 with vs. 228 without breastfeeding experience) and predictive validity (80 successes vs. 265 failures in exclusive breastfeeding). The internal consistency of the whole instrument (49 items) was 0.775. CFA provided an acceptable fit to the a priori four-factor model (Chi-square/df = 1.8, Root Mean Square Error of Approximation (RMSEA) = 0.049, Standardized Root Mean Square Residual (SRMR) = 0.064, Comparative Fit Index (CFI) = 0.911). The difference in means of breastfeeding control (BFC) between the participants with and without breastfeeding experience was significant (P < 0.001). In addition, the total score of BAPT and the score of Breast Feeding Control (BFC) subscale were higher in women who were on exclusive breastfeeding than women who were not, at four months postpartum (P < 0.05). This study validated the Farsi version of BAPT. It is useful for researchers who want to use it in Iran to identify women at higher risks of Exclusive Breast Feeding (EBF) discontinuation.