Iranian Red Crescent Medical Journal
Volume:19 Issue: 4, Apr 2017

Previous studies have reported the weakness of recognition of speech-in-noise and dichotic listening deficit in Learning-Disabled (LD) children. This study aimed at further investigating these two deficits in LD children.
Overall, 33 LD children with dichotic listening deficit from a government rehabilitation center and 39 normal-achieving (NLA) children from three elementary schools were selected with the convenience sampling method to participate in this cross-sectional study (Tehran, Iran). Learning-disabled children were categorized in two categories of unilateral dichotic separation deficit (UDSD) and bilateral dichotic separation deficit (BDSD).
Mean (± SD) of signal-to-noise ratio (SNR) for binaural recognition of words and digits-in-noise in LD children (3.5 ± 1.7 and -11.0 ± 2.1 dB, respectively) was significantly higher than corresponding means of NLA children (1.8 ± 1.1 and -13.8 ± 1.1 dB, respectively (P = 0.001)). Mean SNR of the right ear in BDSD children in recognition of words-in-noise (5.0 ± 1.9 dB) was significantly higher than that of the right ear in UDSD children (3.5 ± 1.5 dB; P = 0.018, d = 0.96).
Monaural and binaural recognition of words and digits-in-noise are impaired in LD children with dichotic listening deficit. It seems that BDSD children show an inter-aural asymmetry in recognition of words-in-noise with poorer performance in the right ear.

In patients with coronary artery stenosis, coronary artery bypass graft surgery (CABG) is the most effective strategy to limit infarct size and improving outcomes. However, the rapid restoring of blood flow to the tissue can paradoxically induce cardiac damage. This phenomenon termed as myocardial ischemic/reperfusion (I/R) injury which is exacerbated under cardiopulmonary bypass (CPB) and is the cause of poor clinical outcomes. Therefore, it is essential to search for novel strategies with further cardio protective effects.
In the current study, we investigated the effects of selenium (Se) administration on I/R injury in CABG patients.
This randomized double-blind clinical trial was conducted in the department of cardiac surgery of a university hospital in North of Iran from May 2015 to September 2015. One hundred and ten patients undergoing an elective isolated CABG surgery were divided into two groups using randomized fixed quadripartite blocks. They received either intravenous Se before induction of anesthesia, or normal saline as placebo. Cardiac troponin I (CTnI) and creatine kinase-MB (CKMB) were measured as biomarkers at four measurement point times, before the intervention (T0), at 6, 12, 24 and 48 hours after the surgery (T1-T4).
Finally, data from 104 patients were analyzed, the Se (n = 53) and control (n = 51) groups. There was no significant difference between the two groups regarding the baseline characteristics. In both groups CPB caused a markedly increase in CKMB and CTnI plasma concentrations compared to the baseline (P = 0.0001). Based on CKMB, there was no significant difference between the two groups at any point times, T0 (P = 0.357), T1 (P = 0.751), T2 (P = 0.46), T3 (P = 0.16) and T4 (P = 0.053). According to CTnI, there was just a significant difference between the two groups at T1 (P = 0.011) but not at T2 (P = 0.116), T3 (P = 0.09) and T4 (P = 0.634). No adverse effect was recorded linked to our intervention.
Selenium can alleviate I/R injury in short time. Further well-planned trials are needed to find the optimized administration method to achieve the most beneficial effects to the patients.

Diabetes mellitus may accompany and complicate a pregnancy, resulting in poor neonatal outcomes.
The aim of this study was to compare middle cerebral arterial (MCA) and umbilical arterial (UA) Doppler assessments for the evaluation of fetal well-being in mothers with pre-gestational or gestational diabetes mellitus.
This cohort study was performed on 103 pregnant diabetic women, admitted for prenatal care to the department of gynecology and obstetrics of Jame Zanan hospital (Tehran, Iran) in 2015. Sampling was performed, using the convenience method. All women underwent one or more Doppler ultrasound examinations in the third trimester of pregnancy, which included blood flow measurement through umbilical and middle cerebral arteries. Women with abnormal UA or MCA Doppler test results were subjected to labor induction or cesarean section, according to different parameters. The outcomes included neonatal acidosis, one- and five-min Apgar scores, hypoglycemia, hypocalcaemia, neonatal intensive care unit (NICU) admission, gestational age at delivery, and neonatal death. Chi-square test, t-test or Fisher’s exact test, and logistic regression analysis were performed to analyze the data.
Based on the findings, poor outcomes were detected in 48 women. Nearly 17.5% and 9.7% of women had abnormal UA and MCA Doppler test results, respectively. In total, 62% of women gave birth via cesarean section. The UA Doppler test results were significantly related with hypoglycemia, respiratory distress syndrome (RDS), one-min Apgar score Both UA and MCA Doppler tests were associated with some neonatal outcomes. However, sensitivity of both UA and MCA assessments was low in the prediction of adverse neonatal outcomes. By the comparison of these two methods, we found that UA Doppler assessment is a better predictor of neonatal outcomes.

Adverse patient outcomes have become a big concern in the quality of healthcare. Different factors can have an impact on the variety and rate of adverse patient outcomes.
The present study aimed at determining the rate of patient safety during events and evaluating nursing workloads as well as identifying the main factors that affect the incidence rate of patient safety events among nurses.
This cross-sectional study was conducted on 293 nurses working in 24 wards of Baqiyatallah hospital in Tehran, Iran, in 2016. The sampling method was stratified random sampling. Data were collected using a self-administered questionnaire, which was classified into 4 subtitles: Individual and organizational characteristics, perceived subjective, objective workloads, and some patient safety events during the past 6 months. Binary and multiple regressions were used to survey the relationship between variables using the SPSS Version 23 software.
Bloodstream infection, pressure ulcer, and patient falls were the most reported adverse outcomes during the past 6 months with 76.1%, 66.2%, and 59%, respectively. At least one of the 6 adverse outcomes was reported by nurses within the range of 45%-77%. Of all individual characteristics, the only significant relationship occurred between work experience and bloodstream infection (P value = 0.28 and 0.32). No significant relationship was detected between adverse patient outcomes and objective workloads. Regression models revealed that the subjective workload of adverse patient outcomes increased with making adjustments in the individual and organizational characteristics. The incidence rates of adverse outcomes were 5.69-9.78 times more than the fixed shifts in all rotational shift works.
The nurses reported a high incidence rate of all patient safety events, and the results revealed that the objective workload could not be a predictor for patient adverse events. According to the findings, subjective workload and work shift were significantly related to the incidence rate of adverse patient events. In conclusion, good regulation of sleep-wake cycles can be an important factor for decreasing the rate of adverse patient events.

Context: Cervical and genital infections are responsible for the more common sexually transmitted cancers among women aged 14 - 55 years. There are more than 100 HPV types which cause 60% - 70% (high risk types: 16, 18) and 90% (low risk types: 6, 11) cervical cancers. This study aimed to evaluate the efficacy of L1 protein vaccines against cervical and vaginal cancer.
Evidence Acquisition: Different databases (including Scopus, Google scholar, PubMed, Cochrane, and Science Direct) were searched using relevant keywords such as Gardasil, Cervarix, and cervical cancer. After restricting the search strategy and excluding duplicates, the remained articles were screened by investigating their titles, abstracts, and full texts. Cochrane Q-test and I-squared index were used to detect the heterogeneity among the results, and fixed effect model was applied to estimate the pooled risk ratio.
By combining the results of 10 primary articles, the efficacy of monovalent (HPV16), bivalent (HPV 16, 18), and quadrivalent (HPV16,11,6,8) vaccines was estimated between 86% and 100%.
The results of this meta-analysis showed that Gardasil and Cervarix vaccines are highly effective against cervical cancer. According to the point that approximately 50% of cervical cancers and human carcinogenicity are related to HPV-16 infection, the bivalent HPV vaccine might have protective effects against HPV-16 CIN2-3 lesion and cervical cancer.

Context: This systematic review and meta-analysis was performed to determine the prevalence (by overall relative frequency) and clinical information of the Behcet’s disease in Middle East and north Africa (MENA) and it has an important effect on the health policy and performing complementary studies in future.
Evidence Acquisition: We performed this systematic literature review from several databases including PubMed, Scopus and ISI Web of Science according to search strategy with two filters, place (MENA countries) and time (all articles published from Jan 1980 to Jan 2016 were considered). The keywords such as “Behcet’s syndrome”, “Behcet’s disease”, “triple symptom complex”, “Middle East” were searched. Out of 4013 relevant articles and according to inclusion and exclusion criteria, 28 papers were selected to study. To examine the quality of the studies, all papers were evaluated independently by two authors and the Kappa coefficient was 95%. Afterwards, the critical appraisal was performed by strengthening the reporting of observational studies in epidemiology (STROBE) form. Due to sever heterogeneity, the pooled prevalence (per 100,000 people) was derived by the random effect model that takes between-study variation into account.
According to the results of the present study, the prevalence rate of BD in Iran was 68; it was after Turkey among MENA. The pooled prevalence (per 100,000 people) of BD in MENA was 120 (95% CI: 86.8, 166.8) according to the random effect model. The oral aphthosis was the most frequent symptom among other symptoms and HLA-51 association was its poor prognosis. Turkey had the highest prevalence (per 100,000 people) of 420 (95%CI: 340, 510) and the lowest prevalence 2.1 related to Kuwait in MENA countries.
There are different statistics about the prevalence rates of the disease that have been published; these different prevalence statistics can be explained by racial and geographical divergence, patient selection and BD diagnosis criteria. The results of this study can be useful for health policy and other studies which are needed to find the reasons of this prevalence difference.

Previous studies have shown the effectiveness of cognitive behavior therapy in improvement of psychological symptoms such as depression, anxiety, and stress. Recent studies suggest that mindfulness-based interventions (MBI) are effective in reducing these psychological symptoms in chronic diseases. The present study was the first study to examine the effects of mindfulness-integrated cognitive behavior therapy (MiCBT) on common comorbid psychological symptoms in patients with multiple sclerosis (MS).
The present study aimed at examining the effect of mindfulness-integrated cognitive behavior therapy on depression, anxiety, and stress in females with multiple sclerosis.
This research was a quasi-experimental study conducted on female patients with MS who referred to Fars MS Society, Shiraz, Iran, in 2015. A total of 56 patients with MS were selected by convenience sampling method and randomly assigned into intervention and control groups. The intervention group received eight 2-hour sessions of MiCBT, while the control group was only given the usual treatment (TAU). The patients in both groups filled out a demographic questionnaire along with depression, anxiety and stress scales (DASS-21) in pre- and posttest.
In the current study, no statistically significant differences were found between the study groups in demographic variables (P > 0.05). Analysis of covariance revealed significant differences between the study groups in all the 3 variables in posttest compared to the pretest. The mean scores of depression, anxiety, and stress in the MiCBT group were significantly lower than the control group (P The results of the present study suggested that mindfulness-integrated cognitive behavior therapy is an effective and affordable treatment in reducing depression, anxiety, and stress for patients with MS.

Context: The aim of this study was to systematically review published articles reporting on the prevalence of vasomotor and sexual symptoms in Iranian women.
Evidence Acquisition: Five databases including MEDLINE, PsycINFO, CINAHL, SCOPUS and Google scholar, as well as four Iranian databases including SID, Iranmedex, IranDoc and Magiran were searched during July 2016 to retrieve studies reporting on the prevalence of vasomotor and sexual symptoms in Iranian middle-aged women. Risk of bias was assessed using a standard risk of bias tool.
Twelve independent studies met our inclusion criteria and provided data for this review. The prevalence of vasomotor and sexual symptoms was high although the ranges were wide. This might be due to utilization of different study designs, methods of recruitment, instruments, and the time frame over which symptoms were assessed. There was a lack of information in most studies on the severity of symptoms as an important determining factor for clinical use. In addition, distress associated with sexual symptoms has not been assessed by any study. High risk of bias was observed for the eleven studies for both external and internal validity.
High quality research is needed to establish the true portray for the prevalence and severity of vasomotor and sexual symptoms associated with distress in Iranian women.

Endocrine diseases, known as a curable etiology for depression, are common among men living with HIV (MLWH); while depression impedes the adherence to treatment and the perceived quality of life. We evaluated the changes in the depressive symptoms after the medical treatment of the underlying endocrine diseases among Iranian MLWH. Since April 2013 to March 2014, a convenience sample of 296 MLWH was recruited. We interviewed all the patients using the beck depression inventory (BDI- II) questionnaire. Participants with moderate to severe depression (n = 110, scores ≥ 21) were evaluated for endocrine diseases (evaluations: total testosterone, triiodothyronine, thyroxine, thyroid stimulating hormone, luteinizing hormone, follicle stimulating hormone, and serum cortisol). Eleven patients diagnosed with hypogonadism were, finally, considered for hormone replacement therapy. We re-evaluated the changes in the depressive symptoms with BDI- II. Out of 237 participants, 136 (75%) had BDI scores ≥ 21; 110 participated in the endocrine evaluations. Secondary hypogonadism was the only observed abnormality in 10% (n = 11) of the patients. Significant improvements were observed in BDI-II scores after 3 months of treatment (P = 0.027). The evaluation and the treatment of hypogonadism can help clinicians to properly address depression among people living with HIV; hence, improve the treatment compliance and the patient outcomes..

The use of a training booklet and electronic software has a special place due to lack of time and space constraints.
This study aimed to compare the effect of electronic software and training booklet on maternal self-esteem and awareness regarding newborn care in nulliparous women.
This randomized controlled clinical trial was conducted on 126 pregnant women with a gestational age of 36 - 38 weeks in health care centers in the city of Miandoab, Iran from February 2015 until April 2016. Using a randomized block design, participants were assigned into 2 groups (42 mothers receiving electronic software and 42 mothers receiving training booklet) and control group (42 mothers receiving postpartum routine training). An oral training session was held for participants in both intervention groups. Then, a training booklet or electronic software was provided to them. Maternal self-esteem and awareness regarding newborn care questionnaires were completed by participants in the 3 groups at the start of the intervention and 4 weeks after the childbirth.
After controlling the baseline values, the mean score of self-confidence in the training booklet group (adjusted mean difference = 5.6; 95% confidence interval = 1.2 to 10.0; P = 0.012) was significantly higher compared with the control group. Furthermore, the mean score of awareness regarding newborn care in the training booklet group (1.5; 0.6 to 2.3; P The results showed a significant effect of electronic software and training booklet in raising awareness about newborn care and self-confidence. Therefore, these methods are advisable to mothers.

Idarubicin (IDA), as a chemotherapeutic drug, has side effects on testicular tissue; different studies have shown the protective and antioxidant effects of rutin.
The current study aimed at investigating the protective effects of rutin on damages induced by IDA in the testes of mice.
In the current experimental study, Balb/c mice were divided into 8 groups, including saline (10 mL/kg), rutin (single doses of 50 and 100 mg/kg via intraperitoneal (i.p) as the control groups, saline-IDA group (saline for 7 days, IDA, 10 mg/kg, i.p), rutin 50 and 100 mg/kg for 7 days before IDA, and rutin (single doses of 50 and 100 mg/kg) before IDA. The expression of Bcl2, Caspase3 and Dazl at the mRNA level was assessed.
Administration of rutin 100 mg/kg for 7 days before IDA could significantly downregulate Caspase3 expression by 45% compared with saline-7d-IDA (P It seems that the preventive effects of rutin against damages caused by IDA can be attributed to its ability to reduce apoptosis, which may be mediated by underexpression of Caspase3 and overexpression of Bcl2 genes. Also, it could increase the expression of Dazl that may be important in spermatogenesis.

Suicide in Iran is more or less the problem of the western region of the country. Although previous studies have described the features of suicide, they didn’t study the trends through reliable methodology.
We study changes in temporal trends of suicide mortality in the west of Iran using joinpoint regression analysis.
This is a cross-sectional study. Data for all registered suicide cases in western province of Kermanshah in Iran during 2003 - 2014 was retrieved from the death registry of Iranian legal medicine organization. After direct standardization of the rates, we analyzed data by joinpoint regression analysis to discover the main changes of the trends.
Overall suicide mortality has increased from 10.6 per 100,000 in 2003 to 12.4 in 2014, which equals to 1.5 % (.1 - 2.8) annual percentage change (APC). Increase in suicide rate for women was remarkably higher than men (APC = 4.5 for women and 0.5 for men (P value Suicide in the west of Iran has increased slightly during 2003 - 2014 with remarkable differences for men and women. Suicide in old men and women has increased profoundly and may be due to losing their familial and social support in modern life. Pattern of suicide in women has changed dramatically from most rural, uneducated, and self-burned to most urban, high educated, and hanging use form.

Burning Mouth Syndrome (BMS) is a burning sensation of the oral mucosa without any sign of mucosal abnormality for which no medical or dental cause can be detected. However, this syndrome belongs to a broader category of patients whose main complaint is mouth burning and, so, their etiologies can largely vary.
This study investigates the prevalence of burning mouth symptom for the first time in an institutional group of patients in Shiraz, Iran, among whom some were found to have BMS through excluding the recognizable physical or biochemical causes of mouth burning.
In this cross sectional study, from the existing records of 2 533 patients who referred to Shiraz Dental School since 2007 To 2015, a total number of 298 patients with the chief complaint of oral burning sensation were chosen. For each patient age, sex, etiology, and site of pain were recorded.
Analysis revealed that amongst 298 individuals who suffered from burning sensation of the oral mucosa, the female/male ratio was 3 to 1; and local factors were found as the primary cause for the symptom development in a large proportion of the patients (63.5%). Followed by systemic diseases with a much less contribution to cause the symptom (22.8%). A number of 8.4% of the patients were idiopathic and 5.4% suffered from psychological disorders. Tongue was the most frequent location of burning (37.2%). Overall, only 25 patients ( The results of this study show that oral burning is mostly caused by the factors recognized during examination and that the idiopathic form or BMS known as a neuropathic pain is uncommon. Understanding the prevalence of the etiologic factors in certain populations would lead to a better diagnostic approach to BMS through the exclusion of those factors.

Eating and body image disorders are 2 of the most debilitating clinical problems among female adolescents and young females. One of the strongest factors contributing to body dissatisfaction and eating pathology is social comparison.
The current study aimed at determining the relationship between perfectionism, self-concept clarity, and self-esteem and the share of prediction of each in social comparison.
The current cross sectional study included all female high school students in Tehran in the 2014 - 2015 academic year. Of these, 477 females were selected by multistage cluster sampling.
The results of the correlation matrix was indicative of a significant negative relationship between self-esteem and self-concept clarity with social comparison (P Targeting individual differences that make people vulnerable to social comparison not only contributes to understanding the development of eating problems and body image, but also has implications for prevention and treatment.

Gilbert’s syndrome can present as a chronic or benign asymptomatic condition, characterized by a slight increase in the serum bilirubin level without any hemolysis. In 1995, a genetic variation, located in the TATA box of UGT1A1 gene promoter, was identified in patients with Gilbert’s syndrome. Also, further analysis identified a new missense variation, Gly71Arg, within the codon region of UGT1A1 gene. Coincidence of TATA box and Gly71Arg variations and their relationship with clinical findings are mostly variable.
The aim of this study was to determine TATA box and Gly71Arg variations of UGT1A1 gene and assess their effects on clinical findings in patients with Gilbert's syndrome in southern provinces of Iran.
In this cross sectional study, 213 unrelated infants and children, below 12 years, who were admitted to the pediatric ward of Namazi hospital, Shiraz, Iran, were enrolled from June 2015 to May 2016. Blood-extracted DNA was used for genotyping TATA box and Gly71Arg variations by sequencing. Further biochemical analyses were performed for each patient.
About 78.9% of the studied subjects had normal homozygous genotypes, and 21.1% were heterozygous for the Gly71Arg variation. In total, 34% of the cases were normal in the promoter region (TA6/6), and 55% were heterozygous with genotypes TA6/7, TA6/5, and TA 6/8. Three combinations of genotypes, ie, TA6/7-Gly/Gly, TA7/7-Gly/Gly, and TA7/7-Gly/Arg, showed significant differences in the serum total bilirubin level. Also, creatinine phosphokinase in TA6/7-Gly/Arg, TA7/7-Gly/Gly, and TA7/7-Gly/Arg had a significant increase.
The present findings showed that the TA7/7 promoter of UGT1A1 gene accounted for a considerable number of Gilbert’s syndrome cases (11.3%). The studied variations had a significant effect on creatine phosphokinase and serum total bilirubin levels.

Wound complications and pain are major causes of morbidity after cesarean section (CS). Although medications are safe for use by mothers after CS, many females prefer non-pharmaceutical methods. An abdominal binder is a complementary therapy, commonly used post-major abdominal surgery.
There is limited evidence about the effect of abdominal binders. The aim of this study was to investigate the effects of an abdominal binder on wound healing and consumed pain medication.
This randomized controlled trial included 178 females, who had undergone non-emergency CS at 1 of the 3 hospitals in Gonbad-e Kavus, and Golestan, northeast of Iran. In the intervention group, patients were administered abdominal binders, in addition to routine care. The binder was used for 2 days after the patient was admitted to the surgery ward. The control group received routine care. We used the demographic data questionnaire, questionnaire for cataloguing analgesic medications taken by participants (each 6 hours after CS), and Redness, Edema, Ecchymosis, Discharge, Approximation of wound edges (REEDA) scale for assessment of wound healing. The participants provided their written consent for participation in this study.
The mean (SD) age of the participants was 26.3 (5) years. Mean (SD) REEDA score was 0.4 (0.5) in the intervention group and 0.5 (0.8) in the control group. The median (quartile 25-75) REEDA score was 0 (0-1) in both groups. Mean REEDA scores did not differ significantly between the 2 groups (P = 0.724). Significant differences were observed in the approximation of wound edges in the intervention group 5 days post-CS (P = 0.007). Administered analgesic medications did not differ significantly between the 2 groups (at 6 hours in suppository, and 6 and 24 hours post-intervention in intramuscular of injection narcotics). Significantly fewer analgesic medications were administered in the intervention group when compared with the control group (P = 0.001). Satisfaction did not differ significantly between the 2 groups (P= 0.443).
In this study, the abdominal binder was effective in pain medication consumption at some intervals. However, it had no healing effect on CS scars.

Elevated levels of homocysteine (Hcy) and fetuin-A are important risk factors for cardiovascular diseases in patients with a nonalcoholic fatty liver disease (NAFLD). There is limited evidence regarding the effects of turmeric on NAFLD.
This study aimed at investigating the effects of turmeric supplementation on serum levels of Hcy and fetuin-A in patients with NAFLD.
In this double-blind, randomized, controlled clinical trial, 46 NAFLD patients (21 males and 25 females; age range, 20 - 60 years) with body mass index ranged 24.9 - 40 kg/m2 were recruited from Sheikh-ol-Raees clinic in Tabriz City, Iran during Nov 2014-May 2015. The participants were allocated into the two groups using the block randomization method. The intervention and control groups received 3g of turmeric (n = 23) and placebo (n = 23), daily for 12 weeks. Fasting blood samples were collected at baseline and at the end of the trial for biochemical analysis.
Turmeric supplementation significantly decreased serum levels of Hcy, compared with the placebo group at the end of the study (by 27.83%, P = 0.034). No significant difference was observed between the two groups in serum levels of fetuin-A after the intervention (P > 0.05). Serum levels of glucose, insulin and homeostasis model assessment for insulin resistance were declined significantly in the turmeric group (by 1.22%, 17.69% and 19.48%, P = 0.039, P = 0.013 and P = 0.001, respectively) compared to the placebo.
Turmeric consumption had beneficial effects on serum Hcy levels and may be useful in management of this risk factor in NAFLD patients.

Regarding the growing prevalence of non-alcoholic fatty liver disease, concentrating on various strategies for its prevention and management seems necessary.
This study aimed to assess the effects of synbiotic administration on body composition and lipid profile in patients with NAFLD.
Eighty patients with NAFLD participated in this randomized, double-blind, placebo-controlled clinical trial (from March to July 2014) in Iran. Based on AST and ALT as main variables of the study, 34 patients were required in each group (power 80% and α = 5%). Considering a 20% sample loss, 80 patients were enrolled. Synbiotic supplement in form of a 500 mg capsule (containing 7 species of probiotic bacteria and Fructooligosaccharides) was administrated to patients in the intervention group and those in the placebo group received 1 placebo capsule daily for 8 weeks. At the baseline and the end of the study, body composition and lipid profile were evaluated.
A significant reduction was observed in weight (P = 0.001), body fat (P = 0.02), and total cholesterol (P = 0.04) within the synbiotic group. On the other hand, WC (P = 0.02), total cholesterol, and LDL-c (P = 0.04 and P = 0.001, respectively) were significantly increased in the placebo group. TG, HDL-c, and FBG levels remained statistically unchanged in both groups. Significance between-group differences were seen in total cholesterol (P = 0.01), LDL (P = 0.01), weight, WC, and body fat after adjustment for energy intake (P = 0.05).
Synbiotic supplementation may improve lipid profile and body composition in patients with NAFLD and might be useful in prevention of the disease progression..

As a legitimate and credible role-model, the ethical nurse leader engages in the proper structuring of the workplace and plays a significant role in improving the organizational climate. Despite the importance of the subject, no studies have yet examined the effect of ethical nursing leadership in improving organizational climates in Iran.
The study was conducted to explore the ways for improving organizational climate through ethical leadership from Iranian nurses perspective.
The qualitative research method used in this original study was employed to explore the means of improving organizational climate through providing ethical leadership. Data were collected using deep and semi-structured interviews with 17 Iranian nurses in different categories in 2015 in Mashhad, Iran. Sampling started as purposive and then continued as theoretical sampling until data saturation. Data were analyzed based on the constant comparative analysis. In order to increase the accuracy and integrity of the data, Lincoln and Guba’s criteria were used.
According to the Iranian nurses interviewed in this study, the ethical leader improves the organizational climate within three dimensions including the work environment, the communication climate, and the ethical climate. The ethical leader creates organizational identification, trust, and solidarity among nurses. He/she improves the communication atmosphere through understanding and empathy, the creation of trust and the establishment of good and reasonable relationships with others. The ethical leader also develops the ethical climate to internalize ethics in the staff through facilitating ethical practice in the organization.
Given the context of nursing practice in Iran, this study helps develop a favorable organizational climate and improve ethics in nursing practice. Creation of an ethical climate by ethical nurse leaders can ultimately be of benefit to the patients, the organization, and the nursing profession.

Gestational diabetes is a particular disorder during pregnancy which can cause complications for mother and fetus. One reason for the limited success in the treatment of diabetes is the lack of patient participation in the process of treatment. Self-care education is an important principle in the treatment of diabetes that can enhance the quality of life.
This study aimed to determine the effect of educational package on self-care behavior, quality of life, FBS (Fasting Blood Sugar), and GTT (Glucose Tolerance Test) among women with gestational diabetes.
This randomized controlled clinical trial was performed on 92 pregnant women with gestational diabetes (n = 46 in each group) referring to diabetes clinic of Tohid hospital in Sanandaj, Iran. The educational program was designed in four sessions (one session per week) for the intervention group and included routine prenatal care along with education on self-care through lecture and question and answer. The participants also received educational booklet at the end of the first session. The control group received only routine prenatal care. Before and four weeks after the intervention, self-care and quality of life questionnaires were completed by the participants in both groups, and fasting blood glucose and GTT were measured.
After adjusting for the baseline score, the mean score of self-care behaviors was significantly higher in the intervention group than the control group four weeks after the intervention [adjusted mean difference: 19.5; 95% confidence interval: 14.4 to 24.6; P Self-care education can improve self-care behavior in women with gestational diabetes and it is also effective in impaired glucose tolerance.

Over the past years, the malaria elimination program has considerably decreased the malaria indigenous cases and confined their incidence to the southeastern areas of Iran encompassing 28 less developed counties with favorable transmission conditions.
The aim of the study was to investigate the effects of climatic and socioeconomic indicators on malaria transmission and to predict malaria transmission risk until 2025 for all the southeastern endemic counties in Iran.
The aggregated data from indigenous malaria cases, as well as, climatic and socioeconomic indicators of malaria endemic areas were collected on the monthly basis from each county between 2005 and 2015. The collected variables were, then, estimated until 2025 using time series analysis. Considering the nature of these data, two different multilevel models were implemented for vivax and falciparum based on the socioeconomic variable that was used. Finally, applying two different models, two sets of estimates were obtained for malaria transmission risk in each county.
The annual decline of malaria transmission was estimated to be 17% based on model 1, and 25% based on the model 2 for vivax (P The results of this study, using climatic variables along with socioeconomic variables, indicated the obvious influence of socioeconomic status improvement on decreasing malaria transmission. According to the results, malaria transmission risk will considerably diminish in the next few years. The pattern of malaria transmission decline was consistent with the declining trend of malaria incidence which will move from the west to the east and from the north to the south in the years to come. The transmission risk for falciparum was considerably lower than that of vivax and the endemic areas of falciparum move towards 0 faster than vivax.

Infections caused by Pseudomonas aeruginosa raise an important issue in burn patients. Molecular epidemiologic studies have been used for investigating the genetic features of P. aeruginosa and rep-PCR technique has been introduced as a rapid low cost method.
This study focused on investigating the genetic similarity and antibiotic resistance pattern of P. aeruginosa isolated from the clinical samples of burn patients in a major burn center in Khuzestan Province, Iran.
In a cross sectional study, a total of 75 strains of P. aeruginosa were isolated from burn patients at Taleghani hospital, which is the main burn center in Ahvaz, Iran, during May- September, 2015. Antimicrobial susceptibility of the isolates was detected using the disk diffusion method. Genetic relatedness of the isolates was analyzed by the rep-PCR technique.
Antimicrobial susceptibility testing showed more than 80% of P. aeruginosa isolates were resistant to ceftriaxone, cefotaxime, meropenem, piperacillin/tazobactam, ticarcillin, ciprofloxacin, and amikacin. Based on the rep-PCR analysis, 20 different common types and 20 unique patterns were illustrated among P. aeruginosa isolates.
According to the findings of our study, there were diverse and high-level resistant P. aeruginosa strains in the major burn center in Khuzestan. Therefore, we faced troubles controlling the diverse P. aeruginosa clones in the burn patients.

Because nurses’ work engagement is related to positive outcomes like increasing organization productivity, it is necessary to promote it. The first step to achieve this goal is to determine the factors associated with nurses’ work engagement, yet very few studies have been conducted on this subject in Iran.
This study aimed at investigating the correlation between work engagement and workplace incivility in nurses who were working in selected teaching hospitals of Shahid Beheshti University of Medical Sciences in Tehran, Iran, during 2015 and 2016.
In this descriptive correlational study, 516 nurses were selected randomly from teaching hospitals of Shahid Beheshti University of Medical Sciences during 2015 and 2016. Data were collected using the demographic questionnaire, the utrecht work engagement scale, and the nursing incivility scale.
The means of work engagement and workplace incivility scores were 3.59 ± 1.16 (average) and 2.68 ± 0.65 (low), respectively. A significant negative correlation was found between work engagement and workplace incivility in nurses (P Nursing managers should use proper strategies to improve nurses’ work engagement and decrease the incidence of incivility in hospitals and clinical environments.

Following Myocardial Infarction (MI) and percutaneous coronary intervention (PCI), the modification of cardiovascular risk factors and inflammation can improve MI progression and PCI outcomes. Up to now, no certain conclusions have been drawn regarding the effect of therapeutic lifestyle change (TLC) diet and a combination of Q10 plus L-carnitine (LC) supplementation on inflammatory biomarkers of In-Stent Restenosis (ISR), lipid profile, and Left ventricular ejection fraction (LVEF).
This study aimed to evaluate the effects of TLC diet and Q10 plus LC supplementation on inflammatory biomarkers of ISR, lipid profile, and LVEF following MI and PCI.
This single-blind randomized controlled trial was conducted on 128 subjects. After randomization for treatment allocation, the subjects were divided into the study groups through block randomization. The MI patients were admitted to 2 hospitals, namely Al-Zahra and Kowsar (Shiraz, Iran), between April 2015 and May 2016. The patients were divided into 4 groups receiving TLC diet (A), oral Q10 150 mg/d and LC 1200 mg/d (B), a combination of LC plus Q10 and TLC diet (C), and the routine care (D). This study evaluated Interleukin-6 (IL-6) and high sensitive C-reactive protein (hs-CRP) as inflammatory biomarkers of ISR, lipid profile, and LVEF in 128 patients with MI undergoing PCI before and 3 months after the intervention.
The results showed a significant decrease in hs-CRP in groups B (11.8 ± 4.3 to 2.0 ± 1 mg/L) and C (11.7±3.9 to 1.3±1.1 mg/L) (P An adjuvant therapy with TLC diet and supplementation with Q10 and LC seems to be required for secondary prevention following MI and PCI. TLC diet and Q10 plus LC appeared to be effective in inflammatory biomarkers of ISR as well as LDL reduction.

Cryptosporidium is a protozoan parasite that has medical and veterinary importance, and causes diarrhea and vomiting in a vast range of vertebrates. Some surface antigens, such as gp40/15, play important roles in adhesion and invasion of the parasite to host cells and consequently stimulate immune responses. Cloning and expression of the gp40/15 gene to provide recombinant proteins of the parasite antigens is valuable.
This study aimed at cloning and expression of the gp40/15 gene in Escherichia coli.
In this experimental study, the gp40/15 gene sequence was extracted from GenBank (No. AF155624) and cloned in the PET28a plasmid. Colony polymerase chain reaction (PCR) and enzyme digestion methods by restricting enzymes, including BamHI and XhoI, were applied for verification. The recombinant plasmid was transferred to the Escherichia coli and the protein expression was confirmed by sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE), Western blot, and enzyme linked immunosorbent assay (ELISA) techniques using serum containing antibodies against Cryptosporidium parvum. The protein was further purified by column chromatography.
The gp40/15 gene was successfully cloned in the PET28a plasmid. The colony PCR and enzymatic digestion methods showed a 921-bp fragment. Furthermore, expression of pEgp40/15 in Escherichia coli demonstrated a 43-kDa band. Antibody titrations in sera of test groups were significantly (P The gp40/15 gene, which was cloned in the PET28a, was successfully expressed and produced in E. coli. Therefore, this protein can be used in future studies to develop recombinant vaccines and diagnostic kits.

Oral administration of pro- and prebiotics has recently been considered as an effective way for nonalcoholic fatty liver disease (NAFLD) recovery.
The current study aimed at evaluating the effect of supplementation with probiotics and/or prebiotics on liver function tests in patients with NAFLD.
In this double blind, placebo-control clinical trial, 75 subjects with NAFLD were voluntarily recruited from May 2013 to March 2014, in Iran. Participants were randomly assigned to 1 of 4 groups using a block randomization procedure. Group 1 received probiotic capsules (Bifidobacterium longum (BL) and Lactobacillus acidophilus (LA): 2 × 107 CFU/day), group 2 received prebiotic inulin high performance (HP): 10 g/day, group 3 received probiotic and the prebiotic, and group 4 received a placebo for 3 months. The sample size was determined on the basis of a primary outcome of a change in aspartate aminotransferase (AST) level.
An intergroup comparison indicated that the AST (P = 0.006) and alanine aminotransferase (ALT) (P = 0.04) levels decreased at the end of the study. Aspartate Aminotransferase (mean difference of group1 versus placebo with P value of 0.001, group2 versus placebo with P value of 0.045, group3 versus placebo with P value of 0.015) and ALT (mean difference of group 1 versus placebo with P value of 0.009, group 2 versus placebo with P value of 0.041, and group 3 versus placebo with P value of 0.046) serum levels decreased significantly in all of the intervention groups compared to the placebo. The grade of fatty liver in group 1 (P of 0.027, and number needed to treat (NNT) = 3) and group 3 (P = 0.019 and NNT = 3) decreased compared to the placebo group with no significant changes in group 2.
Supplementation with probiotics and/or prebiotics improved aminotransferase enzymes, and supplementation with probiotics or pro- and prebiotics recovered the grade of fatty liver in NAFLD patients.

Musculoskeletal pain syndromes (MSPSs) are of the most common disorders in modern societies. Lack of early diagnosis and treatment of this syndrome may lead to significant disabilities later in life.
Due to shortage of information regarding the prevalence and related factors of MSPS in the south-east of Iran, this study aimed at determining MSPS and its relation to demographic variables and underlying diseases such as diabetes and hypertension in this area.
This across sectional population-based study was conducted on 1700 individuals (15 - 80 years), who participated in the second phase of Kerman coronary artery disease risk factor study (KERCADRs), in Kerman, Iran, in 2016. A questionnaire containing demographic information, opium use, smoking and MSPS was completed. Blood pressure, fasting blood glucose and lipid levels were also measured.
From a total of 1700 participants, 41.6% were males and 58.4% were females. The mean age of the participants was 47.8 years. The overall prevalence of MSPS was 65.5% that was more prevalent in women and increased with advancing age approaching the highest prevalence in the group above 75 years (78.4%) (adjusted odds ratio, AOR > 1.6). The prevalence increased with diabetes (AOR 1.5), overweight and obesity (OR 1.6, 2.2), and depression and anxiety (AOR 1.5, 2.3). In multivariate analysis, MSPS had no relationship with smoking, opium consumption, hypertension, level of education and dyslipidemia.
Overall, more than 65% of the population over 15 years in Kerman suffer from MSPSs. If the rate of such complications is not reduced, this can exert heavy health-care costs on the Iranian health system given the existing trend of increase in the age and age-related diseases in the population.