Iranian Red Crescent Medical Journal
Volume:19 Issue: 3, Mar 2017

Tendency of patients toward diseases and their therapeutic responses are different based on their own temperament according to traditional Persian medicine.
The aim of this study is to investigate the difference between therapeutic responses of hot and cold temperament patients (based on traditional Persian medicine) with ulcerative colitis to pomegranate peel extract.
Seventy-eight patients with moderate ulcerative colitis based on the Lichtiger colitis activity index (LCAI) criteria were randomized to receive an aqueous extract of the Punica granatum peel (6 grams per day) or placebo for four weeks. They were assessed before and after the intervention, in terms of symptoms, by the LCAI scoring system. The results were compared in two therapeutic groups based on the patients’ temperament (cold and hot), which were diagnosed based on a previous validated questionnaire.
Therapeutic response was significantly higher in patients with hot temperament compared to patients with cold temperament in the P. granatum group (1.916 ± 0.492 versus -0.500 ± 0.500, P = 0.029).
This study showed the importance of considering syndrome differentiation and temperaments in interpreting the effect of P. granatum peels extract on ulcerative colitis.

Temporal arteritis (TA) is a chronic inflammatory vasculitis involving medium and large arteries, which mostly occurs after the age of 50 and involves one side of the body.
We present a 40-year-old male patient with simultaneous bilateral temporal arteritis along with a headache, mild fever, palpation of temporal arteries and anemia who responded to 1 mg/kg oral daily prednisone for three months. This patient was referred to the Pars Hospital in Tehran, Iran on March 2016.
Temporal arteritis should be kept in mind as an important curable differential diagnosis, not only in ages above 50, but also in lower ages and should be evaluated in both sides.

People with diabetes report that diabetes affects particular aspects of their marital life and leads to other problems in their lives. Moreover, the self-efficacy of diabetic patients is affected by their disease in various respects. There is a significant relationship between self-efficacy and health behaviors.
This study was conducted to determine the effect of audio-visual education on self-efficacy toward marriage in single people with type 1 diabetes.
This randomized, controlled trial study was carried out on 100 unmarried patients with type 1 diabetes visiting Iran’s diabetes society in 2015 - 2016. The convenient sampling method was used in this study. Samples were divided into two groups (50 patients in each group) with a simple, randomized sampling method. The data collecting tool was a researcher-made questionnaire that patients completed before the intervention and eight weeks afterwards. The intervention was an educational CD about improving self-efficacy toward marriage in diabetics. Using descriptive statistics, inferential statistics (i.e., chi-square, t-test, paired t, Fisher, and co-variance tests), and SPSS software version 16, the self-efficacy toward marriage in both the intervention and control groups was compared. A significant level was considered less than 0.05.
The mean of the self-efficacy score improved significantly in the intervention group (84.14 ± 16.29 to 105.82 ± 5.49, P This study showed that audio-visual training can have a significant effect on the self-efficacy of people with type 1 diabetes. Providing audio-visual equipment to referral centers of type 1 diabetics, such as hospitals, health centers, and clinics, as well as informing related officials, can be of benefit to managers.

Nephrotoxicity is a common adverse effect of vancomycin. However, some aspects of vancomycin nephrotoxicity have not been studied well in the Iranian population. Serum creatinine as a classic marker of renal function has several limitations in clinical practice.
To determine the incidence, time onset, and possible associated factors of vancomycin nephrotoxicity, and compare the patterns and the accuracy of urine kidney injury molecule 1 (KIM-1) with that of serum and urine creatinine during vancomycin treatment.
A longitudinal study was performed during 9 months from August, 2015 to April, 2016 at three hematology-oncology wards of the Namazi Hospital in Shiraz, Iran. Patients > 18 years with no documented history of acute kidney injury or chronic kidney disease scheduled to receive vancomycin for at least 1 week were recruited. Required demographic and clinical data of patients were gathered. Serum, as well as urine creatinine and urine KIM-1, were determined at days 0, 3, 5, 7, 10, and 14 of vancomycin treatment.
Thirteen out of the 52 recruited patients (25%) developed nephrotoxicity, with a mean ± standard deviation onset of 11.46 ± 7.56 days. Furosemide co-administration (odds ratio = 0.126, 95% confidence interval = 0.023-0.694, P = 0.017) was significantly associated with vancomycin nephrotoxicity. Vancomycin nephrotoxicity resolved spontaneously in about two-fifths (38.46%) of the affected individuals. Mortality (P = 1) and duration of hospitalization (P = 0.175) were comparable between patients with and without nephrotoxicity. Urine KIM-1 increased during vancomycin treatment, but its mean values did not differ significantly within (P = 0.070) or between (P = 0.179) patients with and without nephrotoxicity. Urine KIM-1 accuracy in detecting vancomycin nephrotoxicity was significantly lower than that of serum creatinine at days 5, 7, and 10 of treatment.
Vancomycin nephrotoxicity is common but usually reversible and has readily manageable adverse effect. Urine KIM-1 was not more accurate than serum or urine creatinine in detecting vancomycin nephrotoxicity in our study population.

Job stress has recently been regarded as a risk factor for some diseases.
In this study, we standardized the Persian version of the HSE management standards indicator tool and studied the psychological properties of the tool.
In this cross-sectional study, the Persian version of the HSE questionnaire was submitted to 429 participants who were randomly drawn from five occupational groups in Isfahan, Iran in 2014. Internal consistency, reliability, discriminative validity, and construct validity were evaluated. Predictive validity was explored with respect to the beck depression inventory (BDI). discriminant validity was explored with respect to type of occupational groups.
Cronbach’s alpha for the all subscales ranged between 0.53 and 0.74. In addition, the intraclass correlations for the domains ranged from 0.52 to 0.73 with a median of 0.7. The confirmatory factor analysis showed that the Persian version of the HSE questionnaire had adequate construct validity. The root mean square error of approximation, incremental fit index, and comparative fit index were 0.064, 0.9, and 0.9, respectively; moreover, other indexes were satisfactory. An analysis of variance highlighted the differences between the stress of the occupational groups (P = 0.012). A lower score on the HSE questionnaire was significantly related to a higher BDI score (r = -0.46, P The analysis of the reliability and validity of the Persian version of the HSE questionnaire showed that it is a useful and reliable measure to analyze work-related stress.

After kidney transplantation, many risk factors can lead to graft rejection and force the patient to return to dialysis treatment.
This study aims to identify risk indicators of renal graft failure, such as serum creatinine, on long-term graft survival, using a novel statistical technique.
In this historical cohort study, 129 patients who underwent kidney transplants were assessed and followed up from September 2003 to December 2014 in Urmia, Iran. The main outcome of the study was assessing the survival rate of kidney transplant in these subjects. In addition, the serum creatinine levels were measured repeatedly for one year after the operation, as the most important risk indicator of graft failure. In addition, the effect of other indicators on graft survival were assessed using a joint modeling of longitudinal and survival technique, using the R software, version 3.0.2.
One-, three-, five-, and ten-year graft survival was 93.8%, 86.8%, 76.6%, and 37.4%, respectively. The results of the joint model showed that risk indicators, such as serum creatinine level (P In general, our study showed that short-term graft failure in Iran is almost equal to the reported rates in some developed countries, but its long-term failure is rather high compared to these same countries. In this context, monitoring the post-operative risk indicators of graft rejection, such as the serum creatinine level, plays an important role in increasing the survival rate of kidney transplantation. The present model can be used to design similarly structured datasets.

Handwriting difficulties are one of the most common reasons for referral to school-based occupational therapy. Assessing handwriting performance using standardized tools is necessary for scientific research and clinical assessment.
The objective of this study was to develop and validate the Persian handwriting assessment tool to evaluate legibility and speed in near-point copying and dictation domains in primary school-aged children.
This methodological study was conducted in Tehran, Iran during 2015 - 2016. Measurement items were selected by reviewing the past literature and considering the opinions of an expert panel. The scale development, the analysis of content validity, and item analysis were performed in phase one using the data from 131 students in grades two and three. Exploratory factor analysis and discriminant validity were analyzed in phase two using the data from 208 subjects. Sampling was conducted using the random cluster method. Confirmatory factor analysis was conducted on a randomly split sample of half of the data.
The content validity ratio of most of the criteria was greater than 0.57. Item analysis confirmed the writing assignments in the copying and dictation domains. Principal component analysis revealed that measurements in the copying and dictation domains loaded into three components separately, which accounted for 71.96% of the variance in the copying domain and 70.46% of the variance in the dictation domain. Confirmatory factor analysis also confirmed the accuracy of the three-dimensional structure designated through exploratory factor analysis. Discriminant validity showed that handwriting speed and legibility increased with maturation.
The Persian handwriting assessment tool as a comprehensive and quickly scored tool that can help therapists identify primary school students with handwriting problems so that appropriate interventions for these students can be implemented.

Context: Dysmenorrhea is the most common gynecological complaint in Iran but the true prevalence of it is not clear yet. This study is aimed to estimate the overall prevalence of dysmenorrhea in Iran.
Evidence Acquisition: International and national electronic databases including PubMed, ISI, Ovid, Scopus, Science Direct, SID, MagIran and IranMedex were searched up to January 2016. All studies, in which the prevalence of dysmenorrhea in Iran had been reported, were included in this meta-analysis. Eligible studies were reviewed, and data was extracted onto a standard data sheet. A Meta-analysis was done by a random-effects model with a 95% confidence interval (CI).
Twenty-five studies were assessed involving an overall of 9,677 participants, of which 6,748 had primary dysmenorrhea and 280 had secondary dysmenorrhea. The overall prevalence of primary and secondary dysmenorrhea was 0.71 (95% CI: 0.65, 0.77) and 0.18 (95% CI: 0.03, 0.32), respectively.
Primary dysmenorrhea is a common problem in Iran however, there are only a few studies regarding secondary dysmenorrhea prevalence. Moreover, there is a significant variation between the results of the studies on the primary dysmenorrhea prevalence. Therefore, further evidence-based data on national studies is needed to estimate the exact estimation of dysmenorrhea prevalence in Iran.

The effect of kidney transplantation on improvement of survival rate and post-transplant-medical health is dramatic. Transplantation is associated with various emotions such as loss, grief and bereavement. Therefore, any psychiatric intervention that can improve the psychological aspects of these patients is valuable.
Due to the specific medical and psychiatric conditions of Kidney transplant recipients, researchers have designed expressive emotion psychotherapy as a simple, feasible and time limited brief psychotherapy for these patients. The aim was the assessment of this psychotherapy on quality of life and general health of kidney transplant recipients.
This 12-week randomized double-blind clinical trial took place at the Kidney transplant department of Imam Khomeini hospital, an academic and governmental hospital affiliated with Tehran University of Medical Sciences (TUMS) from November 2015 to February 2016 (Iran). From a total of 82 patients screened for this study, 64 patients (34 in the intervention group and 30 in the control group) completed the trial. Participants were divided to two groups: the first received expressive emotion intervention and the second received fact recording education as the control group. Outcomes were assessed by the kidney transplant questionnaire (KTQ) and general health questionnaire (GHQ-28) at baseline and at weeks four and twelve.
Baseline demographic characters of patients in both groups were similar. The mean age of patients that participated in the study were respectively 39.26 ± 12.98 and 40.83 ± 14.37 for intervention and control groups. The results of this study indicated that patients in the “intervention” group had a statistically significant enhancement in total KTQ score (P = 0.001) and total GHQ score (P = 0.001). Regarding every domain of GHQ, this group had a better condition than the “control” group (P = 0.000). The intervention had a significant effect on certain domains of KTQ such as “uncertainty/fear” and “emotion”.
Expressive emotion brief psychotherapy that focuses on the instructions of expression about one’s living and dealing with a diagnosis of chronic medical condition is recommended for kidney transplant recipients.

The imbalance in the T helper (Th) 1/Th2 and Th1/T regulatory (Treg) cells-related immune responses plays a key role in pathogenesis of allergic asthma.
The aim of this study was to evaluate the effects of CPG-Oligodeoxynucleotide (CPG-ODN), Monophosphoryl Lipid A (MPLA) and Bacillus Calmette-Guerin (BCG) on the ratio of Th1/Th2 and Th1/Treg cells-related parameters in an animal model of asthma.
This was an experimental study in which female BALB/c mice were divided to five groups and then immunized Subcutaneously (SC) with the allergen Dermatophagoides pteronyssinus 2 (Derp2) on days 1, 15 and 22. Three groups of mice were considered as test groups and pre-treated SC with CPG, CPG MPLA or CPG BCG on days 0, 14 and 21. Two groups were also considered as saline-control group and Derp2-sensitized control group that were administrated only saline or allergen Derp2, respectively. The mice (except saline-control group) were challenged intranasally with allergen Derp2 for ten days, from days 28 to 37 of post immunization. Blood samples were obtained from retro-orbital sinus, on days 0, 23 and 40. The serum Interleukin (IL)-4, Interferon (IFN)-γ, Immunoglobulin (Ig) E and IgG2a levels were measured using the enzyme linked immunosorbent assay (ELISA) technique. The blood count of Th1- and Treg cells was detected using flow cytometry.
At sensitization phase, the serum IFN-γ/IL4 ratio was significantly increased in Derp2-sensitized group pre-treated with CPG plus MPLA or CPG plus BCG as compared with Derp2-sensitized control mice (P These results showed that BCG, MPLA and CPG improve the Th1/Th2- and Th1/Treg cells imbalances in a mouse model of asthma.

Asthmatic chronic rhinosinusitis with nasal polyps (aCRSwNP) is a common disruptive eosinophilic disease. However, up to now, there is no effective medical treatment for the disease, which is partly due to that the molecular mechanism of aCRSwNP is still unknown.
The aim of this study was to facilitate the systematic discovery of diagnostic biomarkers of aCRSwNP based on integrating pathways, differentially expressed genes (DEGs), and mutual information networks (MINs).
This was a foundation-application study carried out in Dongying, Shandong Province, P.R. China, in 2016. First, the gene expression profile of aCRSwNP composed of 13 normal samples and 21 aCRSwNP samples was recruited from the gene expression omnibus (GEO) database (http://www.ncbi.nlm.nih.gov/geo/) and then, data preprocessing was performed. Second, the attract method was utilized to identify differential pathways. In the following, MINs were constructed and underwent topological analysis. Then, DEGs were examined in aCRSwNP group and normal control group to identify significant genes and key genes. Finally, the support vector machine (SVM) with C-classification was utilized to evaluate the performance of the classification.
A total of 11,100 genes and 273 pathways (gene count > 5) were initially obtained. Then, 5 differential pathways which contained 346 genes were identified. Topological analysis conducted on the MINs revealed 20 hub genes (degree centrality ≥ 220). In the following, 795 DEGs were identified (|log fold change (FC)| ≥ 2.0, P value ≤ 0.01). Furthermore, 35 significant genes and 14 key genes were detected. Finally, the results of SVM with C-classification indicated that the key genes gave the best result.
Our research identified several key genes (such as IL6R), which might play key roles in the occurrence and development of aCRSwNP. We predicted that these genes might provide additional diagnostic and therapeutic targets for aCRSwNP.

Myelin basic protein (MBP), a crucial neuro-autoantigen involved in the maintenance of the myelin sheath, is one of the biomarkers of therapeutic response in multiple sclerosis (MS).
The study examines prognostic biomarker and molecular mimicry hypothesis MS etiology by MBP.
This study is convergence of three arms including in silico and in vitro (bioinformatics) with the in vivo (experimental). A novel methodology combining molecular techniques was used to confirm the antigenic properties of MBP and study its efficiency in increasing the susceptibility to MS. One hundred eighty MS patients and healthy subjects were recruited for the study from Jan 2013 to Feb 2016 in Iran. Age and sex-matched healthy volunteers and patients were analyzed using various quantitative and qualitative molecular laboratory techniques. Peripheral blood mononuclear cells (PBMCs) and plasma was used for the retrieval of MBP and IgG assay, respectively.
The optimum concentration of the MBP epitope for the immune system to react and facilitate prognostication was found to be 50 and 150 µg/mL in MS patients and healthy individuals, respectively (P Molecular assays in the early stages of the disease could help in elucidating the effectiveness of the MBP as a prognostic factor in MS.

Lactobacillus reuteri is a probiotic that originated from humans and have been used for eradication of the Helicobacter pylori (HP) infection.
This study was aimed to determine whether adding probiotics to a triple regimen against HP could improve the eradication rate.
In a double-blind randomized clinical trial in Iran between October 2012 and January 2014, all eligible patients (Fifty HP positive children, 5 - 14 years old, mean age: 8.5 2.5 years, Male/female: 17/33) were entered into the study based on the convenience sampling method and random selection. An endoscopy was performed on all patients and the subjects received antibiotics as well as proton pomp inhibitors with or without the probiotic (Lactobacillus reuteri) in two separate groups. Four weeks after the end of treatment (discontinuation of all medicine) a urea breath test was performed in both groups in order to evaluate eradication of the HP infection.
Eradication rate in the group that received Lactobacillus reuteri was 88% compared to the group that was treated with standard Helicobacter pylori regimen (76%). This study showed the eradication rate of the probiotics group was 12% higher than the control group, although it was not significant (P = 0.46). Furthermore, results of this study showed a reduction of symptoms before and after treatment in both groups, although the difference between two groups was not significant.
There was no significant effect of Lactobacillus reuteri on the eradication of Helicobacter pylori compared to the standard group. More research in this regard is recommended.

Glucose is an essential element in the supply of body’s energy. In diseases such as diabetes, glucose increase is associated with disturbance in metabolism. Cortisol is an important hormone in the regulation of glucose metabolism, and human serum albumin (HSA) is one of the most important glucose and cortisol transmitters in blood. Interaction between albumin and these ligands could affect HSA secondary structure and its stability.
The aim of this study was to investigate HSA secondary structure in the presence of different concentrations of glucose and cortisol.
This was an in vitro (analytical/descriptive) study in which, completely randomized design was used to study the interaction between human serum albumin at 37°C at different glucose concentrations of 0, 80, 180, 240, and 400 mg/dL and cortisol at concentrations of 0, 10, 20, and 40 µg/dL. Intrinsic fluorescence spectroscopy and Circular dichroism (CD) were performed to obtain data.
HSA secondary structure underwent changes in the presence of different concentrations of cortisol and glucose. P values less than 0.01 were considered to be statistically significant. Fluorescence spectroscopy and CD results showed that at normal glucose concentrations, HSA was very flexible, beta-sheet content reduced, and the maximum increase in fluorescence and blue-shift happened. At higher concentrations of glucose, HSA became rigid. Also, HSA in presence of 10 µg/dL cortisol was very flexible; but a cortisol concentration of 40 µg/dL caused stability in HSA structure in presence of different glucose concentrations.
Under normal glucose conditions, very low cortisol concentrations create large changes in HSA secondary structure. At normal glucose concentrations, some of the binding sites of HSA that are all occupied by glucose at higher concentrations become available to cortisol. Cortisol structure is very hydrophobic, which causes large changes in HSA secondary structure and significant increases in quenching and blue shift. In conclusion, binding of compounds such as medicines to HSA sites may be affected by competitive bindings of glucose, depending on its concentration in the blood.

The increasing prevalence of overweight and obesity in children has posed some challenges in many countries. There is a relationship between parenting styles, parental feeding practices, and children’s nutritional status.
This study aimed to apply Authoritative Parenting style Model in children’s nutritional status.
This research was a cross-sectional study conducted on 1000 parents selected by random cluster sampling. Parents who had primary school children aged 7 - 8 years in Bojnord, Iran, completed questionnaires related to the constructs of the model in 2016. Structural Equation Model Model (SEM) analysis was used to test the fit of the model. CMIN/DF, GFI, IFI, CFI, PGFI, PNFI, and RMSEA indices were employed to check the goodness-of-fit.
Correctly completed questionnaires were collected from 294 dyads of parents. The mean age was 36.26 years (SD = ±5.38) in fathers and 32.96 years (SD = ±4.88) in mothers. 232 mothers (80.5 %) were housewives and only 99 of them (34.4%) had university education. Most fathers were employee (115, 40%) or self-employed (111, 38.5%) and 120 of them (41.7%) had university education. The values of goodness-of-fit were obtained for CMIN/DF = 4.6, GFI = 0.91, CFI = 0.93, IFI = 0.92, PGFI = 0.68, PNFI = 0.77, and RMSEA = 0.07. Nutritional knowledge and attitude directly affected authoritative parenting style (β = 0.21, P This study indicated that the use of this model in the children’s nutritional status can result in positive outcomes, and this model can make interventions more effective in this regard.

Previous studies demonstrated partial attenuation of noise induced hearing loss (NIHL) by N-acetyl-L-cysteine (NAC) or CoQ10 (ubiquinone).
The present study investigates the protection effect of coadministration of NAC and CoQ10 against NIHL.
In an experimental study in Iran in 2015, a total of 36 male Wistar rats (275 ± 25 g) were divided randomly based on the permuted block design into 6 experimental groups: (I) noise controls, (II) noise and NAC, (III) noise and CoQ10, (IV) noise and CoQ10 and NAC, (V) noise and saline (as vehicle of NAC) and (VI) noise and olive oil (as vehicle of CoQ10). Antioxidants and vehicles were intraperitoneally injected once a day for two days prior to and 1 hour before 102 ± 0.5 dB white noise exposure 8 h/day in 10 executive days and two days after the noise exposure daily. Distortion product otoacoustic emissions were measured one day before and 1, 7 and 21 days after the exposure.
The temporary hearing changes that occurred 1-day post exposure were not significantly different in all groups (P > 0.05). The total recovery (between 1 - 21 days after noise exposure) varied by a frequency increase between 1.08 - 19.10 in the noise group compared to 1.75 - 24.5 and 0.62 - 22.08 in animals treated with NAC and the combination of NAC and CoQ10 respectively. The less permanent hearing impairment was observed in noise exposed animals treated with either NAC or both NAC and CoQ10.
The effect of coadministration of NAC and CoQ10 was neither additive nor synergic in protecting against NIHL.

Low serum levels of vitamin D are supposed to contribute to the incidence of diabetes; therefore, vitamin D supplementation may reduce the incidence of diabetes in individuals with prediabetes.
The aim of this current study was to examine the effect of vitamin D supplementation on the glycemic status and percentage of body fat mass in adults with prediabetes.
In a 3-month randomized placebo-controlled supplementation trial, 120 eligible subjects were randomly assigned in a vitamin D or placebo group. They were stratified according to the percentage of body fat mass into four blocks to receive 1000 IU/daily vitamin D or an identical placebo tablet respectively, for 3 months. The study was conducted from January to March of 2016 in Urmia in the North West of Iran. Participants were adults aged 18 to 70 with prediabetes. The fasting blood sugar (FBS), glycated hemoglobin (HbA1c), homeostasis model assessment of insulin resistance (HOMA-IR), serum 25(OH)D levels, and percentage of body fat mass were assessed before and after the intervention.
The comparison of changes from baseline between two groups showed a significant inverse association between the changes in serum 25(OH)D and changes in FBS (-4.64 ± 11.38 compared with -2.11 ± 9.15 for placebo; P = 0.03), HOMA-IR (-0.73 ± 4.2 compared with 0.44 ± 4.4 for placebo, P = 0.01) and serum insulin (-1.98 ± 15.25 compared with 2.47 ± 15.85 for placebo; P = 0.007) but not in the percentage of body fat mass (-0.28 ± 0.77 compared with -0.39 ± 2.82 for placebo; P = 0.39).
The study demonstrated that 1000 IU vitamin D supplementation for 3 months can decrease the insulin resistance in individuals with prediabetes; however, it has no significant effect on body fat mass percentage.

Preterm premature rupture of membrane (PPROM) prior to 37 weeks’ gestation is among the most common obstetrics problems, which is associated with prenatal mortality and several maternal and neonatal complications. History of PPROM is a risk factor for recurrence. Zinc has an important effect on the strength of membranes by affecting collagen [tensile] strength - a substance with immunity mechanism and antioxidant properties.
This study was conducted to investigate the effect of zinc supplement on the prevention of PPROM and improvement of some pregnancy outcomes in pregnant women with a history of PPROM during the second trimester and the early third trimester.
In this randomized, double-blind, controlled clinical trial, 108 healthy pregnant women (at gestational age of 16 - 30 weeks) with a history of PPROM and singleton pregnancy were selected by convenience sampling method in the Midwifery Clinic of Shahid Akbarabadi hospital in Tehran, Iran, between 2014 and 2015. They were then divided into two groups of placebo and zinc sulfate tablet (40 mg) recipient using randomized block design. In total, 92 subjects completed the study. The frequency of PPROM was regarded as the primary outcome, and frequency of PROM, average gestational age at birth, average birth weight, and average head circumference were considered as the secondary outcomes. The statistical analysis was based on intent-to-treat principle.
There was no between-groups difference in terms of demographic and pregnancy specifications. Results showed no significant between-groups (zinc versus placebo recipient) difference (P > 0.05) in terms of the frequency of preterm pregnancy (22% versus 33.3%), frequency of PPROM (4.9% versus 11.8%), frequency of PROM (14.6% versus 17.6%), average birth weight (3192.17 g versus 3080.52 g), average gestational age at birth (38.2 weeks versus 37.2 weeks), and average head circumference at birth (34.63 cm versus 34.81 cm).
According to the results, daily intake of zinc sulfate (40 mg) by pregnant women with a history of PPROM does not contribute to the prevention of PPROM and PROM and improvement of average gestational age at birth and anthropometric measurements.

Sleep-deprivation in children decreases the quality of life and endangers health. Increasing mother’s level of awareness can help improve the children’s sleep schedule and avoid many associated problems.
This study aimed to investigate the effect of SMS-based education on the level of sleep knowledge in mothers with 7 - 12 years old children.
In this single-blind randomized controlled trial, 13 governmental primary schools in Tabriz (Iran) in 2016 (7 girls’ schools and 6 boys’ schools) were randomly selected among the primary schools, using cluster sampling approach. Then, the mothers of sleep-deprived students were randomly divided into intervention and control groups by using RAS. Both of the groups took a pretest on sleep knowledge by PSKI and then, mothers in the intervention group received education through sending SMS. Finally, all of the participants took again the posttest in two time intervals including a week and three months after the intervention. A number of 92 mothers (experiment = 47, control = 45) completed all of the three phases of the research and the data were analyzed using SPSS ver13.
The results showed that the difference between the scores obtained in the first and the second measurements of sleep knowledge in the experimental group was significantly different from that of the control group [mean between-group difference of 5.98 within 95% CI of 3.56 to 8.41 (P The use of SMS-based education is a constant and efficient educational approach for increasing mothers’ level of knowledge about children’s sleep health.

Surgery as a stressful experience can affect the child and quality of care plan. Nurses can use non-pharmacological intervention to reduce anxiety and help children cope with this stress.
This study was designed to compare the effects of dramatic puppet and therapeutic play on anxiety of children undergoing surgery.
In this randomized clinical trial, 75 children were divided into three groups (dramatic puppet, therapeutic play, and control) using a simple random allocation method. The study was conducted in Iran in 2013 - 2014. The revised children’s manifest anxiety scale (RCMAS) was used to determine the anxiety of children. The data were analyzed using paired t-test, one-way analysis of variance (ANOVA), and Tukey test.
The findings revealed that the changes of anxiety scores after the intervention were significantly different among the three groups (P Therapeutic play and dramatic puppet can be used by nurses as a care strategy and effective preoperative preparation intervention to reduce anxiety in children undergoing surgery.

Context: There is no global consensus on the issue that what dairy subgroups can affect diabetes; thus, this meta-analysis aims to shed light on this matter.
Evidence Acquisition: Main electronic databases such as Web of Science, Scopus, Science Direct, and PubMed, updated to March 2016, were investigated. All original articles from Prospective Cohort and Case-Cohort studies examining the relationship between dairy products subgroups consumption and the risk of diabetes were brought under consideration without any restrictions on age, gender, language, race, and publication year. To validate this study, the STROBE checklist was used. The indices of relative risk and rate ratio were reported using Random Effect Model.
Out of 1391 articles, 13 (covering 421,421 people) were introduced to the current meta-analysis. The findings showed that the consumption of yoghurt and cream has preventive effects on the risk of diabetes: Yogurt: relative risk = 0.74 (95% CI: 0.65, 0.84), rate ratio = 0.66 (95% CI: 0.63, 0.70); Cream: rate ratio = 0.86 (95% CI: 0.82, 0.91). Although the relative risk index showed that milk consumption diminishes the risk of diabetes by 11%, this relationship was not statistically significant: Milk: relative risk = 0.89 (95% CI: 0.82, 0.97), rate ratio = 1.07 (95% CI: 0.93, 1.24). This study also indicated that intake of low-fat milk, ice cream, and cheese has no impact on the incidence of diabetes: Cheese: relative risk = 0.92 (95% CI: 0.82, 1.04), rate ratio = 1.04 (95% CI: 0.93, 1.16); Low-fat milk: rate ratio = 0.93 (95% CI: 0.76, 1.14); Ice cream: rate ratio = 1.05 (95% CI: 0.93, 1.18).
Due to the scarcity of studies related to some dairy subgroups, it is not possible to make a final judgment about their effects on the risk of diabetes; therefore, more studies need to be conducted on this issue.

Heart failure is common in patients with chronic renal disease, either as a complication of renal failure or from shared risk factors, or is the major cause of death in patients on dialysis. At present, end stage renal disease (ESRD) patients who have systolic heart failure are considered high-risk for surgery; and nephrologists and cardiologists are reluctant to refer these patients for kidney transplant evaluation. It is unclear whether such patients should be accepted and waitlisted for transplantation. seven cases with end stage renal disease (ESRD) and severe heart failure with ejection fraction (EF) of less than 20% and newyork class 3 - 4, despite being on optimal treatment, who underwent renal transplant from nonrelative living donor at Shahid Moddaress hospital in Tehran, Iran during the July 2013 to December 2015, were retrospectively collected and analysed. The mean ± SD of patient’s age was 32.7 ± 16 years, and about 72% of them were female. The left ventricle ejection fraction increased by 35% on an average after the renal transplantation. Renal transplantation significantly improved the LV systolic function and ejection fraction status and subsequently decreased the need for medical treatment and heart transplantation.

Multiple sclerosis (MS) is known as a progressive and demyelinating disease, which involves biochemical changes.
To evaluate the effect of IFNβ-1a therapy on the biochemical factors in the MS patients.
In this descriptive study, 30 MS patients and 30 healthy controls were included. The study was conducted in the Neurology Center at the Shefa hospital, Kerman, Iran from September 2013 to July 2015. The patients’ blood test was taken before and after six months of IFNβ-1a therapy and the biochemical factors (LDH, AST, ALT, Creatinine, Uric acid, Malondialdehyde (MDA) and nitric oxide (NO) were measured in all the samples. The participants were divided to three groups, namely main group (30 patients), females (22 patients) and males (8 patients). Before taking the medicine, the groups were compared to the control group. After six months of taking the medicine, each group was compared to its former state before taking the drug.
In the patients group (30 patients), a significant difference was observed in their measured biochemical factors in comparison to the control group (P = 0.001), however, after six months of using IFNβ-1a, only MDA was shown in the main (P = 0.003) and female group (P = 0.003), and the ALT that was shown in the female group had a significant reduction in comparison to that before receiving IFNβ-1a.
This study showed that IFNβ-1a decreased oxidant impacts in MS patients, but had no influence in improving mitochondrial dysfunction.

The exact interacting factor that response to the infection for neonatal sepsis is still needed to urgently to be disclosed.
This research was aimed to explore the potential biomarkers and illuminate the underlying molecular mechanisms associated with neonatal sepsis via identifying differential modules (DMs).
This is a case-control bioinformatics analysis using already published microarray data of neonatal sepsis. This study was conducted in Qingdao, China from September 2015 to May 2016. We recruited the gene expression profile of neonatal sepsis from the Array Express database (http://www.ebi.ac.uk/arrayexpress) under the accessing number of E-GEOD-25504, which included 27 neonatal samples with a confirmed blood culture-positive test for sepsis (bacterial infected cases) as well as 35 matched controls. Meanwhile, the human protein-protein interaction (PPI) data was collected from the database of Search Tool for the Retrieval of Interacting Genes/Proteins (STRING, http://string-db.org). All of the data was preprocessed. Then, the differential co-expression network (DCN) was constructed by integrating co-expression analysis and differential expression analysis. Next, a systemic module searching strategy, which contained seed genes selection, module searching and refinement of modules, was performed by select DMs.
Starting from the gene expression data and PPI data, the DCN that included 430 edges (covering 324 nodes) was constructed, in which each edge was assigned a weight value. From the DCN, we selected a total of 16 seed genes. Starting from these seed genes, a total of 3 modules were identified from the DCN based on the systemic module algorithm. Of them, only one module (Module 3) was considered as DM under P In the present study, we identified a key gene RPS16 and a significant module involved in ribosome biogenesis in eukaryotes that were related to neonatal sepsis, which might be potential biomarkers for early detection and therapy for neonatal sepsis.

Breast cancer is one of the leading causes of death in the world. Early diagnosis of breast cancer can reduce the rate of mortality of this type of cancer. An increasing number of reports have confirmed the excellent sensitivity of dynamic contrast enhanced magnetic resonance imaging (DCE-MRI). Despite the excellent sensitivity of DCE-MRI, there is still some difficulty in the prediction of malignancy in these patients because of the lack of the optimum guidelines for the interpretation of breast magnetic resonance (MR) studies as well as the reported overlap in T1 and T2 relaxation times.
The aim of this study was to extract significant features from MRI images of the breast using chaos, fractal and time series analysis and to classify breast tumors into malignant and benign using the calculated features.
In this research, we utilized the chaos theory and fractal analysis in the interpretation of breast tumors on DCE-MRI. This cross-sectional study was done at Pardisnoor imaging center during years 2015 and 2016 in Iran. Our sample size was 18 mass lesions, which were randomly selected among patients with BIRAD 3 and BIRAD 4 classification by the expert radiologist. The analysis was performed after injecting patients with a contrast agent and 18 mass lesions were extracted from dynamic MR images. After pre-processing and segmentation stages, time series of the tumor was generated for each MR image. The largest Lyapunov exponent (LLE) and statistical parameters for each mass lesion were extracted. Also, fractal analysis was utilized to extract meaningful features from mass contour to evaluate the roughness of tumor margin.
We found that the value of LLE in malignant tumors was higher than benign mass lesions. The obtained results demonstrated that chaos and time series features, such as LLE and non-circularity of the tumor, were the best parameters among all features.
The extracted descriptors can improve the performance of classifiers in the early detection of breast cancer. Significant shape features can also help radiologists increase diagnosis accuracy in classification of suspicious breast masses.

The early repolarization pattern (ERP) has been considered a normal variant in electrocardiography (ECG) for a long time. Nevertheless, increasing evidence has demonstrated its association with adverse outcomes.
The present study aimed to evaluate the prevalence of ERP in the Iranian general population and demonstrate its clinical and ECG correlates.
A cross sectional study, comprising 1424 consecutive healthy adult individuals, was conducted at two university based hospitals in Tehran, Iran in 2012-2013. The ERP prevalence, clinical characteristics and ECG morphology were investigated in volunteers.
ERP was present in 136 out of 1,424 people (9.6%). Slurring comprised the most frequent morphology (41.2%) followed by notching. ERP was predominantly positive in inferior leads (47.8%) followed by lateral leads (30.1%). There was also a significant male preponderance in the ERP positive group (81.6%). The mean diastolic pressure was significantly lower in the ERP positive group versus the ERP negative group (77.3 7.9 mmHg vs. 78.8 10.5 mmHg) (P = 0.03). However, despite a lower systolic blood pressure in the ERP positive subjects (120.9 12.6 mmHg vs. 123.1 14.8 mmHg), the difference was not statistically significant (P = 0.06).
ERP was present in 9.6% of healthy Iranian individuals with a higher frequency in inferior leads and slurring as the most prevalent morphology. Additionally, there was a male preponderance and middle-aged trend for ERP.

Type 2 diabetes (T2DM) is an endocrine disease caused by inadequate secretion or improper utilization of insulin. Studies have shown that AMP-activated protein kinase (AMPK) dysregulation is contributed to the development of T2DM. Urtica dioica (UD) may have anti-hypoglycemic activities in T2DM patients. However, the underlying mechanism is remained unclear. The aim of this study was to assess the UD effect on serum levels of glucose, glycated hemoglobin (HbA1c), insulin concentration, and AMPK levels in diabetic patients.
This study aimed to determine the effect of Urtica Dioica hydro-alcoholic extract on glycemic index and AMPK levels in diabetic patients.
This randomized single-blind clinical trial was conducted in the endocrinology clinic of Rohani hospital (Babol. Iran). Convenience sampling and simple random allocation were used in the study. Sixty diabetic patients were randomly divided into the two drug and control groups. The drug group received 20 mg/kg/d of hydro-alcoholic UD extract three times for 8 weeks and control group received placebo. Fasting blood glucose (FBG), HbA1c, insulin and AMPK were measured and compared at the beginning and end of the study.
FBG levels of the drug group were significantly decreased compared with the placebo group (P = 0.032). Quantitative insulin sensitivity check index (QUICKI) increased significantly in drug group compared with the other group (P According to the results, UD is able to decrease glucose level and improve insulin release in T2DM. In addition, as UD is able to induce a small increase in AMPK activity, it is possible that the anti-hyperglycemic effect of UD is mediated by insulin secretion and the possible changes in AMPK levels.

It is important to be able to predict cancer incidence and mortality rates for planning and managing the risk factors.
The present study investigated the changes in the incidence and mortality rates of five most common cancers in Iran.
The cancer incidence and mortality data were obtained from the national cancer and mortality registries. Five most common cancers in both men and women were selected. Changes in the incidence and mortality rates of the selected cancers in both sexes were estimated by age group, annual percent change (APC), and average APC (AAPC) and then graphically displayed.
The most common cancers (except skin cancer) were breast, colorectal, stomach, esophageal, and thyroid cancers in women and stomach, prostate, bladder, colorectal, and esophageal cancers in men, respectively. The AAPCs of all cancer incidence rates had increased by 11.9% in men and 11.6% in women from 2002 to 2010. Also, the mortality rates had enhanced by 0.4% and 0.1% per year in men and women from 2006 to 2011, respectively. The greatest APC was reported in prostate cancer. The rate had increased by 41.9% from 2002 to 2004, by 13.4% from 2004 to 2008, and slowly augmented by 3.9% from 2008 to 2010. In women, the greatest APC was observed in colorectal cancer; the rate had enhanced by 13.4% per year from 2002 to 2010. The greatest increase for age-standardized mortality and incidence in 2011 was attributed to gastric cancer (12.5% and 17.1% per 100,000 men, respectively). In women, the highest age-standardized mortality rate was related to gastric cancer at 6.9% per 100,000 women. The incidence and mortality patterns of colorectal and esophageal cancers in men and women were similar, although they were slightly higher in men than women.
Overall, cancer incidence rates had increased in both sexes. Many factors were responsible, such as changes in lifestyle, environmental factors, increased life expectancy, improvements in the registration systems, and declining mortality rates due to early detection and treatment. The results of this study provided useful information for the prediction of changes in the incidence and mortality of cancer and subsequent design of cancer control programs in Iran.

Context: Fluid therapy is the basis of resuscitation; however, there has been a heated debate on the choice of appropriate fluid. This study mainly aimed to determine which fluid is correlated with a decline in mortality rate and can be the most suitable choice for each group of patients.
Evidence Acquisition: We conducted a systematic search on Google Scholar, Web of Science, Scopus, BMJ Journals, Thieme, Path Consult, BIDS Index, Embase, Medline, and Cochrane Controlled Trials up to April 2016. The relevant studies were those that provided a comparison between the effects of different fluids on the mortality rate of patients. Two independent authors participated in the evaluating methodological quality, selecting eligible studies, and extracting the relevant data from the studies.
We selected 26 out of 2724 potential randomized controlled trials (RCTs) from the databases for both quantitative and qualitative analyses resulting in a total of 22882 patients receiving either colloid or crystalloid fluids. The approximated pooled Relative risk (RR) for the death of patients who had been resuscitated with crystalloid fluid therapy rather than colloid fluid therapy was 1.008. This meta-analysis illustrated that there was a decline in the mortality rate with borderline significance in both traumatic and hypovolemic patients through utilizing colloid fluids. The mortality reduced more by using dextran and albumin than using crystalloid fluids.
The results of this meta-analysis show that colloid fluids can increase the successful resuscitation rate compared to crystalloid fluids especially in traumatic and hypovolemic patients.Some of the colloids like albumin and dextran have a positive effect on reducing the mortality rate but others like Hetastarch (HES) increase the mortality rate compared to normal saline (NS).

As a common diabetic complication, foot ulcers may cause a huge burden both on the patient and healthcare system. The current study aims at investigating the effectiveness of honey dressing in the presence or absence of olive oil in diabetic foot ulcer.
The study attempted to report a 70-year-old female with the history of diabetes undergoing high doses of oral antidiabetes drugs (OADs). Following a car accident, she developed a neuropathic ulcer categorized as Wagner grade-II. The case was admitted in Imam Reza General hospital, Mashhad, Iran in August 2014. A combined regimen of cephalexin, cefixime and anti-inflammatory drugs was started after hospitalization. Since granulation formation and tissue repair did not occur, honey dressing with and without olive oil was used to repair the ulcer. The whole treatment period lasted a month.
To sum up, honey dressing with and without olive oil could successfully prevent the risk of amputation in case of diabetic foot ulcers.

Intrauterine devices (IUDs) have been used as a commonly convenient, efficient, relatively safe, and inexpensive method of contraception worldwide. Contraceptive efficacy is related to intrauterine location of IUD. Insertion of IUD without prior pelvic evaluation by ultrasound is a predisposing factor for unsuitable placement and may reduce contraception effectiveness.
We present a patient who referred to Royan institute in Tehran (Iran) with IUD displacement due to an inappropriate insertion of the device into her recent cesarean section scar.
IUD displacement into the myometrium could be done in clinics, but advanced laparoscopy is needed for confirmed diagnosis and IUD complication management. Three- dimensional transvaginal ultrasound (3DTVUS) clearly displays the correct position of the IUD in the uterine cavity much better than the two-dimensional transvaginal ultrasound (2DTVUS).

Providing a clear picture of neuromuscular control mechanisms and deficits in patients with chronic ankle instability (CAI) requires further investigation. Gait initiation (GI) is a perfect task to evaluate concurrent open-loop (planned GI) and closed-loop (unplanned GI) neuromuscular control mechanisms in patients with CAI.
The current study aimed at evaluating neuromuscular control mechanisms via assessment of the center of pressure (COP) displacements during planned and unplanned GI in patients with CAI and healthy individuals.
It was a case-control study. Twenty-two subjects with unilateral CAI and 22 healthy subjects stood on a force plate and initiated gait with maximal velocity under 2 conditions: i) planned (initiated gait after hearing the “all set” signal, when subjects felt ready to walk) and ii) unplanned (initiated gait “as soon as possible” after hearing acoustic signal). The COP parameters were assessed during the preparatory and the execution phase of GI.
The peak COP displacement toward swing leg decreased significantly, with P value = 0.003, in the preparatory phase of GI under planned and unplanned conditions in patients with CAI (0.028 ± 0.002) in comparison with the control group (0.038 ± 0.002). Forward velocity of the COP displacement increased in CAI patients (0.026 ± 0.003) compared with the control group (0.018 ± 0.002) in the execution phase of GI, with P value = 0.039.
According to the findings of the current study, both open-loop and closed-loop neuromuscular control mechanisms altered in patients with CAI.

Job satisfaction, which is affected by various factors, indicates positive or negative attitude of employees towards their own occupation and affects the quality of service.
The present study aimed at investigating job satisfaction and some of its related factors in midwives of Tehran primary health centers in 2014.
The present cross sectional study was conducted on 125 employed midwives in Tehran health centers in 2014. Random quota sampling method was used to collect data. Moreover, data were gathered using a self-report questionnaire and analyzed using descriptive and analytic statistical methods (Chi square and Pearson’s correlation coefficient test).
The mean age of the participants was 37.38 ± 8.34 years, and the mean score of job satisfaction of midwives was 59.25 ± 1.33, which is considered moderate. A significant direct relationship was obtained between job satisfaction and the current job promotion system (P = 0.003), and modeling other colleagues (P = 0.05), moreover, a reverse relationship was found between job satisfaction and role ambiguity of midwifery (P = 0).
Considering the findings of the present study, it seems necessary to pay more attention to the factors that increase job satisfaction of midwives such as decreasing role ambiguity and improving job promotion system in midwifery to improve their job satisfaction and the quality of care they provide to patients.