Iranian Red Crescent Medical Journal
Volume:19 Issue: 9, Sep 2017

Context: Given the role of nutrition and food, as well as environmental pollutants in the probability of developing endometriosis, this study aimed to identify the risk factors and preventive factors in a systematic review and meta-analysis.
Evidence Acquisition: In this study, available references were searched for the relevant articles published “between” 2000 - 2015. Among a total of 357 articles extracted from primary studies, 5 articles were finally selected for meta-analysis, which were ultimately analyzed for the effect of dietary factors and risk of endometriosis on 73,102 cases (2,608 cases and 70,494 controls).
Systematic review and meta-analysis of the studies indicated that calcium intake OR: 0.99, (95% CI: 0.83 - 1.18), milk OR: 0.90 (95% CI: 0.65 - 1.23), eggs OR: 1.01(95% CI: 0.81 - 1.28), bacon OR: 1.26 (95% CI: 0.60 - 2.65), red meat OR: 1.26 (95% CI 0.73 - 2.18), increase the risk of endometriosis.
Evidence shows a need to improve the understanding of the impact of dietary components on the risk of endometriosis to modify and prevent this disease. Futhermore, more studies are required and recommended to clarify the role of diet in the incidence and progression of endometriosis.

Chronic hepatitis C is one of the most important causes of cirrhosis and hepatocellular carcinoma (HCC). Camel milk (CM) is a new candidate therapy for chronic hepatitis C (CHC).
The present study assessed the safety and efficacy of pegylated interferon alfa-2a and ribavirin with CM (CM Peg IFN/RBV) and without CM (Peg IFN/RBV) in CHC genotype 2/3 infections.
This study was an open-label, randomized, phase 2 trial. Sampling strategy and date was computer–generated randomization. The researchers randomly selected 45 adult patients (ages > 18 years), who were treatment-naive with CHC infection (non-cirrhotic) to receive Peg IFN/RBV with standard-dose alone (group A, n = 23), CM Peg IFN/RBV: 500 cc orally per day (group B, n = 22) for 24 weeks in Iran. The primary efficacy outcomes were early virological response (EVR12) and end-of-treatment response (ETR24), the secondary efficacy outcome was sustained virological response (SVR24), and the safety outcomes were adverse events and laboratory tests at end-treatment to assess.
The EVR12 was 60% (12/20), ETR24 90% (18/20), and SVR24 100% (18/18) of CM Peg IFN/RBV therapy. The EVR12 was 15% (3/20), ETR24 70% (14/20), and SVR24 rates were 71% (10/14) in Peg IFN/RBV therapy (P Combination of CM with Peg IFN/RBV for 48 weeks showed significant improvements in the viral response and decreased adverse effects in CHC genotype 2/3 (P

Depression and sexual problems are common in patients with coronary artery disease (CAD) and can influence their quality of life.
The aim of this study was to compare the efficacy of saffron and its main constituent, crocin, in improving mental and sexual health and ultimately quality of life in CAD patients.
This double-blind, placebo-controlled, randomized clinical trial was carried out during 8 weeks in 3 groups, including 1 placebo and 2 intervention groups. The study sample included 58 CAD patients within the age range of 40 - 65 years, referred to Shahid Madani cardiovascular hospital, Tabriz, Iran, from April 2015 to November 2016. The intervention groups received saffron aqueous extract (SAE; 30 mg; n, 20) or crocin (30 mg; n, 19). All the groups completed the demographic questionnaire, Beck depression inventory-II (BDI-II), Hulbert index of sexual desire (HISD), and MacNew health-related quality of life questionnaire.
The BDI-II score significantly decreased in the SAE (pre- and post test scores, 26.10 ± 11.98 and 21.05 ± 9.93, respectively) and crocin (pre- and post test scores, 27.89 ± 8.46 and 22.68 ± 8.01, respectively) groups (P SAE and crocin could improve depression and health-related quality of life in patients with CAD, whereas they had no significant effects on sexual desire.

Technological advances in neonatal care have increased the survival rate of preterm infants, but they have not been able to reduce the risk of the multiple complications developing in them.
To determine the short-term effects of developmental care on preterm infants.
The present quasi-experimental study was conducted on 105 preterm infants (three groups of 35) born in Al-Zahra hospital of Tabriz, Iran, from September 2013 to November 2015. The sampling method was convenience, based on study’s eligibility criteria. The control group received no developmental care. Intervention group 1 received developmental care at the neonatal intensive care unit and the neonatal ward, and intervention group 2 received developmental care from birth in the delivery and operating rooms and continued to receive it at the NICU and the neonatal ward. Short-term neonatal outcomes were analyzed with descriptive and inferential statistics.
The overall duration of hospital stay was significantly shorter in intervention group 2 compared to the control group (mean difference: - 13.6; confidence interval: -24.8 to -2.4; P = 0.013) and intervention group 1 (-12.5; -23.7 to-1.3; P = 0.024), and the duration of NICU stay was also shorter in intervention group 2 compared to the control group (-12.4; -22.2 to -2.5; P = 0.009). The incidence of sepsis was significantly lower in intervention groups 1 and 2 compared to the control group, and the incidence of prematurity anemia and the need for blood transfusion were also significantly lower in intervention group 2 compared to intervention group 1 and the control group (P The results obtained showed that developmental care for preterm infants, especially when initiated as early as in the delivery and operating room, can improve certain short-term neonatal outcomes.

More than half of sexual problems, which cause destruction of life and marital relations is due to insufficient knowledge and wrong health beliefs regarding sexuality. Genital self-image plays an important role in sexual health, genital appearance, and sexual function.
This study aimed to determine the effect of training package on genital self-image and sexual function in health centers of Qazvin, Iran.
In this randomized clinical control trial, 124 Iranian women, between the ages of 18 - 40 years, from Qazvin, were randomized into 2 groups, training and control. The intervention group received 3 training sessions weekly for 1 hour daily. Female Sexual Function Index (FSFI) and the genital self-image scale were completed before and 4 weeks after the end of intervention in both groups. P Between 2 groups, in terms of socio-demographic characteristics, there was no significant difference (P > 0.05). The mean (SD) score of genital self-image in the intervention group before and after intervention was 72.0 (11.4) and 75.7 (11.7), respectively. The mean (SD) score of genital self-image in the control group before and after intervention was 72.9 (12.3) and 75.7 (10.9), respectively. According to the ANCOVA test, there was no significant difference between groups at 4 weeks after intervention in terms of sexual function (mean differences: 0.8; confidence interval 95%: -0.6 to 2.3; P = 0.257) and genital self-image (mean differences: 0.5; confidence interval 95%: -3.3 to 4.4; P = 0.808).
The results showed that training has no effect on the genital self-image and sexual function in women. The systematic planned training could be designed for those suffering from body image disorders and sexual dysfunction in order to promote their sexual function and body image.

Based on the importance of quality of hospital hoteling services on health system outcomes and lack of a valid assessment method to determine and implement the required strategies to evaluate and improve the service quality, the current study aimed at determining factors affecting the quality of hoteling services in teaching hospitals affiliated to universities in Iran.
The current cross sectional study was designed in 2 phases of qualitative and quantitative. In the 1st phase, factors affecting the quality of hospital hoteling services were extracted from the literature and through an in-depth interview with 11 experts (6 from healthcare administration and 5 from the Iranian hoteling industry organization).In the 2nd phase, the data from the 1st phase were integrated and a model for the improvement of the quality of hospital hoteling service was designed. The model was validated through a qualitative (expert opinion) and quantitative approaches (exploratory and confirmatory factor analysis). The data of the factor analysis were collected from 960 patients in 10 teaching hospitals from 10 different cities across the country.
The findings of the current study indicated that 11 factors (physical, functional, economical, human factor, social welfare services, clinical welfare services, safety, cultural, personnel identification, patient guide factors, and healthcare services) explained 65.81% of the variances in the quality of hoteling services. Based on the conformity factor analysis, functional and personnel identification factors with a coefficient of 0.953 and 0.779 had the highest and lowest weight to explain the variance of the quality of the hoteling services, respectively, in the teaching hospitals affiliated to different medical universities in Iran.
Hoteling services quality model has a multidimensional construct and in the current study 11 important ones were identified, out of which functional and personnel identification factors had the highest and lowest weight in explaining the variance of the stated construct.

Positional release therapy (PRT) has been suggested as an effective treatment for myofascial trigger points (MTrPs). Considering the mechanism of PRT, a new modified technique, known as Manual Passive Muscle Shortening (MPMS), is introduced for the treatment of MTrPs.
To compare the effects of MPMS and PRT on the sensitivity of latent MTrPs in the upper trapezius and determine the active cervical lateral flexion range.
In this double-blind randomized controlled trial, 30 female university students, who were identified with latent MTrPs of the upper trapezius, were recruited from Tabriz University of Medical Sciences, Tabriz, Iran. The participants were randomly allocated into experimental (n, 15) and control (n, 15) groups. The experimental group was treated with the MPMS technique, while the control group received PRT. The participants took part in 3 treatment sessions, as well as a follow-up session 1 week after the third session. During each session, the second physiotherapist, who was blind to the pretreatment information, applied the appropriate technique. The visual analogue scale (VAS), pressure pain threshold (PPT), and bilateral active range of cervical lateral flexion were recorded to assess the effects of treatment. The first physiotherapist, who was blind to the treatment approach for the participants, recorded the outcomes before treatment, during the first session, after treatment (third session), and in the follow-up.
A total of 30 participants were included in the data analysis. In the follow-up, intergroup changes indicated a significant increase in PPT (P = 0.000), a significant decrease in VAS scores (P = 0.002), and a significant increase in the right lateral flexion (P = 0.012) in the experimental group. Left lateral flexion also increased in this group, although it was not statistically significant (P = 0.254). At the end of the study, there were no significant differences between the groups (P > 0.05).
According to the results, both MPMS and PRT were effective techniques in immediate pain relief of upper-trapezius MTrPs. Therefore, MPMS may be used as a new technique in the treatment of MTrPs.

Given the importance of water-pipe smoking cessation in health improvement, further studies are required to identify the predictors of this behavior.
This study aimed to examine both one-way direct and indirect effects of the constructs of the extended theory of planned behavior (TPB) on nicotine dependence among women residing in Bushehr, situated in Southwest of Iran.
This cross sectional study was performed in Bushehr province in Southwest of Iran. In this study, 430 women were selected through multistage, stratified, cluster, random sampling and were evaluated using a self-administered questionnaire. Path analysis was applied to estimate the direct and indirect effects of attitude, perceived norms, and personal agency on nicotine dependence.
The results demonstrated that extended TPB is a predictor of nicotine dependence (R2, 34%) and intention to quit water-pipe smoking (R2, 40%). According to the results, the modified model was a good fit for the data (RMSEA, 0.05; NFI, 0.97; AGFI, 0.91). Self-efficacy (factor loading, -0.30) and perceived behavioral control (factor loading, -0.17) both directly and indirectly affected nicotine dependence through intention. However, in this study, subjective norms did not predict nicotine dependence.
The finding showed that skill-based training should be implemented in interventional programs to increase self-efficacy, alongside policies to constrain access to water-pipe smoking. Therefore, social and cognitive interventions can be effective only in the presence of political changes.

Electroconvulsive therapy (ECT) is famously known as a treatment for depression; however, memory impairments have always been a point of concern. The use of opioid antagonists may protect against the development of memory deficits after ECT. The current study aimed at assessing the effect of Naltrexone in diminishing memory impairments.
This randomized, double-blinded, placebo-controlled clinical trial took place at Imam Hossein hospital of Tehran/Iran. Patients diagnosed with MDD, were assigned to either Naltrexone or placebo and received 6 sessions of ECT within 2 weeks. Wechsler Memory Scale was performed the day before the first session of ECT, as well as 2 weeks, 1 and 3 months after finishing the 6th session. The Hamilton depression rating scale was performed 2 times to examine the possible interference caused by depression or to relapse as a confounding variable.
Patients receiving Naltrexone and placebo showed no significant difference in WMS scores. However, after further assessment, changes of WMS scores in every round were compared; the results showed that after 2 weeks from baseline, the amount of the reduction of total WMS scores from baseline was significantly lower in the Naltrexone group (P = 0.04).
This study suggests that Naltrexone as compared to placebo has no advantageous effect on attenuating memory deficits in the long term. It is a smaller degree of memory decline that makes Naltrexone superior to placebo.

Oral health has a major role in the health as well as quality of life of older adults.
The present study was conducted with the aim to determine the relationship between oral health and cognitive status of the elderly.
In this descriptive, correlation, cross sectional study, 206 older individuals were selected according to a stratified random sampling method from health centers in Ghaemshahr, Iran between May and October 2016. Data collection tools included cognitive state test (COST), geriatric oral health assessment index (GOHAI), geriatric depression scale, as well as a socio-demographic questionnaire. Dental history and risk factors for cardiovascular diseases were also recorded. Data were analyzed using a logistic regression test.
The mean age was 67.71 ± 7.28 years. Out of all participants, 53% (111 individuals) were women, 81.6% (168 individuals) were married, 50.5% (104 individuals) were overweight, 19.4% (40 individuals) had hypertension, and 30.1% (62 individuals) had concomitant hyper-lipidemia, diabetes, and hypertension. No significant relationship was found between age and oral health; however, the relationship between age and cognitive score was significant (P = 0.002). Tooth loss was the most predictive of the cognitive state. People that lost 5 - 7 teeth were 4.16 times more at risk for cognitive decline. The cognitive score of those with no weight gain was 2.6 times better than those with weight gain. The cognitive state improved by 1.77 times with a higher education level. The cognitive state of participants who better observed oral health was 1.14 times better. Generally, predictive power of the model was 57.2%.
Development of interventions to improve older adults’ oral health seems to be essential.

Acinetobacter baumannii isolates resistant to fluoroquinolones, such as levofloxacin and ciprofloxacin are being increasingly developed every day.
In this study, ciprofloxacin resistance in A. baumannii isolates was determined by the presence or absence of efflux pump inhibitors, as the efflux pumps play an important role in the creation of ciprofloxacin resistance.
One hundred and three Acinetobacter isolates were collected from ventilator-associated pneumonia (VAP) and burn patients of Tehran hospitals, Iran, during six months of 2014. Susceptibility rates of the isolates to levofloxacin and ciprofloxacin antibiotics were assessed using the agar disk diffusion and broth microdilution. The effects of the efflux pump inhibitors including phenylalanine-arginine β-naphthylamide (PAβN) and 1-(1-naphtylmethyl)-piperazine (NMP) on ciprofloxacin resistance were investigated. Further, the quinolone resistance qnrA, qnrB, qnrS, and adeABC genes were evaluated using the polymerase chain reaction (PCR) test. Finally, to examine the mutation in quinolone resistance-determining regions, the PCR products of the gyrA and parC genes were sequenced.
According to the results of the antibiogram test, 74.7% and 33% of the studied isolates were resistant to ciprofloxacin and levofloxacin, respectively. Also, there was a significant relationship between the type of the specimen and resistance to ciprofloxacin (P = 0.02) and resistance to levofloxacin (P = 0.04). As for the synergistic study of the inhibitors with ciprofloxacin, the reduction of minimum inhibitory concentration (MIC) was observed in 40% and 56.6% of the isolates in the presence of PAβN and NMP, respectively. The prevalence rates of qnrA, qnrB, qnrS, AdeA, AdeB, and AdeC genes were 0%, 0%, 3.9%, 100%, 100% and 100%, respectively. In all the resistant isolates, mutation of in the gyrA gene was observed, but no mutation was seen in the parC gene.
The presence of the efflux pumps and the gyrA gene mutation are still considered as the most important factors causing fluoroquinolone resistance; however, identification of the qnr genes for the first time in Tehran hospitals, Iran, can lead to further concerns in the future.

Magnetic resonance imaging (MRI) can provide a reference for tumor treatment and its quantitative parameters can serve as imaging indicators that reflect tumor angiogenesis and vascularity. Kanglaite (KLT) has therapeutic effects on cancers. In this study, DCE-MRI was used to investigate its application in evaluating KLT anti-colorectal cancer.
Evaluating the efficacy of Kanglaite (KLT) injection for treatment of colorectal cancer with dynamic contrast-enhanced MRI (DCE-MRI) parameters.
This study was an experimental study. The 20 successfully modeled nude mice were randomly assigned to 2 groups: blank control group (n = 10) and the KLT injection group (n = 10). The research protocol was approved by the ethics committee of the second affiliated hospital of Xinjiang medical university (protocol NO: 20140216-12) in 2015. A subcutaneous xenograft colorectal tumor model was subjected to KLT treatment. DCE-MRI obtain the parameters including Ktrans, Ve, Kep, Vp, immunohistochemical staining measure microvascular density (MVD), levels of vascular endothelial growth factor (VEGF), and proliferating cell nuclear antigen (PCNA).
Compared to the blank control, the volume of tumor in the KLT group markedly reduced by 49%. 48 hours after, compared to the blank control, the Ktrans (0.028 ± 0.009 vs 0.012 ± 0.006), Ve (0.312 ± 0.089 vs 0.287 ± 0.037), and Kep values (0.321 ± 0.056 vs 0.577 ± 0.033) decreased in KLT group (P The parameters of DCE-MRI may be used as imaging biomarkers for assessing the status of tumor-bearing vasculatures and provide a basis for evaluating the efficacy of anti-tumor drugs.

Buprenorphine is used to treat opioid use disorder and pain syndromes. This drug may be a suitable treatment choice for refractory depression, anxiety, self-injurious behaviors, and suicidal ideation. However, it has a significant abuse potential, which limits its use in suicidal patients with a history of substance abuse.
Case Report: In this report, we present a case of chronic suicidal ideation due to substance-induced depressive disorder in a 25-year-old man from Noorabad, Fars, Iran. The patient was successfully treated with an 8-mg single dose of sublingual buprenorphine with minimal probability of diversion or misuse. We observed that 8 mg of buprenorphine exerted a rapid effect on the reduction and cessation of suicidal thoughts and depression.
We demonstrated the antisuicidal effectiveness of a single dose of buprenorphine, which can be administered with minimum risk of diversion or misuse for suicidal patients with a history of substance abuse.

Cesarean rate increased in recent decades worldwide. One of the consequences of the increased cesarean rate and repeat cesarean is the significant increase in cesarean scar pregnancies (CSPs). Diagnosis of a CSP is more difficult when there is a heterotopic pregnancy in a non-assisted pregnancy.
The patient was a 34-year-old G5P2L2Ab2 referred for spotting in Shahidan Mobini hospital, Sabzevar, Iran in 2016. She had a history of 2 cesareans and 2 abortions. Three ultrasounds were performed showing a gestational sac in the lower segment of the uterus with different diagnoses: 1) with hemorrhage over it, 2) with the 2nd gestational sac over it, which was diagnosed as missed abortion, and 3) with an echo-free and irregularly region supporting the 2nd sac or a clot in the lower part of the uterus. The increased local vascularity suggested a level of placenta accreta, partial mole, or trophoblastic reaction. Since the first diagnosis was missed abortion, curettage was performed. Due to the continuation of severe bleeding, abdominal hysterectomy was performed. The patient was discharged in good condition after 3 days.
Heterotopic CSP does not have any specific symptoms, which caused it to be easily misdiagnosed. Physicians should use precise diagnostic tests in case of controversial test results.

Currently, creating a secure airway for general anesthesia is an integral part of the process of anesthesia. The difficulty of this process effects morbidity and mortality rates. In order to achieve further success in these patients, it is advised to use video laryngoscope.
The patient was a 45-year-old female, who was a candidate for cholecystectomy along with laparoscopic surgery, and had referred to Peimaniyeh hospital of Jahrom, Iran, during September 2016. In the initial assessment, the patient seemed to be in a difficult airway class, while in her surgery documents from 5 and 10 years ago and in her previous records no history of this problem was mentioned. After the administration of drugs before surgery and anesthesia induction, tracheal intubation had failed by use of routine laryngoscope and McCoy laryngoscope in two stages. Finally, the use of video laryngoscope for tracheal intubation was successful. During the intubation attempts, the patient was ventilated with 100% oxygen mask and her arterial blood oxygen saturation had not decreased.
Therefore, it is recommended for the patient to be investigated carefully in terms of airway management. In addition, in case of difficult intubation, selecting video laryngoscope to facilitate intubation may be appropriate. The mere absence of a difficult airway management is not a reason that the problem will not occur in the future.