amal saki malehi

Diabetes mellitus (DM) is a common chronic disease that can significantly decrease life expectancy due to its complications. Grapes ( Vitis Vinifera L. ) and their byproducts, including seeds, have been used globally to treat various ailments. In this clinical trial, we investigated the effect of Iranian grape seed extract (GSE) on fasting blood sugar (FBS), lipid profile [including total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), and triglycerides (TG)], as well as systolic and diastolic blood pressure (SBP and DBP, respectively) in patients with type 2 DM (T2DM). Seventy-four patients with T2DM were divided into two groups; 38 patients in the treatment group received 263.2 mg of GSE (standardized to contain 250 mg of proanthocyanidine) twice daily, and 36 patients in the placebo group received 263.2 mg of placebo twice daily for thirty days. At the end of the intervention, a statistically significant decrease was observed in SBP [from 125.83 ± 13.39 in the placebo group to 121.94 ± 7.49 in the treatment group (P = 0.002]), and FBS [from 144.75 ± 30.82 in the placebo group to 129.87 ± 31.79 in the treatment group (P = 0.001)]. There were no significant changes in total cholesterol, HDL, LDL, TG, and DBP between the two groups. Consuming Iranian GSE for a short duration can lower FBS and systolic blood pressure (BP), suggesting that GSE may play a key role in improving BP and fasting blood glucose in patients with T2DM.

Children, especially at the age of <4 years, are one of the high-risk groups facing burn injuries. In addition, childhood is an important time for children’s growth and development because during this period, children acquire many skills in different areas of motor, cognitive, and social performance. Accordingly, this study investigates the effects of age, burn, and the amount of physiotherapy services on the developmental status of children under 5 years of age with burn injuries using the ages and stages questionnaire.

In this cross-sectional study, conducted using a descriptive-analytical method, information was extracted on 93 children under 5 years of age with second and third-degree burn injuries who were admitted to Ahvaz Accident and Burn Hospital, in Ahvaz City, Iran. The electronic link of the ages and stages questionnaire, which is one of the most common and widely used tools for measuring children’s developmental status, appropriate to the child’s age group was sent to one of the parents. They were asked about the number of physiotherapy sessions after discharge by phone.

The area of fine movements showed the highest frequency of developmental delay (8.25%). The results of the Mann-Whitney analysis showed that the mean age of children with fine movement disorders (area 3) was higher (P=0.016) and more time had passed since their burns (P=0.019) compared to healthy people. No statistically significant difference was observed between the number of sessions receiving physiotherapy services during hospitalization (P=0.74) and discharge (P=0.69) between these two groups.

Burns is one of the influential factors in the delay of children’s developmental status, which involves motor development (fine and gross movements) and problem-solving. Movement disorder is more common in old age. Also, as more time passes since the burn, the delay of fine movements is more visible.

Dear Readers, We wish to inform you of the withdrawal of this article recently published in our journal (1). This decision comes after careful consideration and in accordance with the request of the authors. The authors have provided the following statement regarding their decision (Ticket #512394): "Considering that the authors of the article have realized that the reported results require further review to ensure their accuracy, we request the withdrawal of the article." The integrity and accuracy of the research we publish are of utmost importance to us. In line with this commitment, we respect the authors' decision to withdraw their article for a thorough review and verification of its results. We appreciate the authors' proactive approach to maintaining the quality and reliability of their work and the scientific record. We understand that the withdrawal of an article may cause inconvenience to our readers, and we apologize for any confusion this may have caused. We thank you for your understanding and continued support of our journal's dedication to the highest standards of scientific publishing. Sincerely, Masood Fereidoonnezhad EIC

The physiological changes in postmenopausal women, especially age-related physical changes, may lead to negative experiences in body image among these women.

This study aimed to determine the effectiveness of cognitive behavioral group therapy on the negative body image of postmenopausal women.

This parallel randomized clinical trial study was conducted on 22 eligible postmenopausal women attending a health care center in Ahvaz, Iran, in 2018. They were randomly selected and assigned to intervention and control groups (n = 11 per group). The intervention group attended eight 90-minute sessions of cognitive behavioral therapy (CBT) based on the Cash 8-step model. All participants completed the body image concern inventory (BICI) and Multidimensional Body-Self Relations Questionnaire (MBSRQ) before, immediately after, and 1 month after the intervention. The chi-square test, independent t-test, and repeated measures test were used to investigate the trend of changes in BICI and MBSRQ and their domains over time in both groups. P values less than 0.05 were considered statistically significant for all tests.

Before the intervention, there were no statistically significant differences in demographic characteristics (such as age, age of menopause, and body mass index (BMI)) between the 2 groups; also, there were no statistically significant differences in themean scores of MBSRQ and BICI between the 2 groups (P < 0.05). After the intervention, a significant increase was observed in the mean scores of MBSRQ and its 3 out of 6 domains (appearance evaluation (AE), appearance orientation (AO), and body areas satisfaction (BAS); P < 0.05), while a significant decrease was observed in the mean scores of BICI in the intervention group compared with the control group (P < 0.05).

Cognitive behavioral group therapy based on the Cash 8-step model in postmenopausal women can promote satisfaction with their body image.

This study was aimed to determine the relationship of job satisfaction and quality of work life with organizational citizenship behavior in the staff of rehabilitation clinics affiliated to Ahvaz Jundishapur University of Medical Sciences.

The current research was a descriptive-cross sectional study that was conducted by census method in the second half of 1399 among all staff of the rehabilitation clinics affiliated to Ahvaz Jundishapur University of Medical Sciences. The research tools were the Minnesota job satisfaction questionnaire, the Walton's quality of work life questionnaire, and the Oregon organizational citizenship behavior questionnaire.

The results showed positive and significant relationship between the job satisfaction and organizational citizenship behavior (p < 0.001, r= 0.55) and also between the quality of work life and organizational citizenship behavior (p < 0.001, r= 0.45). Further analysis indicated that among the domains of organizational citizenship behavior, Job satisfaction and quality of work life were significantly associated with domains of the politeness and consideration (p < 0.001, r= 0.76, p < 0.001, r= 0.66, respectively), civic virtue (p < 0.001, r= 0.52, p= 0.01, r= 0.26, respectively), and altruism (p= 0.009, r= 0.28, p= 0.04, r= 0.21, respectively).

Our results suggest that the managers of the health centers develop the programs for the enhancement of quality of work life and job satisfaction in the staff working in the rehabilitation centers. It can be helpful for the development and promotion of the extra and voluntary roles and behaviors in these staff.

Background and Objectives This study compared conventional dose fractionation and hypofractionation in breast cancer radiotherapy to optimize treatment planning using different physical indices Subjects and Methods In this retrospective study, the treatment plans of 30 patients eligible for radiotherapy for left-sided breast cancer were investigated. Patients were treated with a conventional dose- interval regimen and three hypofractionated regimens. Dosimetry indexes such as the homogeneity index, conformity index, and mean dose to the left breast, lung, and heart were extracted from the dose-volume histogram and compared with each other to study the four different treatment regimens. Results According to the data obtained, the mean dose to the left breast (PTV), heart and ipsilateral lung was significantly reduced in hypofractionation methods compared to conventional regimen. The homogeneity and the conformity index values showed no significant difference in any of the treatment regimens. The dose received showed no difference in lung volume. For heart, the volume of 38 and 43% of the prescribed dose were significantly higher in the conventional method than in the three hypofractionation regimens. Conclusion Hypofraction treatment regimens with fewer treatment fraction and a dose per fraction greater than 2Gy compared to conventional dose fractionation led to a dose reduction for the heart and the same side of the lung.

 One of the most common cognitive disorders after major surgery is delirium which can increase morbidity and mortality. This study compared the effect of dexmedetomidine with or without melatonin to reduce delirium following coronary artery bypass graft (CABG) surgery.

 This trial was a double-blind, randomized, controlled clinical trial. Eighty patients in two different groups with the administration of dexmedetomidine alone or with melatonin undergoing CABG surgery in Golestan Hospital, Ahvaz, 2022 - 2023, were randomly allocated. This study evaluated the occurrence, onset, and length of delirium, haloperidol, the time required for weaning, and the duration of stays in the intensive care unit (ICU) and hospital.

 The occurrence of delirium was lower in the melatonin/dexmedetomidine group (15%) than in the dexmedetomidine group (30 %) (P = 0.09). Additionally, the melatonin/dexmedetomidine group had a significantly lower duration of delirium than the dexmedetomidine group (1.95 (0, 20) and 8.46 (0, 40) P = 0.04). However, no significant difference was observed in the onset of delirium between the two groups (P = 0.25). The length of hospital stays in the melatonin/dexmedetomidine group was significantly shorter than in the dexmedetomidine group (7.53 (7, 10) and 8.60 (7, 15), P = 0.03). However, the two groups demonstrated no significant difference between extubation (P = 0.38) and length of ICU stay (P = 0.19).

 The administration of melatonin and dexmedetomidine reduced the incidence of post-cardiac surgery delirium, shortened its duration, and decreased the impact of many risk factors observed in those not receiving the added melatonin.

Recently published researches show that 59% of all transmission came from asymptomatic transmission and at the time of diagnosis health‑care workers (HCWs) tend to present without respiratory symptoms. These evidences have raised questions on whether an essential policy for use of personal protective equipment (PPE) is the best approach in HCW and other people or not. Therefore, this study conducted to investigate the effectiveness of using face masks and PPE in reducing the spread of COVID‑19 in health‑care and non‑health‑care settings. This systematic review and meta‑analysis study was prepared according to the preferred reporting items for systematic review and meta‑analysis statement and guided by meta‑analysis of observational studies recommendations. Searches in databases were conducted from December 2019 to July 2021. Random‑effects meta‑analysis was performed to investigate the effect of using face masks and PPE on spread of COVID‑19. Heterogeneity among studies was assessed using Cochran’s Q test and the I2 metrics. In total, 9920 individuals from 14 studies were included in this study. In all settings, application of PPE or any type of masks was associated with reduction in risk of COVID‑19 (odds ratio [OR] = 0.44; 95% confidence interval [CI]: [0.29, 0.65]; I 2 = 85.21%). In the HCW subgroup, the protective effect had a combined OR of 0.33 (95% CI: (0.15,0.73), I2 = 82.61%). Six studies were found protective effects of wearing mask in non‑HCWs (OR = 0.58, 95% CI: (0.31, 1.06), I2 = 85.63%). Results suggest that there is association between face mask/PPE use and reduction of COVID‑19.

Pediculosis, caused by Pediculus spp is an important public health problem in urban and rural areas around the world. Natural compounds such as plant essential oils (EOs) have been suggested as a potential alternative for insect pest control recently. The purpose of this study was to investigate the toxicity of Foeniculum vulgare essential oil against the head louse, Pediculus capitis under laboratory conditions.

Fennel essential oil components were analyzed using GC-mass apparatus. Immersion and contact filter paper bioassays were used to evaluate fennel essential oil toxicity at the two-fold concentrations of 2.5, 5, 10, 20, and 40% against nit and nymph/adult stages of the head louse.

Trans-anethole, α-Thujone, and limonene, which consisted of 76.08%, 10.37%, and 5.34% were the most com ponents of fennel oil respectively. The LC50 values for the adult /nymphs were 11.5, 6.4, 3.9, 3.1 and 2.5% and LC99 values were 29.5, 15.2, 12.8, 10.8, and 7.4% at 10, 20, 30, 45 and 60 minutes after exposure respectively. The le thal times (LT50) for adults/nymphs were 5.2, 8.1, 9.5, 20.5, and 45.8 minutes and LT99 were 138.6, 91.3, 23.8, 21.7, and 13.9 minutes in the concentrations of 2.5, 5, 10, 20 and 40%, respectively. LC50 and LC99 values were 2.32% and 7.36% after 5 days for the eggs.

Fennel essential oil at the concentration of 15% after 20min is suggested to develop as an appropriate for mulation to evaluate in clinical trials.

Age at menarche affects women’s health outcomes and could be a risk factor for some diseases such as Metabolic Syndrome. We assessed the association between age at menarche and metabolic syndrome components in women aged 35 to 70 in Hoveyzeh, southwest Iran. Study Design: A case-control study

This case-control study was conducted on 5830 women 35 to 70 years in the Hoveyzeh cohort study (HCS), a part of the PERSIAN cohort study, between 2016 and 2018. The case group was women with MetS, while the controls were women without MetS. Metabolic syndrome is determined based on standard NCEP-ATP III criteria. Data from demographic, socioeconomic, and reproductive history were gathered face to face through trained interviews. Also, lab, anthropometrics, and blood pressure measurements were assayed for participants. Multiple Logistic Regression was used to estimate the association between age at menarche and metabolic syndrome, with adjustment for potential confounding variables.

The mean age at menarche was 12.60 ± 1.76 years old. Urban and rural women differed in their age at menarche (12.58±1.71 and 12.63±1.83 years, respectively). A comparison of the four menarche age groups (≤10, 11-12, 13-14, 15-16 years) was statistically different between age at menarche and MetS. The odds of having metabolic syndrome for groups with menarche ages 13-14 years and 16-15 years, compared to women with a menstrual age ≤10 years, decreased by 21% and 20%, respectively.

The present study showed the effect of age at menarche on the odds of having MetS in women 35-70.

In many studies, Cox regression was used to assess the important factors that affect the survival of cancer patients based on demographic and clinical variables. The aim of this study was to determine the factors affecting the survival of patients with Hodgkin's lymphoma using the random survival forest (RSF) method and compare it with the Cox model.

In this retrospective cohort study, all patients with Hodgkin's lymphoma who were referred to the Oncology and Hematology Center of Ahvaz Shafa Hospital from March 2000 to February 2010 were included. The survival time was calculated from diagnosis to the first recurrence event date (based on month). To assess the process of the disease, demographic characteristics and disease-related variables (including disease stage, chemotherapy, site of lymph involvement, etc.) were extracted from the records of 387 patients with Hodgkin's lymphoma. To investigate the prognostic factors that affect the recurrence of disease the Cox model and RSF were implemented. Moreover, their performance based on the C-index, IBS, and predictor error rate of the two models were compared Data analysis was implemented by using R4.0.3 software (survival and RandomForestSRC packages).

The results of the Cox model showed that LDH (P=0.001) and classical lymphoma classification (P<0.001) were associated with an increased risk of relapse in patients. However, the results of the RSF model showed that the important variables affecting the recurrence of disease were the stage of disease, chemotherapy, classical lymphoma classification, and hemoglobin, respectively. Also, the RSF model showed a higher (c-index=84.9) than the Cox model (c-index=57.6). Furthermore, the RSF model revealed a lower error rate predictor (0.09) and IBS index (0.175) than the Cox model. So, RSF has performed better than the Cox model in determining prognostic factors based on the suitability indicators of the model.

The RSF has high accuracy than the Cox model when there is a high number of predictors and there is collinearity. It can also identify the important variables that affect the patient's survival.

Although cochlear implantation (CI) is a safe surgical procedure for severe to profound sensorineural hearing loss (SNHL) but, due to the embryological and anatomical connection between the vestibular and cochlear structures, vestibular dysfunction may occur after CI. Video head impulse test (vHIT) is a reliable test for assessing the function of semicircular canals (SCCs). This study aimed to determine the early effect of CI on SCCs function, by comparing pre- and post-operative vHIT results.

In this cross-sectional study, participants were 22 adults with SNHL scheduled for unilateral CI in the right ear and 22 age-matched healthy subjects as a control group. The vHIT was conducted before and two weeks after CI.

The mean vHIT gains in the SNHL group were significantly lower than in controls, with a large effect size. Furthermore, the mean vHIT gains in the right lateral SCCs (p<0.001) and right anterior SCCs (p=0.003) were significantly reduced after CI, compared to the gain values before CI, with a large pooled effect size. However, these differences were not statistically significant for the right posterior SCCs. The comparison of vHIT gains in the nonimplanted ear showed no statistically significant difference between pre- and post-operative phases.

The vHIT is a useful clinical method to detect the early effects of CI on the function of SCCs. These effects are more obvious in the lateral and superior SCCs in the implanted ear.

Foods with low glycemic index (GI) and high satiety index (SI) have been associated with decreased risk of chronic diseases and obesity. This study investigated the effect of date seed flour (DSF) on the GI, glycemic load (GL), and SI of white bread (WB).

Ten healthy subjects were examined on four different days within 3-6 days intervals to determine GI and GL. The blood sugar level was measured during fasting, and 15, 30, 45, 60, 90, and 120 min after receiving glucose, WB, and breads containing 20% and 40% DSF, and GI and GL were calculated. To determine SI, 20 healthy individuals consumed 240 kcal portions of test breads in separate instants at 3-6 day intervals. The satiety ratings were collected at fasting and every 15 min for over 120 min after food ingestion, and SI was calculated.

The GI of breads containing 20% (52.64) and 40% (49.11) DSF was significantly lower than that of WB (73.9) (p<0.004, p<0.005, respectively). Also, the GL of breads containing 20% (9.45) and 40% (7.32) DSF was lower than that of WB (p<0.001, p<0.001, respectively). The SI of breads containing 20% (200) and 40% (290.79) DSF was significantly greater than that of WB (p<0.001, p<0.001, respectively). Finally, the SI of bread containing 40% DSF (290.79) was greater than that of bread containing 20% DSF (200) (p<0.01).

Replacing part of white wheat flour with DSF significantly reduces the GI and GL and increases the SI of WB.

Breast cancer is the most important cause of cancer death in women. The purpose of this study was to evaluate the effect of Estrogen Receptor (ER), Human Epidermal Growth Receptor (HER2) and other factors on post-surgical survival of the patients with breast cancer using Bayesian approach for parametric proportional hazards model.

This was a retrospective study. Data of 165 breast cancer patients who had undergone surgery at Ahvaz Healing Diagnostic Center from 2004 to 2014 were recorded in a data collection form. The variables of age, tumor size, number of lymph nodes involved, cancer grade, ER status and HER2 status were evaluated. Survival time was calculated from the date of surgery to the date of death or study end date (September 2015), in months. In the Bayesian approach in parametric survival analysis models with proportional hazards, the lateral distribution of parameters was estimated using MCMC method. Also, we evaluated efficiency of the models using the deviance information criterion. All data analysis steps were performed by using Stata15 software. Significance coefficients of the model were determined using the 95% credible interval.

The mean and standard deviation of age were 46.40 and 9.94 years, respectively. Deviance information criterion for Weibull parametric model was lower than those of other parametric models. Based on the Bayesian estimation of the Weibull's proportional hazards parametric model, tumor size (HR = 1.40), the number of involved lymph nodes (HR = 1.016), Ki67 status (HR = 1.115), tumor grade (HR = 1.022), HER2 status (HR = 1.760) and ER status (HR = 1.381) had a positive effect on risk of death. Age had a negative effect on risk of death (HR=0.978).

Based on the Bayesian proportional hazards Weibull model, tumor size, the number of involved lymph nodes, Ki67, tumor's grade, HER2 and ER had a positive effect on the risk of death.

Breast cancer is the most common type of cancer and the leading cause of cancer death among women. According to estimates in 2018, the most frequency of cancer in Iranian women was related to breast cancer with 13776 (12.5%) new cases. Metastasis is a complication of this disease that occurs in 1%-5% of patients. The aim of this study was to investigate the effect of hormone receptors and Her-2 status on metastasis status in patients with breast cancer using logistic regression.

In this retrospective study, medical records of 165 breast cancer patients referred to the Ahvaz Shafa Diagnostic and Treatment Center who underwent surgery during 2006-2014 was recorded. Multinomial logistic regression model was applied to identify the related factors to the metastasis status.

In the studied patients, 35.2% (58 patients) experienced metastasis. In multinomial logistic model, Her-2 status (P = 0.026) and lymph node involvement (P <0.001) were significant. The odds of metastasis in ER-positive individuals was 2.24 times that of ER-negative individuals (AOR=2.24; CI95%: (0.955-5.275)). Also, the odds of metastasis in patients with lymph node involvement was 5.40 times that of patients without involvement (AOR=5.407; CI95%: (2.180-13.414)). This odds in people with Her-2-positive status was 2.35 times than in those with Her-2-negative status (AOR=0.438; CI95%: (1.109-4.999)).

In this study, Her-2-positive status and lymph node involvement were identified as factors associated with metastasis. Early detection of these factors can lead to greater survival of breast cancer patients.

Patients undergoing mechanical ventilation cannot self-report pain because of intubation, altered levels of consciousness, and high doses of sedative agents. Therefore, inadequate pain management increases the duration of connection to the ventilator. The aim of this study was to evaluate the effect of pain control algorithm on pain intensity and duration of patientschr('39') connection to ventilator.

This clinical trial was conducted on 396 patients undergoing mechanical ventilation conveniently recruited from intensive care units of teaching hospitals affiliated to Ahvaz Jundishapur University of Medical Sciences (Ahvaz, Iran) from August 2017 to June 2016. Participants were allocated to the intervention (n=198) and control (n=198) groups through permuted block randomization. Block size was four. In the experimental group, pain intensity was measured daily for 10 days using pain behavioral instrument and pain relief was performed based on pain control algorithm. In addition, the two groups were examined daily by a researcher-made checklist for weaning criteria from the ventilator for 10 days.

In the experimental group, pain intensity started to decrease from the first day of intervention (P<0.0001). The connection time to the ventilator was also reduced and this difference was statistically significant compared to the control group (P<0.0001).

The findings of this study showed that the use of pain control algorithm could lead to better pain management and reduce the duration of ventilator connection in patients admitted to intensive care units. However, to increase clinical utility and to achieve more targeted pain treatment, more focus on implement an algorithm and reassessment of patients’ pain is needed.

 Dioxins and dioxin-like chemicals composed of 419 compounds are a large group of compounds, including polychlorinated di-benzo-p-dioxins (PCDDs), dibenzofurans (PCDFs), and biphenyls (PCBs). Dioxins are extremely persistent in the environment and disperse in a great distance from the emission source, and bioaccumulation in the food chain is one of their critical properties. The incidence of breast cancer among Iranian women is about 30 to 35 per 100,000 cases. The present study is a systematic review of published studies in English language to discover the relationship between exposure to dioxin compounds and breast cancer.

We conducted a comprehensive literature review utilizing PubMed, Embase, Scopus, and ISI web of science databases. The MeSH-based keywords used included Organic Chemical (MeSH) OR Dioxins (MeSH) AND cancer (MeSH) OR Breast cancer (MeSH) AND Breast disease (MeSH).

The review of the literature indicated a significant positive association between dioxins exposure and the risk of breast cancer. Only in one study, breast cancer mortality rate was reported in terms of exposure to dioxins, and standardized mortality rates (SMRs) were determined.

Although there were limitations in this study, statistical analyses in various epidemiological studies demonstrated that dioxins exposure is linked to an increased risk of breast cancer.

 In clinical cancer studies, there has been a high tendency of searching for more specific and new prognostic factors in cancers in the last few years. This multistate study aimed to model the progression of Hodgkin's disease by accounting for individual effect (heterogeneity) using the joint and independent frailty models.

 After the utilization of the illness-death model, joint-modeling accounted for the dependency between relapse and death by considering the individual characteristics as a frailty term. Therefore, the effect of influential prognostic factors was evaluated on disease progression by frailty and joint-frailty multistate models.

 The individual predictions were determined using the frameworks of the both models. The model was applied to 389 Hodgkin lymphoma patients. Gender (male), age (over 55 years), and low level of hemoglobin (less than 10.5) were associated with an increased risk of death and relapse in patients. The likelihood cross-validation criterion was proposed to choose the joint frailty model as a better fitting model.

 Multistate models were appropriate tools to study the whole event history of the subjects, which provided a deep insight into the dynamics of the disease. The problem of events-subjects dependency in the survival data was clarified using the multistate model. Therefore, the heterogeneity and dependency between the states led to more accurate estimations of the effects of the prognostic factors, thereby improving the predictions.

In Iran, breast cancer accounts for 24.4% of all cancers and contributes to 14.2% of cancer-associated mortality in women. A major challenge facing the health system is to examine the health status of patients with breast cancer, which often involves the axillary lymph nodes. The number of involved nodes should be clinically predicted to ascertain postoperative radiotherapy and chemotherapy. The present study employed regression models to investigate the determinants of the number of lymph nodes involved in patients with breast cancer.

This retrospective study recruited patients diagnosed with breast cancer during 2005-2015 referring to Shafa Hospital affiliated to Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. The outcome variable was the number of involved lymph nodes. Regression models for count outcomes, were utilized for investigating the related factors to the number of involved lymph nodes in patients with breast cancer.

A sample of 165 patients was eligible for the present study. The Akaike information criterion (AIC) of the zero-inflated negative binomial (ZINB) model was the lowest. The logistic part showed that absence of metastasis significantly increased the chance of node-negative breast cancer (P=0.027). The negative binomial part revealed an increase of 86% in the risk of a greater number of involved nodes in stage III breast cancer compared to stages I and II, suggesting that the patients were at a high risk (P=0.006).

Metastasis status and tumor grade significantly relate to the number of lymph nodes involved in breast cancer. Determining the factors associated with nodal involvement is crucial for the early diagnosis of breast cancer by clinicians.

 To review the most recent GHS index annual report to observe the regional and global level of health security against the COVID-19 outbreak, as well as their relationship with the case fatality rate, among 210 countries and territories worldwide.

 We analyzed October 2019 GHS index, to assess the capacity of health security-based on the GHS index in the context of six categories. We prioritized not only the capacities of 210 countries and territories around the world using the GHS index but also the existence of functional capabilities to prevent pandemics at the source. Data were collected from global databases, including Worldometer, WHO, and Disease Control and Prevention Center (CDC).

 This study collected data on 210 countries and territories, of which up to April 14, 2020, 72 countries (34.28%) with more than 1,000 total COVID-19 cases were present. In the most prepared group, the number of total COVID-19 diagnostic tests had a significant positive relationship with the GHS index (r = 0.713; P = 0.006). Case fatality rate was directly associated with the detection index (r = 0.304; P = 0.023) in more prepared group”. In the Lower-middle-income economies group, the case fatality rate was positively related to detection, response, and risk environment indices.

 With the exception of a very small number, countries that were ranked as most prepared countries were more likely to be affected by the COVID-19 outbreak of the virus and its health consequences and needed to seriously reconsider their capabilities and health security in the context of detection, prevention, rapid response, health system facilities, and risk environment against disease outbreak.

Breast cancer remains the most prevalent neoplasm in women, with more than 450000 deaths each year, worldwide. In cancer researches, several factors such as serum tumor markers have an important role in screening, treatment, and recurrence of the disease. Carcinoembryonic antigen (CEA) is one of the most widely used serum tumor markers in the clinical evaluation of patients with breast cancer. This study aimed to evaluate whether increasing serum CEA levels is an indicator of breast cancer patient’s survival or not.

This retrospective study was done at Hematology Department of Shafa Hospital of Ahvaz, southwest of Iran. Only those patients who had mastectomy during 2006-2014 and regularly referred to the hospital were included. The joint survival longitudinal model was applied to analyze the data. JM package in R software was used for joint modeling analysis.

The five-year survival rate was 73.0%. Age and follow-up time were associated with CEA tumor marker values. Higher age is associated with higher CEA values over time (P=0.0156). There was a significant linear increasing trend in CEA values over time (P=0.0465). There was a significant difference between patients with and without nodal involvement (HR [95% CI]: 1.880 [1.330- 5.565]; P=0.0298). There was a positive correlation between CEA tumor marker levels and death (HR [95% CI]: 2.770 [1.369-5.603]; P=0.0046).

Higher age is associated with higher CEA values over time. The involvement of lymph nodes increases the hazard of death. Death is more likely to occur in patients with higher CEA tumor marker levels

Cultural competence is the ability to work effectively as an individual or an organization in the context of the cultural beliefs, behaviors and needs of customers and society. Due to the necessity of this feature in nurses, the present study aimed to investigate the level of cultural competence in employed nurses.

This descriptive study was performed on 230 nurses working in educational and private hospitals in Ahvaz and Isfahan, Iran, who were selected by random sampling with inclusion criteria. Data gathering tool was a researcher-made cultural competency questionnaire. Data were analyzed using SPSS 22 by describing and deduction examining like independent samples t-test, ANOVA, and Tukey test.

  Of the participants, 67.8% were women and 92.6% had undergraduate degrees. The average work experience was 10 years, and 69.1% of nurses reported experience of working with patients with different cultures. The mean score of nurseschr('39') cultural competence was in the average level (104.8±11.58). The results also showed that the mean score of cultural competence was the highest in cultural flexibility dimension (24.46 ± 3.46) and lowest in cultural desire dimension (10.73±3.90).

Due to the expansion of cultural diversity of patients in Iran, the average level of nurseschr('39') cultural competence in this study indicated the necessity of increasing the attention and planning of nursing managers to promote nurseschr('39') cultural competence.

Nowadays, bedbug infestation is one of the public health problems around the world. The objective of this study was to evaluate the spatial distribution of bedbug in different parts of the infested houses. Moreover, the association between house sanitation and presence of bedbug infestation was determined in infested houses in Ahvaz City, Iran.

Totally, 57 bedbug-infested houses were visited door-to-door in Ahvaz City from April 2015 to April 2018. Data were collected by visual inspection. The spatial distribution of bedbug in different parts of the infested houses was assessed visually. Logistic regression was applied to assess the association between bedbug presence and house sanitation level.

In the 57 infested houses, bedroom and living room were the main infested parts in 74% and 26% of the houses, respectively. The highest infestation sources in houses were bedding as well as cracks and crevices with frequency rates of 58% and 18%, respectively. No significant correlation was observed between house sanitation and presence of infestation (χ2 = 3.5; df = 4; P = 0.522). In total, 56% of the residents reported high levels of bedbug infestation in their houses. Furthermore, 46% of the participants mentioned that their houses had recently been infested, but many residents did not know the exact time of first infestation in the house.

The present study confirms that bedbugs' infestations cannot be associated with house sanitation. Further research is needed to better understand the association between house situation and bedbug infestations.

The present study aimed to develop an instrument for assessing nursing students’ satisfaction with First Clinical Practical Education (SFCPE), and then to test the validity and reliability of the instrument.

In this methodological research, the views of a panel of 15 clinical professors, in terms of the clinical nursing principles and skills training, were used to develop the instrument. The content validity of the instrument was evaluated quantitatively and qualitatively based on the panel’s views. The data was collected from the questionnaire completed by 380 second‑ and third‑semester nursing students in 15 medical universities of Iran. The Exploratory Factor Analysis (EFA) was later performed to determine the construct validity of the instrument. The reliability of the instrument and stability analysis were evaluated using the internal consistency test by calculating Cronbach’s alpha and by the test‑retest method, respectively.

Throughout the development phase, 16 items were added to the SFCPE instrument, and a 42‑item instrument was later developed. During the qualitative and quantitative content validity reviews, the number of added items decreased to 38 items. Finally, a 37‑item instrument consisting of seven factors was developed. The Cronbach’s alpha coefficients of 0.95 and 0.75–0.9 were obtained for the whole instrument and the factors, respectively. Pearson’s correlation coefficient was within the normal range (0.71–1).

The developed SFCPE is a valid and reliable instrument that can be used for assessing the satisfaction of nursing students in terms of clinical nursing principles and skills.

Today, for better assessment of midwifery care quality, in addition to maternal death, a useful supplementary indicator, called "maternal near miss" (MNM) is used. It means that mothers who have survived due to complications of pregnancy or childbirth. Limited studies have been conducted in this regard in Iran and no study has been performed in Khuzestan to evaluate this index. This study was performed with aim to determine the prevalence and factors related to MNM in Ahwaz hospitals in 2016.

This cross-sectional study was performed on 3002 delivery in 5 state hospitals in Ahwaz, from 22 May until 25 July 2016. WHO criteria was used for MNM including potential life-threatening conditions (cardiovascular, respiratory, renal, blood, coagulation, hepatic, and neurological disorders) and criteria for severe maternal complications (severe postpartum haemorrhage, severe pre-eclampsia, eclampsia, sepsis/severe systemic infection, and uterus rupture). The prevalence of MNM and related factors were investigated. Data were analyzed by SPSS software (version 22) and Chi-square, Mann-Whitney test, t-test and logistic regression. P<0.05 was considered statistically significant.

The prevalence of MNM was 29.6 per 1,000 live births. The most common direct causes of MNM cases were preeclampsia (49.5%) and severe postpartum hemorrhage (38.2%). 26 of MNM (29.2%) were admitted in intensive care units. The lower gestational age (p <0.001), lower education level (p <0.008), and cesarean delivery (p <0.001) were more likely to resulted in cases of MNM.

As for the reasons of maternal death, preeclampsia and obstetrical hemorrhage were the main reasons for MNM. Cesarean and lower gestational age increase the likelihood of MNM.