majid sadeghi

Fatigue is the most common complaint among patients with rheumatoid arthritis, leading to decreased productivity and reduced quality of life.

The present study was conducted with aim to compare the effect of sole reflexology and stretching exercises on fatigue of rheumatoid arthritis patients.

This clinical trial study was conducted on patients with rheumatoid arthritis in Yasuj city of Iran during 2017-2018. Participants were selected through convenience sampling method but randomly allocated to one of the three groups using randomized block allocation. Multidimensional fatigue questionnaire was used to collect data at two times of pre and post interventions. The interventions were performed during 30 minutes per session for three sessions per week over one month.

Mean scores of global fatigue before the interventions in the sole reflexology group was 80.72±8.61, in stretching exercise group 81±7.30, and in control group (76.43±8.17), however, these values for post intervention were reported to be 68.72±8.59, 50.95±5.73, and 76.82±7.43, respectively. Intergroup comparison showed significant differences between the sole reflexology and stretching exercise groups with the control group (p<0.001); also the two intervention groups significantly differed (p<0.001).

Implications for Practice: 

Both sole reflexology and stretching exercises could improve fatigue of patients with rheumatoid arthritis, but this improvement was higher by stretching exercises than sole reflexology.

This paper analyzed the effects of exchange rate pass-through with emphasis on the inflationary environment of Iran and the behavior of the Central Bank. Therefore,the STAR model during the period 2001:03 to 2019:04 was used. The results showed that GDP and the volume of money have a positive relationship and nominal interest rate, exchange rate and the central bank intervention have a negative relationship with the price index. The difference between the coefficients of the variables in the two regimes indicates that the effect of exchange rate and GDP growth on the price index in each regime is different. In the low exchange rate regime, the increase in the exchange rate causes a decrease and in the high exchange rate regime, the price index increases. There may be a causality relationship between exchange rates and inflation. That is, inflation increases with the increase in the exchange rate and the price of imported goods, and this inflation causes the exchange rate to rise again. On the other hand, the growth rate of the exchange rate in the impulse function is more than its deviations from the equilibrium which indicates the interventions of the Central Bank have been more to control the growth of the exchange rate. In fact, with this policy, the central bank has sought to control rising prices.

The purpose of this article is the effects of exchange rate passage with emphasis on the inflationary environment of Iran's economy and the central bank's authority to control the foreign exchange market. Therefore, the STAR model based on quarterly data of Iranian economy during the period 2001:03 to 2019:04 was used. The results of estimating the linear part of the model (first regime) show that the variables of GDP, interest rate on facilities and money supply have a positive relationship with the price index in the Iranian economy. Also, the results of estimating the nonlinear part of the model (second regime) show the positive relationship between the variables of money supply, interest rate on facilities and exchange rate with the price index. The difference between the coefficients of the variables in the two regimes indicates that the effect of exchange rate variables and GDP growth on the price index in each regime is different. In the case of a low exchange rate (linear regime), economic growth has a positive effect on the price index and with an increase in the exchange rate, the price index will decrease; While in the high exchange rate regime (non-linear regime), the impact of economic growth on the price index is negative and an increase in the exchange rate will increase the price index. According to the results of artificial pricing, the exchange rate in the years before the crisis and preventing it from adjusting to the economic conditions is one of the main reasons for the currency crisis. Therefore, it is suggested that in order to reduce the pressure on the foreign exchange market, in proportion to the difference between Iran's inflation and global inflation, the official exchange rate should be adjusted annually to prevent currency shocks.

Mullā Ṣadrā introduces philosophy as a knowledge for the perfection of all human souls and does not limit to a certain group; the complexity of philosophical issues and the difficulty of understanding them due to their abstract nature, however, is not hidden. Nevertheless, according to Mullā Ṣadrā, the power of imagination and speech are two divine gifts that make it possible for different audiences to understand and convey such complex issues. The power of imagination, by analyzing and combining forms and meanings, is constantly creating new forms and meanings, and language, with a wide range of mental creativity, through continuous changes in form and content, is a tool at the service of the speaker’s mind to convey meanings to the audience. Story is a format which is distinguished from other texts by the two elements of imagination and speech. In this article, the elements of story are explained from the perspective of Ṣadrā’s philosophy in a descriptive-analytical way, and its narrative capacities are examined. The existence of allegories in Ṣadrā’s philosophy and its presentation in the form of four journeys makes it possible to have a narrative reading of it using the old narrative archetype of “hero’s journey”.

There is no doubt that the future environment of meta complex higher education system and organizations, the strategic environment, and one of the ways in which people in leadership success turning into their environment with a special look to dominate another through personal and its restraint in archaeology with the goal of future use, preventing entropy and syntropy for Educated gun and the collective efficacy of the, the Community system of higher education graduates will be in the future. The aim of this study was to identify and determine the validity of the content of personal mastery and its dimensions on the graduate students of universities and centers of higher education from the perspective of experts. This applied research, exploratory and qualitative. Participants in this research is targeted in the first part of 7 people with Delphi technique, and in the second part of the 22 people, Certified masters of the Harvard, Florida, Kharizmi and Sciences and Research Universities The academic level of associate with the criteria above and specialized books. There are two types of The closed questionnaire responses and Open questionnaire answers in the data analysis of the method of frequency analysis, CVR and CVI, was using. The findings show the consensus of the universities on the concept of personal Mastery and identification of its main dimensions: Forgiveness, Know Yourself, Love Yourself, Maintain a Positive Mindset, Practice Discipline, Be Proactive, The beliefs of Self-Regulations, and Develop writ and live your purpose statement, in university graduate students.

Depression is a major health problem in old age that is closely related to cultural and social contexts. Studies have shown a higher prevalence of geriatric depression in Iran. This qualitative content analysis study aimed to explore the psychosocial factors related to the experience of late life depression in older people in Iran. This qualitative study with a directed content analysis approach was conducted in Tehran in 2015. First, a systematic search in major English and Persian data banks was carried out to develop an analysis matrix. The participants with maximum variations in demographic characteristics were recruited from psychiatric clinics, if they met inclusion criteria, which included: 1) age of 60 years and, and 2) diagnosis above of depression by a psychiatrist in the last six months. Semi-structured interviews were conducted up to reaching data saturation. The interviews were recorded, transcribed verbatim and transformed into meaning units and codes. The codes were then analyzing matrix and reviewed again to form new subcategories and categories. Twelve old people participated in this study. Analyzing the data, 534 codes in 42 subcategories and 17categories led to six main themes which included: 1) transition of value system, 2) role changes, 3) life concerns, 4) inadequacy of social relations, 5) regrets, and 6) impaired health and function. From the perspective of the depressed old people, recent changes in values and impaired social relations, made them feel lonely confronting life struggles and inevitable changes of roles, health status and function. Some context-based interventions such as community alertness and providing more formal support may be helpful in preventing late life depression.

The purpose of this study was to relationship between service quality and aesthetic dimensions with customer's loyalty to public and private pools in mazandaran province. Descriptive research, correlational research that has been conducted in this field. 380 people from the private and public pools as customer’s sample was determined using simple random sampling. Data collection aesthetics questionnaire Soleimani, Service Quality questionnaire Liu & Loyalty Questionnaire Lim, with Likert scale was used with five values. For data analysis, using Pearson correlation and Shannon entropy, SPSS20 software. Data analysis showed that significant differences between the study community aesthetic and its subsidiaries, Service quality and its subsidiaries, with loyalty. There is no significant relationship between ages at testing the loyalty. There are significant differences between male and female customer loyalty. There is no significant difference between the educations of customer loyalty, according to the study. There was no difference between the aesthetic aspects of indoor pools. There was no difference between the service quality aspects of indoor pools. Also the weight of dimensions is not a priority quality services to customer loyalty in sports pools with aesthetic aspects.

Recently, the use of T7 RNA polymerase instead of other viral and cellular promoters is increasing due to high efficacy of transcription in the cell cytoplasm by this polymerase. In order to translate the transcripts produced by T7 RNA polymerase in mammalian cell lines, it is necessary to include Internal Ribosome Entry Site (IRES) sequences. In addition, if sequence of poly A signal would be included after interested gene, the rate of expression could be increased in the cells. For expression of eGFP in HEK-293 and T7-BHK cells by T7 RNA polymerase, the sequence of eGFP as well as IRES sequences upstream of eGFP gene and poly A signal were inserted into a pUC57 plasmid. On the other hand, gene of T7 RNA polymerase was cloned into modified pIRES2-EGFP plasmid. Then, the constructed plasmids were transfected into HEK-293 cells. T7-BHK cell was used for control of T7 RNA polymerase activity. Our results showed that using T7 RNA polymerase for expression of foreign genes in mammalian cell lines is highly efficient. Highly efficient eGFP expression in HEK-293 cells showed that T7 RNA polymerase could be used for cytoplasmic RNA transcription such as production of anti-cancer proteins and oncolytic viral genomic RNA by reverse genetics.

The aim of this study was to evaluate the efficacy of a new psychiatry clerkship curriculum which was designed to improve the knowledge and skills of medical students of Tehran University of Medical Sciences (TUMS), Iran. This quasi-experimental study was conducted in two consecutive semesters from February 2009 to January 2010. In total, 167 medical students participated in the study. In the first semester, as the control group, the clerks’ training was based on the traditional curriculum. In the next semester, we constructed and applied a new curriculum based on the SPICES model (student-centered, problem-based, integrated, community-based, elective and systematic).At the end of the clerkship, the students were given two exams: Multiple Choice Questions (MCQ) to assess their knowledge, and Objective Structured Clinical Examination (OSCE) to assess their skills. Baseline data and test performance for each student were analyzed. Compared to the control group, students in the intervention group showed significantly higher OSCE scores (P= 0.01). With respect to MCQ score, no significant difference was found between the two groups. The results suggest that the revised curriculum is more effective than the traditional one in improving the required clinical skills in medical students during their psychiatry clerkship.

Evaluation of the accuracy and performance of sonography units needs tissue-mimicking phantoms. These phantoms play an important role by simulating soft tissues, obviating the need to experiment on humans or animals.. To present a simple sonographic phantom for quality control and training purposes.. The presented phantom consists of a two-part Plexiglas box. The larger part is filled with a mixture of ethanol (9.5 ± 0.25%) in distilled water and a solution of sodium nitrite (0.1 M) to prevent rusting. The second part is filled with a combination of 3.85% by wt. % agar, and 50 g/L of powdered graphite as the background material. In this study, chrome-plated electric guitar strings, 0.52 mm in diameter, were used. Several objects were considered as tissue-equivalent material, and their images were obtained at different times. Criteria for the selection of suitable objects comprised similarity between the obtained image and the corresponding tissues in the human body, minimal shrinkage, and change in brightness level at different times. In addition to quantitative analysis obtained from image processing, a blind qualitative study was done by a radiologist.. Both results of quantitative analysis using MATLAB software and independent qualitative analysis showed that the commercial rubber and agar were appropriate as solid and cystic objects, respectively. Moreover, quantitative analysis done with MATLAB on images obtained from the phantom showed that the commercial rubber and agar had a 5% and 2% change in image pixel intensity (brightness) after 2 months, respectively.. The presented phantom not only has lower cost and complexity, which make it suitable for educational centers, but also is capable of providing good images of cystic and solid objects for quality control and training purposes. Furthermore, it confers reliable stability for at least 2 months, as was assessed in the present study..

Bipolar spectrum disorders may often go undiagnosed or unrecognized. The aim of this study was to determine the proportion of bipolar disorder symptoms in Iranian patients with a major depressive episode. 313 patients with a current DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders 4th ed. Text rev.) diagnosed with a major depressive episode entered this cross-sectional study. Thirty two items revised Hypomania/ mania Symptoms Checklist (HCL-32) was used to determine the frequency of bipolar episodes. Considerable proportion of patients (53.9%) previously diagnosed as major depressive disorder fulfilled the criteria for bipolar disorder by Bipolarity Specifier. The Bipolarity Specifier additionally identified significant association for manic / hypomanic states during antidepressants therapy (p<0.0003) and current mixed mood symptoms (p<0.0001) Bipolar symptoms meeting the criteria for bipolar disorders in depressed patients who have not been previously diagnosed with bipolar disorder are frequent. Current DSM criteria may not be sufficient to diagnose more subtle or atypical forms of bipolar disorders.

Recently several clinical and social psychologists, in line with their empirical and objective researches, have stepped toward determining the role of "content" of various thoughts and its relation with "conscious awareness". They also interested on importance of thought strategies, perceptions and the way of individual interpretation on behavior and emotion. Intense negative and unwanted intrusive thoughts may occur in conscious awareness of normal individuals which ultimately can develop negative moods, however these types of intrusive thoughts, which at times may even seems unpleasant, are usually rare, controllable and easily can substitute by positive thoughts. Generally, these intrusive thoughts are common in normal population. At present, one of the most important issues in psychiatric disorders literature (depression, insomnia, generalized anxiety disorders, obsessive compulsive disorders, eating habits, psychoses and sexual behaviors) is study on similarities between content of these thoughts and conscious awareness in clinical and non clinical population. Considering the role of negative cognition issues as a key and pathogenic factor in psychiatric disorders, the aim of this review is to describe the recent developments on the role of thoughts and conscious awareness in clinical and non clinical population. Therefore this review may also lead us to identify content of the unwanted intrusive thought as well as mechanism of its development in clinical population.

The increasing use of standardized patients in the psy-chiatric Objective Structured Clinical Examination (OSCE) promoted the investigators to explore the viewpoints of examining professors and participating psychiatric residents towards the performance of the standardized patients. In an OSCE, 22 of the final year psychiatric residents and 16 examiners participated in our study. Performance of the 8 standardized patients in all 8 stations was evaluated after the test. This study showed acceptable and appropriate performance of standardized patients both in acting according to and in actualizing the scenarios. Use of standardized patients in psychiatric OSCE is recommended by the examining professors and also residents

This study aims to compare viewpoints of standardized patients (SPs) and consultant psychiatrists about the performance of volunteer residents in the first Objective Structured Clinical Examination (OSCE) in Iran. OSCE was hold with 9 stations and 8 SPs, in one day with attendance of 22 senior psychiatric residents. In each station two raters independently scored the residents based on a previously prepared checklist. SPs were three females and five males with the mean age of 27 years. In the end, viewpoints of consultant psychi-atrists and SPs on the performance of residents were compared. Beside three stations, no significant correlation between SPs’ and consultants’ opinions could be found in other stations. SPs in the stations with significant correlation had higher level of educa-tion especially in the psychiatry-relevant fields. Despite capabilities of the SPs, it is probably not reason- able to rely on their opinion as raters unless they have higher level of education.

To report the case of a 28-year old hypercholesterolemic female with postpartum depression, whose triglyceride (TG) and total cholesterol (TC) levels decreased while being treated with fluoxetine. A 28-year old female, with a diagnosis of major depressive disorder with postpartum onset based on DSM-IV criteria, was hospitalized at a mental health hospital. Her past history included another episode of depression 4 months after giving birth to her second child, which was 12 years prior to her recent episode. Her serum total cholestrol and triglyceride levels were measured prior to the initiation of medication. Then fluoxetine was initiated at a daily dose of 20 mg and had been increased to 40 mg per day at the time of discharge. The lipid profile measurements was repeated at week 4 and 8 following treatment. Total cholesterol level was reduced from 242 mg/dL at baseline to 224 mg/dL at week 4 and to 202 mg/dL at week 8; triglyceride level was decreased from 516 mg/dL to 448 mg/dL at week 4 and to 404 mg/dL at week 8. Fluoxetine may be an appropriate treatment for hyperlipidemic women with postpartum depression..

Diabetic Neuropathy is the most common and troublesome complication of Diabetes Mellitus, leading to the greatest morbidity and mortality and resulting in a huge economic burden for diabetes care. Early diagnosis of distal symmetric sensorimotor polyneuropathy, a common complication of diabetes, may decrease morbidity by allowing potential therapeutic interventions. In 68 diabetic patients after neuropathy screening by U.K and Michigan scores, Bilateral sural nerve conduction parameters as nerve conduction velocity, latency and amplitude were determined and analysed. 54.4% of patients had Rt sural abnormal response, 50% had abnormality in left side and 39.7% had bilateral abnormality. There was significant statistical correlation between Michigan physical score and electrophysiologic finding (P-value < 0.003) but no correlation with U.K score (P-value > 0.3). The most prevalent abnormal electrophysiologic finding was amplitude decrement of sural response. Sural nerve response is one of the simplest and most sensitive peripheral sensory nerves for electrophysiologic study of diabetic neuropathy and its evaluation is recommended in all diabetic patients in spite of normal physical examination and history for detection of subclinical neuropathic cases. For increment of sensitivity, amplitude measurement of sensory response is highly recommended.

This study was designed to compare the effects of fluoxetine and imipramine on fasting blood glucose (FBG) in patients with major depressive disorder.
Non-diabetic patients, with major depressive disorder (based on DSM-IV criteria) entered this randomized, double - blind study. Patients did not receive any medication affecting serum FBG levels at least for 2 weeks prior to the initiation of the study. Patients were assigned to receive 20 to 40 mg/day of fluoxetine or 75 to 200 mg/day of imipramine for 8 weeks. Benzodiazepines were allowed when needed for anxiety, agitation or sleep. Pregnant women, and patients with diabetes mellitus, and history of major heart diseases were excluded from this study. Additionally, none of the patients should have received electroconvulsive therapy (ECT) within 6 months prior to initiation of the antidepressants. FBG levels were measured at the initiation of study as well as 4 and 8 weeks after starting antidepressants.
Nineteen patients in the fluoxetine and 24 patients in the imipramine groups completed the study. In the fluoxetine group, FBG level was decreased from 88.5 mg/dL (baseline) to 85.0 mg/dL at week 4 (P=0.73), and to 79.8mg/dL at week 8 (P This 8-weeks study showed that FBG levels may decrease in depressive patients receiving fluoxetine and may increase in those patients treated with imipramine. Therefore, it is suggested to measure and monitor FBG before initiation and during treatment with fluoxetine and imipramine.