فهرست مطالب mohammad taher

We evaluated the response to Trans-arterial chemoembolization (TACE) in hepatocellular carcinoma (HCC) patients according to modified Response Evaluation Criteria in Solid Tumors (mRECIST) criteria. We determined the prognostic value of the neutrophil-to-lymphocyte ratio (NLR).

TACE is the most commonly used method to treat patients with large, unresectable tumors or as bridge therapy in patients with HCC before liver transplantation.

In this cross-sectional study, patients with a diagnosis of HCC who were referred for TACE were studied. The response rate to TACE treatment was assessed based on dynamic MRI 28 days after treatment according to mRECIST criteria. The NLR value was calculated, and its prognostic value was evaluated to predict the response to treatment.

Forty patients with HCC who underwent TACE were included. The response to TACE treatment included a complete response (CR) in 6 patients (15%), partial response (PR) in 16 patients (40%), and stable disease (SD) in 18 patients (45%). No progressive disease (PD) was found. Responders (CR and PR) were 22 patients (55%). The mean NLR after treatment in the non-responders was significantly higher than in the responders (4.2 vs. 2.4, P-value = 0.026). NLR values greater than 2.6 after treatment had a sensitivity of 70.6% and a specificity of 77.3% in diagnosing non-responders, with an Area Under the Curve (AUC) of 0.73 [95% confidence interval 0.58-0.89], P-value = 0.011.

Non-responders observed higher levels of NLR after treatment than responders. As a moderate prognostic factor, an NLR level of more than 2.6 after treatment could discriminate against non-responders.

Uropathogenic Escherichia coli (UPEC) is the most common cause of urinary tract infection in humans including cystitis and pyelonephritis. Antimicrobial resistance (AMR) in UPEC is one of the global public challenges that is due to prevalent use of antibiotics in healthcare setting. Therefore, the purpose of this study is to investigate the frequency and antibiotic resistance pattern of UPEC isolated from patients admitted to Modares Hospital in Saveh, Iran.

In this study, in total 633 isolates were evaluated. UPEC isolates were obtained from patients with urinary tract infection and identified using conventional microbiological protocols. Antibiotic resistance pattern of UPEC against different antibiotic were determined using disk diffusion method. SPSSTM software was used for statistical analysis.

In this study, the most sample was related to outpatients and the lowest sample was related to the CCU wards. The highest antibiotic resistance showed against cephalothin (63.8%) and nalidixic acid (62.2%) antibiotics. The highest effective antibiotics for the tested UPEC was nitrofurantoin (90.7%) and gentamicin (77.3%). Cephalothin and nalidixic acid in hospitalized patients in ICU and emergency wards, respectively, showed the highest antibiotic resistance. Out of 633 UPEC, the rate of Multi Drug Resistant (MDR) isolates were 343 (54.2%).

The result of this study highlighted the role of UPEC as one of the important cause of UTI in individuals. Also, nitrofurantoin then gentamicin are the most effective antibiotics against UPEC infections. Logical prescription of antibiotics and infection control strategies are needed for prevention and control of nosocomial infections especially urinary tract infection.

We aim to present incidence rates and geographical distribution of most common early-onset gastrointestinal cancers (EOGICs), including early-onset esophageal cancer (EOEC), gastric cancer (EOGC) and colorectal cancer (EOCRC) in Iran, 2014- 2018.

Data on new cases of EOEC, EOGC and EOCRC were obtained from publicly available annual reports of the Iranian National Population-based Cancer Registry (INPCR). Incidence rates were calculated using the population data available from the Statistical center of Iran. We considered the World standard population for calculation of age-standardized incidence rates (ASR). We also calculated 95% confidence intervals (CIs) for ASR. All rates are presented per 100 000 person-years.

Overall, 19,679 new cases of EOGIC were registered by the INPCR between 2014 and 2018. The ASRs (95% CI) of EOEC, EOGC and EOCRC were 0.49 (95% CI: 0.47–0.51), 1.67 (1.63–1.71), and 3.07 (3.01–3.13) per 100,000 person-years, respectively. Our findings indicate decreasing and constant trends in the ASR of EOEC and EOGC during the study period, 2014-2018. There was an increasing trend in the ASR of EOCRC. We also found geographical disparities in the incidence rates of EOGICs across provinces of Iran, suggesting the highest ASRs of EOEC in Golestan (1.3), EOGC in Ilam (2.99) and EOCRC in Ilam (4.49).

Our findings suggested that the incidence rate of EOCRC is consistently increasing. We also found variations in the incidence of EOGICs among different provinces. Further investigations are recommended to clarify the time trends and risk factors of EOGICs in Iran.

Chronic constipation is a common health concern. Defecatory disorders are considered one of the mechanisms of chronic idiopathic constipation. This study aimed to evaluate the effect of concurrent irritable bowel syndrome (IBS) on the success rate and response to biofeedback therapy in patients with chronic constipation and pelvic floor dyssynergia (PFD).

This prospective cohort study was performed at the Imam Khomeini Hospital Complex in Tehran from October 2020 to July 2021. Patients aged 18–70 years with chronic constipation and PFD confirmed by clinical examination, anorectal manometry, balloon expulsion test, and/or defecography were included. All patients failed to respond to treatment with lifestyle modifications and laxative use. The diagnosis of IBS was based on the ROME IV criteria. Biofeedback was educated and recommended to all patients. We used three different metrics to assess the patient’s response to biofeedback: 1) constipation score (questionnaire), 2) lifestyle score (questionnaire), and 3) manometry findings (gastroenterologist report).

Forty patients were included in the final analysis, of which 7 men (17.5%) and 21 (52.2%) had IBS. The mean age of the study population was 37.7 ± 11.4. The average resting pressure decreased in response to treatment; however, this decrease was statistically significant only in non-IBS patients (P = 0.007). Patients with and without IBS showed an increase in the percentage of anal sphincter relaxation in response to treatment, but this difference was not statistically significant. Although the first sensation decreased in both groups, this decrease was not statistically significant. Overall, the clinical response was the same across IBS and non-IBS patients, but constipation and lifestyle scores decreased significantly in both groups of patients with and without IBS (P < 0.001).

Biofeedback treatment appears to improve the clinical condition and quality of life of patients with PFD. Considering that a better effect of biofeedback in correcting some manometric parameters has been seen in patients with IBS, it seems that paying attention to the association between these two diseases can be helpful in deciding on treatment.

The main goal of the present study was to evaluate the effect of topical mastic oil, compared to placebo on treatment of functional dyspepsia (FD).

Sixty-three patients with FD were included. Thirty-two subjects received the topical mastic oil (10 drops/TDS after meal) with massage and 31 patients received topical sesame oil with mas- sage. Both groups received pantoprazole (40 mg daily) along with oil and massage. The severity of early satiation, postprandial fullness, epigastric pain and epigastric burning was assessed after 4 weeks using the Visual Analogue Scale (VAS) as well as frequency of symptoms. Sat- isfaction with the treatment was also assessed using a researcher-made questionnaire. Changes in the severity of symptoms were evaluated by Friedman’s test.

Mean and standard deviation of age of the subjects were equal to 36.95±13.64 and 50 (79.4%) patients were fe- male. Both groups experienced a significant decrease in the severity of all the four symptoms (P<0.001). The percentage of decrease in the severity of early satiation was significantly higher in the mastic group than the control group (76.03±34.91% vs. 37.24±38.86%, P=0.003). No significant differences were found in the percentage of decrease in the severity of postprandial fullness, epigastric pain and burning between the study groups (P=0.05, 0.06, and 0.13, respec- tively). The frequency of symptoms was decreased similarly in both groups. Satisfaction with the treatment was reported to be significantly higher in the mastic group than the sesame group (P=0.01). There were no intolerable side effects in both groups.

Mastic oil reduced early satiation better than the placebo. In addition, satisfaction with the treatment was higher in the mastic group than the sesame group.

Pruritus is one of the disturbing complications induced by chronic liver disease (CLD), bearing a negative impact on patient quality of life and potentially resulting in early liver transplants. Given the main role of the autotaxin enzyme in pruritus induced by CLD and the suppressive effects of melatonin on the expression of the autotaxin gene, this study was designed to evaluate the antipruritic effect of melatonin in patients with CLD. A double-blind, cross-over, randomized, placebo-controlled pilot trial was conducted on patients with CLD -induced pruritis. Patients were randomly assigned to two groups where they received melatonin 10-mg at night or placebo for 2 weeks. After a 2-week washout period, patients were then crossed over to the other group. The Visual Analog Scale (VAS) and the 12-Item Pruritus Severity Score (12-PSS) were used to assess patient response to therapy as the co-primary outcomes, while liver function tests were assayed too. Forty patients completed the study. The VAS score showed alleviation of 3.21 ± 2.24 (in pruritus) with melatonin (p-value <0.05). The study goal (a reduction of at least 20% in VAS) was achieved in 33 (82%) of study participants. In patients who received melatonin, the 12-PSS and Body Surface Area (BSA) affected by pruritus decreased on average 46.57% and 51.71%, respectively, with mood, sleep pattern and daily activity levels also demonstrating significant improvement (p-value < 0.05). Melatonin was found to be effective for managing pruritus in patients with CLD.

Colonic malakoplakia is a rare chronic granulomatous disease that can involve many organs such as the lung, brain, pancreas, bone, adrenal glands, and genitourinary tract. The most common site of involvement outside the genitourinary tract is the gastrointestinal tract. We report a case of colonic malakoplakia who presented with unintentional weight loss, abdominal pain, and chronic diarrhea. There was a history of lupus nephritis and Sjogren disease, receiving various immunosuppressive drugs. Physical examination other than pallor was unremarkable in this patient, but colonoscopy revealed multiple polyps in the rectum with a cobblestone appearance in the cecum. The histopathological assessment showed infiltration of numerous lymphoplasma cells and neutrophils in the lamina propria, and rare Michaelis-Gutmann bodies were seen in foamy epithelioid histiocytes. These findings are suggestive of malakoplakia. We treated the patient with tetracycline, and after 3 months of follow-up, clinical improvement was achieved.

The coronavirus associated disease 2019 (COVID-19) caused by the SARS-CoV-2 virus has rapidly spread all around the world and became pandemic in March 2020. Data on liver transplantation and chronic liver disease during the pandemic has remained scarce, and there is little information on whether immunosuppressed patients are at higher risk of developing severe COVID-19 infection. This review provides information for health care providers who care for patients with liver transplantation and chronic liver diseases.

From mid-December of 2019 a newly diagnosed Corona virus with a highly human to human transmission rate was discovered in china which rapidly involved many countries and became pandemic. Although most infected cases are mild but this virus can cause severe lung injury which lead to severe mortality and morbidity. The mortality rate of this virus is high in immunosuppressed patient or with previous medical disorder. Many Inflammatory bowel disease patient are using immunosuppressive or immunomodulating agents which has raised the concern of severe disease in these patients.

Inflammatory bowel disease (IBD) is a chronic disorder that influences many aspects of a patient’s life. The medical treatment of the affected patient has been broadly investigated. Studies have shown that most physicians are familiar with treatment options, but they are not aware of proper preventive care for their patients. As most patients consider their gastroenterologists as their primary care provider, it is essential for gastroenterologists to inform the primary care providers of the unique needs of the patients with IBD, especially those receiving immunomodulators and biologics or are considered for such treatments. As most patients with are treated with long-term immune-suppressive drugs, and these drugs predispose the patients to many infectious diseases and cancers, it is important for primary care providers to document patients’ vaccination history comprehensively and screen for the cancers that these patients are encountered with, so that many of these disorders be prevented. Identification, safety, and proper timing of vaccinations, screening for cervical cancer, melanoma and non-melanoma skin cancers, osteoporosis, identification of depression and anxiety, smoking cessation, and care during traveling and flights are issues that will be discussed in this systemic review.

Anxiety and its control is a public health problem worldwide. This study was conducted to determine the effect of family members’ presence on the anxiety level of patients who were candidates for esophagogastroduodenoscopy (EGD).

This randomized controlled trial study was performed in Shahid Chamran hospital in city of Saveh in IR Iran. In this study, 96 patients who were candidates for EGD and met the inclusion criteria were assigned into control and intervention groups by simple random sampling method. The demographic questionnaire and Spiel Berger's State and Trait Anxiety Questionnaire (STAI) were used to measure anxiety.

  No significant difference was found between the 2 groups in the mean level of anxiety before intervention (p=0.13). After intervention, the level of anxiety decreased significantly in the intervention group (p=0.001). However, the mean level of anxiety was not significant in the control group after intervention (p=0.09).

The results of the present study showed that the presence of family members during endoscopy may reduce the patient’s anxiety level, and thus it is recommended as a non-pharmaceutical, beneficial, and safe intervention.

A healthy and balanced diet is quit important in life time and during pregnancy in particular for health of the mother and her unborn baby. The aim of this study was to Measure health belief model construct about nutritional practices of pregnant women in Saveh University of Medical Sciences.
This is a cross-sectional and analytical study that carried out on 260 pregnant women in health centers dependent of Saveh University of medical sciences. Data collecting based on the Health Belief Model (susceptibility, severity, perceived benefits and barriers, self efficacy and cues to action) and the checklist of practice pregnant women about diet. The data collected from organized interviews and finally using descriptive and analytical statistics were analyzed.
The mean age of participant was 27.4± 5 and mean gestational age was 5.5±2.4. In this study significant correlation observed between perceived barriers, sensitivity, severity, benefits, barriers and perceived self efficacy with nutritional practices of pregnant women (p As regards the mean score of Health Belief Model construct in pregnant women is moderate. Therefore, to improve the health of mothers and their children a educational program based on health belief model for enhancing sensitivity and perceived severity of health worker to their health and increase their self efficacy and benefits perceived with the reduce perceived barriers is recommended.

Improvement in HIV care have resulted in prolonged life expectancy for HIV-positive persons, hence, identify preventive behaviors of HIV transmission in HIV-positive persons has not only become a necessity, but a main concern in HIV prevention. The aim of this study was to evaluate of beliefs and factors influencing preventive behaviors of HIV transmission in HIV-positive patients.
A descriptive-analytical study was conducted in two cities (Sarbaz and Saravan) in Sistan&baloochestan Province. Participants included 92 HIV-positive patients. Data were obtained anonymous self-reported questionnaires. Descriptive statistics, multiple logistic regression analyses were employed to identify factors associated with preventive behaviors of HIV transmission.
The 78% and 22% of subjects were male and female, respectively. The result indicated that all Health Belief Model construct were signifcant prediting facotrs for preventive behaviors. Inaddition, percieved barriers, self efficacy, benefit, severity, susceptibility were the most important predictor respectivly. Also, variable of educational level, marital status, perceived depression and anxiety, and social support were significant factors to preventive behaviors (p The present study showed that the HBM can be used to explain the predictors of behaviors in HIV-positive patients. . Future prevention interventions should be focused on the improvement in self-efficacy, the reduction in the barriers and the increasing perceived benefits of to preventive behaviors among HIV-positive patients.

Despite the fact that hepatic involvement is frequently seen in systemic primary amyloidosis, major hepatic symptoms as primary manifestation and severe impaired liver function are rare. Herein, we report a 38-year-old woman with primary hepatic amyloidosis, and severe portal hypertension. The patient had ascites and markedly elevated alkaline phosphatase level at presentation. She had a rapid downhill course resulting in death. In case of an unexplained intrahepatic cholestasis or portal hypertension the possibility of amyloidosis should be considered and a Congo red staining should be performed.

Self-care is an essential element in treating a person with diabetes; and managing diabetes is of prime importance. The aim of this study was to investigate the predictors of adherence to self-care behavior among women with Type 2 diabetes.
This cross-sectional study was conducted on 210 female patients aged 30 to 60. Data collection tool was an anonymous valid and reliable questionnaire designed based on the Health Belief Model (HBM), which acquired information about the followings: Perceived susceptibility, severity, benefits, barriers, self-efficacy and diabetes self-care behavior. Data were analyzed by t-test, chi-square and regression analysis.
The multiple regression models revealed 59.9% of the variance of self-care behavior with self-efficacy, perceived barrier, benefit and susceptibility. Additionally, the highest weight for β (β=0.87) was found for self-efficacy. Self-care behavior was positively correlated with all HBM variables except for perceived barriers showing a negative correlation.
The Health Belief Model may be used as a framework to design intervention programs in an attempt to improve adherence to self-care behaviors of women with diabetes. In addition, the results indicated that self-efficacy might play a more crucial role in developing self-care behaviors than t other HBM components. Therefore, if the focus is placed on self-efficacy when developing educational programs, it may increase the likelihood of adherence to self-care behavior.

The horror of HIV/AIDS as a non-curable, grueling disease is a destructive issue for every country. Drug use, shared needles and unsafe sex are closely linked to the transmission of HIV/AIDS. Modification or changing unhealthy behavior through educational programs can lead to HIV prevention. The aim of this study was to evaluate the efficiency of theory-based education intervention on HIV prevention transmission in drug addicts.
In this quasi-experimental study, 69 male drug injecting users were entered in to the theory-based educational intervention. Data were collected using a questionnaire, before and 3 months after four sessions (group discussions, lecture, film displaying and role play) of educational intervention.
The findings signified that the mean scores of constructs (self-efficacy, susceptibility, severity and benefit) significantly increased after the educational intervention, and the perceived barriers decreased (p The present research offers a primary founding for planning and implementing a theory based educational program to prevent HIV/AIDS transmission in drug injecting addicts. This research revealed that health educational intervention improved preventive behaviors and the knowledge of HIV/AIDS participants.

Tobacco use among medical students is important for the health of the general population since medical groups are important role models in terms of health related behaviors. Therefore، the objective of this study was to investigate tobacco use and its predictors among medical students of Ahavaz University based on the theory of planned behavior (TPB). A cross-sectional study using a self-administered questionnaire was conducted in 2014 among 170 medical students (56 males، 114 females)، at Ahvaz University of Medical Sciences. Data were analyzed using SPSS version 18 software program. Logistic regression analysis was used to calculate the odds ratio (OR) and 95% confidence interval (95% CI) and to determine the effect of demographic factors and theory of planned behavior (TPB) constructs on students’ smoking behaviors. From all subjects، 36% of boys and 3. 5% of girls were current smokers. Using multiple logistic regression models، being male (OR = 4. 8، 95% CI: 1. 08-21)، having friends who smoke (OR = 5. 6، 95% CI: 1. 7-18)، smoking parents (OR = 5. 3، 95% CI: 1. 14-24. 4) and smoking brother (OR = 4. 9، 95% CI: 1. 06-23. 7) were strongly associated with tobacco use. Furthermore، all component of TPB (attitudes (OR = 0. 54، 95% CI: 0. 36-0. 83)، subjective norms (OR = 0. 88، 95% CI: 0. 82-0. 94)، perceived behavioral control (OR = 0. 79، 95% CI: 0. 68-0. 91) and intention (OR = 1. 40، 95% CI: 1. 05-1. 87) were found to predict student’s smoking. The present study propose that subjective norms and selection of friends need to be considered as the most important factors explaining smoking behavior among medical students besides the TPB constructs.

Diabetic foot affects more than 25% of diabetic patients and finally up to 20% of cases result in amputation. The most important factor resulting in severe complications or even death is lack of self-care. Health locus of control has been introduced as one of health factors and predicting factors of self-care. This research was performed for analyzing the correlation between self-care behaviors and health locus of control in diabetic foot patients.In this descriptive study, 120 patients with diabetic foot were chosen using convenience sampling from endocrine clinic and wards of endocrine and vascular surgery of Teleqani Hospital of ShahidBeheshti Medical University. The data were gathered by demographic, self-care behavior, and health locus of control questionnaires. The t-test, analysis of variance (ANOVA) and spearman coefficient were used to analyze the data.Results of this research showed that there is a direct and significant relation between self-care behaviors and internal health locus of control (p<0.001), and also in contrast with chance health locus of control (p<0.001).We have to consider these factors’ role in nursing interventions and patient-care education programs and plans. Probably, interventions and programs that will lead to the strengthening of internal health locus of control improve and strengthen patients’ self-care behaviors and their involvement in treatment.

Epidemiological changes leading to chronic diseases are becoming more important day by day. Hypertension is also known as a chronic disease. Worldwide prevalence of hypertension have caused serious complications. The disease has become a health problem in all communities. This research aims at analyze the correlation between compliance with the treatment regimen and health locus of control in hypertension patients. In this study, 130 patients diagnosed with high blood pressure have been included using convenience sampling. Information has been gathered including demographic data, compliance with the treatment regimen and health locus of control. The patient's blood pressure was measured twice and the mean was compared with the first blood pressure recorded in medical records. Data were analyzed using SPSS 17. The results showed that there is a direct correlation between the adherence to the treatment regimen with internal health locus of control. In patients with internal health locus of control, better compliance with treatment regimen was detected. Health locus of control is associated with treatment regimen. Considering health locus control can help nurses and managers in their health programs and also can motivate patients to participate in their self-care and improve patients care quality.

Although social support seems to be effective in adherence to the treatment of hypertension، its effects in hypertensive patients have not been well documented. The current study tried to clarify the relationship between social support and adherence to the treatment in patients with hypertension. This cross-sectional study applied census sampling to recruit all eligible patients with hypertension (130 patients). A demographic questionnaire، the Hill-Bone Compliance to High Blood Pressure Therapy Scale، and the Social Support Behaviors Scale were used to collect data. Spearman’s correlation coefficient، t-test، and analysis of variance were conducted to analyze the data. All analyses were performed in SPSS-16. Poor، moderate، and acceptable adherence to the treatment was detected in 9. 2%، 85. 4%، and 5. 4% of the patients، respectively. There was a significant relationship between social support and level of compliance with the treatment regimen، i. e. patients with moderate-high levels of social support had higher adherence to the treatment. Moreover، subjects with poor compliance were found to have poorer social support. Social support was also found to be significantly related with level of education and marital status. This study highlighted the role of social support as a determinant of adherence to the treatment in patients with hypertension. Therefore، attention to social support can increase hypertensive patients’ adherence to treatment regimens and improve their health status.

Bad news disclosure is one of the complex communication tasks of the physicians. Bad news is defined as: «any news that adversely and seriously affects an individual''s view of his or her future». Recent studies indicate that the patients’ and physicians’ attitudes toward disclosure of bad news have been changed since few years ago. The evidence of breaking bad news is also different across different cultures. In the present study, we aimed to evaluate the patients'' prospect about breaking bad news and to provide a clinical guidance for Iranian patients and those patients in countries with a similar cultural background. A cross sectional descriptive study was conducted on a sample of 200 cancer patients at a cancer institute in Tehran. The patients'' demographic characteristics and their attitudes toward the manner of disclosing the diagnosis were registered in a research based questionnaire. In this study, 165 patients (82. 5%) claimed to be aware of the diagnosis; however, only 121 patients (73%) were aware of the actual diagnosis of their disease. Most patients tended to know the diagnosis (n = 186, 93%) and accepted patient as the first person to be informed (n = 151, 75. 5%) by their physician (n = 174, 87%). The preference of being alone or with a family member when exposed to bad news was almost the same. Most patients (n = 169, 84. 5%) believed that physicians should consult the patients to make treatment decisions. Treatment options (n = 140, 70%) and life expectancy (n = 121, 60. 5%) were the most desirable topics to be discussed. Most patients (n = 144, 72%) agreed upon allowing them to express their emotional feelings. According to the patients'' preferences about being fully informed about the diagnosis, it is suggested that the disclosure of cancer diagnosis be done by a physician and in the presence of a family member. It is also recommended that physicians consult the patients about treatment options.

Inflammatory bowel disease (IBD) is a chronic relapsing, idiopathic disorder of the gastrointestinal tract of an unknown etiology. Ulcerative colitis (UC) and Crohn''s disease (CD) have become important health problems. Current medical therapy of IBD has advanced dramatically with the introduction of new biologic therapies in addition to the optimization of conventional therapies that include drugs such as immunosuppressors and 5-aminosalicylic acid (5-ASA), and a better identification of factors involved in the pathogenesis of IBD.The aim of this review is to provide a brief historical perspective of the available evidence for the use of various medications in IBD followed by a recent literature update. The intent is to enhance the clinician''s perspective regarding IBD treatment.

We described a case of lymphoid follicular hyperplasia that arose from the ileum of a 52-year-old woman. Her colonoscopy revealed a large mass in the cecum associated with multiple polypoid lesions in the ileum. Histologic examination demonstrated severe lymphocytic infiltration and lymphoid follicles with regular germinal centers, without evidence of malignancy. A right hemicolectomy was performed, which confirmed the diagnosis of lymphoid follicular hyperplasia.