Crescent Journal of Medical and Biological Sciences
Volume:6 Issue: 3, Jul 2019

Fuzzy logic is considered a powerful instrument for dealing with uncertainty and is implemented in both type-1 and type-2 ways. The expert systems (ESs) and decision support systems (DSSs) are applied based on type-1 and type-2 fuzzy logic since medical decision-making has always been associated with various uncertainties. The present study reviewed different types of fuzzy ES/DSS in the medical domain in order to investigate whether the fuzzy type-2 performance was better compared to that of type-1.  A systematic review was conducted on PubMed, Web of sciences, Scopus, Embase, Medline, and Science Direct databases. The title, abstract, and full text of the articles, published during 2007-2017, were independently evaluated by two reviewers. The cases of disagreement were solved in a pair-work discussion. Finally, based on inclusion criteria, 12 articles were included in the study and were investigated in terms of the purpose and application, architecture and structural details, as well as the method of evaluation and the findings. Type-2 expert systems were found to have a better diagnostic function compared to Type-1 systems and other different machine learning methods. Increasing the accuracy, precision, and resistance to noise was an issue that was achieved in such systems using type-2 fuzzy logic. In general, medical expert systems based on type-2 fuzzy logic are considered more appropriate for model uncertainty and ambiguity, therefore, they could be used in different medical domains that need to make decisions under uncertain circumstances.

Spinal cord injury (SCI) often occurs in young adult men. Factors such as erectile and ejaculation dysfunction and abnormal anomalies may contribute to the incidence of infertility. In healthy men, there is a balance between reactive oxygen species (ROS) and antioxidant scavenging systems and antioxidants have a positive impact on male fertility. Therefore, the present study examined the findings of different review studies on the role of oxidative stress (OS) and antioxidants in reducing the sperm function and treating the sperm components, respectively. The relevant keywords were used to search for related articles in different databases such as Medline, PubMed, ISI, Scopus, and Google Scholar, which resulted in retrieving 28 articles about OS, antioxidants, DNA damage, apoptosis, and sperm parameters. Based on the findings of previous studies, antioxidant supplementation improved the number, motility, morphology, and the DNA integrity of the sperm. In addition, the combination of several antioxidants was found to perform better compared to using only one antioxidant. In general, the heightened levels of uncontrolled OS is modified through the antioxidant supplements or their combination. Therefore, antioxidant supplementation can be considered in the treatment of infertile men.

Carpal tunnel syndrome (CTS) is a complicated disorder which occurs when a localized median nerve is compressed in the carpal tunnel. It causes neurological symptoms, pain, and functional limitation of the wrist, which in turn leads to problems in daily routines and activities and reduced ability to work, ultimately negatively affecting the quality of life and public health status. In this regard, this review aimed to evaluate the effective diagnosis and conservative treatments of CTS. To conduct this review study, Google Scholar, PubMed, and Elsevier databases were searched using the keywords "carpal tunnel syndrome, treatment outcome, review, corticosteroids, and diagnosis". At last, 40 articles were selected and fully reviewed. Our results were obtained based on the results of the reviewed articles. Therefore, local and oral corticosteroid, splint, physical examination, and reported outcomes in surgeries revealed the effective diagnosis and conservative treatments in CTS. Based on the results, the CTS diagnosis should be based on the medical history of patient. In addition, physical examination must be done along with electrodiagnstic test. To reduce the signs and symptoms of moderate CTS, the use of local and oral corticosteroid could be effective according to the evidence. Only in some limited conflicting evidence, it was observed that nonsteroidal anti-inflammatory drugs, vitamin B6, and diuretics were no more effective than placebo in relieving the CTS symptoms. Therefore, surgery may be the sole treatment that takes away the median nerve compression in moderately severe cases.

Globally, violence against women is considered as a violation of human rights, a major barrier to gender equality, and one of the health problems that require immediate attention. The aim of this study was to explain the reproductive health and rights of abused women in Tehran, Iran. This qualitative study was carried out using the content analysis method among 18 abused women and 8 key informants. Data were collected using an unstructured interview in healthcare centers of Tehran, Iran. To this end, the samples were selected through purposeful sampling technique. Data analysis was performed using the content analysis method, with the help of MAXQDA software, version 10. According to the results, there were three main categories: fostering the nobility of proper and timely marriage, institutionalization of gender stereotypes in the society, and mutual commitment in marital relationships. Regarding the results, domestic violence is a human rights violation, which has serious impacts on women"s reproductive health and rights. It is essential to address the reproductive health and rights of abused women in order to improve the health status of women and society.

The aim of this study was to evaluate possible changes in thyroid and parathyroid glands tissues and functional structures. About 30 adult male rats were divided into 3 groups: control, negative control (exposed to dust in the clean area free from oil contaminants), and the treatment group (exposed to dust in the polluted area of Asalouyeh with oil hydrocarbons). Before grouping, all the animals were co-cycled. After 25 days of treatment, changes in pancreatic tissue and serum levels of thyroid and parathyroid hormones were measured. Moreover, the amount of heavy metals including lead, cadmium, arsenic, and mercury in animals" serum were measured using atomic absorption. The amount of heavy metals like lead, cadmium, arsenic, and mercury showed a significant increase in the serum of animals in treatment group compared to negative control and also control groups (P ≤ 0.05). Serum levels of thyroid and parathyroid hormones in treatment group showed a significantly decrease in comparison with control groups. In addition, histological investigations demonstrated relative changes in tissue and functional structures of important thyroid and parathyroid glands tissues. Dust of Asalouyeh polluted air had relative toxicity effects on thyroid and parathyroid tissues and their hormones.

Vitamin D deficiency is prevalent in heart failure (HF) and the anti-inflammatory impacts of vitamin D may affect the pathogenesis of HF. Therefore, the present study aimed to investigate the effect of vitamin D supplementation on echocardiographic and biochemical factors in vitamin D-deficient HF patients. To this end, 39 HF patients with 25(OH)D ≤20 ng/mL participated in the current double-blind, randomized, and placebo-controlled trial, who belonged to class III, New York Heart Association classification. About 50 000 IU vitamin D3 (group D+) or placebo (group D-) were prescribed within 2 months. Then, the ejection fraction (EF%), tumor necrosis factor alpha (TNF-α), B-type natriuretic peptide (BNP), and high sensitive C-reactive protein (hs-CRP) were assessed before and after supplementation. The mean serum level of 25(OH)D increased markedly in D+ group (P < 0.001). The mean increase of EF% was 5.3±9.03% (P = 0.03) and the decrease of TNF-α (-0.09 pg/mL, P < 0.001) and BNP (-3.14 ng/mL, P = 0.04) were statistically significant in D+ group after supplementation. In addition, the blood concentration of BNP declined significantly in D+ group compared to placebo while hs-CRP and TNF-α levels failed to differ between the two groups. The results revealed that vitamin D could be effective against inflammation and thus its supplementation may reduce the severity of HF by improving the serum level of BNP and EF%. However, more clinical trials are required to approve the beneficial role of vitamin D in HF patients.

  Anxiety is among the most prevalent psychological disorders induced by myocardial infarction. Traditional medicinal herbs have long been used to reduce anxiety. Avicenna was the first physician in the world who referred to the inotropic effects of Melissa officinalis as a fragrant herb. In addition, he emphasized the strengthening effects of this herb on the heart, nerves, and brain with exhilarating effects. Further, M. officinalis plays a role in removing nightmares, phobias, and palpitations. Accordingly, the present study assessed the effectiveness of aromatherapy using M. officinalis in alleviating anxiety in cardiac patients. This study was conducted on 96 patients who were equally assigned into 2 groups on a quasi-random basis. The case group underwent aromatherapy in the CCU as a cotton patch measuring 15 * 15 cm soaked in three drops of M. officinalis extract and attached to their collar for 30 minutes twice a day during 3 successive days. However, the same treatment pattern was followed by the control group while they only received odorless sesame oil on a similar cotton patch attached to their collar. Furthermore, the patients completed the Spielberger anxiety questionnaire before the intervention, on the second day after the second phase of aromatherapy, and immediately after completion of the intervention. The data were analyzed using independent t test. Based on the findings, no statistically significant difference was observed in the mean total scores of anxiety between the 2 groups at pretest and during the treatment (P ≥ 0.05). However, there was a significant difference between the mean total scores of anxiety in both groups at the post-test (P ≤ 0.05). In general, aromatherapy with M. officinalis extract reduced anxiety in cardiac patients. This method, as one branch of complementary medicine, can exert positive effects on diminishing the anxiety of cardiac patients.

The consumption of fruits and vegetables (F and V) improves health and nutritional status while it reduces the risk of diseases. The present study aimed to promote fruit and vegetable consumption among adolescents using Albert Bandura"s social cognitive theory (SCT) among students of Ardabil. In this interventional-experimental study, a total of 308 second-grade male and female high school students were selected and randomly assigned into control and intervention groups (154 subjects in each group). The entry criteria included the age range of 13-15 years, informed consent, and voluntary participation in the study. The SCT-based interventions were employed for the students, families, and schools using the student-family-school (SFS) approach. Data were collected employing a 3-part questionnaire including demographic characteristics, SCT-based determinants of F and V consumption by adolescents, as well as the frequency of F and V consumption. Finally, the obtained data were analyzed by descriptive and analytical statistics using SPSS software. Based on the results, the application of the student, family, and school-based interventions significantly increased the scores related to the constructs of environment, knowledge, skills, outcome expectations, outcome expectancies, observational learning, reinforcement, and self-efficacy in the intervention group compared to the control group (P < 0.001). In addition, the average amount of F and V consumption prior to intervention was 3.7±1.40 and 2.98±1.38 in experimental and control groups, respectively. Further, the corresponding values were 3.39±1.56 and 2.83±1.53 in the intervention and control groups two months after the intervention while they found to be 3.27±1.31 and 3.04±1.11 six months after the intervention in the two groups, respectively, which showed a difference between the groups during 2 and 6 months after the intervention (P < 0.002, <0.106, respectively). In general, the application of interventions based on SFS approach led to an increase in the scores of SCT structures and the amount of F and V consumption in students. Therefore, SCT-based interventions are recommended to be used at the level of schools, families, and students in order to enhance the consumption of F and V among the students.

The current study was intended to examine the empowerment of mothers concerning their adolescent girls" reproductive health in Iran. Content analysis was used in this qualitative research and purposive sampling technique was performed until reaching data saturation. In addition, the study sample included 26 mothers, with 11-19 years old daughters living in Khorram Abad, and 14 key informants. Finally, semi-structured interviews were conducted for data collection, followed by using conventional content analysis to analyze the data by MAXQDA10 software. Based on the aim of the study, 4 themes and 11 main categories each with some subcategories were extracted including "proper family-adolescent interaction (i.e., the establishment of healthy parent-children relationship and emotional support)", "educating the adolescent (i.e., age-appropriate education and teaching method)", "parental responsibility (i.e., the type of education, the identification and acceptance of parental responsibilities, and supervision on the adolescent"s behavior)", and "the promotion of parental knowledge about sexual and reproductive health (i.e., an authentic information source, appropriate time for receiving information, as well as educational measures and procedures to enhance parental knowledge)". In general, the results of the current study can be effective and helpful for healthcare authorities to present intervention programs with the help of the other organizations in order to enhance the adolescent reproductive health.

The national registry system of infertility has been established at various levels in different countries over the years due to the high prevalence of infertility in the world, as well as its social and economic effects on communities. Therefore, the present study was conducted to provide a model of the National Infertility Registry System for Iran. This comparative study was conducted in 2016, and the sample data included those related to the infertility registry systems in the United States, Canada, and England. Based on the aim of the study, different articles, databases, books, and the related websites were searched and national and international experts were consulted with in order to investigate the infertility registry system in developed countries (e.g., the United States, Canada, and England). Then, based on economic, cultural, and geographical conditions of Iran, an infertility registry system was proposed including 7 main axes and 20 sub-axes. Finally, the proposed model was validated using the Delphi technique at two stages, showing an agreement coefficient of 85%. In this study, the model for the Iranian National Registry System was proposed based on seven aspects encompassing the objectives and the structure of the system, data elements, the criterion of the registry, the process of data collection and reporting, as well as data quality control and classification. In general, due to the importance of the infertility registry in taking health measures, the proposed model can improve the management of infertile patients, in terms of providing a system to follow the results, and the effectiveness of the treatment, health family planning, and controlling the factors which influence infertility.

The aim of this study was to assess the efficacy of balance training in combination with physical modalities in patients with knee OA. In this single-blinded randomized clinical trial, 60 patients (mean age: 56.5±0.90 years) with primary knee osteoarthritis were recruited. Participants were assigned to two groups. Physiotherapy (PT) group received routine physical therapy (hot pack, ultrasound, transcutaneous electrical nerve stimulation (TENS), and exercise) while balance training group (BT) received conventional physical therapy plus balance training using Biodex balance system (BBS). The comparison between two groups revealed significant differences with regard to the visual analogue scale (VAS) pain score (P = 0.023), Western Ontario and McMaster Universities Osteoarthritis (WOMAC) pain score (P = 0.018), WOMAC total score (P = 0.042), Lequesne index (P=0.015) as well as the score of Timed Up and Go (TUG) test (P = 0.003). Similar results were observed for the fall risk score (P < 0.001). The WOMAC stiffness score in the BT group significantly decreased from 2.80±0.34 to 1.70±0.32 (P < 0.0 1), but it did not decrease in the PT group (P = 0.096). The combination of balance training and physical therapy provided more pain relief and development of functional abilities in patients with knee OA.

Polycystic ovarian syndrome (PCOS) is one of the most common endocrine disorders in women of reproductive age (6.8%-18%) and is one of the leading causes of infertility due to ovulation factors in 55%-70% of infertile women. In this study, we compared the first-line and second-line treatments of infertility through ovulation induction with clomiphene citrate and letrozole, respectively, in the infertile patients with PCOS.
Patients and This randomized clinical trial included 80 infertile patients with PCOS intent on pregnancy. Having considered the inclusion criteria and obtaining the informed consent, the patients were divided into two groups of 40 and treated with either clomiphene citrate or letrozole. In the first group, two tablets of clomiphene (50 mg/d) were taken and in the second group, two tablets of letrozole (2.5 mg/d) were prescribed on the third to seventh days of the menstrual cycle for 5 days. Over the course of the treatment for 3 months, pregnancy rate was detected at every menstrual cycle by performing BHCG titers. Data were entered into SPSS software version 21.0. All data were analyzed using independent t-test, and chi-square test with a significance level less than 0.05. Mean age of patients, and mean body mass index (BMI), as well as duration of infertility were not significantly different between letrozole and clomiphene groups. Fifteen patients in the clomiphene group (37.5%) reported a history of infertility treatment, compared to the letrozole group in which 12 patients (30%) reported such treatment, though this difference was not statistically significant. In the clomiphene group, the menstrual cycle was compatible with PCOS in 30 patients (75%), while in the group receiving letrozole, it was compatible in 33 patients (82.5%). Hyperandrogenism consistent with PCOS was present in 25 patients (62.5%) in the clomiphene group and in the group receiving letrozole in 22 patients (55%). The evidence of PCOS-compatible ultrasonography was found in 31 patients (77.5%) in the clomiphene group and in 35 patients (87.5%) in the letrozole group. The frequency of pregnancy in the clomiphene group (45%) was lower than that in the letrozole group (50%). Chi-square test showed that this difference was not statistically significant. It seems that the efficacy and success rate of clomiphene and letrozole in the treatment of infertility due to ovulation failures are similar in patients with PCOS in that both could increase ovulation and pregnancy rate. In other words, these two drugs are not superior to each other and can be selected according to the patient"s tolerance, cost, and side effects.

As men age, they experience changes due to reduced androgen level that is called andropause. Several factors contribute to reduced androgen levels in men. This study aimed at determining predictive factors for andropause. This study was conducted in 2015 on 264 andropausal men living in Tabriz who were selected using cluster sampling. Data was collected from April 2015 to September 2015 using demographic questionnaires and the male andropause symptoms self-assessment questionnaire. The mean age of the participants was 58.8±6.3, and the mean male andropause symptoms self-assessment questionnaire score was 53.7±9.9. In addition, linear regression analysis showed that the variables of education, employment, satisfaction with the spouse"s behavior, housing status were among the predictors of andropause symptoms. According to the results, the prevalence of andropause symptoms was moderate. Some social determinants of health such as employment, education, and marital satisfaction played a role in andropause symptoms. It seems that conducting further studies on the main causes of this problem and finding practical solutions to reduce andropause symptoms is necessary for providing health care for andropausal men.

  MicroRNAs are small (19–23nt) noncoding RNAs that adjust gene expression post-transcriptionally. In addition, microRNA (miRNA) profile modification is revealed in various abnormalities including cancer. Formalin-fixed paraffin-embedded (FFPE) material archives are valued for searching human diseases. Therefore, the present study aimed to investigate FFPE samples for miRNA expression, as an alternative analyte for gene expression with the growing therapeutic and diagnostic potential. Further, the validity of RNA isolation kits was evaluated in order to identify a preferred method. The two extracted methods were qualitatively and quantitatively assessed in order to compare the archived specimens between these methods. The total RNA and gene expression were quantified in each method as well. Based on the results, the level of RNA extracted from FFPE tissues and real-time polymerase chain reaction (RT-PCR) of hsa-miR-623, hsa-miR-515-5pin miRNeasy FFPE (P value < 0.047) was significantly higher than that in RNAX Plus (P < 0.084). In general, the spin column method for miRNA expression profile had better expression compared to the non-column method. The results further confirmed the validity of FFPE tissues as an appropriate resource for miRNA analyses.

  Upper crossed syndrome (UCS) can exert adverse effects on rehabilitation after a coronary artery bypass graft (CABG). Hence, the present study aimed to investigate the effects of stretching exercises on UCS in women undergoing CABG. The present quasi-experimental study was carried out on 30 women in Shahid Madani hospital of Tabriz, Iran. According to a similar study, the participants were selected through a convenience sampling method and randomly assigned to two groups of A and B. Those in group A participated in an 8-week intervention of stretching exercises (3 sessions per week) in accordance with the existing protocol. The data were statistically analyzed using analysis of covariance, the dependent t test, and the Wilcoxon test at the significance level of 0.05. The results indicated a significant difference between the two groups in terms of kyphosis angle (P=0.001) and forward head angle (P=0.019) after the intervention. The data analysis also showed that stretching exercises had no significant effect on the improvement of angles of left and right shoulders (P=0.109 and P=0.111) respectively. The study findings suggest that corrective and stretching exercises might improve head forward posture and kyphosis angle, but do not affect shoulder angle.

  In this experimental research, a rat model was used to investigate the protective effect of Fumaria parviflora on oxidative stress and testis tissue damage in diabetic rats. To this end, a total of 28 male Wistar rats were utilized and randomly divided into 4 groups including control group (G1), diabetic control group (G2, DC), diabetic treated with F. parviflora extract (G3), and healthy group (G4) that received F. parviflora extract. In addition, the therapy lasted for 56 days. Then, the blood levels of some markers of oxidative stress and antioxidant enzymes, as well as sperm parameters such as concentration, motility, and morphology were assayed based on the aim of the study. The histological examination showed a negative change in the DC group, and they were included in the treated groups. The plasma levels of glutathione peroxidase (GPx) and superoxide dismutase (SOD) significantly reduced in the DC group while the malondialdehyde (MDA) level enhanced the duration of diabetes. As regards the sperm parameters, the results demonstrated a significant reduction in the DC group whereas treatment with FP extract led to an increase in the quality of sperm. Based on the results of the present research, the F. parviflora extract has a positive role in protecting the testis tissue and sperm quality against oxidative stress in diabetic rats.

The use of dehydroepiandrosterone (DHEA) before initiating in vitro fertilization (IVF) cycles to increase the ovarian reserve is considered as one of the best therapies in women with diminished ovarian reserve (DOR). Therefore, the present study aimed to compare the effect of DHEA on women (below and above 35 years old) with DOR and to find if this therapy is useful at an earlier age. This clinical trial study was conducted on 35 infertile women with DOR who referred to Imam Khomeini hospital in Sari, Iran, during 2017. The intervention lasted for 6 weeks and DHEA tablets were used before the start of the intra-cytoplasmic sperm injection-embryo transfer (ICSI-ET) cycle. Antral follicular counts (AFCs) and the serum levels of anti-Mullerian hormone (AMH) were estimated before and after the intervention, followed by performing the ICSI. Finally, the changes in AMH levels and AFC, the number and quality of ovum and embryos and pregnancy, along with the rates of implantation and abortion were measured as well. The mean AMH levels (P = 0.02) and AFC (P < 0.001) after DHEA consumption varied significantly from those before administering the DHEA, and the increase in the AFC was more significant in the age group under 35 years (P = 0.03). In addition, these changes were more significant in body mass of less than 25 kg/m2 (P = 0.04). In general, the supplementation of DHEA in women with insufficient ovarian capacity probably improves IVF prognosis and other parameters including AFC and AMH, especially in women under 35 years old. Further, based on different evidence, the probability of pregnancy occurrence in women is lower with increased body mass index (BMI).

The pregnancy-related anxiety questionnaire is one of the specialized scales designed for pregnancy-related anxiety measurement including fear of delivery, fear of birth of a handicapped child, and concern about pregnancy- and delivery-related body changes. The present study aimed to assess psychometric properties of Pregnancy Related Anxiety Questionnaire- Revised2 (PRAQ-R2) among Iranian women. In this methodological, cross-sectional study, 109 pregnant women in the second trimester of pregnancy were studied through proportional randomized sampling. Content validity was evaluated in two qualitative (by experts) and quantitative (content validity ratio [CVR] and content validity index [CVI]) stages. In the next step, a confirmatory factor analysis was used to determine the validity of the structure. For reliability, the internal consistency (Cronbach α) was calculated and the stability of the questionnaire was analyzed using intragroup correlation coefficient with 20 samples.
b> Based on the results, the evaluation of content validity in quantitative step showed that CVI and CVR were 0.97 and 0.98 for PRAQ-R2, respectively. The reliability of the questionnaire calculated by intraclass correlation coefficient (ICC = 0.73) and internal correlation (α = 0.74) verified the high reliability of the instrument. Moreover, the construct validity was confirmed by confirmatory factor analysis. In general, the findings support the validity and reliability of the questionnaire. Therefore, it is recommended that a short form of anxiety questionnaire be used to assess the anxiety and concerns of Iranian women during pregnancy in clinical trials.

Infertility causes psychological problems in infertile patients and exerts adverse effects on the marital life of couples. Therefore, the present study investigated the effects of transactional analysis (TA) group behavioral therapy on marital satisfaction of infertile women. This before/after controlled trial was conducted on 30 infertile women referring to in vitro fertilization ward of Mahdieh hospital of Tehran in 2018. Patients were randomly assigned to intervention and control groups. The intervention group underwent TA for 4 weeks while the control group only received the routine treatment. Data were gleaned from Four ENRICH Couples Scale and analyzed by the SPSS software version 22.0 using independent and paired t-tests. The results of the paired t test showed a significant difference between the 2 groups after the intervention (P = 0.001) compared to before the intervention while no significant change was observed in the control group (P = 0.789). In addition, independent t-test indicated no significant change in the control group after the intervention (P = 0.000) compared to before intervention (P = 0.949). In general, training in TA group behavioral therapy significantly increased marital satisfaction in the intervention group compared to the control group. Accordingly, the TA can serve as a useful treatment for infertile women. Therefore, psychological counseling and psychotherapy centers are recommended to be established and promoted in obstetric hospitals in order to improve the therapeutic course in infertile women.

Objectives: Focusing on the associated factors of sexual dysfunction is essential for promoting the quality of life in multiple sclerosis (MS) patients. Therefore, the present study aimed to assess sexual dysfunction, along with its levels and correlates in women with MS. Materials and Methods: A total of 150 women aged 18-45 who referred to the MS society of Tabriz (Iran) were recruited in this cross-sectional study using a convenience sampling method during March-June 2018. The data were collected employing demographic characteristics questionnaire, Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 (MSISQ-19), Fatigue Severity Scale (FSS), and Beck Depression Inventory-Short Form (BDI-13) Items. Then, a neurologist rated the level of disability by the Expanded Disability Status Scale (EDSS). Finally, multivariate linear regression was applied to analyze the data. Results: The mean (standard deviation) age of MS patients was 36.64 (5.93) and the mean score of MSIS was 47.30 (14.92), ranging from 19 to 95. In addition, among the MS patients, 133 (88.6%) women reported sexual dysfunction (SD) including 125 (83.3%) women with primary SD, 85 (56.6%) women with secondary SD, and 55 (36.6%) women with tertiary SD. The results of multivariate regression analyses showed that predictive variables for SD in women with MS included education, depression, and spouse cooperation in home affairs. Conclusions: In general, SD is a common manifestation of MS. Women with MS should be screened and treated for depression. Further, the findings demonstrated that implementing support strategies by the husband could reduce SD in women with MS.

This study aimed at investigating the effect of low-dose ketamine on prevention of hypotension due to positioning after induction of general anesthesia in lumbar disc surgery. This double-blind clinical trial was performed during a 3-month period in 2016. A random sample of 84 patients with ASA (American Society of Anesthesiologists), class I, were enrolled in the study and the impact of ketamine on prevention of hypotension due to repositioning was investigated. After induction of anesthesia and intubation, ketamine 0.5 mg/kg of body weight as well as normal saline solution, with equal volumes, were injected to the intervention and control groups, respectively. Patients were repositioned though a similar method to prone position after peak of ketamine (after 1.5 minutes), and then, systolic, diastolic, and mean of the blood pressure were measured as a baseline, once before and 1 minute after the intubation, before repositioning, immediately after repositioning the patient from supine to prone position, and then every 2 minutes until 10 minutes after repositioning. There was significant differences in means (SDs) of systolic pressure and blood pressure in the first, second, and fourth minutes after repositioning, as systolic pressure and mean of the blood pressure in ketamine group was higher than those of control group. The changes of blood pressure in ketamine group was the least amount after repositioning. Ketamine can increase blood pressure, especially systolic pressure of patients, on other hand changes of blood pressure in ketamine group after repositioning was least amount.

Adolescence is a period of maturity between childhood and adulthood and thus is considered as a key step for the establishment of health behaviors. Therefore, the present study aimed to evaluate the effect of consultation on the healthy behaviors of girl adolescents. This randomized controlled field trial was conducted on 120 eligible girls aged 14-18 years old who studied in one of the ten stratified randomly selected schools among five districts of Tabriz-Iran from October 2017 to January 2018. The schools were randomly assigned to counseling (n=60) or control (n=60) groups as one pair in each district. The intervention group participated in three 45-60-minute counseling sessions about health behaviors in groups of six students. In addition, demographic, menstrual hygiene questionnaire, food frequency questionnaire (FFQ), as well as the international physical activity questionnaire were completed by participants before and 8 weeks after the intervention. All analyses were based on the intention to evaluate the healthy behaviors of girl adolescents. Both counseling and control groups were similar in terms of socio-demographic characteristics (P>0.05). The adjusted analysis of covariance (ANCOVA) for the baseline scores indicated a significant increase in the mean score of menstrual hygiene in the counseling group compared to the control group (adjusted mean difference =26.63, 95% confidence interval =25.39-27.87). Further, the consumption of milk and vegetable groups increased in the intervention group as compared to the control group (P<0.001). However, the mean score of physical activity was not statistically significant between the two groups after the intervention (P=0.686) while, based on within-group analysis, a significant increase was observed in the physical activity score in the intervention group (P=0.002). Based on the results of this study, counseling sessions for adolescent girls seem to be a good way to improve their health behaviors and promote the health of future mothers.

AIDS is among chronic disorders that severely affects the individuals" physical and mental health. Considering the importance of spirituality in counteracting the stress arising from chronic diseases and accepting the disease, our study aimed to determine the relationship between spirituality and mental health in HIV-positive patients who referred to the Behavioral Disorders Center in Tabriz, Iran. This descriptive analytic cross-sectional research was conducted on 81 HIV-positive patients referred to behavioral disorders center of Tabriz, Iran in 2017 using the census method. The instruments used in this study included socio-demographic characteristics questionnaire, Parsian and Dunning"s spirituality questionnaire, and General Health Questionnaire-28 (GHQ-28) . Data analysis was carried out through independent t test, one-way ANOVA, Pearson correlation coefficient, and multiple linear regressions. The mean (SD) of the overall mental health score was 36.0 (16.4) (range: 0-84). Two-thirds of the patients suffered from mental health disorder; mean (SD) of overall spirituality score in people suffering from positive HIV was 89.0 (15.3) (range: 29-116). The relationship between the total score of spirituality and overall mental health and its sub-domains was significant (P < 0.05). Self-awareness was the only mental health predictor. A considerable percentage of people with HIV suffer from mental health disorders. Regarding the positive relationship between spirituality and all mental health sub-domains, strengthening spirituality can lead to the promotion of mental health in these patients.

  Hypofibrinogenemia can worsen the outcome of patients with gastrointestinal bleeding (GIB). There are a few domestic surveys on the issue. We conducted this study to evaluate the prevalence of hypofibrinogenemia and its effect on the outcome of patients with acute GIB. In this cross-sectional study, all data about the patients with acute GIB admitted to the emergency departments of hospitals of Shahid Beheshti University of Medical sciences in 2016 were collected and analyzed using SPSS statistical software version 21.0 and all tests were considered significant at P value ≤ 0.05. From the patients under the study, 69% were male and the mean age was 53.38±13.18 years old. Mean levels of haemoglobin, international normalized ratio (INR), and fibrinogen were 10.68, 1.65, and 250.43, respectively. Moreover, most cases of hypofibrinogenemia had liver disorders or lower GIB (P < 0.05). While, fibrinogen level had no significant effect on mortality. In summary, afibrinogenemia is mostly correlated with liver diseases and lower GIB, and can cause severe morbidity.

Radiologists frequently diagnose two ureteral duplications including complete and incomplete types. Incomplete ureter duplication, which is also called bifid ureter, refers to a situation in which the ureteric bud bifurcates before meeting the metanephric blastema. On the other hand, complete ureter duplication, which is also named double ureter, defines another situation in which two separate ureteric buds, on either side of the embryonic body, are formed from the mesonephric duct (Wolffian duct) and then arrive in the metanephric blastema. Therefore, two separate ureters, renal pelvis, as well as a duplex kidney (upper and lower poles) are formed in a common renal capsula. Embryologically, in complete ureter duplication, the ureteric buds rotate 108 degrees when incorporating into the urogenital sinus, which is known as Weigert-Meyer rule. In this posture, the upper and lower poles of the kidney are drained by the laterocranial and mediocaudal orifice, respectively. Complete duplication is more common in women than men and is often associated with vesicoureteral reflux, ectopic ureterocele, and/or ectopic ureteral insertion. In the present case report, a 40-year-old woman, mainly complaining of abdominal and lower back pain, was discovered to have bilateral complete ureteral duplication on computed tomography (CT) scan, as well as kidney, ureter, and bladder x-ray radiography. Moreover, the embryological causes were discussed in forming the duplicated ureter and duplex collecting system.

This letter to the editor addresses some of the shortcomings and limitations of a recently published article entitled "Women"s Health and Status in Kurdistan Region of Iraq: A Review" by Shabila and Al-Hadithi in the Crescent Journal of Medical and Biological Sciences. The present review failed to highlight the developments that have been made in the Kurdistan Region of Iraq in the last decades. In addition, little is reported about mental health in the article while accessing effective and culturally appropriate mental health services is considered as one of the biggest challenges that Kurdish women face in the Kurdistan Region of Iraq. Therefore, systematic documentation of the women" status was agreed to be important for improving the health of women in this region. Such reports and reviews should conscientiously and deliberately seek for capturing the depth and scope of the women"s health status in order to help public health, along with medical and political leaders to make progress towards achieving the intended goal.

This paper was published in Crescent Journal of Medical and Biological Sciences in 2019.1 The corresponding author Razieh Parizad under a full agreement with all named co-authors wishes to retract this publication since some data, without referring, have been duplicated/misrepresented from a previous article2 due to some miscommunications with the co-authors and not getting approval from all the co-authors on her part. The corresponding author regrets any inconvenience that publishing such information may have caused.