فهرست مطالب
Medical Journal Of the Islamic Republic of Iran
Volume:35 Issue: 1, Winter 2021
- تاریخ انتشار: 1400/06/30
- تعداد عناوین: 200
-
-
Pages 1-9Background
One of the important aspects in the field of refugee health is the availability of primary health care, and the quality improvement of health care requires identifying barriers and facilitators. The present study aimed to identify obstacles and facilitators of providing primary health care to Afghan refugees from the perspective of health care providers.
MethodsIn this qualitative study, a semi-structured interview was conducted based on purposeful sampling with the involvement of 21 managers and experts in primary health care centers. Data were analyzed using the content analysis method and MaxQDA.
ResultsData analysis led to the production of 4 main themes: (1) challenges while providing primary health care, with 10 subthemes; (2) challenges after providing care, with 4 subthemes; (3) opportunities, with 3 subthemes; and (4) solutions, with 6 subthemes.
ConclusionAccording to the results of this study, identifying the challenges and providing opportunities and solutions to existing problems seem to be effective steps in the quality improvement of providing primary health care to refugees.
Keywords: Barriers, Facilitator, Primary health care, Health care providers, Refugees -
Pages 10-21Background
Iran will face the "aging Tsunami" phenomenon by the 2040s. Therefore, paying attention to the elderlychr('39')s driving to maintain and promote their independence and quality of life on the one hand and paying attention to the dangers of driving by the elderly for road safety will be important. The purpose of this research was to determine the components of driving competency in the elderly.
MethodsThe research has employed a scoping review. To this end, searches of scientific databases were conducted using keywords between 1990 and 2019. The process of selecting the documentation was-based on the PRISMA chart.
ResultsIn the first phase, 2769 records were found, and finally, 37 records met the inclusion criteria set for this study. The results indicated that 18 components were extracted that were classified into seven main categories including cognitive, sensory, motor, mental functions, and medications, diseases, and driving history.
ConclusionSensory, motor, and cognitive abilities are the most important components of elderly safe driving. Therefore, as age increases, chronic disease, multiple drug use, and subsequent problems increase. This can affect the ability to drive safely and can cause traffic injuries. Therefore, it is recommended to use the results of this research to design a suitable tool and model for assessing driving competency in the elderly.
Keywords: Automobile driver examinations, Aged, Automobile driving, Licensure, Traffic crashes, Geriatric assessment, Driving competency, Safe driving, Elderly -
Pages 22-32Background
Ulcerative colitis (UC) is specified by a chronic mucosal inflammation that has a deleterious impact on the quality of life (QoL). Coenzyme Q10 (CoQ10) appears to influence disease activity by its obvious properties. Therefore, the current research intends to assess the impacts of CoQ10 on QoL, disease activity, and blood pressure in UC patients.
MethodsThis clinical trial performed on men and women with UC in 2017 who were attended the gastrointestinal center of Hazrat Rasool Akram Hospital and private clinic. Eighty-eight UC patients were randomly allocated to receive either CoQ10 (200 mg/day) or placebo for 8 weeks. The anthropometric parameters, blood pressure, inflammatory bowel disease questionnaire-32 (IBDQ-32) score, and the Simple Clinical Colitis Activity Index (SCCAI) score were measured pre and post-intervention. P-value <0.05 was considered to be statistically significant. All statistical analysis was done using SPSS software version 24.
ResultsEighty-six UC patients (44 males) with a mean age of 39.29 (10.19) years completed the trial. The results of between- and within-group analysis revealed that the SCCAI score (p<0.001 and p<0.001, respectively), diastolic blood pressure (p=0.025 and p=0.001, respectively), and systolic blood pressure (p=0.001 and p<0.001, respectively) decremented significantly; while, the mean IBDQ-32 (p<0.001 and p=0.001, respectively) increased substantially in the CoQ10 group; whereas there was no significant difference in anthropometric indices in both groups.
ConclusionFindings suggest that CoQ10 can be used as a potential intervention for diminishing the disease severity and blood pressure and may improve QoL and UC patients.
Keywords: Coenzyme Q10, Quality of life, Ulcerative colitis, SCCAI score, IBDQ-32 -
Pages 33-37Background
Although soft markers may be seen as normal variants, they are important due to their association with chromosomal and congenital abnormalities.
MethodsThis cross-sectional descriptive-analytical study was done on 3016 women who referred for perinatal care. Fetuses with any of soft markers including thickened nuchal fold (TNF), mild pyelectasis (MP), choroid plexus cyst (CPC), single umbilical artery (SUA), mega cisterna magna (MCM) and mild ventriculomegaly (MVM) were followed during pregnancy and birth. Data analysis was carried out using SPSS for Windows (version 22). Data were analyzed using chi-square and T-test. A p-value <0.050 was considered statistically significant.
Results285 (9.4%) fetuses with soft markers Including 148 (4.9%) fetuses with CPC, 118 (3.9%) fetuses with MP, 2 (0.1%,) fetuses with isolated TNF, 8 (0.3%) fetuses with isolated MVM, 4 (0.13%) fetuses with SUA, 4 (0.13%) fetuses with MCM were identified, and one fetus had TNF and MVM simultaneously. In cases with CPC, no abortion or major structural abnormalities were observed and all 148 neonates had normal phenotypes at birth. Among 118 cases with MP, one case had a major cardiac disorder, and 2 cases of abortions (1.7%) were reported (p=0.481). 83 cases (70.3%) were male and 35 cases (29.7%) were female (p=0.021) and all neonates had a normal phenotype. Both pregnancies with isolated TNF resulted in abortion. Of the 8 cases with isolated MVM, two cases had major structural abnormalities. 2 cases of abortion were reported and all infants had a normal phenotype. In one case, that fetus had TNF and MVM simultaneously. Amniocentesis showed no aneuploidy. No major structural abnormalities were observed in fetuses with SUA. One case of abortion was reported. Among the three births, two pre-term births were reported, and all three infants had normal phenotype. In four cases with MCM, no major structural abnormality was observed and all four neonates had normal phenotype.
ConclusionIn cases without association with other structural abnormality, mothers who have fetuses with CPC or MP should be reassured that the pregnancy outcomes are generally favorable.
Keywords: Ultrasonography, Fetus, Soft marker, Outcome -
Pages 38-42Background
Aging is a major challenge not only for high-income countries but also for middle- and low-income countries. The length of stay (LOS) in hospitals is one of the major concerns of elderly patients, which should be taken into consideration. We aimed to investigate the factors affecting LOS of elderly patients admitted to a referral hospital of northeast of Iran.
MethodsA relatively large population of 7130 hospitalized elderly patients (over 65 years old) who referred to Ghaem hospital (Mashhad, Iran) from March 20, 2016 to March 19, 2017 were selected. The demographic and medical records data of patients were extracted from the hospital database. Univariate analyses as well as count regression models, including poisson regression and negative binomial regression, were conducted to assess the influential factors on the LOS and the number of admissions considered for potential confounders using SAS software. In this study α =0.05 was considered as statistically significant.
ResultsThe mean age of participants was 76.57±7.29 years, and 54.8% were male and 45.2% were female. The mean LOS was 8.11±13.97 days and the mean number of admissions 1.5±1.73 times. The negative binomial regression model had better fitness than Poissonchr('39')s model. Findings indicated that emergency hospitalization (RR: 0.21), admission to the CCU (RR: 0.33), and male gender (RR: 0.92) were statistically reducing factors for LOS among elderly patients, respectively. Discharge status (deceased, RR: 1.50), patients with diagnosis of injuries and poisoning (RR: 1.34), and native residence (RR: 1.10) were factors that statistically increased the length of stay among hospitalized elderly patients.
ConclusionLOS in hospitals is affected by multiple factors and the negative binomial regression model is a better statistical method for estimating the influencing factors.
Keywords: Elderly, Length of stay, Count regression models, Negative binomial regression -
Pages 43-49Background
It is assumed giving oxygen to patients with acute myocardial infraction may increase the oxygenation of the ischemic tissue; however, the usefulness of oxygen in these patients has become a challenging topic. Thus, the present study aimed to determine the effect of oxygen inhalation on cardiac biomarkers in patients with acute myocardial infarction.
MethodsThis randomized clinical trial study was performed on 2 groups of intervention and control within 2 days of admission to critical care unit (CCU). A total of 64 patients with ST-segment elevation acute myocardial infarction who referred to Zeyaei hospital, Ardakan, were selected using simple random sampling. In the intervention group, the pulse oximetry was monitored and they only breathed regular air and received supplemental oxygen in case their oxygen level dropped below 94%. The levels of creatine kinase-MB and troponin I enzymes were measured. Data were analyzed using SPSS version 20 through repeated measure ANOVA, t test, and chi-squared test. Significance level was set at 0.05.
ResultsThis study showed that during the 48 hours of hospitalization, there were no significant differences between the 2 groups regarding the levels of creatine kinase-MB (p=0.509) and troponin I (p=0.604).
ConclusionSince the level of cardiac biomarkers is a sign of the extent of infracted area, it is assumed receiving supplemental oxygen in patients with acute myocardial infarction has no effect on decreasing the infracted area.
Keywords: Troponin I, Creatine kinase, Oxygen inhalation therapy, Myocardial infarction -
Pages 50-59Background
There is sparse information to describe the clinical features and outcomes of patients infected with coronavirus disease 2019 (COVID-19).
MethodsIn a single-center retrospective observational study, 50 patients infected with COVID-19 were studied. Epidemiological, demographic, clinical, laboratory, radiological, and treatment data were collected and analyzed. Outcomes of critically ill patients and noncritically ill patients were compared.
ResultsThe mean age of the patients was 48.8 years, with male predominance. Dry cough, fever, and dyspnea were the most complaining symptoms on admission. Chronic medical illnesses before admission were present in 56% of the patients. The most common laboratory abnormalities were lymphopenia, neutrophilia, thrombocytopenia, increased aspartate aminotransferase, high serum creatinine level, elevated lactate dehydrogenase, and increasing ESR and CRP levels. Bilateral mixed ground-glass opacity and consolidation were observed in chest CT scan of most patients. Some patients required supplemental oxygen and some needed invasive mechanical ventilation. Blood oxygen saturation was different between survivors and nonsurvivors. 10% of patients died, of whom 60% were men. 40% of dead cases had chronic medical illnesses; 60% underwent invasive mechanical ventilation.
ConclusionAmong the patients diagnosed with COVID-19 infection, the frequent clinical presentation was with a wide range of signs and symptoms. The laboratory changes suggest that COVID-19 infection may be related to cellular immune deficiency, myocardial, hepatic, and kidney injury. Additional research is needed to elucidate COVID-19 pathogenesis.
Keywords: SARS-CoV-2, Coronavirus disease 2019, COVID-19, Clinical features, Laboratory, Chest CT scan, Outcomes -
Pages 60-71Background
Attention deficit hyperactivity disorder (ADHD) is among the most common neurodevelopmental disorders in children and adolescents. There is a controversy over the true prevalence of ADHD in Iran, the knowledge of which is crucial for allocating health care resources and identifying research priorities. This is an updated systematic review of the prevalence of ADHD in Iranian children and adolescents.
MethodsFor this systematic review, PubMed/Medline, Web of Science, Scopus, PsycINFO, IranPsych, IranMedex, Irandoc, Google Scholar, and grey literature were reached for publications between January 1990 and December 2018 that reported prevalence estimates of ADHD in Iran. Parallel independent assessments were conducted. The Quality Assessment Checklist for Prevalence Studies was used to assess the overall quality of studies.
ResultsA total of 34 original studies covering 33 621 Iranian children, adolescents, and adults were included. The included studies were mostly conducted on the population of preschool, elementary, middle, and high school-aged children as well as adolescents. Also, 6 studies addressed university students. Prevalence estimates of ADHD reported varied substantially across the studies and offered a range of heterogeneous data.
ConclusionOverall, making exact comparisons among studies was not easy because the assessment method and the type of sampling could impact prevalence estimates. These factors need to be considered when comparing data from different studies.
Keywords: Attention deficit disorder with hyperactivity, Iran, Prevalence, Review -
Pages 72-77Background
The emergence of drug-resistant strains of herpes simplex virus type 1 (HSV-1) has been increasingly reported. Therefore, attempts to discover new antiviral agents in particular from natural compounds are required. In this study, we evaluated the possible inhibitory effects of hydroalcoholic extract of Sambucus ebulus (S. ebulus) against HSV-1.
MethodsS. ebulus extract was produced by maceration method. MTT assay was used to evaluate the cytotoxicity effects of the S. ebulus extract; also, antiviral effects were measured both by test TCID50 and quantitative real-time PCR methods. To study the inhibitory impact of S. ebulus extract on the expression of HSV-1 antigens, indirect immunofluorescence assay (IFA) was also performed. All analyses were performed using the GraphPad Prism software v. 7.0.
ResultsIn the postexposure assay of HSV-1 with S. ebulus extract at the highest nontoxic concentration (75 μg/mL), S. ebulus extract led to 2.6 log10 TCID50 reduction in infectious virus titer. At the highest nontoxic concentration, the S. ebulus extract led to inhibition rates of 91.2%, based on the quantitative real-time PCR assay results (p<0.001). Also, in the immunofluorescence assay, a significant reduction was observed in fluorescence emission intensity in HSV-1-infected cell treated with S. ebulus extract compared to the control group.
ConclusionS. ebulus extract is a novel and effective natural compound in reducing HSV-1 titer and future studies should be conducted to discover the complete mechanism of antiviral effect of this natural compound.
Keywords: Herpes simplex virus, Antiviral activity, Natural product, Sambucus ebulus -
Pages 78-86Background
The International Convention on the Rights of Persons with Disabilities (CRPD) is the most important International Document for recognizing the rights of persons with disabilities, including the right to health and rehabilitation. Islamic Republic Iran acceded to the Convention in 2008, but still has a long way to go to achieve its desired status and in line with the objectives of the convention. This study aimed to identify the barriers to the implementation of articles 25 and 26 of the CRPD in Iran.
MethodsThis study was performed using conventional content analysis. Twenty-one individuals were recruited by purposive sampling with maximum variation and were continued until saturation. Data were gathered through in-depth, semi-structured interviews from June 2018 to May 2019. MAXQDA version 10 was used for analyzing data.
ResultsThe resulting data analysis yielded 860 initial or open codes. The concepts were categorized into 27 subcategories and 7 categories. Main categories were included: "Structure inefficiency", "lack of comprehensive rehabilitation program", "inadequate awareness", "neglected economy of people with disabilities", "weak access to services", "cultural challenges" and "disregard for new technologies".
ConclusionThe findings showed that the executive structures in the country have a lot of problems with health and rehabilitation programs for people with disabilities. It seems understanding the barriers to implementation of articles 25 and 26 of the international CRPD empowers officials in the field and improve services by providing a better view of the disabled. Nevertheless, it is recommended for policymakers to consider rehabilitation as a main element of the health system.
Keywords: Convention on the Rights, Disabilities, Health, Rehabilitation, Content analysis -
Pages 87-94Background
Given the importance of maintaining the mental health of workers, the present study was conducted to determine the effect of the individual factors on hypochondriasis and job stress under the corona epidemic condition in a company.
MethodsThis cross-sectional study was performed on 275 workers in 2020 in one of the industries in southern Iran. To gather the data, demographic, researcher-made, standard hypochondria, and job stress questionnaires were sent electronically along with a guide and study objectives. The participants completed the questionnaires during 2 weeks and send them electronically to the research team. Finally, data were analyzed using tests of one-way ANOVA and linear regression in SPSS software version 22.
ResultsThe results showed that the mean score of hypochondriasis in different groups of variables, including age, work experience, use of personal protective equipment, corona experience, and attention to preventive measures was significantly different (p<0.05). Based on the results, the mean score of job stress significantly differed in different groups of variables of personal protective equipment use, corona experience, and awareness on corona (p<0.05). Moreover, based on the regression relationships, hypochondriasis could be predicted by variables of personal protective equipment, corona experience, awareness on corona, and attention to preventive measures; and job stress could be predicted by variables of awareness on corona and attention to preventive measures.
ConclusionRegarding the importance of providing the physical and mental health of employees, the implementation of measures to reduce stress and hypochondriasis of employees, particularly in identified groups, is helpful.
Keywords: Individual factors, COVID-19, Hypochondriasis, Job stress -
Pages 95-98Background
There is no clear consensus regarding the potential of denosumab for increasing the risk of infection in patients who concurrently receive biologic disease-modifying anti-rheumatic drugs (bDMARDs). In this study, we compared the rate of infection in postmenopausal women with rheumatoid arthritis who received concurrent bDMARDs and denosumab with those who received bDMARDs alone.
MethodsIn a case-control study, postmenopausal patients with a confirmed diagnosis of rheumatoid arthritis who received concurrent bDMARDs and denosumab for at least one year were identified and included as the case group (n=40). A total of 44 age-matched postmenopausal rheumatoid arthritis women who received bDMARDs alone were included as the control group of the study. Using a chi-squared test, the incidence of bacterial or viral infections was extracted from the patients’ profiles and compared between the two study groups. Statistical analyses were performed by SPSS for Windows, version 16 (Chicago, Illinois, USA). A p-value of fewer than 0.05 was regarded as significant.
ResultsThe clinical and demographic characteristics of the patients of the two study groups were not significantly different. In total, four infections were recorded in the present series, two infections in each group. Accordingly, the rate of infection was 4.5% in the bDMARDs alone group and 5% in bDMARDs + denosumab group. This difference was not statistically significant (p=0.655, 95% CI: 0.121-6.742). Three out of four infections were herpes zoster infection. The other one was osteomyelitis of the first metatarsal bone, which occurred in the bDMARDs+denosumab group. None of the infections needed a hospitalization of IV antibiotics.
ConclusionThe risk of infection is comparable between postmenopausal osteoporotic women with rheumatoid arthritis who receive bDMARDS alone and those who receive bDMARDS in combination with denosumab.
Keywords: Rheumatoid arthritis, Postmenopausal osteoporosis, Denosumab, bDMARDs -
Pages 99-103Background
Tuberculosis (TB) is a major global health problem, so for better planning in the health sector, it is necessary to know the real burden of tuberculosis in our country. The main aim of this study was to calculate the burden of TB for the Iranian population in 2001-2012.
MethodsThe Disability Adjusted Life Years (DALYs) index was calculated using a computer model (DisMod version II) in Iran between the years 2001 and 2012. DALYs are age-weighted (β= 0.04) and are discounted for time preference (r= 0.03).
ResultsThe trend was decreasing from 2001 till 2006, and after it, there is an increasing trend. The incidence was more in younger age groups and in female, and the YLL is higher in men (11744 in male vs 7897 in female in 2012); it showed that the life lost is higher in men. The YLD in men and women are very close. In comparison, the DALY of TB was higher in men than women.
ConclusionIn the present investigation, it has been found that the overall tendency to get TB was higher in the female population. It shows that the incidence was higher in the younger age groups but the mortality was higher in the elderly groups. It that shows the significant success of the country in controlling the disease.
Keywords: Tuberculosis, Burden of disease, Disability-Adjusted life Years -
Pages 104-109Background
Household food insecurity is one of the major public health issues that may affect an individual’s nutritional state, especially in patients with chronic diseases. The aim of this study was to evaluate the prevalence of household food insecurity and its association with sociodemographic and clinical factors among patients with HIV/AIDS in Kerman province, Iran.
MethodsA cross sectional study was performed among the 179 patients with HIV/AIDS in Kerman province. Participants completed a questionnaire focusing on personal information, health, and clinical status. Also, household food security status was evaluated by the USDA (US Department of Agriculture) questionnaire. Data were analyzed using SPSS (Version 22) by descriptive, univariate, and multivariate logistic regression. P<0.05 was considered statistically significant.
ResultsOverall, 98 responding men and women were classified as household food secure (n=41; 40.8%) and household food insecure (n=58; 59.2%). Among the household food insecure patients, 14% (n=8) experienced lower household food insecurity, 38% (n=22) moderate household food insecurity, and 48% (n=28) severe household food insecurity. No significant differences were observed between household food secure and insecure groups in demographic variables. In clinical variables, only BMI index was significantly different between the two groups (p=0.040), but CD4 count was not significant between groups (p=0.220).
ConclusionPrevalence of household food insecurity was high among people living with HIV/AIDS in Kerman. It seems clinical variables such as BMI index, which indicates the nutritional status of individuals, affect household food security status among people living with HIV/AIDS.
Keywords: AIDS, HIV, Food insecurity, CD4 cell counts -
Pages 110-113
COVID-19 was first discovered in Wuhan, China, and has spread rapidly around the world. The most important manifestation of COVID-19 was ARDS-like lung injury at first, but the involvement of other organs, such as kidney, heart, liver, and skin, was gradually reported. It is important to report and share all atypical manifestations of this disease to help other physicians to gain more knowledge about this new viral disease. As mentioned, there are also studies that show different types of cutaneous involvement in these patients, but due to the lack of more detailed studies in this field, and on the other hand, the possible usefulness of skin lesions as a diagnostic or alarming sign in the COVID-19 era, in this study we report a COVID-19 patient with a large hemorrhagic blister similar to sepsis-induced skin lesion. Despite the lack of common symptoms of the disease, the lung scan of the patient was positive for COVID-19.
Keywords: COVID-19, Skin lesion, Extra pulmonary complication, Cutaneous manifestation, Coagulopathy, Hemorrhagic bullae, Vascular injury, Vasculitis, Vasculopathy -
Pages 114-120Background
Determining the factors affecting survival and appropriate treatment methods leads to improving the survival rate and quality of life in cancer patients; therefore this study was aimed to determine the effective factors on the survival rate of patients with Laryngeal cancer in Kerman city, Iran.
MethodsThis retrospective cohort study included 370 patients with Laryngeal cancer who referred to the hospitals of Kerman city, Iran during 2008 to 2018. Data were analyzed using Cox Proportional Hazards and Lin-Ying’s Additive Hazards models. Data analysis was done using SAS software version 9.4. The P-value of less than 0.05 was considered as statistically significant.
ResultsThe mean age at the time of diagnosis was 58.16±10.60 years. About 92% of the patients were men. The patient’s 1, 3, 5, 7 and 10-years of overall survival rates were equal to 82.38%, 60.68%, 55.98%, 49.83%, and 30.91%, respectively. Age at the diagnosis (p=0.001), radiotherapy (p=0.001), chemotherapy (p=0.015), surgery (p=0.031), and smoking (p=0.001) were found to have significant effect on the patient’s survival rate in the Cox model. These variables were significant in the Lin-Ying model too.
ConclusionTreatment is an important factor in controlling the disease and survival of cancer patients, and choosing the best treatment depends on the condition of the patient and the disease level.
Keywords: Survival analysis, Laryngeal cancer, Treatment, Hazard ratio, Excess risk -
Pages 121-124
COVID-19 is a novel highly contagious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Immunosuppressed people are at a higher risk for unfavourable outcomes if infected with SARS-CoV-2, as cellular immunity plays a key role in determining the course and outcome in COVID-19. Kidney transplant recipients (KTRs) are thus a distinct subset of the population. We describe our early experience with 2 KTRs requiring hospital admission due to COVID-19 and who recovered well. We conclude that timely intervention in the form of modifying immunosuppression and close monitoring and institution of further measures based on clinical severity is needed in KTRs with COVID-19.
Keywords: Severe acute respiratory syndrome coronavirus 2, Kidney transplant -
Pages 127-131Background
The pathogenesis of Alzheimer’s disease (AD) is believed to be occurred by the production of neurotic plaques of the beta-amyloid peptide (Aβ) and deposition of them. Therefore, biomarkers of abnormal Aβ processing may represent before the AD clinical biomarkers, which could be benefit for a successful disease management that may prevent the AD development. The aim of this study is to investigate of plasma Aβ40,42 levels in Alzheimerchr('39')s patients in Syria and thus determine whether they may have a potential role as biomarker for identifying and predicting AD.
MethodsIn this cross-sectional study, the plasma levels of Aβ1-40 and Aβ1-42 were investigated in two groups represent Syrian population, AD group; clinically diagnosed AD patients (n=50) and CN group; cognitively normal participants (n=33). This study first determined the reference interval of plasma Aβ1-40 and Aβ1-42 for cognitively normal Syrian. Results were analyzed using SPSS, 24, depending on independent-samples t test, considering that the value of p < 0.05 is statistically significant.
ResultsThe results showed that the plasma levels of Aβ1-40 (p<0.001, OR=1.031, 95%CI: 1.012-1.051) and Aβ1-42 (p<0.001, OR=1.306, 95%CI: 1.145-1.490) were significantly higher in AD patients than in cognitively normal participants, and no significant association was shown between both of education and sex with plasma Aβ levels.
ConclusionThe plasma levels of Aβ1-40 and Aβ1-42 could be potential biomarkers for identifying and predicting AD.
Keywords: Alzheimer disease, Aβ40, 42, Biomarkers, Syria -
Pages 132-142Background
Coronavirus primarily targets the human respiratory system, COVID-19 (Coronavirus disease 2019) triggered in China in the late 2019. In March 2020, WHO announced the COVID-19 pandemic. This study aims to analyze and visualize the scientific structure of the COVID-19 publications using co-citation and co-authorship.
MethodsThis is a scientometric study. Web of Science Core Collection (WoSCC) was searched for all documents regarding COVID-19, MERS-Cov, and SARS-Cov from the beginning to 2020. An Excel spreadsheet was applied to gather and analyze the data and the CiteSpace was used to visualize and analyze the data.
ResultsA total of 5159 records were retrieved in WoSCC. The structure of the network indicated that the network mean silhouette was low (0.1444), implying that the network clusters’ identity is not identifiable with high confidence. The network modularity was 0.7309. The cluster analysis of the co-citation network on documents from 2003 to 2020 provided 188 clusters. The largest cluster entitled, “the Middle East respiratory syndrome coronavirus” had 255 nodes. The coauthorship network illustrated that the most prolific countries, USA, China, and Saudi Arabia, have focused on a specific field and have formed separate clusters.
ConclusionThe present study identified the important topics of research in the field of COVID-19 based on co-citation networks as well as the analysis of clusters of countrieschr('39') collaborations. Despite the similarities in the production behavior in prolific countries, their thematic focus varies so that a country like China plays a role in “Quantitative Detection” cluster, while USA is the leading country in the “Biological Evaluation” cluster.
Keywords: Covid-19, Scientometrics, Visualization analysis, Co-citation, Collaboration network, Coauthorship, CiteSpace -
Pages 143-156Background
Current Health care delivery systems are not effective for the elderly. Countries with high elderly populations are expected to design special models to serve their elderly population. The aim of this study is to investigate the models of health care delivery to the elderly in different countries.
MethodsThe present study is a systematic review based on PRISMA standard guidelines. The search for related studies was conducted in electronic databases (Cochran Library, Scopus, PubMed, Embase, Web of Science) and the Google Scholar search engine without time limits until May 2019. Keywords were extracted based on MeSH strategies. At first, 16243 articles were found. After the screening phase (elimination of duplicated articles, title screening, abstract screening, and full-text screening) 19 articles remained. Two articles deleted after text appraisal using the CASP checklist. In the next stage, after reviewing the gray literature and reviewing the references of remaining articles, three new articles were added (Included studies = 20).
ResultsTwenty articles (models) corresponding to the study objectives were finally extracted. These models are limited to nine countries and most have local scopes. These models mainly use a case manager, an intra- or inter-disciplinary team, and an elderly assessment tool in their structure. In addition to the use of an information system, these models provide a wide range of services to the elderly.
ConclusionMost of the models mentioned are local models. Smaller models to become applicable at the national level, they need to be reviewed and evaluated by policymakers and experts. Given the inefficiency of current systems in providing services to the elderly, it is recommended that countries use an integrated model of health care provision for the elderly.
Keywords: Aging, Elderly, Integrated care, Health care delivery, Financing -
Pages 157-160Background
Lung cancer accounts for about 13% of all cancers and about 60% of patients with lung cancer also experience weight loss during treatment. There seems to be a clear correlation between the therapeutic outcomes of patients based on their weight changes during treatment. The aim of this study was to investigate the relationship between weight changes during and after treatment and the therapeutic outcomes of a patient with metastatic lung cancer.
MethodsThis cohort study was performed on patients with the diagnosis of non-surgical metastatic lung cancer referred to Hematology and Oncology Clinic, Rasoul-e-Akram Hospital. Patients were divided into two groups with a weight gain of more than 5% and a weight gain of 5% and less. The information was entered into the SPSS version 21 software. In the descriptive analysis, mean and standard deviation (SD) were used. To compare quantitative variables, independent samples t-test , Mann-Whitney, chi-square or Fisher exact tests were used to compare qualitative variables and correlation test was used to determine the correlation between quantitative data. Survival curves were used to show differences in two groups of studies. A regression model was used to calculate the hazard ratio. The significance level was less than 0.05.
ResultsSixty patients, including 40 males (66.7%) and 20 females (33.3%) were studied. The mean age of patients was 62.22±9.00 years (43-83 years). The mean weight changes in the patients were -1.28±6.11 kg (-16 to 16kg). Forty-seven patients (78.3%) had weight gain less than 5%. There was no significant difference in overall survival (OS) and progression-free survival (PFS) according to weight gain.
ConclusionFinally, the findings of the study showed that, despite the fact that PFS and OS in the weight gain group were greater than 5% of the original weight; the difference was not statistically significant.
Keywords: Metastatic lung cancer, Weight gain, Overall survival, Progressive free survival -
Pages 161-168Background
The health sector evolution plan was implemented in 2014 in government hospitals across the country as a part of the universal health coverage achievement programs. This study assessed the performance of hospitals before and after the implementation of this plan, using the Pabon Lasso model.
MethodsThe population of this study consisted of the hospitals of the country in the 2013-2015 time frame; overall, 874 hospitals (94.5% of the population) were included in the study. In order to assess performance, we used the Pabon Lasso model and hospital performance indicators (Average Length of Stay, Bed Turnover, and Bed Occupancy Rate). The data were collected from the Hospital Information System and provincial deputies of curative affairs and were then analyzed using the descriptive indicators of mean, frzquency, and median in SPSS 22. Also, Paired Student T-test and ANOVA were used to compare the performance of different groups of hospitals before and after the implementation of the health sector evolution plan.
ResultsThe implementation of the health sector evolution plan has led to a significant improvement in the three performance indicators in the hospitals of the country. Before the implementation of the health sector evolution plan, the most inefficient, inefficient, fairly efficient, and most efficient zones included 31%, 18%, 17%, and 33% of the studied hospitals, respectively. However, the implementation of the health sector evolution plan changed the percentages to 29%, 21%, 20%, and 30%, respectively. Teaching hospitals, which are governmental and are mostly located in capital cities of the provinces, were overall more inefficient than non-teaching hospitals.
ConclusionThe number of the most efficient and most inefficient hospitals has decreased, and the number of average performance hospitals has increased after the implementation of the health sector evolution plan. Therefore, the health sector evolution plan has not led to an overall increase or decrease in the performance of hospitals but has reduced the difference in the performance of hospitals. Equal support of government hospitals along with financial protection against health expenses, improves the performance indicators of hospitals and reduces performance differences among them.
Keywords: Average length of stay, Bed occupancy rate, Bed turnover, Teaching hospital, Health Sector Evolution Plan, Iran -
Pages 169-177Background
COVID-19 pandemic crisis motivated researchers worldwide to deeply investigate it from different perspectives. As Iran is one of the highly-affected countries by Covid-19, Iranian researchers have focused on studying it. This study aimed at analyzing and visualizing Iranian researcherschr('39') papers on COVID-19 from a bibliometric perspective.
MethodsBy searching MeSH-selected keywords related to COVID-19 in Scopus, Iranian researcherschr('39') papers on COVID-19 were extracted in a CSV format and underwent bibliometric techniques, such as coauthorship analysis, citation, and co-citation analysis, keyword and term co-occurrence mapping and etc. in the Microsoft Excel and VOSviewer software package.
ResultsA total of 405 papers were authored by Iranian researchers on COVID-19 during the study period, with the average number of citations per paper of 2.60 and a mean h-index of 15. The majority of papers were original articles in English. Archives of Clinical Infectious Diseases and Archives of Iranian Medicine and Medical Hypotheses were highly ranked publishing journals, respectively. The most productive institute and author were Tehran University of Medical Sciences with 119 papers and Rezaei, N. with 12 papers. Iranian researchers collaborated with the researchers of 73 countries, with the USA ranking first in Covid-19 research, followed by Italy, Canada, and United Kingdom. In publishing papers on COVID-19, Iran ranked first among the Middle Eastern countries and thirteenth internationally.
ConclusionIranian researchers were active in 5 main areas of COVID-19 research, including epidemiology, diagnosis, treatment, virology, and systematic review.
Keywords: Bibliometrics, COVID-19, Data visualization, Iran, SARS-CoV-2 -
Pages 178-187Background
To quantitatively estimate the relationship between IL‐1β -511C>T, −31T>C, and +3954C>T polymorphisms and risk of gestational disorders.
MethodsIn this meta-analysis, eligible publications were searched in Web of Knowledge, MEDLINE, PubMed, Scopus, and Google Scholar databases (updated April 2020), using appropriate or relevant keywords. Case-control population-based reports were included if provided with genotypic frequencies of both studied groups. Statistical analyses were performed using the MetaGenyo web tool software, where a P value less than 0.05 indicated a significant association. For the assessment of between-study variations, heterogeneity analysis was applied with the I² statistics.
ResultsA total of thirteen studies were included. We observed a significant association between IL‐1β−31T>C polymorphism and reduced risk of gestational disorders under codominant CT vs. CC [OR= 0.74, CI (0.59-0.92)], and dominant CT+TT vs. CC [OR= 0.74, CI (0.60-0.91)] contrasted genetic models. The stratified analysis considering the disease type showed that the 511C>T variant, under the recessive CC vs. CT+TT model, enhanced the risk of preterm birth by 1.29 fold.
ConclusionOur results failed to support an association between two IL‐1β polymorphisms, 511C>T and +3954C>T, with the overall risk of gestational disorders. In contrast, the 31T>C variant reduced the incidence of such diseases. Further studies are encouraged to get more precise estimates of effect sizes.
Keywords: Cytokine, Interleukin, Polymorphism, Pregnancy, Meta-analysis -
Pages 188-196Background
Metabolic syndrome (MetS) and osteoporosis are two of the worldchr('39')s major healthcare issues. There are several studies which explored the association between MetS and bone mineral density (BMD), but all of them are cross-sectional. These studies cover all populations, including expatriated, which did not determine the actual problem among Saudi women. This is the first case-control study that determines the causal relationship between MetS and BMD. The objective of this study is to determine the relationship between metabolic syndrome and bone mass density among Saudi menopausal women in Eastern Province - Saudi Arabia.
MethodsIt’s a case-control study and 380 menopausal Saudi women were selected through simple random sampling. They were divided into 190 cases with osteoporosis and 190 without osteoporosis. Bone Mineral Density (BMD) at the total hip was determined using dual-energy X-ray absorptiometry (DEXA). T score was calculated. The association between the risk factors of MetS and bone mineral density was determined by binary logistic regression analysis using SPSS (statistical package of social science) software.
ResultsAmong women, the prevalence of MetS was substantially higher in those with osteoporosis. The Mets is positively correlated with bone mineral density. (r=0.08, p=0.051). The occurrence of MetS was associated with increased osteoporosis among Saudi women (B=0.004; p=0.005) after adjustment of confounders. The existence of obesity was significantly associated with increased odds of Bone marrow density among women (OR 2.56; 95 % CI, 2.22-3.44; p=0.030) after adjustment of confounders.
ConclusionThe incidence of MetS was associated with osteoporosis in Saudi women.
Keywords: Bone mineral density, Menopausal women, Metabolic syndrome, Osteoporosis -
Pages 197-212Background
Clinical decision support systems (CDSSs) interventions were used to improve the life quality and safety in patients and also to improve practitioner performance, especially in the field of medication. Therefore, the aim of the paper was to summarize the available evidence on the impact, outcomes and significant factors on the implementation of CDSS in the field of medicine.
MethodsThis study is a systematic literature review. PubMed, Cochrane Library, Web of Science, Scopus, EMBASE, and ProQuest were investigated by 15 February 2017. The inclusion requirements were met by 98 papers, from which 13 had described important factors in the implementation of CDSS, and 86 were medicated-related. We categorized the system in terms of its correlation with medication in which a system was implemented, and our intended results were examined. In this study, the process outcomes (such as; prescription, drug-drug interaction, drug adherence, etc.), patient outcomes, and significant factors affecting the implementation of CDSS were reviewed.
ResultsWe found evidence that the use of medication-related CDSS improves clinical outcomes. Also, significant results were obtained regarding the reduction of prescription errors, and the improvement in quality and safety of medication prescribed.
ConclusionThe results of this study show that, although computer systems such as CDSS may cause errors, in most cases, it has helped to improve prescribing, reduce side effects and drug interactions, and improve patient safety. Although these systems have improved the performance of practitioners and processes, there has not been much research on the impact of these systems on patient outcomes.
Keywords: Clinical decision support system, Medication, Significant factors, Patient outcomes, Systematic review -
Pages 213-223Background
Over the years, cognitive-behavioural therapy (CBT) has gained momentum because of its robust evidence in the treatment of several disorders. However, there is an issue of religious and cultural appropriateness as CBT principles are based on Western conceptualization. This single‐case study (N = 1) implements a culturally and religiously adapted CBT on a 34‐year‐old male with panic disorder with agoraphobia in Malaysia. The client had symptoms comprising various episodes of sudden onset of breathlessness, accelerated heart rate, and fear of dying for the last 14 years. The CBT was culturally and religiously adapted based on (1) A CBT manual in Bahasa Malaysia that was previously modified and adjusted according to the norms of the Malaysian society and (2) General guidelines in “Religious–Cultural Psychotherapy in the Management of Anxiety Patients” by Razali et al in 2002. The present modified CBT had 3 assessments formulation sessions and 12 intervention sessions.
MethodsThe first 6 sessions were based on the behaviour component of CBT (ie, a relaxation technique using Islamic prayer, reciting verses from the Holy Quran, slow breathing exercise, body scan, and progressive muscular relaxation). However, sessions 7 to 12 were focused on cognitive restructuring and exercises, such as identification of negative automatic thoughts, cognitive distortions, dysfunctional thought records, vertical arrow technique, and the coping statement was practised through collaborative empiricism, while implementing Islamic and cultural elements. The focus of termination sessions was on interoceptive exposure, cognitive rehearsal, and in vivo situational exposure.
ResultsBeck Anxiety Inventory (BAI) was administered at regular intervals. BAI scores revealed the effectiveness of adapting the intervention.
Keywords: Psychotherapy, Religion, Cognitive-Behavioural Therapy, Culturally Adapted Treatment -
Pages 224-231Background
The novel 2019 Coronavirus disease (COVID-19) poses a great threat to global public health and the economy. The earlier detection of COVID-19 is the key to its treatment and mitigating the transmission of the virus. Given that Machine Learning (ML) could be potentially useful in COVID-19 identification, we compared 7 decision tree (DT) algorithms to select the best clinical diagnostic model.
MethodsA hospital-based retrospective dataset was used to train the selected DT algorithms. The performance of DT models was measured using performance criteria, such as accuracy, sensitivity, specificity, receiver operating characteristic (ROC), and precision-recall curves (PRC). Finally, the best decision model was obtained based on comparing the mentioned performance criteria.
ResultsBased on the Gini Index (GI) scoring model, 13 diagnostic criteria, including the lung lesion existence (GI= 0217), fever (GI= 0.205), history of contact with suspected people (GI= 0.188), O2 saturation rate in the blood (GI= 0.181), rhinorrhea (GI= 0.177), dyspnea (GI = 0.177), cough (GI = 0.159), history of taking the immunosuppressive drug (GI= 0.145), history of respiratory failure (ARDS) (GI= 0.141), lung lesion situation (GI= 0.133) and appearance (GI= 0.126), diarrhea (GI= 0.112), and nausea and vomiting (GI = 0.092) have been obtained as the most important criteria in diagnosing COVID-19. The results indicated that the J-48, with the accuracy= 0.85, F-Score= 0.85, ROC= 0.926, and PRC= 0.93, had the best performance for diagnosing COVID-19.
ConclusionAccording to the empirical results, it is promising to implement J-48 in health care settings to increase the accuracy and speed of COVID-19 diagnosis.
Keywords: COVID-19, Novel Coronavirus, Machine Learning, Decision Tree, Data Mining -
Pages 232-237Background
There is controversy about the efficacy of 5-alpha-reductase inhibitors in COVID-19 patients. Some assumed that finasteride might be a risk factor for deterioration and others proposed it as a possible adjunct treatment for moderate to severe COVID-19 infection in the elderly.
MethodsWe performed a randomized controlled clinical trial (registration ID IRCT20200505047318N1) on 80 hospitalized male patients aged ≥50 years diagnosed with COVID-19 pneumonia in a tertiary hospital in Qazvin (Iran) from April to July 2020. The patients were randomized into one of the 2 treatment groups using simple randomization. Treatment group patients underwent routine drug therapy and 5 mg finasteride once daily for 7 days. The primary endpoint was mortality rate and length of hospital stay (LOS), and secondary endpoints were peripheral capillary oxygen saturation, respiratory rate, and inflammatory markers changes. The study protocol was approved by the medical ethics committee of Qazvin University of Medical Sciences (registration ID IR.QUMS.REC.1399.080). Data were analyzed by statistical tests and SPSS version 25. Also, p<0.05 was considered to be statistically significant.
ResultsWe found a significant difference on O2 saturation among the 2 study groups on fifth day compared with the admission time (p= 0.018). The results did not show significant differences in mortality rate (2.5% vs 10%; p= 0.166) and LOS (p= 0.866) between patients in the finasteride and the control group.
ConclusionA short course of finasteride administration partially improves O2 saturation but does not influence other outcomes in hospitalized male patients aged ≥50 years with COVID-19 pneumonia. Further research in a large scale with longer follow-up is required to help clarify the role of finasteride in this setting.
Keywords: Finasteride, Adult, Male, Therapy, COVID-19 Infection -
Pages 238-243Background
Perioperative glycemic control is an important factor in the clinical management of a patient with diabetes mellitus under surgery. Poorly controlled long-term hyperglycemia not only predisposes individuals to systemic complications of diabetes mellitus and cardiovascular morbidity but also increases the risk of anesthesia and weakens the outcome of the surgery. Given the importance of the issue and the limited studies on glucose control using insulin glargine during surgery, we aimed to investigate the effects of glargine on glucose control in patients with diabetes mellitus during vitrectomy surgery.
MethodsThis randomized, double-blind trial was conducted in two groups of 35 patients with diabetes mellitus under treatment with insulin. In the control group, the patients received regular insulin based on the blood glucose and the sliding scale, and in the intervention group, they received insulin glargine (0.3 unit/kg) before surgery. From the start of the operation up to 3 hours of the surgery blood glucose of the patients was measured every 45 minutes and once 6 hours after the operation, and if needed, the regular insulin was injected. Data were analyzed using SPSS 16. Frequency, percentage, mean, and standard deviation (SD) were used to describe the data. To compare the quantitative variables, the independent t-test or U-Mann-Whitney test was used. For comparison of the qualitative variables, Chi-square test or Fischerchr('39')s exact test and repeated measure ANOVA was employed. The significance level (P-value) was considered as p<0.05.
ResultsUse of insulin glargine was associated with significantly lower blood glucose levels compared to regular insulin at 90-minutes (p=0.004), 135 minutes (p=0.001), and 6 hours after the operation (p=0.005).
ConclusionGlycemic control using glargine compared to regular insulin has a better performance with less need for surplus insulin dose administration during surgery.
Keywords: Type 2 Diabetes Mellitus, Regular Insulin, Insulin Glargine, Perioperative Glycemic Control -
Pages 244-256Background
Undoubtedly, economic and social value added depends on the functions of universities. Moving toward third-generation universities (3rd GU) is an inevitable process. These universities need different functions than traditional ones; therefore, identifying and determining their functions is essential. The purpose of this study is to collect, match and explore the functions of universities in the transition to 3rd GU and ultimately offer a functional model of the 3rd GU for the use of professors, academics and policymakers in order to evaluate and promote universities.
MethodsA critical review method was adapted. Literature was included based on their relevant empirical data to research objectives and referral rates, and texts with more conceptual richness entered the study without time limitations.
ResultsA total of 20 texts were included in the final analysis. While presenting the basic model, extracts the overarching concepts associated with the success of 3rd GU. These key concepts include the 7 core functions of innovative and entrepreneurial activities, supportive activities (financial and non-financial), entrepreneurial education ( curriculum and academic workforce empowerment), creation and provide applied knowledge, boundary-spanning function or communications and interactions with other elements of the national innovation system (state and industry), develop innovative and entrepreneurial culture and institutional governance and leadership in the direction of economic growth and development.
ConclusionUsing new functions at universities would be a move toward 3rd GU, economic growth and development in the country. So, these functions are a practically useful guide to policymakers to estimate the rate of success in each university and deliver the necessary suggestions to provide the mechanisms for the establishment of a successful university.
Keywords: Innovation Function, Transition, Third Generation University -
Pages 257-262Background
Higher mortality due to coronavirus disease 2019 (COVID-19) is reported among some immunocompromised patients; however, the relation between immunosuppression due to HIV infection and severity of COVID-19 infection remains unclear. We aimed to investigate the severity and mortality of COVID-19 infection in HIV-infected patients.
MethodsThis was a retrospective cohort study on all COVID-19 suspected and confirmed cases hospitlized in Iran between Febuary 19 (epidemic onset date) and April 8, 2020, whose data were recorded in the national database for Medical Care Monitoring Center. Hospitalized patients were followed from admittion to death/discharge. Patients’ HIV status was recorded based on their self report. Logistic and Cox regression models were used to evaluate the association between HIV infection and the severity (according to the Glascow-Coma Scale situation, need for intubation and hypoxemia) and mortality of COVID-19 infection, respectively. Analyses were performed separately for COVID-19 suspected and confirmed cases.
ResultsOut of 122 206 severe acute respiratory infection (SARI) cases, 90 were HIV-positive (0.07%), with a similar mean age (Pt-test= 0.750) and distrubtion of gender (PChi-square= 0.887) and nationality (PChi-square= 0.202) as HIV-negative patients. A comparable proportion of HIV-positive and HIV-negative cases were tested for COVID-19 (p= 0.170); however, the frequency of positive results was lower among HIV-positives (p= 0.038). The frequency of COVID-19 and HIV coinfection was lower than expected among confirmed cases (adjusted OR= 0.54; 95% CI: 0.29-1.02) and suspected cases (adjusted OR= 0.68; 95% CI: 0.45-1.02), which means that the frequency of COVID-19 infection was lower among HIV-positive cases. HIV infection decreased the risk of death among confirmed (adjusted HR= 0.33; 95% CI: 0.05-2.32), suspected cases (adjusted HR= 0.81; 95% CI: 0.33-1.94), and among SARI cases (adjusted HR= 0.73; 95% CI: 0.35-1.54).
ConclusionOur findings support the concept that HIV infection was not a risk factor to increase the severity and risk of death among COVID-19 infected patients.
Keywords: COVID-19, HIV, Severity -
Pages 263-269Background
Chronic obstructive pulmonary disease (COPD), as an airway limitation condition, is accompanied by alteration of muscle mass and function. We aimed to determine the relationship between disease severity and body composition, muscle function, and nutritional status in COPD patients.
MethodsThis cross-sectional study was conducted on 129 COPD participants. Muscle strength, body composition, and calf circumference (CC) were measured using a hydraulic hand dynamometer, bioelectrical impedance analysis (BIA), and a tape measure, respectively. Furthermore, fat-free mass index (FFMI), body mass index (BMI) and muscle mass value were calculated by equations. Forced expiratory volume in one second (FEV1) was assessed as well. Nutritional status was also evaluated by subjective global assessment (SGA) questionnaire. SPSS software (version 21 ) was used, chi-square, fisher’s exact test, univariate and multivariate linear regression models were used for statistical analysis. P-values less than 0.05 were considered significant.
ResultsBased on FEV1 classification, 52.7% of the patients had severe conditions. The reports indicated that the prevalence of low CC was 54.2%, low muscle mass 38.7%, low FFMI 34.8%, low right handgrip strength 61.2% and low left handgrip strength 64.3%. Furthermore, there was an increasing trend based on FEV1 in low CC (p=0.032), low muscle mass (p=0.005), low FFMI (p=0.002), low right handgrip strength (p=0.004) and low left handgrip strength (p=0.014). The results of univariate analysis showed muscle mass (p=0.036), total protein (p=0.043), FFM (p=0.047), FFMI (p=0.007), SGA (p=0.029), right handgrip strength (p=0.004) and left hand grip strength (p=0.023) were associated with FEV1. In addition, the results of multivariate analysis demonstrated low values of FFMI (p=0.005) and right handgrip strength (p=0.042) were the main detrimental factors for FEV1. The results of multivariate analysis were confirmed by stepwise model.
ConclusionLow values of muscle mass and function are prevalent among COPD patients. The present study revealed that low FFMI and handgrip strength were closely related to disease severity.
Keywords: Muscle Mass, Lean Body Mass, Nutritional Status, Muscle Strength, Respiratory Disease -
Pages 270-276Background
Salmonella induced infections remain one of the most important health problems worldwide. The purpose of this study is to investigate the incidence and geographical distribution of typhoid using GIS and to predict its incidence in Iran in 2021.
MethodsThis study is a descriptive analytical study. Information on pertussis was obtained from the Center for Communicable Diseases Control during 2009-2015. In the next step, ArcGIS 9.3 was used to prepare geographic maps of the disease incidence and frequency Therefore, using the Raster Calculator tool, the disease prediction map was drawn.
ResultsThe results showed that the highest incidence of typhoid during 2009-2014 was in Kermanshah, Lorestan, Hamadan, Kurdistan, and Ilam provinces. The incidence of typhoid in Iran increased during 2009-2010. The annual incidence of typhoid decreased from 0.85 per 100,000 in 2010 to 0.5 in 2014. Based on the modeling results for Iran, Kermanshah, Lorestan, Kurdistan, Ilam and Hamadan provinces with 92.17%, 46.56%, 31.74%, 25.62% and 22.96% of their areas (Km2) are at high risk for typhoid in the coming years, respectively.
ConclusionConsidering that the provinces of Kermanshah, Lorestan, Kurdistan, Ilam, and Hamadan are at risk of typhoid incidence in the coming years in Iran, and given that salmonella infections have a direct relationship with the individual’s health status and individual’s environmental health and socioeconomic status, improving the health status and disease control in carriers as well as improving the socio-economic status of the population living in these areas can prevent the disease in the years to come.
Keywords: Incidence, Typhoid, GIS, Iran -
Pages 277-282Background
Anthrax is a zoonotic infectious disease that is still considered as a health problem in developing countries. Therefore, the aim of this study was to investigate the incidence and geographical distribution of anthrax using the Geographic Information System (GIS) and predict its incidence in Iran in 2021.
MethodsThis study is descriptive analytical study. Information on anthrax was obtained from the Center for Communicable Diseases Control during 2010-2015. In the next step, ArcGIS 9.3 was used to prepare geographic maps of the disease incidence and frequency. Therefore, using the Raster Calculator tool, the disease prediction map was drawn.
ResultsThe highest incidence of anthrax during 2010-2015 was observed in the provinces of Kurdistan, North Khorasan, and Chaharmahal and Bakhtiari, respectively. The trend of the incidence of anthrax in Iran had increased from 2010 to 2013, while its incidence decreased in 2014. Based on the results of modeling in Iran, the provinces of Kurdistan, West Azarbaijan, Tehran, and Zanjan, respectively, with 37.16%, 33.83%, 16.78%, and 10.49% of their area (km²) had the highest risk of anthrax disease in the country in the year 2021.
ConclusionSince the provinces of Kurdistan, West Azerbaijan, Tehran, and Zanjan are among the high-risk areas in the country in the coming years, the cooperation between the veterinary organization and the health care system and the vaccination of livestock in these areas can significantly help to control and prevent the disease.
Keywords: Prediction of the Incidence, Anthrax, GIS, Iran -
Pages 283-288Background
Entrepreneurship leads to an increase in national income by creating new jobs and plays a role as a positive factor in economic growth by serving as a bridge between innovation and the market. The aim of this study was to identify the capacity and barriers existing in the medical universities of Iran to develop entrepreneurship from the viewpoint of some of the officials and academic experts.
MethodsThis qualitative, descriptive-analytic study was conducted to explore threats and opportunities in educational entrepreneurship at medical universities. The sample consists of medical universitieschr('39') deputies of education across the country, attending the national meeting of education deputies. A questionnaire containing 10 open questions was tailored and given to the participants. After returning the questionnaires, the responses were evaluated using the content analysis method.
ResultsThe issues related to the strengths of the medical universities in entrepreneurship development can be summarized in 3 categories: human factors, organizational and infrastructure factors, and technical and technological factors. With regard to the existing weaknesses while developing entrepreneurship in the context of medical universities, there are 3 general categories: education and research barriers, state-legal-political, and economic-managerial shortcomings.
The barriers to entrepreneurship development among medical graduates can be categorized in 4 groups, including education and information, cultural and social factors, financial barriers as well as structural and infrastructural drawback.ConclusionThe most important movement toward entrepreneurship development in medical universities could be making structural revisions in transforming into third-generation universities. This important issue is being pursued and implemented by the government in the form of Plan for Development and Innovation in Medical Education.
Keywords: Entrepreneurship, Entrepreneurial University, Barriers of Entrepreneurship, Entrepreneurship Development -
Pages 289-296Background
The number of children ever born (CEB) to a woman, as an index of her fertility behavior, are interesting for the governments and demographer policymakers. In recent years, a notable reduction of fertility and population aging in Iran has caused concern among politicians, and it has led to starting new changes in demographic policies. Therefore, to adopting new demographic and health policies programs, identification of factors that affecting CEB is essential.
MethodsTo evaluate determinant factors on CEB, information of 20093 married Iranian women aged between 15 and 54 years has been analyzed from the Iranian National Institute of Health Research survey. Based on the structure of data and the possible influential unobserved population heterogeneity on CEB in each city and province, a multilevel count regression model was applied. The analysis was performed using the ‘R’ software (version 3.5) with a significant level of 0.05.
ResultsFindings show that the mean and median number of CEB was 2.82 and 2.00 for all women, respectively. Meanwhile, these values were 4.56 and 4.00 for the women who reached menopause. There was a significant unobserved heterogeneity affecting CEB in each province (σp=0.018). Also, the results of the multilevel model show that living in an urban area (RR=0.90), higher age at first marriage (RR=0.96), higher education (RR=0.84, RR=0.81), and exposure to mass media (RR=0.87) decrease the risk ratio of the number of CEB (p <0.001).
ConclusionIt seems that the tendency of women to academic education and their access to mass media has a significant effect on reducing childbearing. Therefore, in future planning, attention to these two factors can be useful and helpful to move to increase fertility.
Keywords: Fertility, Multilevel Analysis, Count Response, Children ever Born -
Pages 297-304Background
There is conflicting evidence in favor of the hemispheric distribution of motor planning. Some studies supported the left-hemisphere-dominance hypothesis for motor planning and claimed that the left-hemisphere has a crucial function in motor control even in left-handers. The present study aimed to compare the right- and left-handed participants on motor planning ability and to investigate the performance of their dominant hands in a specific action selection task. Also, the effect of task complexity was assessed.
MethodsTwenty right-handers and 20 left-handers performed an action selection task. The participants had to grasp a hexagonal knob with their dominant hand and consequently rotated it 60° or 180 ° clockwise or counterclockwise. Depending on our objects, we used mixed factorial ANOVA and the groups were examined in terms of the planning time, grasping time, releasing time and planning pattern for initial grip selection. The SPSS 19 was used for analyzing the data and p≤0.05 was considered as the significant level.
ResultsNo significant differences were observed between the two groups. The movement-related measures revealed a main effect of rotation (p˂0.001). However, a significant interaction between direction × planning pattern × group (p˂0.001) indicated a preferential bias for rotatory movements in the medial direction which is consistent with the “medial over lateral advantage”.
ConclusionBoth left- and right-handed participants had a similar motor planning ability while performing a planning task with their dominant hands. Because our study was behavioral, it only provided a test of the left-hemisphere hypothesis of motor planning.
Keywords: Motor Control, Hemispheric Specialization, Handedness -
Pages 305-313Background
Various studies have used multiple attribute decision making (MADM) techniques to assess and rank health technologies. The goal of the present study was to prioritize health technologies using various techniques of MADMs in combination with decision rules.
MethodsThe study is an applied research using multi-attribute decision making (MADM) methods. This study extracted the attributes related to health technology assessment from global literature and experts’ opinions. In this study, two different types of experts were consulted: the first type, including three experts in the field of the decision-making techniques, on the subject of setting priority on health focusing on MADM; and the second one consists of seven experts in the field of HTA, asked about the selection of attributes and determination their importance. Candidate health technologies were individually weighted and ranked using TOPSIS, SAW and VIKOR by the weight and decision matrix. The results obtained from various techniques were combined and ranked using Copeland’s technique to obtain the final ranking of health technologies. To determine HTA type reports, decision rules were defined. All models were designed via MS Excel.
ResultsThis study chose eight technologies according to six tradeoff attributes. These attributes included health benefits at the population level, vulnerable population size, availability of alternative technologies, budget impact, financial protection, and quality of evidence. Their exact weights were 0.25, 0.121, 0.146, 0.132, 0.167 and 0.181, respectively. Also, safety and uncertainty about the cost-effectiveness were considered as the veto and decision rules respectively. Copeland’s method was therefore used to combine the methods Whereas HT2 (The technology for treating patients suffering from varicose) was ranked the highest priority and HT3 (The palliative method for patients who suffer from various cancers) was ranked the lowest (for preventing from any ethical issue, the exact name of each technology wasn’t mentioned).
ConclusionFinally, in accordance with decision rules which are based on various conditions of “uncertainty about the cost-effectiveness”, it is recommended that full health technology assessment report be performed on three technologies, rapid health technology assessment report be performed on four others, and, finally no prioritizing for health technology assessment be made on one of them.
Keywords: Topic Selection, Health Technology Assessment, Multiple Attribute Decision Making -
Pages 314-321Background
Estimation of the survival of very preterm infants is necessary to make decisions and design interventions in order to improve their quality of care. This survey aimed to estimate the survival of very preterm infants born at 23 up to 33 weeks of gestational age (GA) in Iran.
MethodsThis population-based retrospective cohort study included 8536 infants born before 33 weeks of GA, from March 21st to December 22nd 2013 in Iran. The primary data were extracted from the Iranian national maternal and neonatal registration network (IMAN). All infants who have been discharged alive, followed up by telephone contact up to one year after birth. The Kaplan-Meier and Log-rank tests were performed to estimate survival and to compare survivals, respectively, using SPSS version 26 and R 3.5.2 softwares.
ResultsThe overall survival was estimated at 56.70% (95% C.I: 55.60%-57.80%) at the end of the follow-up period. Total death rate was estimated at 43.30% and was significantly decreased with increasing birth weight (p<0.0001). Survival was increased significantly with increasing GA (p<0.0001), from 5.7% at 23 weeks to 79.6% at 32 weeks. The estimated cumulative proportion of death until the end of the neonatal period had a decreasing trend and then had a steady trend until the end of the follow-up period. The hazard ratio of quadruple or more birth and GA were 1.46 (p=0.021) and 0.83 (p<0.001), respectively.
ConclusionThe overall estimated survival of very preterm infants was not high. Even with modern perinatal technology and care, early deaths of very preterm infants were still common.
Keywords: Preterm Birth, Survival, Death Rate, Iran -
Pages 322-326Background
Rheumatoid arthritis (RA) is a progressive and common autoimmune disease with multifactorial etiology. Several pieces of research show that genetic factors play a major role in the incidence of RA. Several genome-wide association studies (GWAS) have identified the tumor necrosis factor alpha inducible protein 3 (TNFAIP3) genes as one of the candidate loci. The TNFAIP3 gene encoding ubiquitin-editing protein A20 witch restricts B cell survival and prevents autoimmunity. Previous studies have indicated that single nucleotide polymorphisms (SNPs) in the TNFAIP3 gene are correlated with several autoimmune disorders. In the present study, we assessed the possible association between SNP rs5029937 (intronic variant) in the TNFAIP3 gene with RA risk in the Iranian population.
MethodsA case-control study using 50 RA patients and 50 control subjects was undertaken to evaluate rs5029937 (G>T) genotypes using real-time PCR high resolution melting method (HRM). The SPSS22 was used for statistical analyses and the significance level was set at P<0.05.
ResultsLogistic regression analysis demonstrates that homozygous TT + heterozygous TG genotypes compared with GG genotype increase the risk of RA (TT+TG vs GG; P= 0.004, OR= 3.46; 95%CI [1.492-8.075]). Also, individuals with allele T were more frequently affected with RA than subjects with G allele (T vs G; P= 0.004, OR= 2.61; 95%CI [1.382-4.919]).
ConclusionOur findings propose a substantial correlation between rs5029937 (G>T) polymorphism and RA risk in Iranian population.
Keywords: Rheumatoid Arthritis, TNFAIP3 Gene, Single-nucleotide Polymorphism, Autoimmune Disorder, HRM -
Pages 327-340Background
eHealth has a notable potential to help in prevention, diagnosis, treatment, screening, management, and control of the COVID-19 pandemic. Since ehealth is considered here broadly, as an umbrella term, it also covers subsets like telehealth and mhealth. This study aimed to review the literature to identify and classify subdomains of eHealth solutions that have been utilized, developed, or suggested for the COVID-19 pandemic.
MethodsA comprehensive literature search was performed using the PubMed, Scopus, Embase, and Cochrane library databases in April 2020, with no time limitation. The search strategy was built based on 2 concept domains of eHealth solutions and covid-19. For each concept domain, the search query comprised a combination of free text keywords identified from reference papers and controlled vocabulary terms. Obtained results were classified, graphically presented, and discussed.
ResultsOf the 423 studies identified initially, 35 were included in this study. From related papers, general characteristics, study objective, eHealth-related outcomes, target populations, eHealth interventions, health service category, eHealth solution, and eHealth domain were extracted, classified, and tabulated. Most publication types were ideas, editorials, or opinions (46%). The most targeted populations were people of the community and medical staff (80%). The most implemented or suggested eHealth solution was telehealth (63%), followed by mhealth, health information technology, and health data analytics. Most of the COVID-19 ehealth interventions designed or suggested for improving prevention (48%) and diagnosis (48%). Most of the studies applied or proposed eHealth solutions for general practice or epidemiological purposes (48%).
ConclusioneHealth solutions have the potential to provide useful services to help in COVID-19 pandemics in terms of prevention, diagnosis, treatment, screening, surveillance, resource allocation, education, management, and control. The obtained results from this review might be used for a better understanding of current ehealth solutions provided or recommended in response to the COVID-19 pandemic.
Keywords: COVID-19, eHealth, Telemedicine, Public health, Health informatics -
Pages 341-348Background
Colorectal Cancer (CRC) is the most prevalent digestive system- related cancer and has become one of the deadliest diseases worldwide. Given the poor prognosis of CRC, it is of great importance to make a more accurate prediction of this disease. Early CRC detection using computational technologies can significantly improve the overall survival possibility of patients. Hence this study was aimed to develop a fuzzy logic-based clinical decision support system (FL-based CDSS) for the detection of CRC patients.
MethodsThis study was conducted in 2020 using the data related to CRC and non-CRC patients, which included the 1162 cases in the Masoud internal clinic, Tehran, Iran. The chi-square method was used to determine the most important risk factors in predicting CRC. Furthermore, the C4.5 decision tree was used to extract the rules. Finally, the FL-based CDSS was designed in a MATLAB environment and its performance was evaluated by a confusion matrix.
ResultsEleven features were selected as the most important factors. After fuzzification of the qualitative variables and evaluation of the decision support system (DSS) using the confusion matrix, the accuracy, specificity, and sensitivity of the system was yielded 0.96, 0.97, and 0.96, respectively.
ConclusionWe concluded that developing the CDSS in this field can provide an earlier diagnosis of CRC, leading to a timely treatment, which could decrease the CRC mortality rate in the community.
Keywords: Colorectal cancer, CRC, Fuzzy logic, Artificial intelligence, Risk analysis, Screening -
Pages 349-356Background
Happiness, a factor in social, political, and economic development, leads to higher performance, increase in production, and great efficiency. The goal of this study was to assess the level of happiness in Iran’s work communities.
MethodsIn this cross-sectional survey study, we randomly selected 13842 people from 380 workplaces in 31 provinces of Iran. Trained interviewers based on structured questionnaires collected data. Reliability of the questionnaire determined by using internal consistency. Collected data were analyzed through SPSS 16 software (SPSS Inc., Chicago, IL) and the charts and tables were prepared to indicate each province’s happiness level and the national mean.
ResultsAverage age of employees was 35.4±7.78 years. The majority of the respondents were male(n=11835, 85.5%), had finished middle/secondary school (n=7142, 51.6%) and were married (n=11323, 81.8%). The level of happiness varied from the highest value 148.97±21.49 in Boushehr Province and the lowest 130.39± 25.28 in Hormozgan Province. The mean ± SD value of happiness in the work communities of Iran was 141.22±22.89.
ConclusionPolicymakers should consider workers’ happiness as an effective factor in production and efficiency.
Keywords: Happiness, Workplace, Iran -
Pages 357-365Background
Tuberculosis (TB) is still a serious health problem with a remarkable global burden. In this study, we aimed to assess the trend of TB mortality in Asian and North African countries in the period 1990-2017 and provide a new classification according to TB mortality trend.
MethodsTB mortality rates from 1990 to 2017 were extracted from the Global Burden of Disease website for 55 Asian and North African countries. Trend analysis of TB mortality rates for males, females, and the total population was performed using the marginal modeling approach. Moreover, the latent growth mixture modeling (LGMM) framework was applied to classify these 55 countries based on their trend of TB mortality rate
ResultsIn the period between 1990 and 2017, South Asia and High Income Asia-Pacific regions had the highest and lowest death rates due to TB, respectively. The marginal modeling results showed that the Asian and North African countries had experienced a downward trend with an intercept of 28.79 (95%CI: 19.64, 37.94) and a slope (mean annual reduction) of -0.67 (95%CI: -0.91, -0.43) per 100,000 the study period. Finally, the LGMM analysis classified these 55 countries into four distinct classes.
ConclusionIn general, our findings revealed that although the countries in Asia and North Africa super region experienced a descending TB mortality trend in the past decades, the slope of this reduction is quite small. Also, our new classification may be better suited for combating TB through future healthcare planning in lieu of the commonly used geographic classifications.
Keywords: Tuberculosis, Asia, North Africa, Trend Analysis, Classification -
Pages 366-374Background
Despite studies about anxiety in the older adult, the prevalence of anxiety in this age group is not exactly clear, which may be due to the use of tools and criteria that were not born for this age group. One of the instruments designed to assess anxiety in the elderly is the Geriatric Anxiety Inventory (GAI). The aim of this research was to analyze the psychometric properties of the Persian version of the Geriatric Anxiety Inventory (GAI-PV) and its short form (GAI-PV-SF) in a sample of older adults in Iran.
MethodsIn this cross-sectional study, a sample of 150 community-dwelling and a psychogeriatric sample of 48 adults older than 60 years completed the GAI-PV and GAI-PV-SF, the anxiety sub-scale of the General Health Questionnaire (GHQ-28), the Geriatric Depression Scale (GDS-15), and the Structured Clinical Interview for DSM-IV (SCID-I). Different types of validity and reliability were evaluated for GAI-PV and GAI-PV-SF using SPSS and the LISREL software.
ResultsBoth the GAI-PV and GAI-PV-SF exhibited excellent internal consistency (over 80 %) and desirable concurrent validity against GHQ-28 and GDS-15. The optimal cutpoint score to detect current generalized anxiety disorder (GAD) was 10/11 and 13/14 for GAI-PV in the community-dwelling and psychogeriatric samples, respectively, and 3/4 for GAI-PV-SF in both study samples. Good test-retest reliability (correlation coefficient: 0.96 and 0.88 for GAI-PV and GAI-PV-SF, respectively) and a single-factor structure were also demonstrated.
ConclusionSound psychometric properties of the GAI-PV in both subsamples suggest that the instrument could be used successfully as an accurate screening instrument in the elderly Iranian population.
Keywords: Geriatric Anxiety Inventory (GAI), Aged, Psychometric Property, Validity, Reliability -
Pages 375-382Background
Dietary patterns and diet quality index (DQI) are widely discussed in relation with different health conditions and have recently been taken into consideration for all cancer types. Since chronic inflammation has been recognized as an important biologic risk factor for cancer occurrence, especially in epithelial tissues, proinflammatory or anti-inflammatory characteristics of diet has become the center of attention. In the present study, we aimed to identify whether a specific dietary pattern, Mediterranean dietary score (MDs), and dietary inflammatory index (DII) were associated with overall cancer risk in Iranian population.
MethodsThis study was performed in the context of the Golestan cohort study. Participants with extreme daily energy intake or those who did not answer more than 30 question of the Food Frequency questionnaire (FFQ) were excluded. Dietary patterns, MDs, and DII were measured from FFQ. Age, sex, total energy, place of residence, smoking, wealth score, ethnicity, opiate use, BMI, education, marital status, and physical activity score were considered as confounding variables. Using Cox proportional hazards regression models, hazard ratios (HRs) and 95% confidence interval of cancer were estimated.
ResultsHRs (95% CIs) of all cancers by quartiles of Western dietary pattern, DII, and MDs showed that the forth quartile of the Western dietary pattern is attributed to 23% higher cancer risk (HRs: 1.23, CI: 1.09-1.40, P< 0.001, adjusted for age and sex) compared to the first quartile. It also remained significant after further adjustments (HRs = 1.20, CI: 1.06-1.36, P< 0.001). There was a higher cancer risk in the fourth quartile of DII in comparison with the first quartile (HRs = 1.16, CI: 1.01-1.32, P trend < 0.001, adjusted for age and sex). The lower adherence to the Mediterranean dietary pattern also largely contributes to 27% higher cancer risk (HRs: 1.27, CI: 1.12-1.44), P trend < 0.001, adjusted for age and sex), which also remained remarkable after further adjustments ((HRs =1.19, CI: 1.05-1.35, P trend < 0.001).
ConclusionCancer is highly correlated to dietary intake and dietary patterns, such as the Western dietary pattern, while the Mediterranean diet score was inversely associated with cancer risk. Further investigations are required to get a broader insight into cancer determinants in population.
Keywords: Dietary Patterns, Dietary Quality Index, Dietary Inflammatory Index, Risk, Cancer, Golestan Cohort Study -
Pages 383-386Background
Among the medications administered for the management of COVID-19 patients, the induction drugs used for intubation have received little attention. The aim of this study was to compare the effect of induction drugs on the mortality of patients with COVID-19 requiring intubation.
MethodsIn this retrospective study, all patients who were admitted to Shahid Sadoughi and Shahid Rahnemoun hospitals in Yazd from February to March 2020 with definitive diagnosis of COVID-19 and needed intubation were enrolled. Patients were divided into 4 groups based on the type of drugs used in intubation, and mortality rate was assessed at the end of the first, second, fourth, and seventh days of the study. Statistical analyses were performed using SPSS 20 and P values < .05 was considered significant .
ResultsIn this study, 76 patients were examined. Patients were divided into 4 groups, of which 21 were in etomidate group, 8 in ketamine group, 21 in sodium thiopental group, and 35 in midazolam group. Mortality rate in these 4 groups was 25%, 12.5%, 14.3%, and 14.3% (p=0.822), respectively at the end of the first day after intubation; it was 83.3%, 12.5%, 28.6%, and 25.7% (p=0.001), respectively, at the end of the second day; it was 83.3%, 12.5%, 42.9%, and 42.9% (p=0.015), respectively, until the end of the fourth day; it was 100%, 25%, 61.9%, and 65.7% (p=0.007), respectively, until the end of the seventh day. Admission to intubation time interval was 0.91±0.99, 3.12±1.95, 4.09±2.44, and 4.74±2.62 days, respectively (p<0.001).
ConclusionThe results of this study suggest that the use of etomidate may be associated with higher mortality in COVID-19 patients. Further studies are needed to verify the results of this study.
Keywords: Mortality, COVID-19, Intubation, Etomidate -
Pages 387-393Background
Board of Trustees (BOTs) in Iranian medical universities has been considered as one of the most important structural and managerial changes to create a revolution in decision-making and accountability. This study aimed to explore challenges facing BOTs in governing Medical Universities (MUs).
MethodsIn this qualitative study, 27 semi-structured interviews were conducted with current and former members of BOTs, chancellors of universities, BOTs’ secretaries, and staff in the Ministry of Health and Medical Education in 2017. These participants were selected using a purposive and snowball sampling method. Data were analyzed by framework analysis and using Atlas-Ti software.
ResultsFive key themes were identified, including 1) infrastructure (problems in BOT laws and membership requirement), 2) planning and decision-making (evidence-based decision making and planning and meeting), 3) organizing (ambiguity in positions and lack of necessary administrative structure), 4) performance evaluation (self-reporting, lack of time allocation, lack of evaluation criteria and lack of required structure for evaluation), 5) independence and influence on performance (dependency on the Ministry of Health and Medical Education and financial independence).
ConclusionDue to obsolete laws, it seems that the structural and executive reform of BOTs is essential. The issues of university autonomy and empowerment of the boards’ members should particularly be considered in such reforms. However, it appears that more delegation and empowering the position of the boards could be effective strategies in governance medicals universities.
Keywords: Governing board, Trustees, Qualitative study, Iran -
Pages 394-408Background
Health inequities are among debatable and challenging aspects of health systems. Achieving equity through social determinants of health approach has been mentioned in most upstream national plans and acts in Iran. This paper reports the findings of a systematic review of the current synthesized evidence on health equity in Iran.
MethodsThis is a narrative systematic review. The relevant concepts and terminology in health equity was found through MeSH. We retrieved the relevant studies from PubMed/MedLine, Social Sciences Database, and Google Scholar in English, plus the Jihad University Database (SID), and Google Scholar in Farsi databases from 1979 until the end of January 2018. The retrieved evidence has been assessed primarily based on PICOS criteria and then Ottawa-Newcastle Scale, and CASP for qualitative studies. We used PRISMA flow diagram and a narrative approach for synthesizing the evidence.
ResultsWe retrieved 172 455 studies. Following the primary and quality appraisal process, 114 studies were entered in the final phase of the analysis. The main part (approximately 95%) of the final phase included cross-sectional studies that had been analyzed through current descriptive inequality analysis indicators, analytical regression, or decomposition-based approaches. The studies were categorized within 3 main groups: health outcomes (40.3%), health utilization (32%), and health expenditures (27%).
ConclusionAs a part of understanding the current situation of health equity in the policymakers’ need to refer the retrieved evidence in this study, they need more inputs specially regarding the social determinants of health approach. It seems that health equity research plan in Iran needs to be redirected in new paths that give appropriate weights to biological, gene-based, environmental and context-based, economic, social, and political aspects of health as well.
We advocate addressing the aspects of Social Determinant of Health (SDH) in analyzing health inequalities.Keywords: Health Equity, Health Inequality, Health Care Disparity, Health Care Inequality, Health Social Determinants, Health Care Availability, Health Care Accessibility, Health Disparity, Health Care Utilization -
Pages 409-412Background
Idiopathic nephrotic syndrome is one of the most common glomerular diseases, which may be secondary to infections or systemic diseases. The aim of this study was to evaluate the effect of Helicobacter pylori (H. pylori) eradication on childhood nephrotic syndrome.
MethodsIn this randomized controlled clinical trial study, 38 children with concomitant idiopathic nephrotic syndrome and H. pylori infection were divided into 2 equal groups; the intervention group received a cotreatment for both diseases and the control group received only nephrotic syndrome treatment. Patients were followed for 6 months. Data were analyzed using SPSS 21 software. Chi square test, Fisher exact test, and student t test were used. P value <0.05 was considered statistically significant.
ResultsThe mean interval time from treatment to the recovery of nephrotic syndrome was 48.36±14.48 days in the intervention group and 51.68± 17.32 days in control groups, which was shorter in the intervention group, but not statistically significant. The recurrence of nephrotic syndrome and the mean number of recurrences in the intervention group were lower than the control group, but were not statistically significant. The frequency of diarrhea in the intervention group was significantly higher than the control group (p=0.003).
ConclusionIn children with concomitant idiopathic nephrotic syndrome and H. pylori infection, the treatment of both diseases may accelerate the recovery and decrease the recurrence of nephrotic syndrome.
Keywords: Nephrotic Syndrome, Helicobacter pylori Infection, Children -
Pages 413-417Background
Carpal tunnel syndrome (CTS) is the most common compressive neuropathy presenting with sharp pain, parenthesis, dysfunction of the hand in coordination and gripping. Splinting is the most common conservative intervention to improve pain and enological symptom of this Syndrome (CTS). With regard to the importance of these interventions and controversies about different designs of splints, the aim of this study was to compare the therapeutic effects of volar wrist cock-up orthosis and dorsal lock wrist hand orthosis on pain, sensory and motor latency in carpal tunnel syndrome.
MethodsIn this Randomized controlled trial study, 30 patients diagnosed with mild to moderate CTS were recruited. The subjects were randomly divided into two equal groups. Both groups received one form of splints for three weeks. Before receiving the splints, Electromyography (EMG) and Visual analog scale (VAS) were performed. Then, two different designs of splints were used for a period of three weeks. After that, EMG and Numerical Rating Scale (NRS-11) were repeated to reveal the effects of splints on reducing pain, sensory and motor latency in CTS. Independent t and paired t-tests were done uding SPSS software version 19.0 . P-value was set at 0.05.
ResultsAll the variables in both groups showed significant improvement. The NRS-11 test was significantly improved in the dorsal lock wrist hand orthosis group (p<0.05).
ConclusionThis study showed that the use of the dorsal lock wrist hand orthosis for about three weeks was significantly improved pain and neurological symptoms of patients with CTS because of maintaining the wrist in the neutral position. Knowing this fact helps us to design and make a less cumbersome and restrictive splint with an accurate position for the wrist and distal joints.
Keywords: Carpal Tunnel Syndrome, Electromyography, Wrist Splint -
Pages 418-422Background
By informing and educating, the Media play a main role in increasing the health literacy of the community. Broadcasting health channels (BHCs) are established to improve health literacy and public health worldwide. This study was aimed to evaluate the role of Islamic Republic of Iran the broadcasting health channel (IRIB HC) on public health.
MethodsA cross-sectional, comparative study was performed on 500 participants throughout 6 urban areas in Tehran, the capital of Iran in 2019. About 250 of the samples were included in viewing the health channel group. A standard questionnaire was used to measure the levels of public health in the 2 groups. Data were analyzed and compared using SPSS software version 25.
ResultsAccording to the results, health literacy was higher in the group that used the health channel rather than the other group. Also, with regard to physical and psychological health levels, a significant difference was observed between audiences and nonaudiences (p= 0.013, p= 0.001, respectively).
ConclusionThe IRIB HC has positive effects on increasing the level of health literacy, Physical and psychological health, and consequently improving public health. Therefore, these channels have a great role in the implementation of health polices to improve health status.
Keywords: Mass Media, Public Health, Health Literacy, Iran -
Pages 423-428Background
Injection of drugs is one of the most serious health problems among Iranian living with HIV/AIDS. The injection of drugs, accounting for the transmission of more than two-thirds of HIV infections. HIV remains a major concern around the world and is expected to be the third leading cause of mortality worldwide. Thus, the aim of this study was to explore the predictors of injection drug use in the elderly patients living with HIV/AIDS.
MethodsThis was a cross-sectional study executed in Tehran City, Iran, in 2018. A total of 160 individuals aged 60 years and older with HIV from different counseling centers were selected by convenience sampling. Data were collected using questionnaires including a positive state of mind, coping, social support, and a checklist of demographical variables. Bivariate analysis and multiple logistic regression using SPSS software version 21.0 were employed to determine factors associated with drug injection. The statistical tests were performed with a significance level of 5% (p≥0.05).
ResultsThe study participants’ mean(SD) age was 65.6(±6.6) years. In total, 33 people (20.6%) of the samples reported injection drug use. The frequency of injection drug use was greater among men (AOR: 2.28, 95% CI 2.2-22.8; p=0.010), those reporting a monthly income of ≥30000000 Rials (AOR: 31.56, 95% CI 2.95-338; p=0.004), subjects with past experience of drug use (AOR: 7.11, 95% CI 2.18-23.2; p=0.001), those with ≥2 years past from their HIV diagnosis (AOR: 4.04, 95% CI 1.12-14.58; p=0.033), and those living with more than two people in one residential place (Household size AOR: 5.9, 95% CI 1.64-21.24; p=0.007).
ConclusionIt seems that the design and implementation of harm reduction programs among the elderly with HIV/AIDS who inject drugs are essential and should be considered as an agenda of policymakers and health professionals.
Keywords: Drug Injection, Elderly People, HIV, AIDS, Drug Use, Determinants -
Pages 429-434Background
The overdose of illicit drugs is not always fatal but can lead to various complications. One of the unusual medical complications is a sensorineural hearing loss (SNHL). There are multiple case reports about this subject. Considering the importance of hearing loss on quality of life, we investigated hearing status in patients with overdose of illicit drugs.
MethodsThis cross-sectional study was performed in Loghman Hakim hospital in Shahid Beheshti University of Medical Sciences, Tehran, Iran, in 2016-2017. The hearing status of 95 patients with illicit drugs overdose and 44 healthy individuals were assessed using standard pure tone audiometry and distortion product otoacoustic emissions. The patient group was categorized based on hearing status and compared based on some variables. We applied 2 independent t tests, Mann-Whitney, Chi-square, and binary logistic regression tests. All analyses were conducted in Stata 12 (STATA Corp, USA) and significance level was set at less than 0.05.
ResultsWe found higher percentage frequency of SNHL in the patient group than the control group (15.8% vs 2.3%; p=0.021). The frequency of hearing loss was 21.7% in opioid users, 5.3% in stimulant users, and 6.3% in concomitant use of both. There was a significant relationship between SNHL and overdose of illicit drugs (aOR = 14.48, 95% CI = 1.53-136.44; p=0.019) with adjusting age, sex, and smoking.
ConclusionIllicit drugs overdose can potentially affect the hearing system. Opioid drugs, especially methadone and tramadol, have been found to affect the hearing system. Therefore, it is important to conduct longitudinal studies to demonstrate the role of opioid drugs on the hearing system.
Keywords: Hearing Loss, Illicit Drugs, Inner Ear -
Pages 435-442Background
Self-determination skills enable to support an individual’s needs and make decisions to function independently. Improvement of self-determination skills has had a positive result for adolescents at risk of Emotional and Behavioral Disorders (EBD). The aim of this study was to investigate the effect of occupational therapy interventions on the self-determination skills of adolescent girls at risk of emotional-behavioral disorders.
MethodsIn this single-blind control trial study, 14-16-years-old girl students (n=54) at risk of EBD were recruited by cluster sampling from secondary high schools of Tehran, Iran. Youth self-report Questionnaire (YSR) was used to include adolescents at risk of EBD in the study and were randomized into the intervention (n=27) and control group (n=27) by block randomization. The Student Self-Determination Scale (SDSS) and the Self-determination Parent Perception Scale (SDPPS) were used to collect data. Students in the intervention group participated in 8 – once a week- sessions of occupational therapy and the control group received no training. Data were analyzed by repeated-measures analysis of variance (RMANOVA), Bonferroni test and SPSS 16.0 version. The significance level was set at 0.05.
ResultsThe score of self-determinations (SDSS) increased significantly in the intervention group after the intervention (p<0.001). Although the mean scores of self-determination at follow-up have increased in the intervention group compared to the post-test. No significant differences were found (p>0.05); also, the score of parentschr('39') perception of student self-determination (SDPPS) increased but there were not significantly different (p=0.064).
ConclusionThe findings indicated self-determination skills could be taught to adolescents at risk of EBD in OT sessions. Since self-determination has been identified as the necessary skills for adolescents at-risk to transition into adulthood, occupational therapists have an important role in promoting self-determination skills in adolescents at risk of EBD.
Keywords: Occupational Therapy Interventions, Self-Determination, Emotional, Behavioral Disorders, Adolescents -
Pages 443-447Background
Exposure to noise associated with injuries has become a public health issue in recent years. This study aimed to show the role of the acoustical structure of the ear canal on the typical occupational sound pressure levels at different frequencies.
MethodsThis cross-sectional study was done on 20-30-year-old participants. White noise was used at 3 levels, including 75, 85, and 95 dB as the stimulus sound pressure levels (SSPLs). The speakers had a 1.5-meter distance from the participants and at the height of 87 centimeters from the lab ground and were located in front of the participants. The SSPLs were measured outside (cavum part of the external ear) and inside the right ear of each participant. Measurements were done at the total sound pressure level and in the 1/1 octave frequencies. The duration for each measurement was 10 seconds. The independent sample t test was used for the statistical analysis, and the equality of means were rejected at p<0.05.
ResultsThere were 30 (50%) males out of the 60 participants. The mean ± SD for the age of all the participants was 23.29±2.93 years. The total sound pressure level difference between the inside and outside of the ears of male and female participants was statistically significant (p<0.001) at the stimulus sound pressure levels. The peak resonance was observed in the frequencies 2000 Hz and 8000 Hz for males and 8000 Hz for females.
ConclusionThe ear canal can amplify the sounds and increase the sound pressure levels. This amplification was found to be greater for males than for females.
Keywords: Ear Canal, Resonance, Occupational Noise -
Pages 448-456Background
Myofascial pain syndrome is one of the most common complaints in patients referring to orthopedic treatment centers. The present study aimed to examine the effects of instrument-assisted soft tissue mobilization (IASTM) and dry needling (DN) on active myofascial trigger points (AMTrP) of the upper trapezius muscle (UTM).
MethodsThe current study was designed as a randomized clinical trial and a total of 81 patients, aged 18-40 years, with active myofascial trigger points in the upper trapezius muscle were randomly divided into 3 groups: group 1 (n = 30) received DN treatment, group 2 (n = 26) received IASTM treatment, and group 3 (n = 25) was considered as the control group (no intervention). The numeric pain scale (NPS), pain pressure threshold (PPT), active cervical contra-lateral flexion (ACLF), neck disability index (NDI), and muscle thickness (MT), according to rehabilitative ultrasonic imaging (RUSI), were measured at baseline, immediately after the last session (session 4 in week 2), and 1 month after the last session. The statistical analysis was conducted at a 95% confidence level. The P values less than .05 were considered as statistically significant.
ResultsBoth techniques were effective in treating active trigger point of the upper trapezius (p<0.05), but there was no significant difference between the treatment groups in terms of any of the above variables except for ACLF (p>0.05)
ConclusionBoth IASTM and DN were determined to improve NPS, PPT, ROM, and NDI in participants with active trigger points in the upper trapezius, although IASTM was more effective in increasing ACLF in these patients.
Keywords: Instrument Assisted Soft Tissue Mobilization Technique, Dry Needling, Active Myofascial Trigger Points, Trapezius Muscle, Myofascial Pain Syndrome -
Pages 457-463Background
There are relatively scant data to determine whether hospital visitors could serve as a proper source of controls in case-control studies of illicit drug use. The aim of this study was to evaluate using neighborhood versus hospital visitor controls in reporting opium use.
MethodsWe used data from 2 independent case-control studies of cancer in Iran. In the first study, controls were selected from neighborhoods of the patients. For the second one, controls were selected from among hospital visitors. In the latter study, hospital visitors were companions of the patients or others visiting the hospital for reasons other than disease treatment. We used stata (version 12; Stata Corp( for all analyses and with a significance level of 0.05.
ResultsData from 616 of neighborhood controls and 414 of hospital visitor controls were analyzed. Opium point prevalence among men was significantly higher in hospital visitors than neighborhood controls (43.3% vs 32.2%; P = 0.047), while the prevalence of cigarette smoking was very similar in both control groups (46.3% vs 47.2%; P = .847). Using a logistic regression analysis, in an unadjusted analysis, neighborhood controls were less likely to report opium use in both genders, with (unadjusted OR = 0.77; 95% CI: 0.59,1). After adjusting for potential confounders, the differences of opium use between the 2 control groups became more pronounced (Adjusted OR = 0.26; 95% CI: 0.10, 0.69).
ConclusionBecause of the similarity of reporting cigarette smoking among neighborhood controls but substantially lower reporting of opium use among them, we concluded that neighborhood controls underreport opium use—a sensitive question— and that using neighborhood control biases the findings in case-control studies. Hospital visitor controls may be more appropriate than neighborhood controls for case-control studies of illicit drugs.
Keywords: Substance-Related Disorders, Opium, Case-Control Study, Epidemiologic Studies, Cigarette Smoking, Hospital Visitor Control -
Pages 464-472Background
Serological surveillance of COVID-19 through conducting repetitive population-based surveys can be useful in estimating and monitoring changes in the prevalence of infection across the country. This paper presents the protocol of nationwide population-based surveys of the Iranian COVID-19 Serological Surveillance (ICS) program.
MethodsThe target population of the surveys is all individuals ≥6 years in Iran. Stratified random sampling will be used to select participants from those registered in the primary health care electronic record systems in Iran. The strata are the 31 provinces of the country, in which sampling will be done through simple random sampling. The sample size is estimated 858 individuals for each province (except for Tehran province, which is 2574) at the first survey. It will be recalculated for the next surveys based on the findings of the first survey. The participants will be invited by the community health workers to the safe blood sampling centers at the district level. After obtaining written informed consent, 10 mL of venous blood will be taken from the participants. The blood samples will be transferred to selected reference laboratories in order to test IgG and IgM antibodies against COVID-19 using an Iranian SARS-CoV-2 ELISA Kit (Pishtaz Teb). A serologically positive test is defined as a positive IgG, IgM, or both. After adjusting for the measurement error of the laboratory test, nonresponse bias, and sampling design, the prevalence of COVID-19 will be estimated at the provincial and national levels. Also, the approximate incidence rate of infection will be calculated based on the data of both consecutive surveys.
ConclusionThe implementation of these surveys will provide a comprehensive and clear picture of the magnitude of COVID-19 infection and its trend over time for health policymakers at the national and subnational levels.
Keywords: COVID-19, Serological, Surveillance, Sero-prevalence, Antibody tests, Survey, Nationwide, Population-based, Iran -
Pages 473-480Background
Trauma is the first leading cause of death and disability in the active population in developing countries. In Iran, traumatic injuries are the second leading cause of death after cardiovascular disease and also the leading cause of years of life lost (YLL). Population-based surveys can estimate all types of injuries. This study aimed to estimate the annual incidence of nonfatal injuries in adults older than 15 years in Kashan.
MethodsIn a cross-sectional population-based study, people older than 15 years who were living in Kashan during 2018-2019 were studied. A cluster stratified sampling method was used. Data analysis was performed using SPSS 22 software. Chi-square and t tests and ANOVA were used to analyze the data. Significance level was set as P ≤ .05 and confidence interval (CI) at 95%.
ResultsIn this study, which included 3880 households residing in Kashan during 2018-2019, the incidence of all injuries was estimated to be 70.61(62.60-78.70) per 1000 people in 1 year. For traffic accidents, the incidence was estimated at 36.08 (30.20-42.00) per 1000 in 1 year. Also, 231 (77.7%) of people with trauma were male, 137 (50.0%) aged 20 to 39 years, and 191 (69.7) were married. The most common cause of injuries (n = 140; 51.1%) was related to traffic accidents, and among the traffic accidents, the highest cause was motorcycle accident (n = 99; 70.71%).
ConclusionThe results of this study showed that the highest rate of injuries occurred among men, younger ages, married, and those with primary education. Also, the results showed the most common causes of trauma were injured hand and foot and head, and the most common location in which trauma occurred was street. The findings of this study are important to better explain the epidemiology aspects of injuries in Kashan.
Keywords: Epidemiology, Incidence, Population-based, Trauma -
Pages 481-490Background
In the pandemic era of Coronavirus disease 19 (COVID-19), one of the most important issues is the nature of real pathological events that occur during disease course in different parts of the body. There are several ways to know more about COVID-related histopathological events,such as tissue sampling which means biopsy from the tissues of either livepeople or necropsy/autopsy of people who died from COVID-19.
MethodsWe conducted an original study for assessing histopathological findings of lung necropsy samples collected from 15 Iranian patients.The continuous variables were presented as mean and standard deviation, and for the qualitative data on histopathological findings, the percentage or qualitative scores (0 to +3) were used.
ResultsWe found similar presentations of COVID-related histopathologic events regarding percentage and severity in pulmonary tissue, includinglymphocytic infiltrations, inflammatory infiltrations of septal and perivascular areas, desquamated type2 pneumocytes, hyaline membrane changes, fibrin material depositions, abnormal changes of alveolar capillaries, presence of megakaryocytes, PMN infiltrations, septal necrosis, microabscess formation and bacterial colony formation. Also, we found few interesting features which were not completely compatible with previous similar studies or newly reported by ours asa high percentage of anthracosis (86%: 13 patients) that was not clearly reported in other previous studies, also a lower percentage of microthrombotic vascular lung injuries (20%: 3 patients), and a higher percentage of viral cytopathic effects (27%: 4 patients).
ConclusionThis article suggests a greater need for evaluatingthe autopsy samples of COVID-19 patients to provide better management strategies and propose the question of whether anthracosismay be a mortality risk factor in COVID-19 patients.
Keywords: COVID-19, Autopsy, Necropsy, Biopsy, Tissue Sampling, Histopathology, Lung, Anthracosis -
Pages 491-498Background
The COVID-19 epidemic is one of the major health problems worldwide due to its inconceivable spreading power and potential damage. Given the increasing prevalence of the disease, the identification of care needs and preferences of patients could play an important role in providing effective training and caring programs. This study was conducted to explain the preferences and needs of care based on the experiences of patients with COVID-19.
MethodsThis qualitative study with a content analysis approach was performed in 2 months at a referral general hospital and quarantine centers of COVID-19 in Tehran, the capital of Iran, in 2020. The participants consisted of 15 COVID-19 patients selected through purposive sampling. The data analysis was performed using the conventional content analysis method according to the procedure proposed by Graneheim and Lundman.
ResultsThe results were classified into 5 main categories: (1) access to desirable care and comfort services; (2) access to education and information from credible sources; (3) access to specialized care; (4) support social needs; and (5) need for deep emotional interactions.
ConclusionAccording to our results, identifying priorities and care needs from the perspective of patients with COVID-19 can help improve knowledge, reduce unrealistic patient concerns, and improve emotional interactions between patients and health care providers.
Keywords: Coronavirus Disease 2019, Health Preferences, Iranian Health System, Needs Assessment, Qualitative Study -
Pages 499-514Background
Human papillomavirus (HPV) infection is considered as the most common viral sexually transmitted infection worldwide. This poses an increasingly interdisciplinary medical challenge. Since there is vast scattered information in databases about HPV and the correlated diseases, we decided to collect useful data so that the experts can get a more comprehensive view of HPV.
MethodsIn this article, HPV-associated diseases, prevalence, prevention, and new treatments are discussed. The retrieved articles reporting the latest data about the required information for our review were selected through searching in Web of Science, Scopus, Medline (PubMed), EMBASE, Cochrane Library, Ovid, and CINHAL with language limitations of English and German.
ResultsThere are 2 groups of HPVs: (1) low-risk HPV types that can lead to genital warts, and (2) high-risk HPV types that are involved in HPV-associated oncogenesis. About 70% of all sexually active women are infected and most of these infections heal within many weeks or months. In the case of HPV-persistence, a risk of preneoplasia or carcinoma exists. These types of viruses are responsible for the existence of genitoanal, gastrointestinal, urinary tract, and head and neck tumors. There is still no definite successful treatment. The detection of HPV-related condylomata occurs macroscopically in women and men, and the diagnosis of the precursors of cervical carcinoma in women is possible by Pap smear.
ConclusionFor extragenital manifestations, there is no structured early detection program. Meanwhile, studies on HPV vaccines confirm that they should be used for the primary prevention of HPV-dependent diseases. However, we need more research to find out the real advantages and disadvantages of vaccines.
Keywords: Human Papilloma Virus, Cancer, Epidemiology, Warts, Vaccines, Virology, Diagnostic -
Pages 515-522Background
Risk factors of noncommunicable diseases (NCD) are increasingly contributing to morbidity and mortality in Iran. Health care providers’ competencies and motivation are essential factors for the success and efficiency of primary health care. This field trial aims to evaluate the impact of a results-based motivating system on population level of the NCD risk factors field trial (IRPONT) in Iran.
MethodsPopulation groups of 24 rural or urban catchment areas from 3 provinces were randomized to 1 of the 4 types of study groups. The groups were defined based on a set of 4 intervention packages. Extra 8 rural or urban catchment areas in a separate city were considered as independent nonintervention (control) group. Population levels of major NCD risk factors in all 32 population groups were measured at the beginning of the trial, at the end of the first year, and will be measured in the second year through standardized population surveys. As the outcome measure, the difference in population levels of the risk factors will be compared among the study groups. Study group IV will be compared with combined control groups (study groups I, II, and III). Also, we will conduct subgroup analysis to determine the effects of interventions 2, 3, and 4.
Ethics:
This trial has received ethical approval from National Institute for Medical Research Development in Iran (IR.NIMAD.REC.1396.084) in 2017.
Trial Registration Number:
This trial has been registered on the Iranian Registry of Clinical Trials (identifier: IRCT20081205001488N2). Registered on 3 June 2018 and updated on 12 April 2020.
Keywords: Pay for performance, Risk factors, Noncommunicable diseases, Trial, Iran -
Pages 523-528Background
To document the clinical presentation of carpal tunnel syndrome (CTS) and evaluate the outcome of mini-incision open carpal tunnel release in terms of surgical complications, relief/persistence of symptoms at 4 months, and recurrence at 1 year.
MethodsThis prospective case series included patients of all genders and ages who presented with CTS. They underwent release of transverse carpal ligament (TCL) under local anesthesia and tourniquet control on day care basis. Mini-incision of 2 cm to 2.5 cm was employed. The data were subjected to statistical analysis using SPSS version 21 (SPSS Inc). The percentages of key categorical variables were compared by employing the chi square test, and a P value of less than .05 was regarded as statistically significant.
ResultsThere were 67 patients with 77 CTS affected wrists. A Significant majority of the patients (n = 54; 80.59%) were females, whereas 13 (19.40%) patients were males. The age range was 26 to 69 years, with a mean age of 41.01 ± 11.70 years. The CTS was found to be moderate among 34 (44.15%) and severe among 43 (55.84%) patients. The majority of patients had no operative complications. At 4 months follow-up, the majority of patients (n = 74; 96.10%) reported symptomatic relief, whereas 3 (3.89%) patients continued to have persistent severe symptoms. All the cases with persistent symptoms had diabetes mellitus of more than 5 years duration. There was no case of recurrence at one year follow-up.
ConclusionCTS predominantly affected women aged 30 to 45 years. The open carpal tunnel release with mini-incision yielded good results in terms of relieving symptoms among the majority of patients and was associated with no critical complications or recurrence at 1 year.
Keywords: Carpal tunnel syndrome, Transverse carpal ligament release, Open carpal tunnel release, Compressive neuropathies -
Pages 529-534Background
Nowadays, digital games are not just entertainment, but beside routine treatments, they are used in patient care, especially in patients with diabetes. Application of digital games in patient’s education can improve self-management of diabetes. The aim of the present study was to evaluate the effect of a mobile game (Amoo) implementation on enhancing dietary information in patients with type 2 diabetes.
MethodsA mobile game (called Amoo), which was developed by researchers of this study, was applied to assess the self-education of patients with diabetes. Sixty patients with type 2 diabetes participated in the study. The participants took part in a pre-intervention test to determine their dietary information. The participants were randomly divided into one of two groups, including the intervention group: played the game for 15 minutes daily for 6 weeks, and the control group: did not involve in the game. A post-intervention test was run to show a possible improvement in dietary information. Data were analyzed using paired t test and suitable non-parametric testes including Mann-Whitney and Wilcoxon signed rank tests as well as Spearman and Pearson correlation coefficients via IBM SPSS statistics version 21 (SPSS, v 21.0, IBM, Armonk, NY, USA). A P-value less than 0.05 was considered as a significant level.
ResultsThe results indicated a statistically significant difference between the pre and post test scores in the intervention group (p<0.001). However, there was no significant difference in fasting blood sugar (p=0.125).
ConclusionThe mobile game (Amoo) could enhance the knowledge of patients with type 2 diabetes about food calories and glycemic index. This means that mobile games may serve as an educational aid to these patients.
Keywords: Diabetes, Mobile Game, Education, Mobile-Health -
Pages 535-541Background
Radiation-induced rectal toxicities remain as a major risk during prostate radiotherapy. One approach to the reduction of rectal radiation dose is to physically increase the distance between the rectal wall and prostate. Therefore, the aim of this study was to evaluate whether the application of the rectal retractor (RR) can reduce rectal dose and toxicity in prostate cancer 3-dimensional conformal radiotherapy (3D-CRT).
MethodsOverall, 36 patients with localized prostate cancer were randomized into the 2 groups, 18 patients with RR in-place and 18 without RR. All patients underwent planning computed tomography (CT). Patients were treated with 70 Gy in 35 fractions of 3D-CRT. In the RR group, RR was used during cone-down 20 treatment fractions. Acute and late gastrointestinal (GI) toxicities were assessed using EORTC/RTOG scoring system weekly during radiotherapy, 3, and 12 months after treatment. Device-related events were recorded according to CTCAE version 4.0. Patient characteristics, cancer differences, and dosimetric data for the RR and non-RR groups were compared using a Man-Whitney U test for continuous variables, and Fisher exact test for categorical data. The EORTC/RTOG scores for the 2 groups were compared using Fisher exact test. A P value <0.05 was considered statistically significant.
ResultsA RR significantly reduced mean dose (Dmean) to the rectum as well as rectal volume receiving 50% to 95% (V50-95%) of prescribed dose. The absolute reduction of rectal Dmean was 10.3 Gy. There was no statistically significant difference in acute GI toxicity between groups during treatment or at 3 months. At 12 months, 2 patients in the RR group and 9 in the control group experienced late grade ≥ 1 GI toxicity (p=0.027). No patients in the RR group reported late grade ≥ 2 GI toxicity, whereas 3 patients in the control group experienced late grade 2 GI toxicity. In the RR group, 6 patients reported grade 1 rectal discomfort and pain according to CTCAE version 4.0.
ConclusionThe application of the RR showed a significant rectum sparing effect, resulting in substantially reducing late GI toxicity.
Keywords: Prostate cancer, Radiotherapy, Rectal toxicity, Rectal retractor -
Pages 542-553Background
Overweight is related to increased risks of cardiovascular diseases and dyslipidemia, and reduced quality of life (QOL). Exercise training improves QOL and modifies cardiovascular risk factors and lipid profile. The present study was conducted to compare three types of exercise in terms of their short term effects on QOL and lipid profile in overweight individuals with moderate hemophilia A (IWMHA).
MethodsThis study was a randomized, controlled, assessor-blinded trial (IRCT20180128038541N1). Sixty IWMHA with a body mass index (BMI) of 25-30 kg/ m2 and a mean age of 35-55 years were randomly assigned to four groups of 15, namely aerobic training (AT), resistance training (RT), combined training (CT) and control. The intervention groups participated in 45-minute exercises three days a week for six weeks. The 36-item short-form health survey (SF-36) was used to measure QOL. Total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), waist-to-hip ratio (WHR), and waist circumference (WC) were measured before and after six weeks of training. For the data analysis using SPSS version 20, the ANCOVA was used to determine the differences among the four groups.
ResultsA significant decrease was observed in the intervention groups compared to the control group in terms of weight, BMI, LDL-C, TC, WHR, and WC (p<0.05). Significant increase was observed in HDL-C and SF-36 subscales in the intervention groups compared to the control group (p<0.001). There was no significant difference among the intervention groups (p>0.05). In comparison with the control group, more significant improvement was observed in the TC, TG, LDL-C, HDL-L, and SF-36 subscales in the CT group compared to the RT and AT groups.
ConclusionCT was the most effective training method in improving lipid profile and QOL in overweight IWMHA.
Keywords: Hemophilia A, Overweight, Lipid Profile, Combined Training, Quality of Life -
Pages 554-562Background
Health service utilization (HSU) is a significant health and political issue. Awareness of factors that affect HSU and the status of health service utilization can help health professionals improve their services. The aim of this study was to investigate the status of HSU and identify the factors affecting health service utilization among households residing in Tehran.
MethodsThe present cross-sectional study included 1200 residing households from different regions of Tehran, the capital of Iran. They were selected by a multi-stage cluster sampling method in accordance with the zoning of Tehran concerning socio-economic development. Interviews were conducted by trained individuals using a health service utilization questionnaire introduced by the World Health Organization, Zimet’s social support questionnaire, and demographic checklist during winter 2018 and spring 2019. Simple and multiple logistic regression models were applied to analyze the data. In order to include the factors related to the status of outpatient health service utilization, a set of bivariate analyses was conducted, and then the factors with a p-value of ≤0.20 were included in the multiple models. Data were analyzed using Stata 12 software.
ResultsThe results of the study indicated that the rate of outpatient HSU among households residing in Tehran was 63.61% (CI:60, 66.80). In addition, regarding the results of the study, asset index of family (OR=0.51, 95% CI: 0.28, 0.91), the level of awareness and knowledge of family members regarding health issues (OR=0.55, 95% CI: 0.34, 0.88) as well as the mother knowledge on health issues (OR=0.64 , 95% CI: 0.45, 0.93), the level of social support (OR = 0.50, 95% CI: 0.37,0.68), family health expenditure (OR=1.20, 95% CI: 1.18, 4.06), having a member with a sort of disability in family (OR=1.66, 95% CI: 1.01, 2.77), and having an alcoholic member in family (OR=2.44, 95% CI: 1.27, 4.68) were factors associated with outpatient HSU among households. Considering the adjusted values of odds ratios, the prevalence of the HSU varied according to the area of residence. It should be noted that the variables included in the model explained 15% of the changes in the prevalence of HSU.
ConclusionAccording to the results of the study and in order to increase HSU in different classes, the level of social support, especially among women in the family due to their role in the general health of family members, should be enhanced. Also, policies should be adopted to increase the awareness, knowledge, and information of family members about health issues, lifestyle changes, nutrition, and health behaviors through social media.
Keywords: Outpatient, Health service utilization, Household, Tehran -
Pages 563-567Background
Uropathogenic Klebsiella pneumoniae is one of the well-kown uropathogens that have the main rule in biofilm formation. Increased prevalence of ESBL enzyme is one of the therapeutic problems. However, the aims of this study were to characterize the ability of biofilm formation and ESBL-producing isolates produced by urinary tract infection’s K. pneumoniae to identify the prevalence of this type of infection in the studied area.
MethodsBetween the 500 nonrepetitive clinical isolates, 128 isolates were detected as K. pneumoniae. Biofilm production of these isolates was showed by Merrit and Christensen method. The standard Kirby-Bauer disk diffusion method was used for antimicrobial susceptibility testing. The phenotype ESBL was confirmed by double disc synergy test (DDST). Genotypic identification of ESBLs did by molecular detection. The statistical analysis was done using software IBM SPSS Statistics (SPSS Inc) and chi-square and Fisher exact tests.
ResultsThe result of microtiter plate was observed and it was found that 86 (67.2%) isolates had weak biofilm, 24 (18.8%) moderate biofilm, and 18 (14.1%) strong biofilm. Also, 57 (44.5%) out of 128 isolates were diagnosed as MDR. The highest frequency of resistance was identified for cefotaxime 60 (46.9%) and tetracycline 60 (46.9%), and the lowest rate was for amikacin 16 (12.5%). The results of DDST showed 55 of 128 (43%) produced ESBL enzymes. PCR detection in ESBL-producing isolates showed contained blaTEM 33 of 55(63.1%), and blaVEB 13 of 55 (23% ). Also, 1 of 55 (2%) had both blaTEM and blaVEB. Also, 5 of 13 (38.4%) isolates that had the blaVEB gene were also MDR and had weak biofilm (8/13; 61.5%), intermediate biofilm (3/13; 23%), and strong biofilm (2/13; 15.4%).
ConclusionTo decrease treatment complications and mortality rate of drug-resistant bacterial infections, rapid detection of β-lactamases genes and evaluation of these properties and infection management programs can help to prevent the transmission of drug resistant-strains.
Keywords: Extended-spectrum β-lactamases (ESBLs), Biofilm Formation, Klebsiella pneumonia, Antibiotic resistance, blaTEM, blaVEB -
Pages 568-579Background
Recovery of children does not appear on its own after cochlear implantation. Coherent, thoughtful, and comprehensive rehabilitation is needed to achieve complete success. The purpose of this study was to identify the types of rehabilitation interventions for children with cochlear implants that have been performed in Iran.
MethodsA scoping review study was conducted. An electronic search was carried out both in English and Persian. In English, the following keywords were used: cochlear implantation, child, cochlear implants, auditory rehabilitation, deaf, hearing loss, comprehensive, interventions, rehabilitation, and telerehabilitation and a combination of them in ProQuest, PubMed, Science Direct, and Scopus databases, Web of Sciences, Medline and Embase. Persian electronic search was conducted in the Scientific Information Database (SID) of Jihad Daneshgahi, Iran Journals Database (MagIran), and Islamic World Science Citation Database (ISC). Searches were done using articles published until September 25, 2020, and a total of 902 articles were found, of which 14 were directly related to the purpose of the study. Interventional studies were included in the study, and the quality of studies was measured using the Structured Effectiveness Quality Evaluation Scale.
ResultsThe results showed that using music and rehabilitation equipment, different methods of speech therapy and auditory training, story-based instruction, creative play, family-centered instruction, and occupational therapy are interventions in cochlear implant rehabilitation. Speech therapy accounts for 54% of the rehabilitation share. The mean number of rehabilitation sessions was 26. These interventions were all somehow effective in children with cochlear implantation; the longer the training duration, the better the results.
ConclusionThe process of cochlear implant rehabilitation in children is multi-professional; auditory training and speech therapy possesses the highest share of rehabilitation. Therefore, it is recommended to develop speech therapy centers in Iran.
Keywords: Rehabilitation, Cochlear Implant, Child, Iran -
Pages 580-585Background
One of the most important aspects of life is reproductive health, which receives less attention in public policy considerations because of its sociopolitical sensitivities. The aim of this study was to evaluate the effect of a designed health education program on knowledge about puberty health among visually impaired female adolescent students during 2011 and 2015.
MethodsThis quasi-experimental study was conducted on 100 visually impaired female students aged 10 to 19 years. Data collection tool was a researcher-made questionnaire. Participants were recruited using convenience sampling method from Narjes educational center in Tehran. The educational needs assessments survey was used to learn about important issues and problems faced by this group to design effective educational programs. The effectiveness of the designed program was assessed by comparing the studentschr('39') knowledge at the baseline and at 1-month follow-up. Data were analyzed in SPSS V.21 by using parametric descriptive statistics. The significant level was set as p<0.05
ResultsThe results showed that the puberty knowledge of participants was increased in all educational domains after intervention compared to the baseline (p<0.05). The knowledge about the onset of puberty changes showed the highest increase (from 2.02 at baseline to 7.51 at follow-up) and the knowledge about personal hygiene had the least change after the intervention (from 6.67 to 8.23). The majority of students did not have any information resources regarding puberty health, and about one quarter of them reported their mother as the main resource of puberty information.
ConclusionProviding educational programs during puberty has a crucial role in young girls’ knowledge increase. Providing a continuous health educational program that is tailored to the needs of this group of students using suitable strategies is recommended.
Keywords: Puberty, Health Education, Blindness, Visually Impaired, Adolescent, Women's Health -
Pages 586-590Background
Gastroesophageal reflux disease (GERD) is a prevalent condition. Erosive esophagitis (EE) and Barrett’s esophagus (BE) are the two important complications of GERD. We aimed to study the prevalence of EE and BE in a group of Patients with reflux symptoms who were referred for endoscopy. The relationship between reflux symptoms and endoscopic findings was also examined.
MethodsWe enrolled 139 consecutive patients with characteristic symptoms of GERD. Demographic and clinical characteristics of the patients including duration and severity of reflux symptoms, were recorded. Endoscopic findings of EE were identified and classified according to the Los Angeles classification, while BE was confirmed by histopathology examination. The Fisher’s exact test and the two-sample 𝑡-test were used to test the association of esophageal lesions (BE and/or EE) with the patientschr('39') clinical and endoscopic data.
ResultsForty seven and 13 patients were found to have EE and BE, respectively. Multivariate analysis showed that older age (p=0.001) and hiatal hernia (p=0.004) was significantly related risk factors for erosive esophagitis and BE. While an increase in BMI (p=0.004) was related to EE, patients with BE were more likely to have severe reflux symptoms than others (p=0.002).
ConclusionIn patients with GERD, the presence of hiatal hernia may be strong risk factor for erosive esophagitis and BE, as does older age. For Barrett’s esophagus, severe reflux symptoms are more likely.
Keywords: Barrett’s esophagus, Reflex esophagitis -
Pages 591-594Background
Using morphologic features of the bones is the basis of gender determination in anthropology and forensic medicine. In this study, we evaluated the calcaneus diameters for gender determination in the Iranian population.
MethodsThis cross-sectional study was conducted on Iranians referring to Hazrat-e Rasool Hospital’s radiology ward for plain lateral X-ray of the foot. Lateral foot X-rays from 100 men and 100 women were gathered and evaluated for calcaneal indexes. These patients aged between 18 and 80 years old who did not suffer major trauma to the calcaneus bone were recruited. Using a picture archiving and communication system (PACS), four variables were calculated for each X-ray graph: Maximum anterior-posterior length of the calcaneus (MAXL), Maximum height of the bone (MAXH), Height of the cuboid facet (CFH) and Height the calcaneal body (BH). Cut off points for each index were calculated using the area under curve (AUC) in ROC curves.
ResultsLateral foot X-rays from 100 men and 100 women were gathered and evaluated for calcaneal indexes. The means of the four indexes were compared between the sexes which showed all four means are significantly different p value <0.001. AUC for MAXL in differentiating the genders was 0.824 , which showed 86.8 as the cut off with a sensitivity of 80% and specificity of 69.0%. Cut off point for MAXH was set at 59.8 with sensitivity and specificity of 78.0% and 60.0%, respectively. For BH, 49.5 was set as the cut off point with a sensitivity of 79.0% and specificity of 64.0%. The best cut off point for CFH was 27.8 with 76.0% sensitivity and 63.0% specificity.
ConclusionIt can be concluded that the calcaneal diameters are reliable criteria for sex determination. Although the cutoff points are different between various races and populations, it is evident that these diameters can be used for sex determination in general.
Keywords: Gender determination, X-ray, Calcaneus, Iranian population -
Pages 595-604Background
Given the various reports of the clinical spectrum of the disease, the aim of the present study was to determine possible scenarios of Coronavirus 2019 (COVID-19) iceberg using published articles.
MethodsThe present study was a rapid review of all international databases, including PubMed (Medline), Scopus, Web of Sciences, Embase, and Cochrane Library from January 1 to October 30, 2020.
ResultsIn this review, 7 scenarios were considered for COVID-19 iceberg, in which the range of fatality percentage was estimated to be 0.5% to 7%, the range of asymptomatic cases 1% to 88.6%, the range of cases with mild symptoms 8% to 78%, no symptoms 1 % to 90 %, the range of intensive care unit (ICU) admission was 0.5% to 14.2%, and finally the intubation percentage was estimated to be 0.2% to 12.2%. The Scenarios Diamond Princess Cruise Ship and Iceland are closer to the reality of the clinical spectrum of COVID-19 around the world, which represent 0.6% and 0.5% of deaths, 0.7% and 1% of intubations, 2.5% and 9.7% of ICU admissions, 1.1% and 6% of hospitalizations, 15% and 31% of cases with mild symptoms, and finally 56.9% and 75% of asymptomatic cases of COVID-19, respectively, which should now be considered as the basis of the clinical knowledge of the disease.
ConclusionUnderstanding the clinical spectrum and natural knowledge of the disease and paying attention to asymptomatic or mild-symptom cases can help to make better decisions and develop more effective interventions to control COVID-19.
Keywords: Best Estimates, Iceberg, COVID 19, Clinical Spectrum, Natural Knowledge, Rapid Review -
Pages 605-609Background
Contrary to health indices advancement during recent years, health inequalities are still a global challenge. This study aimed to determine socioeconomic factors for noncommunicable diseases using concentration indices (CI).
MethodsThis cross-sectional study was conducted on the baseline data from a cohort study in Fasa (southern Iran). Principle component analysis was used to measure asset index. Moreover, socioeconomic inequalities were calculated by CI. Analysis was done at 95% confidence level using STATA software.
ResultsA total of 7990 individuals were included in the study. The highest negative CIs were significantly found for epilepsy (-0.334), paramnesia (-0.255), and learning disabilities (-0.063), respectively, and the lowest were significantly found for chronic headaches (-0.046), recurrent headaches (-0.03), infertility (-0.028) and hypertension (-0.057). This index was positive for breast cancer (0.298). Furthermore, it was not Significant for diabetes, thyroid disorders, depression, and chronic lung diseases.
ConclusionThe findings showed a significant inequality in the most of the noncommunicable diseases in the region, which are more concentrated among the poorest population. Policymakers in the health system and city planners should consider these results to decrease the burden of noncommunicable diseases in the society by identifying vulnerable subcategories.
Keywords: Inequality, Noncommunicable Diseases, Concentration Index -
Pages 610-615Background
High tidal volume leads to inflammation, and low tidal volume leads to atelectasia and hypoxemia. This study was conducted to compare the effect of 6 mL/kg with positive end-expiratory pressure (PEEP) and 8 mL/kg without PEEP on pulmonary shunt and dead space volume.
MethodsThis clinical trial was done on 36 patients aged 20 to 65 years old with ASA I-II. They were candidates for upper abdominal surgery and divided randomly into 2 groups. One group were ventilated with the tidal volume = 8 mL/kg without PEEP (TV8). The other group received the tidal volume = 6 mL/kg with low PEEP = 5 cm H2O (TV6). Arterial and central venous blood gases were taken after intubation and 2 hours later. Additionally, the vital signs of the patients were checked every 30 minutes. Data analysis was performed using t test, chi-square test, and repeated measures analysis of variance with SPSS software, version 16 (SPSS Inc). P value less than .05 were meaningful.
ResultsThere was no significant difference on the preanesthesia parameters. The pulmonary shunt was 13.5±0.1% and 18.6±0.2% in the groups TV6 and TV8, respectively (p=0.132), which slightly decreased after 2 hours in both groups without any significant difference (p=0.284). Prior to the ventilation, the ratios of dead space to tidal volume were 0.25±0.2 and 0.14±0.1 in the TV6 and TV8 groups, respectively (p=0.163), and after 2 hours, they were 0.23±0.11 and 0.16±0.1 in the TV6 and TV8 groups, respectively (p=0.271). There was no significant difference between the groups for blood pressure and peripheral and arterial oxygenation changes.
ConclusionThe tidal volume of 6 mL/kg with the PEEP of 5 mmHg was similar to the tidal volume of 8 mL/kg without PEEP for hemodynamic and pulmonary changes (oxygenation, shunt, and dead space).
Keywords: Mechanical Ventilation, Tidal Volume, Pulmonary Shunt, Positive End-expiratory Pressure -
Pages 616-624Background
Training needs assessment is the process of recognizing educational needs. This study aimed to apply a community-based nutrition education needs assessment to revise the nutrition course plan in the curriculum of the doctorate of medicine and that of the baccalaureate of nursing.
MethodsThe study was designed in 2 phases: (1) nutritional needs assessment; (2) community-based revision of nutrition course plan. In the first phase, 13 nutrition professionals working in the region set out 5 priorities of nutrition-related health problems in the community by a training need assessment based on a survey and scoring system. Then, an expert panel determined the priorities of behavioral and nonbehavioral causes of the nutrition-related health problems by the nominal group technique (NGT). The results of the first phase were used to review the topics of nutrition course plans up to 20%.
ResultsThe priorities identified in Abadan, Khorramshahr, and Shadegan were obesity and type 2 diabetes mellitus in adults as well as anemia in pregnant women, respectively. Also, wrong eating habits and insufficient nutrition knowledge were among the most important behavioral causes of nutrition-related health problems in the target community. These results were applied to a community-based review of nutrition course plans for medical and nursing students.
ConclusionThe use of nutritional needs assessment approaches by a survey and nominal group technique with a group of professionals provided an opportunity for a community-based review of the nutrition course plan for medical and nursing students as a first phase in the development of a community-based nutrition course plane.
Keywords: Community, Course Plan, Educational Content, Nutrition-Related Health Problems -
Pages 625-649Background
The Willingness to pay (WTP) for and acceptance of cervical cancer prevention (CCP) methods have an important role in the control of this type of cancer. Therefore, the aim of this study was to estimate the WTP and acceptance of CCP methods with the contingent valuation method (CVM).
MethodsIn this systematic review and meta-analysis study, the required information was collected by searching relevant keywords in PubMed, Scopus, Embase, Web of Knowledge, and their Persian equivalent in the Scientific Information Database (SID) and Elmnet databases during January 1, 2000 to June 30, 2020. All studies that reported the WTP and CCP methods with the CVM in English or Persian were included. The reporting quality of studies was assessed by strengthening the Reporting of Observational Studies in Epidemiology (STROBE). Comprehensive meta-analysis (CMA: 2) software was used to conduct the meta-analysis. The content analysis method was used for qualitative data analysis.
ResultsFinally, 28 articles (with 49610 people) were included in the study. Most of the participants were women (35.7%). The HPV vaccine was the most common method of prevention (75%). The overall acceptance rate was 64% and the overall positive WTP rate was 66%. The average WTP was US$30.44, which accounts for about 0.84% of GDP per capita. The most significant effective factors included income, age, education, high-risk sexual behaviors, and awareness of cervical cancer, belief in the risk of cervical cancer, and belief about the effectiveness of prevention methods. The cost was the most important reason for the unwillingness to pay and accept.
ConclusionResults show that the WTP and acceptance rate of CCP methods are relatively high. It is recommended to reduce the cost of prevention methods, especially the HPV vaccine, and to increase awareness and improve the attitude of people. Also, it is recommended to consider other methods of estimation of WTP and other cancers in future studies.
Keywords: Acceptance, Preventive Measures, Cervical Cancer, Human Papillomavirus Vaccine -
Pages 650-656Background
Currently, stem cell therapy has been proposed as an efficient strategy to prevent or treat myocardial injuries. The current study was conducted to examine cardioprotective effects of human mesenchymal stem cells derived from amniotic membrane (hAMSCs) against isoproterenol (ISO)-induced myocardial injury and explore its potential mechanisms.
MethodsThe hAMSCs were injected intramyocardially in male Wistar rats 28 days after last injection of ISO (170 mg/kg body weight for 4 consecutive days). The echocardiography was performed to confirm induction of myocardial damage and cardiac function 28 days after last injection of ISO and 4 weeks hAMSCs transplantation after HF induction. The expression of apoptotic markers such as Bcl-2, Bax and P53 was evaluated using Western blotting assay. Masson’s trichrome staining was used to determine fibrosis. The cytoarchitecture of myocardial wall and morphology of cells were investigated using hematoxylin and eosin (H&E) staining.
ResultsAs compared to ISO group, hAMSCs transplantation after heart failure (HF) induction significantly blunted the increasing of cardiac dimensions and restored ejection fraction (EF) and fractional shortening (FS) parameters (p<0.05). Moreover, hAMSCs transplantation after HF induction increased the expression of antiapoptotic markers such as Bcl-2 and decreased the expression of pro-apoptotic markers such as P53 and Bax (p<0.05). As compared to ISO group, hAMSCs transplantation after HF induction markedly reduced interstitial myocardial fibrosis and contributed to maintain of normal cytoarchitecture of myocardial wall and morphology of cells.
ConclusionCollectively, the results of current study suggest that transplantation of hAMSCs confers cardioprotection by targeting ISO‐induced mitochondria‐dependent (intrinsic) pathway of apoptosis.
Keywords: Cardiac injury, Apoptosis, Human mesenchymal stem cells, Cardiac function, Fibrosis -
Pages 657-663Background
Currently, the role of calcium in reducing the duration and severity of diarrhea and its consequences has been considered as a topic of concern. The aim of this study was to evaluate the effect of oral calcium on the duration of acute gastroenteritis in children.
MethodsThis single-blind randomized clinical trial was performed from 2014 to 2016 at Ali Asghar Children’s Hospital, Tehran, Iran. Totally, 124 patients (one month to twelve years old) with acute gastroenteritis were enrolled in this study. The patients were divided equally into intervention and placebo groups and received the calcium gluconate 10%, 0.5cc/kg/day and distinct water, respectively. Data analysis was performed using the statistical software SPSS version 20.0 for windows (SPSS Inc., Chicago, IL) and p<0.05 was considered significant.
ResultsThe mean age of the intervention and placebo groups was 26.43±3.74 and 20.84±2.70 months, respectively, and the difference was not significant (p=0.228). The duration of diarrhea in the intervention and placebo groups was 5.27±2.01 and 6.71 ± 2.44 days respectively (p=0.001). In the placebo group, the plasma calcium level was less than 8mg/dl in 1 (1.6%), 8 - 10 mg/dl in 55 (88.7%) and more than 10mg/dl in 6 cases (9. 7%). In the intervention group, there were 7 (11.3%), 55 (88.7%) and 0 (0%) cases in three groups, respectively (p=0.005).
ConclusionThe oral calcium gluconate might shorten the duration of acute gastroenteritis. Therefore, it could be considered as an adjunctive therapy. Whether the formulation of the oral rehydration solution (ORS) will be updated in the future with adding the calcium salts remains to be defined and needs more investigations.
Keywords: Calcium, Calcium-sensing receptor, Diarrhea, Gastroenteritis, Pediatrics -
Pages 664-667Background
Constipation is one of the most common gastrointestinal discomforts that affects various age groups in humans. Different mechanical cleansing devices have been introduced yet. However, they are very expensive and not available in our country.
MethodsThis was a pilot experimental trial. Fifteen patients with eligible ROME III criteria and at least two years of chronic constipation and resistant to medical therapy entered the study. Wexner and Longochr('39')s scores were checked before and after using the “Roodeshur” device. Data entered SPSS 16 and analyzed using T-test. A p value below 0.05 was considered as a statistically significant difference.
ResultsFive patients were female and 10 males. The mean age of patients was 53.56±18.34 years. There was a significant difference regarding intestinal movement before and after using the device (p˂0.001). Wexnerchr('39')s score decreased after the intervention with a significant difference (p˂0.001).
ConclusionOur mechanical cleansing device (Roodeshur) was effective and safe for patients with resistance constipation. No complication occurred. Due to its low cost and easy access in our country, it can be recommended for other patients as well. However, more studies with a larger sample size are recommended.
Keywords: Chronic Constipation, Mechanical Cleansing, Wexner -
Pages 668-673Background
Coronary artery disease (CAD), as a most common cause of death, is mainly caused by atherosclerosis. Due to the role of inflammation in the process of atherosclerosis, in the present study, the relationship between the severity of coronary artery disease and inflammatory factors of monocyte to HDL-C ratio (MHR), platelet-to-HDL-C ratio (PHR), neutrophil to HDL-C ratio (NHR), and IL-25 was investigated.
MethodsIn this cross-sectional study, 64 patients with diagnosis of coronary artery disease who were undergoing angiography in Farshchian heart center in Hamadan were studied. For each patient, the count of monocytes, neutrophils, platelet, and HDL-C, and IL-25 were measured from their blood and serum samples. Also, demographic information, such as age, gender, diabetes, smoking, and history of hypertension, was collected using a checklist. Data were described using frequency, percent, mean, and standard deviation. Statistical analysis was performed using independent t test, Mann-Whitney, Wilcoxon, and Spearman rank correlation tests, and multiple linear regression by SPSS version 25.0 SPSS Inc). P < .05 was considered as significant.
ResultsThe results of this study showed that IL-25 and MHR index has a significant correlation with coronary artery disease and Gensini score (P ˂ .001). The PHR index was associated with coronary artery disease. Also, qualitative variables, such as history of hypertension, history of smoking, and gender, have a significant association with the severity of coronary artery disease (P < .05).
ConclusionAmong the inflammatory markers examined, IL-25 and MHR are stronger markers for assessing the severity of coronary artery disease. Simple and available IL-25 and MHR measurements may be able to, along with common risk factors and lipid profiles, predict the amount of vascular occlusion in treatment centers as an alternative of angiography as well as screening high risk patients prone to cardiovascular disease.
Keywords: Coronary Artery Disease, IL-25, HDL-C, MHR, NHR, PHR -
Pages 674-680Background
Anemia is a multifactorial and common public health problem in geriatric age groups, especially in developing countries. Therefore, this study was designed to study the prevalence of anemia and associated factors among the elderly population in Birjand, Iran, in 2019.
MethodsThis was a cross-sectional approach to the baseline data of the Birjand longitudinal aging study (BLAS) in which 1396 people aged ≥ 60 years were screened for the presence of anemia based on the World Health Organization (WHO) criteria. For each participant, a standard questionnaire was administered. Furthermore, the height, weight, and body mass index (BMI) were calculated. Blood samples were obtained from each participant for hematological examination. Hemoglobin, hematocrit, and other indices of cell blood count were measured using an automatic cell counter. The prevalence rates were estimated using survey analysis with the weight of Birjand county older population. Univariate and multivariable logistic regression analyses were applied to detect the associated factor with anemia.
ResultsThe mean age of the participants was 69.73±7.66 years. The crude prevalence of anemia was 11.10%, and the age-standardized prevalence based on the standard WHO population 2000-2025 was equal to 16.78% (12.81%–21.66%) (15.95% [10.41%–23.69%] in women and 17.32% (12.65%–23.25%) in men. Mild and normocytic anemia were the predominant types. The mean hemoglobin, hematocrit, mean cell volume (MCV), mean corpuscular hemoglobin (MCH), and mean corpuscular hemoglobin concentration (MCHC) were lower in women than in men and the mean platelet count in women was higher (p<0.001). In the final multivariate logistic regression model, only age groups, BMI, fish consumption, and chronic kidney disease (CKD) were related to anemia.
ConclusionIn conclusion, our findings showed the association of anemia with some risk factors and diseases. Anemia in geriatric age groups is often underdiagnosed; hence, identification of subgroups at risk for anemia and its associated risk factors in geriatric groups has a paramount importance in preventing adverse outcomes.
Keywords: Anemia, The Elderly, Population, Prevalence, South Khorasan -
Pages 681-687Background
N-acetylcysteine (NAC) is an antioxidant derived from the amino acid cysteine and is one of the drugs used in the treatment of respiratory diseases. The aim of this study was to investigate the effect of NAC on the treatment of acute respiratory distress syndrome in mechanically ventilated patients admitted to the intensive care unit.
MethodsThis study was a randomized clinical trial. Patients under mechanical ventilation admitted to the intensive care unit were examined. Patients in the intervention group received daily 150 mg/kg of NAC on the first day of admission and then 50 mg/kg up to the fourth day of admission. Patients in the control group received routine care. The vital signs, level of consciousness, and other important variables were recorded. Data were analyzed using statistical tests and SPSS software version 24.
ResultsThere was no significant difference between MAP, heart rate, respiratory rate, O2Sat, APACHE II score, and pulmonary capacity of the patients in the two groups on the first, second, third and fourth days after the intervention (p>0.05 ). There was no significant difference between the level of consciousness (according to GCS criteria), respiratory index (PAO2/FIO2) and PEEP of patients in the two study groups within 1 to 2 days after the intervention (p>0.05). There was a significant difference between the level of consciousness (based on GCS criteria), respiratory index (PAO2/FIO2) and PEEP of patients in the two study groups within 3 to 4 days after the intervention (p<0.05). There was no significant difference between the duration of hospitalization in the ICU, the time required for mechanical ventilation and the mortality rate of the patients in the two groups (p>0.05).
ConclusionIt seems that N-acetylcysteine has a positive effect on the treatment of acute respiratory distress syndrome in mechanically ventilated patients admitted to the intensive care unit.
Keywords: N-acetylcysteine, Acute respiratory distress syndrome, Mechanical ventilation, Intensive care -
Pages 688-691Background
Pituitary adenoma (PA) is a frequent intracranial lesion, that needs surgical evacuation. In this study, we evaluated the surgical outcome of PA treated via endoscopic and microscopic trans-sphenoidal approach
MethodsIn this retrospective cross-sectional study, we evaluate ten years of PA surgery experience in the northwest of Iran. 721 patients underwent trans sphenoidal surgery of PA. Complication of the surgery, extension of tumors resection, demographic and clinical findings (gender, age , tumor type ,..) were reviewed in this study. SPSS version 25 and statistical tests including chi square and T-test were used. P-value ˂0.5 was considered as statistically significant.
Results483 males (58.9%) and 336 females (41.02%) were included in this study. Mean age of patients was 47.3±1.96 years.The most common initial complaints were deterioration of vision (n=528, 64.4%) and headache (n=343, 41.88%), followed by accelerated development (n=254, 31.01%), amenorrhea and galactorrhea (n=253, 30.8%). 57 (6.95%) patients had symptoms of Cushing’s disease. 105 (12.8%) patients had acromegaly. TR was achieved in 87.5% of cases and sub-TR in 103 (12.5%) cases and no patient had a partial or insufficient resection. After surgery, the endocrine function was normalized in 76 (31.7%) patients who had preoperative hyper hormonal levels. 36 (4.3%) patients developed postoperative CSF leakage; of which, 4 (0.48 %) patients did not improve by lumbar drainage and other conservative treatments and needed reoperation for reconstruction of the skull base.
ConclusionThe combination of microscopic and endoscopic trans-sphenoidal approach in PA surgery can be lead to total resection of tumors.
Keywords: Pituitary Adenoma, Pituitary Hormone, Trans-Sphenoidal Approach -
Pages 692-695Background
Impulse oscillometry (IOS) is a method that does not depend on the cooperation of the patient and can detect small airway diseases with higher sensitivity than spirometry. However, the clinical application value of IOS in the screening of patients exposed to risk factors COPD and early diagnosis remains unclear. The aim of this study is to evaluate diagnostic sensitivity of IOS in the early detection of patients exposed to risk factors COPD.
MethodsA prospective cross-sectional study was conducted in Rasoul Akram Hospital, Tehran, Iran, from 2013 to 2015. 28 patients with COPD risk factors and normal spirometry participated in the study. The IOS was performed. We obtained the respiratory resistance and impedance of 5 Hz (R5) and 20 Hz (R20) and 5 Hz (Z5), respectively. The data were analyzed using SPSS version 17 using Chi-square and two independent sample t-test. Spearman correlation test was used to measure the correlation of oscillometry parameters in the diagnosis of COPD. P-value <0.05 was considered significant for all statistical analyses.
ResultsThe mean patient age was 55.50±11.27 years. In this study, the sensitivity of Z5, R5, and R20 was respectively 28.5%, 25%, and 31.5%. All oscillometry parameters were significantly correlated with each other but none of the oscillometry parameters showed significant correlations with FEV1/FVC (rZ5=0.018, rR5=0.082, rR20=0.041 and PZ5=0.932, PR5=0.711, P R20=0.850). According to the results, only 9 patients (32.5%) with normal values of FEV1/FVC had abnormal values of oscillometry.
ConclusionIOS has a low sensitivity and cannot be used in the screening of early-stage chronic obstructive pulmonary disease.
Keywords: COPD, Impulse oscillometry, Spirometry, Airway obstruction -
Pages 696-715Background
Transfer of learning (ToL) is the endpoint of simulation-based training (SBT). It is affected by numerous factors, which can be classified into 3 categories: learner characteristics, work environment, and training design. The first 2 have been identified to some extent in previous research. In this study, the aim was to identify the instructional design (ID) features affecting the ToL in SBT.
MethodsThis qualitative study was conducted in 2 phases. Phase 1 covers thematic analysis of comparative studies in the field of SBT. A systematic search was performed on 6 databases of Ovid MEDLINE, EMBASE, PsycINFO, CENTRAL, Scopus, and Web of Science, and the references of related systematic reviews were also checked. In phase 2, semi-structured interviews were conducted with key informants (instructors and learners) and analyzed using directed content analysis. The results of the 2 phases were combined, and finally ID features of SBT were identified and categorized.
ResultsIn the first phase, 121 comparative studies were reviewed and in the second phase, 17 key informants were interviewed. After combining the results of the phases, the ID features affecting the ToL in SBT were classified into 3 broad categories and 15 subcategories as follows: (1) presimulation: preparation, briefing, and teaching cognitive base; (2) underlying theories: deliberate practice, mastery learning, and proficiency-based training; (3) and methods and techniques: distributed practice, variability, increasing complexity, opportunity for practice, repetitive practice, active learning, feedback/debriefing, simulator type, and simulator fidelity.
ConclusionAlthough learning is transferred from the simulated setting to the clinical setting, this process is not automatic and straightforward. Numerous factors affect this transfer. The results of this research can be used in designing and evaluating the SBT programs.
Keywords: Simulation Training, Manikins, Transfer, Psychology, Education, Medical, Students -
Pages 716-726Background
Diarrhea-associated-hemolytic-uremic-syndrome (D+HUS) is a common from of HUS. Central-nervous-system (CNS) involvement is one of the most common extrarenal organ involvements in children with D+HUS. This systematic review and meta-analysis aim to recognize the frequency of neurological complications in pts with HUS.
MethodsDatabases of PubMed, Embase, and Web of Science were searched systematically to find the papers on neurological involvement in HUS pts. Two researchers independently assessed the papers’ quality and extracted data. CMA v. 2.2.064. was used for data analysis. Heterogeneity was evaluated using the I-squared (I2) test, and a fixed/random-effects model was used when appropriate.
ResultsIn this review, 21 studies including 2,189 participants with a median age between 1.3-40-year-old, entered the meta-analysis. The meta-analysis in D+HUS patients indicated 27.0% with neurological complications (95% CI, 22.0%-32.6%), 25.5% of symptoms weren’t categorized (95% CI, 15.9%-38.3%), 20.8% of them developed the seizures (95% CI, 2.3%-74.4%). In D-HUS pts, 20.8% of them were presented neurological symptoms (95% CI, 17.9%-24.0%), of which 29.0% weren’t categorized (95% CI, 19.2%-41.2%), 17.5% of pts got into coma (95% CI, 9.6%-29.7%), 5.6 % showed hemiparesis (95% CI, 2.8%-10.9%), 17.2% experienced lethargy (95% CI, 5.2%-44.1%), 30.5% developed the seizures (95% CI, 18.2%-46.2%), 7.4% manifested speech abnormalities (95% CI, 0.2%-7.22%), 6.4% of D-HUS pts presented visual-disturbances (95% CI, 3.4%-11.6%).
ConclusionThis systematic review and meta-analysis indicated more than one-fourth of both D+HUS and D-HUS patients were presented with neurological symptoms, and the most prevalent symptoms were seizures, which can lead to an epilepsy sequel.
Keywords: HUS, CNS, Diarrhea, Neurological symptoms, Pediatrics, Adults -
Pages 727-731Background
Discharge from the hospital against the doctor’s advice and refusal of receiving treatment is one of the significant issues at the time of hospitalization, which is especially crucial in relation to psychiatric patients. It can exacerbate the disorder and the subsequent complications and increase further hospital admissions. The present study was designed to evaluate the causes of discharge from the hospital and the refusal of receiving treatment against medical advice in hospitalized patients in Iran Psychiatric Hospital.
MethodsThe present study was a descriptive cross-sectional study. One hundred patients hospitalized in Iran Psychiatric Hospital discharged with personal consent against medical advice from July to December 2018 were studied. Two methods were used for assessment; the fulfillment of a routine ministry-approved checklist by the dischargers themselves and the face-to-face interview with both the patient and discharger based on a researcher-made checklist. Cohen’s Kappa coefficient was used to assess the agreement of the answers of patients to both routine ministry-approved and researcher-made checklists by SPSS software version 16.0 with an overall accuracy of 95%.
ResultsBased on the results extracted from the researcher-made checklist, 43 (43%) of the discharges were generally based on patient-related factors. The personal insistence to discharge by the patient was cited as the main reason for discharge. Cohen’s Kappa coefficient showed no significant agreement between the patient’s answers to the interview and what they have previously filled in the routine ministry-approved checklist. More specifically, the measure of agreement for answers of patients to questions in the standard checklist and the questions asked by the interviewer was 0.078 (p=0.167).
ConclusionFrom the results of this study, it can be concluded that the face-to-face interview based on the researcher-made checklist can more effectively determine the reasons for discharge of patients due to the accuracy of the interview.
Keywords: Discharge against medical advice (DAMA), Psychiatric patient, Hospitalization -
Pages 732-736Background
Although acute appendicitis is a common problem, it remains a difficult diagnosis to establish, particularly among females of reproductive age. The present study was conducted to devise a new decision making model for diagnosing acute appendicitis in non-pregnant women.
MethodsThe present study was a retrospective study consisting of women who had undergone an appendectomy between 2007 and 2015 at the emergency department of Imam Hossein Medical Center, Tehran, Iran. The inclusion criteria were being a female, presenting with abdominal pain, being a suspected case of acute appendicitis, and undergoing an emergency appendectomy. A classification and regression tree (CART) analysis was performed to partition exam and laboratory data obtained from these patients into homogeneous groups in order to develop a prediction rule for appendicitis diagnosis.
ResultsThe study population included 433 non pregnant women who underwent emergency operations with a preliminary diagnosis of acute appendicis. Out of these patients, 295 patients (68.1%) were appendicitis positive based on the pathology exam results, while 138 patients had a normal appendix, indicating a negative appendectomy rate of 31.8%. The final devised CART model included hemoglobin level, PMN count, age, and history of abdominal incision and yielded a sensitivity of 82.7% and specificity of 55.8%, which were better than Alvarado prediction results for the Asian population.
ConclusionWe have devised a simple and cost effective prediction model for predicting the outcome among non-pregnant women undergoing emergency appendectomy operation with good sensitivity and specificity compared to the Alvarado model.
Keywords: Appendicitis, Prognosis, Decision Making, Model -
Pages 737-743Background
Ever since coronavirus disease 2019 (COVID-19) has emerged as a global public health problem, risk factors for severe disease have been reported in studies from Western countries. However, apart from studies of Chinese origin, few reports are available on COVID-19 severity among the Asian population. This study investigates potential risk factors for development of critical COVID-19 in an Iranian population.
MethodsIn this retrospective cohort study, we included all adults with COVID-19 from 2 tertiary centers in Iran who had been diagnosed between February 20 and April 1, 2020, in either inpatient or outpatient settings. “Critical COVID-19” was proposed when a hospitalized patient was scheduled for admission to intensive care unit, assisted by mechanical ventilation, or pronounced dead. We used univariable and multivariable logistic and linear regression models to explore the potential risk factors associated with critical COVID-19, admission to hospital, and length of hospital stay.
ResultsOf the 590 recruited patients, 427 (72.4%) were hospitalized, 186 (31.5%) had critical COVID-19, and 107 (18.2%) died. In the multivariable regression analysis, age >60 years and physical/mental disabilities were associated with critical COVID-19 (odds ratio (OR), 2.33 and 7.03; 95% CI, 1.51-3.60 and 2.88-17.13, respectively); and history of renal, heart, or liver failure was associated with both COVID-19 hospitalization (OR, 4.13; 95% CI 1.91-8.95; p<0.001) and length of hospital stay (Beta 1.90; 95% CI, 0.76-3.04; p=0.001).
ConclusionAge >60 years and physical/mental disabilities can predict development of critical COVID-19 in the Iranian population. Also, the presence of renal, heart, or liver failure might predict both COVID-19 hospitalization and length of hospital stay.
Keywords: COVID-19, Prognosis, Risk Factor, Age, Disability, Iran -
Pages 744-749Background
Typically, blood pressure dips during sleep and increases during daytime. The blood pressure trend is affected by the autonomic nervous system. The activity of this system is observable in the low and high activity conditions. The aim of this study was to assess the effect of individual characteristics on systolic blood pressure (SBP) across day-night under low and high activity conditions.
MethodsThe samples were 34 outpatients who were candidates for evaluation of 24 hours of blood pressure with an ambulatory. They were admitted to the heart clinic of Farshchian hospital, located in Hamadan province in the west of Iran. The hourly SBP during 24 hours was considered as a response variable. To determine the factors effecting SBP in each condition, the hidden semi-Markov model (HSMM), with 2 hidden states of low and high activity, was fitted to the data.
ResultsMales had lower SBP than females in both states. The effect of age was positive in the low activity state (β=0.30; p<0.001) and negative in high activity state (β= -0.21; p=0.001). The positive effect of cigarette smoking on SBP was seen in low activity state (β=5.02; p=0.029). The overweight and obese patients had higher SBP compared to others in high activity state (β=11.60; p<0.001 and β=5.87; p=0.032, respectively).
ConclusionThe SBP variability can be displayed by hidden states of low and high activity. Moreover, the effects of studied variables on SBP were different in low and high activity states.
Keywords: Activity, Body mass index, Ambulatory monitoring, Systolic blood pressure, Cigarette smoking -
Pages 750-757Background
Clinical faculty development plays a significant role in the professional empowerment of future physicians. Identification of educational needs is an important step in planning faculty development. This study identified the educational needs of medical faculties in the clinical setting.
MethodsThis cross-sectional needs assessment study was conducted in Iranian medical universities during 2016-2018 using a triangulation paradigm. A total of 384 medical clinical faculties, 54 medical education specialists, and 194 faculty evaluation forms completed by medical residents participated in the study using a convenient randomized sampling method. The data were gleaned with a researcher-made questionnaire with 14 areas developed on the basis of clinical education goals and contexts and were analyzed with SPSS16 using descriptive statistic indices such as mean, standard deviation, and frequency percentile. Analytical tests including independent t-test, chi-square and Cramerchr('39')s V were also applied (p<0.05). The content validity, face validity, and reliability were approved.
ResultsThe response rate was %59 (227) for clinical faculties, %77 (42) for medical education specialists, and %58 (110) for residents. Professionalism was the first priority of needs from the viewpoint of clinical faculties and faculty development planners. The clinical teacherschr('39') highest level skills, in their own perspective and also students’ perspective, were procedure training and grand round, whereas their lowest level skills were emotional intelligence and morning report. The greatest gap existed between the current skill and the need is management and leadership in the clinical setting. Cramer’s index ranged between 0.18 and 0.34 (p<0.05); hence, there was a correlation between the current status and the announced needs in all subjects.
ConclusionDesigners of faculty development programs ought to pay due attention to areas of professionalism, management, and leadership and carry out accurate and comprehensive planning to enable students to become competent future physicians in the roles of therapist, manager, teacher, supporter, and researcher.
Keywords: Needs Assessment, Faculty, Medical, Clinical Teacher, Triangulation -
Pages 758-762
The current COVID-19 pandemic started in Wuhan, China, in December 2019. The World health Organization (WHO) declared the COVID-19 as a public health emergency of international concern on January 30, 2020, and recognized the situation as a pandemic on March 11, 2020. Around 135 million confirmed cases and around 2.9 million deaths until the first week of April 2021 have been among its direct impacts on human health.All countries have been affected in different degrees, and each of them has used different strategies to protect themselves against health and nonhealth consequences of this epidemic. Although all approaches are full of mistakes with fatal and painful results, some of them were successful in limiting the epidemic. One of the astonishing improvements is development of several vaccines in a relatively short period of time, which has increased hopes for epidemic control. This review aims to critically appraise the strategies for COVID-19 epidemic control in Iran since the beginning of the disease until the fourth peak of disease in March 2021.
Keywords: COVID-19, Control, Iran -
Pages 763-769Background
Gaming disorder has been identified as a health problem. Disorders in emerging adulthood might negatively affect individuals’ attitude toward the world, their communication with others, and formation of their personal identity. Thus, the present study was performed to identify the frequency of gaming disorder and its related factors among students of Tabriz University of Medical Sciences.
MethodsA total of 813 undergraduate students of Tabriz University of Medical Sciences participated in this descriptive correlational study in 2018. All students filled the personal-social information form and Social Readjustment Rating Scale, and gamers filled gaming behaviors form and Internet gaming disorder-20 test (IGD). Data were analyzed using descriptive statistics and Pearson correlation coefficient, t- test, ANOVA, chi-square, and multiple linear regression.
ResultsA total of 394 (48.5%) students were currently playing games. The mean of IGD scores among the gamers was 45.47 ±13.93, and 17 (4.3%) of them were recognized as having gaming disorder. The frequency of the disorder among all students was 17 (2.1%). Being male, playing online games, and having access to all 3 gaming devices (computer, smart phone, and tablet) were recognized as determining factors of gaming disorder.
ConclusionThis study revealed that almost half of the university students were playing video and or on line games; however, a low percentage of the gamers had addictive gaming behaviors. The results indicated the necessity of applying modifications to individuals’ gaming methods as well as implementing the individual and family-centered interventions to prevent and manage gaming disorder.
Keywords: Video Games, Internet, Behavior, Addictive, University students -
Pages 770-772
Since the discovery of coronavirus disease 2019 (COVID-19), which started in Wuhan, China, the epidemic has not only swept through China but also spread throughout the world in spite of the concerted attempts from the governments to contain it. Thus, prevention and control of COVID-19 infection is very effective in ensuring the safety of medical specialists, health care workers, and patients. Audiology clinics are also crucial in the fight against the infection epidemic, as audiologists provide their diagnostic and rehabilitative services in an environment with different contaminated objects that come in either direct or indirect contact with multiple patients. The current article explains the importance of infection control in audiology and priority setting for audiologic evaluation in COVID-19 pandemic.
Keywords: COVID-19, Coronavirus, Audiology, Audiometry, Protection -
Pages 777-786Background
Anxiety affects social, economic, and physical aspects of daily life in patients with AIDS. Therefore, it is necessary to take preventive measures and design plans to maintain their general health. The present study was the first comprehensive systematic literature review research that examined the worldwide prevalence rate of anxiety in patients with AIDS.
MethodsWe searched for papers published in the English language in the major databases including Embase, PubMed, Web of Science, Scopus, Cochrane, and Google Scholar from 2000 to October 2018. There were 40 studies which found to be eligible. These studies were independently evaluated and the collected data were entered in a data extraction form, which was then analyzed by two authors and a third author if necessary. Der Simonian-Laird model was used to estimate the prevalence rate on a Forest plot at the interval confidence of 95%.
ResultsThe total sample size was 24111, and the total number of people with anxiety was 5546. The results based on the random-effects model showed that the rate of anxiety prevalence in the patients was 25% (CI: 95%, 21% -30%) with heterogeneity of 97.9% and a significance level of p<0.001. The South America continent with a prevalence of 38% (95% CI, 34%-42%) had the highest anxiety prevalence rates and Africa with 19% (95% CI, 12% -29%) had the lowest anxiety prevalence rates.
ConclusionBased on findings, the prevalence of anxiety in developed countries was partially higher than in underdeveloped countries and the obtained mean in the present study. It can be a significant point for policymakers. Therefore, WHO and the world community should have special plans for these countries.
Keywords: Worldwide, Prevalence, Anxiety, Acquired Immune Deficiency Syndrome, HIV -
Pages 787-795Background
Hospital-acquired infections (HAIs) are a global problem in hospitals and significant causes of mortality and morbidity regardless of advances in supportive care, antimicrobial therapy and prevention. The study aimed to determine a comprehensive estimate of the HAIs prevalence, influential factors, and types of these infections in Iran.
MethodsA systematic literature review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using the online databases; Medline, EMBASE, Scopus, Cochrane, SID, Magiran, and Medlib from January 1995 to September 2020 using a combination of medical subject heading terms (‘Nosocomial infection [Mesh] OR ‘’ Hospital infection [Mesh] OR Hospital Acquired Infection[Mesh] OR Healthcare-associated infection ‘’AND (‘Iran’ [Mesh]) among observational and interventional studies. SPSS version 25 and STATA version 11 were used for data analysis.
ResultsA total of 66 (cross-sectional, cohort, and case-control) observational studies were identified. More of the studies had been done before 2014(43 papers or 65%). Based on the random-effects model, the overall prevalence of HAIs in Iran was 0.111 [95% CI: 0.105 - 0.116] with a high, statistically significant heterogeneity (I2= 99.9%). The infection rate was 0.157 and 0.089 before and after the Iranian Health Transformation Plan (HTP), respectively. HAIs rates reported more in the South and West of Iran rather than other regions (0.231 and 0.164) (p= 0.001). Escherichia coli and klebsiella infections were reported in 53 and 52 papers (0.239 and 0.180, respectively). In addition, respiratory and urinary infections were reported 0.296 and 0.286 in 51 and 38 papers, respectively.
ConclusionThe prevalence of HAIs in Iran is relatively high. Preventing and decreasing hospital nosocomial infections can considerably affect reducing mortality and health-related costs. This should be taken into consideration by health policymakers for pathology and revision of some previous programs and standards as well as the development of appropriate and evidence-based control and education programs to reduce this health problem.
Keywords: Hospital infection, Nosocomial infection, Meta-analysis, Hospital, Iran -
Pages 796-800Background
Coronavirus disease 2019 (COVID-19) is a contagious disease caused by a newly identified coronavirus. Our knowledge about the survival rate and prognostic factors of the disease is not established well. The purpose of this study was to evaluate the predictors of COVID-19 mortality in Hamadan province in western Iran.
MethodsIn this study, we included all laboratory-confirmed COVID-19 cases with known treatment outcomes in Hamadan province, Iran, between 20, 2020, to May 10, 2020. Demographic, clinical, laboratory data, and treatment outcomes were obtained from computerized medical records and compared between survived cases and patients with death outcomes. Univariable and multivariable logistic regression models were used to determine the predictors of death.
ResultsFrom 749 investigated patients, 77 patients (10.28%) died during the treatment. The Mean age of patients was 53.97±19.04 years. Multivariable logistic regression showed that males had 2.07 (95% CI: 1.73, 2.54) fold higher odds of death. Those with 60 years old and more had 6.49 (95% CI: 4.53, 7.93) fold higher odds of death. Patients with an underlying disease had 7.14 (95% CI: 6.94, 7.38) fold higher odds of death, and patients who were hospitalized in the ICU ward had 2.24 (95% CI: 1.75, 2.90) times higher odds of COVID-19 related mortality.
ConclusionThe potential predictors of death in COVID-19 cases, including the male gender, older age, and having an underlying disease could help physicians to identify patients with poor prognoses at an early stage and better management of them.
Keywords: Coronavirus, COVID-19, Epidemiology, Mortality, Iran -
Pages 801-803
The Coronavirus disease 2019 (COVID-19), which was declared to be pandemic on March 12, 2020, is the latest health concern worldwide. COVID-19 patients may develop cerebrovascular complications either during the course of COVID-19 or even as an initial presentation of the disease. Herein, a case of myocarditis in a COVID-19 patient without any respiratory signs and symptoms is presented.
Keywords: COVID-19, SARS-CoV-2, Coronavirus, Myocarditis, Myopericarditis -
Pages 804-810Background
Tuberculosis (TB) causes over a million deaths annually and is still one of the most important public health problems worldwide. According to the World Health Organization estimates, the highest rates of TB in the European Region are in Tajikistan, Kazakhstan, Moldova, Kyrgyzstan, Romania, and Uzbekistan. The purpose of this study was to investigate the spectrum of nonspecific microorganisms isolated in patients with multidrug-resistant TB in Central Kazakhstan and to assess their susceptibility to antimicrobial drugs.
MethodsThe patients were divided into 2 groups: group 1 with multidrug-resistant forms of pulmonary TB (n = 107 patients); group 2 with sensitive forms of pulmonary TB (n = 122 patients). Gender, age, and social status of the patients were studied. Microorganisms were identified using the MALDI-TOF method. The statistical significance of different values for binary and nominal parameters was determined using the chi-square test. Changes in binary variables were analyzed using the McNeimer test.
ResultsDuring the study, an expectedly high proportion of tetracycline-resistant pneumococcal strains (66.7% and 60%, respectively) was isolated, which was a consequence of a long-term and practically uncontrolled use of these drugs in Kazakhstan. Fluoroquinolones showed low activity. The results showed that beta-lactam antibacterial drugs maintained their high activity against the causative agents of pneumococcal infection.
ConclusionIt was concluded that secondary microorganisms isolated in patients with multidrug-resistant TB were represented by the strains that were resistant to modern antibacterial drugs. Therefore, for appropriate antibiotic prescription, it is necessary to study materials from the respiratory system in all patients admitted for TB treatment to study the spectrum of nonspecific microorganisms and assess their susceptibility to antimicrobial drugs.
Keywords: Health care, Treatment efficacy, Non-specific microorganisms, Antibacterial drugs -
Pages 811-817Background
Diabetic foot syndrome (DFS) causes damage to the peripheral arteries in 50% of patients with diabetes mellitus (DM). The purpose of this study was to evaluate the efficacy of endovascular interventions, stenting, and balloon angioplasty for the treatment of patients with purulent and necrotic lesions in DFS.
MethodsThis was a retrospective study. During 2019-2020, stenting and balloon angioplasty were performed in 51 patients (study group) with purulent and necrotic complications of diabetic foot with limb ischemia. There were 32 women (62.7%) and 19 men (37.3%). The age of the patients varied from 45 to 81 years. Endovascular interventions were performed in combination with conservative therapy and topical treatment on 2 to 3 days after the debridement of the purulent lesions. To assess the outcomes of endovascular interventions, we studied the nature of changes in arterial circulation in the lower extremities. The mean blood flow velocity was calculated using the Doppler ultrasonography. The study was performed on the popliteal artery (PA), the posterior tibial artery (PTA), and on the dorsalis pedis artery. In this study, patients were divided into 2 groups: the study group— those who received endovascular intervention— and the control group— those who received only conservative therapy, which included local treatment without surgery.
ResultsThe weightbearing function of the foot at discharge from the hospital was preserved in 94.2% (48 patients) of the study group and in 73.4% (22 patients) of the control group. During the next 6 months, repeated small foot surgeries were required in 7.3% (3 patients) of patients from the study group and in 20% (4 patients) of patients from the control group. Six months after discharge, the weightbearing function of the foot was preserved in all the patients from the study group available for follow-up and in 85% of the patients from the control group.
ConclusionThe results of the study demonstrate the positive corrective effects of endovascular interventions, stenting, and balloon angioplasty on the clinical course of ischemic and neuroischemic forms of DFS.
Keywords: Diabetes Mellitus, Revascularizing Surgery, Weightbearing Function of The Foot, Purulent Complications, Wound Healing -
Pages 818-821Background
Due to the COVID-19 outbreak, protective measures including alcohol-based hand rub, received unexampled popularity in Iran. Alcohol hand rub is effective, inexpensive and simple to use, but it is a flammable liquid, which might cause burn injuries. In this study, we investigated burn injuries due to alcohol hand sanitizers during the COVID-19 disease outbreak in Iran.
MethodsThis cross-sectional study was performed on burn patients referred to Motahari Burns and Reconstruction Center from February 20th, 2020 (official announcement of the epidemic of COVID-19 in Iran) up to April 19th, 2020. All outpatients and hospitalized burn injuries caused by alcohol during the abovementioned period were included.
ResultsThere were 76 burn injuries due to the use of alcohol hand sanitizer. Sixty patients were treated outpatient, and 16 were hospitalized. The mean ± SD age of patients was 33.2±17.9 years and most were males (57 individuals, 75%). Also, the mean ± SD of TBSA was 6.1±6.5%. In hospitalized ones, the mean ± SD hospital stay was 11.7±8.6 days. The most burnt area was the head (39.5%) followed by the right upper limb (35.5%) and the left upper limb (23.7%). Patients were actively engaged in burn injury in 61.8% of cases, while they were passively burnt in 34.2% of cases and in 3.9% the mechanism was unknown. Burn injuries mostly happened in the yard (22.4%) followed by the rooftop (21.1%) and outdoors (18.4%).
ConclusionAppropriate general education, especially through mass media, can reduce burns caused by alcohol-based sanitation during the COVID-19 outbreak. Most of these burn injuries involved face and hands, which are cosmetically and functionally important.
Keywords: Alcohol-Based Hand Sanitizer, COVID-19 Outbreak, Burns -
Pages 822-828Background
Pertussis is a respiratory tract infection caused by Bordetella pertussis, which causes inflammation of the lungs and respiratory tract. The purpose of this study was to investigate the incidence and geographical distribution of pertussis using the geographic information system (GIS) and to predict its incidence in Iran in 2021.
MethodsThis was a descriptive analytical study. Information on pertussis was obtained from the Center for Communicable Diseases Control during 2009-2015. In the next step, the ArcGIS 9.3 was used to prepare geographic maps of the disease incidence and frequency. Therefore, the disease prediction map was drawn.
using the Raster Calculator tool.ResultsThe results showed that the highest incidence of pertussis during 2009-2015 was in Zanjan, Qom, Mazandaran, and Qazvin provinces. The incidence of pertussis in Iran increased from 0.74 in 2009 to 1.53 in 2015. Based on the modeling results for Iran, Qom, Mazandaran, Tehran, Qazvin, and Zanjan provinces, with 76.76%, 73.69%, 66.32%, 30.94% and 24.18% of their areas (Km2), are at high risk for pertussis in the coming years, respectively.
ConclusionThe incidence of the disease has been increasing in recent years, indicating the emergence of the disease in Iran. The modeling maps show that the Iranian provinces of Qom, Tehran, Zanjan, and Qazvin are at risk of the disease incidence in the coming years, indicating the need for planning, appropriate interventions and more precise implementation of the vaccination program against the disease.
Keywords: Incidence, Prediction, Pertussis, GIS, Iran -
Pages 829-835Background
Leptospirosis is known as a public health problem in developing and developed countries. The aim of this study was to investigate the incidence and geographical distribution of leptospirosis using the Geographic Information System (GIS) and to predict its incidence in Iran in 2021.
MethodsThis was a descriptive analytical study. Information on leptospirosis was obtained from the Center for Communicable Diseases Control during 2009-2015. In the next step, The ArcGIS 9.3 was used to prepare geographic maps of the disease incidence and frequency. Therefore, using the Raster Calculator tool, the disease prediction map was drawn.
ResultsThe results showed that the highest incidence of leptospirosis during 2009-2015 was observed in Gilan, Mazandaran, and Golestan provinces, respectively. The incidence of the disease had an increasing trend from 2013 to 2015. Based on the results of the modeling in Iran, the provinces of Gilan, Mazandaran, and Golestan, with 72.18%, 8.54%, and 4.95% of their area, respectively, have the largest areas at a high-risk for leptospirosis in the coming years.
ConclusionThe prevalence of leptospirosis is affected by geographical and climatic conditions of every region; thus, the incidence of the disease is higher in the provinces located at the Caspian coastal side and in some regions in Semnan province. Hence, if health authorities pay more attention to developing health plans to prevent the disease, the risk of disease in these areas will be reduced in the future.
Keywords: Incidence, Leptospirosis, GIS, Iran -
Pages 836-841Background
Meningitis is classified as a medical emergency where the identification and early treatment of bacterial meningitis can eliminate serious consequences, such as hearing loss, memory problems, learning disabilities, brain damage, seizures, and death. The purpose of this study was to investigate the incidence and geographical distribution of meningitis using Geographic Information system (GIS) and to predict its incidence in Iran in 2021.
MethodsThis was a descriptive analytical study. Information on pertussis was obtained from the Center for Communicable Diseases Control during 2010-2015. In the next step, ArcGIS 9.3 was used to prepare geographic maps of the disease incidence and frequency. Then, the disease prediction map was drawn using the Raster Calculator tool.
ResultsThe results showed that the highest incidence of meningitis during 2010-2015 was in Qazvin, Qom, and Kurdistan provinces. The incidence of meningitis in Iran increased from 9.77 in 2010 to 10.33 in 2015. Based on the modeling results for Iran, Qom, Qazvin, Kurdistan, Hamadan, and Mazandaran provinces with 78.89%, 74.68%, 70.07%, 43.97%, and 22.93% of their areas (Km2) are at high risk for meningitis in the coming years, respectively.
ConclusionAccording to the results of this study, it can be concluded that Qom, Qazvin, Kurdistan, Hamedan, and Mazandaran provinces are at risk of the disease. Monitoring vaccination in high-risk groups can partially prevent the incidence of the disease in these areas.
Keywords: Incidence Rate, Meningitis, GIS, Iran -
Pages 842-847Background
Bullous pemphigoid (BP) is a widely recognized autoimmune blistering disease (AIBD) linked with a high incidence of morbidity and mortality. The aim of this study was to evaluate the available findings of randomized clinical trial studies to update interventions for Bullous pemphigoid.
MethodsThis article provides an updated overview of interventions for BP. A literature search was performed using Cochrane Central Register of Clinical Trials, MEDLINE, Scopus, and Web of Science from August 2010 to December 2020. All randomized clinical trials (RCTs) were done on adults and investigated the effectiveness of administered topical or systemic medications versus placebos or controls included in the current systematic review. Three RCTs comprising 363 patients were included in the systematic review. One of the eligible studies was placebo-controlled. All of the included studies used various interventions including, methylprednisolone plus azathioprine versus methylprednisolone plus dapsone, doxycycline versus prednisolone, and intravenous immunoglobulin (IVIG).
ResultsFollowing their potentials in disease control, no difference was observed between dapsone and azathioprine; although, dapsone had a higher corticosteroid-sparing potential. The evaluation of the effect of doxycycline in short-term blister control in comparison to corticosteroids showed that the medication was not inferior to prednisolone, although it had a higher long-term safety.
ConclusionTherapeutic outcome of IVIG for steroid-resistant patients was satisfactory. Moreover, the effectiveness and reliability of various immunosuppressive drugs and tetracyclines are investigated by blinded RCTs for the treatment of BP.
Keywords: Bullous pemphigoid, Intervention, Treatment, Randomized controlled trials -
Pages 848-858Background
The unknowingness of COVID-19 compared to other respiratory diseases and gaining an overview of its diagnostic criteria led to this study, which was designed to summarize the signs and symptoms along with the clinical tests that described these patients.
MethodsPubMedMEDLINE, Web of Science, Core Collection, Scopus, and Google Scholar were systematically searched on September 27, 2020. After screening, we selected 56 articles based on clinical characteristics and laboratory and imaging findings in confirmed COVID-19 patients as eligibility criteria. To evaluate risk of bias, the Newcastle Ottawa scale, for publication bias, Egger’s test, and for heterogeneity, I2 and tau test were used; and finally, random-effects models were used for pooled estimation.
ResultsPooled estimates for frequently clinical symptoms were as follows: fever (78% [95% CI, 74-82]), cough (60% [95% CI, 57-63]), and fatigue (31% [95% CI, 26-36]); and they were as follows for laboratory findings in lymphocyte (1.02 [95% CI, 0.92-1.12]), CRP (19.64 [95% CI, 13.96- 25.32]), and platelet count (175.2 [95% CI, 165.2-185.2]); they were as follows for imaging findings in bilateral pneumonia (64% [95% CI, 56-72]), and ground glass opacity (60% [95% CI, 48-7]). Also, in the subgroup analysis, bilateral pneumonia with 18% and fatigue with 15%, had the highest difference in values between the groups.
ConclusionAccording to Forest plots, the CI and dispersion among studies were smaller in laboratory findings than in symptom and imaging findings, which might indicate a high alignment in the laboratory findings among studies.
Keywords: COVID-19, Clinical Signs, Imaging, Laboratory Findings, Meta-Analysis -
Pages 859-864Background
Under physiological conditions, the activity of the formation of active oxygen is low. The activity of these processes is intensified under stress-induced situations. This study aimed to investigate the role of free-radical oxidation (FRO) in adrenal tissues and immunocompetent organs and cells in mature white rats after 6 hours of immobilization stress.
MethodsThe studies were performed on 40 White male rats of the Wistar line with a bodyweight of 200 to 240 g. Two series of experiments were conducted: I series: determination of indices in intact rats (10 rats); II series: determination of indices after a 6-hour immobilization stress action on them. Animals of II series were divided into 3 groups of 10 rats in each: group 1: those undergoing acute immobilization stress, withdrawal from the experiment in 1 hour; group 2: those undergoing acute immobilization stress, withdrawal from the experiment in 25 hours; and group 3: those undergoing acute immobilization stress, withdrawal from the experiment in 49 hours. The obtained data were processed by statistical methods with the help of the "Biostat" and "Excel" software packages.
ResultsIn groups 1, 2, and 3, the animals were simulated acute immobilization stress by fixing the animals for 6 hours in bright light. The results of the conducted studies indicate changes in lipid peroxidation and antioxidant system (LPO-AOS) in case of immobilization stress-excitation. In developing free-radical pathology at immobilization stress-excitation, the more expressed disturbance of LPO-AOS, and accordingly the intensity of lipoperoxidation in the structural membrane of all investigated organs was high at the initial stage of exposure.
ConclusionAt 49 hours after immobilization, stress less pronounced influence on the lipoperoxidation process was noted. The increase in the intensity of excessive lipoperoxidation testifies to the inhibited manifestation of AOS in the organism.
Keywords: Immobilization Stress, Antioxidation, Free Radicals, Lipid Peroxidation -
Pages 865-869Background
The COVID-19 infection is a novel virus that mainly targets the respiratory system via specific receptors without any coronavirus-targeted therapies. Many efforts have been made to prepare specific vaccines for COVID-19 or use of prefabricated vaccines of other similar viruses, especially severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), and influenza (flu). We aimed to evaluate the effects of previous flu vaccine injection on severity of incoming COVID-19 infection.
MethodsWe conducted a large cross-sectional study of 529 hospitalized Iranian COVID patients to evaluate the severity of disease courses in patients with or without previous flu vaccination history using some main factors like length of hospitalization, need for the intensive care unit (ICU) admission and length of stay in the ICU for comparison between COVID-19 infected patients with or without flu vaccination history. For the quantitative data, we used independent-samples t and Mann-Whitney tests. The qualitative data were calculated using the Fisher exact and chi-square tests in IBM SPSS Statistics version 22 (SPSS Inc) and P value <0.05 was considered statistically significant.
ResultsThere were no significant differences in the demographic data of patients, disease, and severity-related parameters between the 2 groups. It means that there were not any significant differences between patients with and without history of flu vaccination regarding mean days of hospitalization, percentage of needing to be admitted to the ICU, days being admitted to the ICU (8.44±6.36 vs 7.94±8.57; 17% vs 11.5%; and 1.17±3.09 vs 0.92±3.04, retrospectively) (p=0.883, 0.235, and 0.809, respectively).
In the laboratory tests, in comparison between patients with and without history of previous flu vaccination, only lymphocytes count in the vaccine positive group was higher than the vaccine negative group (20.82±11.23 vs 18.04±9.71) (p=0.067) and creatine phosphokinase (CPK) levels were higher in the vaccine negative group (146.57±109.72 vs 214.15±332.06) (p=0.006).ConclusionWe did not find any association between flu vaccination and decrease in disease severity in our patients. It seems that patients with previous history of flu vaccination may experience less laboratory abnormalities in some parameters that could be interpreted in favor of lower overall inflammation; however, this study cannot answer this definitely because of its design. As we collected retrospective data from only alive discharged patients and had no healthy control group, we could not discuss the probable effect of the vaccine on the mortality rate or its probable protective role against the infection. We need more well-designed controlled studies with different populations in different geographic areas to address the controversies.
Keywords: Corona, COVID-19, SARS-CoV-2, Influenza Vaccine, Flu, Vaccine, Vaccination, Severity, Outcome -
Pages 870-874Background
The COVID-19 infection is a novel virus without any specific targeted therapies; thus, focusing on primary epidemiologic concerns, preventive strategies, risk factors, exacerbation factors, and mortality-related factors are of great importance to better control this disorder. There are some controversies about the factors associated with COVID-19 in different theories, and addiction is no exception.
MethodsWe conducted a large cross-sectional study of 513 hospitalized Iranian patients with COVID-19 infection to evaluate the severity of disease courses in patients with or without history of opium addiction. We recorded these data retrospectively after patients’ discharge from the hospital. For the quantitative data, we used independent-samples t and Mann-Whitney tests. The qualitative data were calculated using Fisher exact and chi-square tests in IBM SPSS Statistics Version 22. Also, p<0.05 was considered statistically significant.
ResultsThere was no significant difference regarding mean days of hospitalization in opium positive and negative groups (7.95±8.39 vs 8.35±5.11, respectively) (p=0.771); however, the need for intensive care unit (ICU) admission was significantly higher in the opium positive group (36% vs 11%) (p=0.005). The mean days of ICU stay was significantly higher in the opium positive group (2.36±3.81 vs 0.86±2.90) (p=0.026). The percentage of febrile patients, anosmia/hyposmia, and dysgeusia at the initiation of hospitalization was significantly lower in the opium positive group (39% vs 66%; 8% vs 23%; 8% vs; 20%, respectively) (p=0.002, 0.018, and .031, respectively). In the laboratory tests, only the white blood cell (WBC) count and the segmented cells were higher in the opium positive group (10.1±6.60 vs 7.38±4.14 and 73±20.47 vs 56.5±32.60, respectively) (p=0.018 and .001, respectively) and lymphocytes were lower in the opium positive (15.60±8.25 vs18.70±10.12) (p=0.048). Opium addicts had a significantly lower rate of azithromycin and lopinavir/ritonavir prescription in their initiation therapy (19% vs 34%, and 47% vs 70%, respectively) (p=0.038 and 0.012, respectively).
ConclusionOpium addict patients with COVID infection may be more febrile and experience more disease-specific symptoms and more severe disease course. These patients may show more evidence of laboratory inflammation and probable superinfections, so may manage with more caution and somehow different therapeutic regimen.
Keywords: Corona, COVID-19, SARS-CoV-2, Opium, Substance, Addiction, Drug Abuse, Severity, Outcome -
Pages 875-879Background
COVID-19 spread rapidly throughout the world and affected many people. The purpose of this study was to investigate the epidemiological characteristics of patients with COVID-19 in southwest of Iran from February 19 to June 20, 2020.
MethodsIn this retrospective study, the epidemiological characteristics of 7313 patients with COVID-19 in southwest of Iran were analyzed and reported from February 19, 2020, to the end of Jun ,2020. Data were extracted from electronic records in hospitals. Sex ratio and mortality rate of the disease were calculated. A multiple logistic regression analysis was used to evaluate the factors affecting mortality.
ResultsFrom all patients studied, 3920 (53.5%) were men and 2066 (28.24%) were in the age 30 to 40 years age group. The case fatality rate of the disease based on the total number of patients (hospitalized and nonhospitalized) was 4.84%. The highest mortality rate was seen in patients with various cancers and in those aged over 80 years. The most common symptoms in patients were fever and cough, diabetes, hypertension, and cardiovascular diseases. Logistic regression results also showed that the chances of death in the 70-60 and 80-70 years age group were 5.94 (OR, 5.94; 95% CI, 2.14-16.43) and 8.63 (OR, 8.63, 95% CI, 3.09-24.14) compared to 10-20 years age group.
ConclusionThese results indicate the need to increase primary care, provide the necessary equipment to treat patients, and more importantly, early identification of patients and treatment for them.
Keywords: COVID-19, Coronavirus, Eepidemiology, Iran -
Pages 880-883
Hierarchical leadership is an antiquated practice seen commonly in health care, whereby strictly defined roles and their importance are overemphasized. This can have unintended negative consequences in a pressurised environment. In contrast, flat hierarchies are gaining popularity, as they afford the flexibility and equality that is vital in a caring environment, where no one should be afraid to raise concerns and voice their opinions.
Are hierarchical power structures inhibiting hospitals from achieving effective medical leadership and quality care? With increasing pressures on the health care system, is it time to move away from a hierarchical power structure that has been present for over 70 years? To inspire culture change, is it time to explore alternatives, such as a flat hierarchy?Keywords: Hierarchial Leadership, Leadership In Healthcare, Patient Safety, Reverse Ward Rounds -
Pages 884-888Background
Non-fatal birth defects and developmental disabilities are the most important causes of congenital disabilities in young children. This study was performed to determine the prevalence of congenital disabilities among children aged 0-2 years resident in urban slums of Pune.
MethodsIn 2016, using a random sampling method, 840 children from 28 registered slums located in each of the 14 wards of Pune city, India, were included in the study. Data on congenital disabilities and the clinical diagnosis responsible for the disability were collected. Data were also collected on selected risk factors for these conditions and current treatment through a structured questionnaire. Descriptive analysis was used to describe relationships among variables. Pearson’s chi-square test was used to determine associations, and the level of significance was established at P<0.05. Associations between outcomes of interest and risk factors were expressed as Odds Ratios (OR) at 95% Confidence Interval (CI).
ResultsIn this age group, the prevalence of congenital disability was 1.67% (95% CI 0.91-2.78) (14/840). The prevalence of clinically diagnosed birth defects was 1.19% (95% CI 0.57-2.18) (10/840). The prevalence of developmental disabilities was 0.48% (95% CI 0.13-1.21) (4/840). Children with birth defects were more likely to be premature (P=0.045, OR=4.34, 95% CI=1.03-18.28) and low birth weight (P=0.003, OR=10.41, 95% CI=2.21-48.38). Only seven out of 14 children with birth defects and developmental disabilities were taken for treatment after the initial diagnosis.
ConclusionBirth defects and developmental disabilities are prevalent conditions. Community awareness, provision of appropriate medical and habilitation care, as well as screening and early intervention for these conditions are essential to prevent morbidities and ameliorate disabilities.
Keywords: Congenital, Disability, Birth Defects, Developmental Disabilities, Prevalence, Child Health, Congenital Abnormalities -
Pages 889-898Background
Studies of treatment methods for patients with acute ischaemic stroke should include aetiological causes, concomitant pathology, and localisation of the lesion, and the extent of the lesion in the brain. The purpose of the study was to determine changes in clinical and neurological parameters in patients with ischaemic stroke in the acute period.
MethodsThis is an open clinical study for which 240 patients were selected with an acute condition after an ischaemic stroke. All patients were divided into 4 groups (depending on the treatment). Clinical neurological examination and testing was performed upon admission to the hospital and upon discharge– after treatment. Electroencephalographic biofeedback (EEG-BFB) therapy was performed using a EEG-BSE device (Bio-Link). Data was processed according to the statistical method of experimental data assessment.
ResultsTo study the effectiveness of treatment upon acute ischaemic stroke, a comprehensive treatment system was developed, involving acupuncture, Qigong breathing exercises, and electroencephalographic biological feedback (EEG-BIOFEEDBACK), based mainly on the mechanisms of action. The study investigated the features of the acupuncture treatment in patients with ischaemic stroke during recovery. The authors noted the degree of effectiveness of EEG-BFB therapy, Qigong therapy, acupuncture, and standard treatment. Studies revealed that the development of ischaemic stroke begins gradually and at an early age.
ConclusionIt was concluded that the most effective method for treating the clinical and neurological manifestations of acute ischaemic stroke is EEG-BFB therapy, followed by acupuncture, Qigong therapy, and standard treatment.
Keywords: Treatment, Rehabilitation Programme, Subarachnoid Haemorrhages, Illness, Neurorehabilitation -
Pages 899-905Background
Procrastination is a common and widespread phenomenon that affects 15-20% of the general population and 50% of students. Since developing and providing beneficial and effective interventions for procrastination needs a strong, comprehensive theoretical background explanation, the aim of the study was to assess the underlying transdiagnostic factors of procrastination and presenting a causal model.
MethodsIn this cross-sectional study, 390 college students were asked to fill out a packet of self-report measures, which included the Pure procrastination scale, Difficulties in emotion regulation scale, Depression-anxiety-stress scales, Frost multidimensional perfectionism scale, Rumination response scale, Penn state worry questionnaire, Acceptance and action questionnaire. The causal model was tested using structural equation modeling (SEM).
ResultsResults of the SEM indicate that perfectionism was significantly associated with increasing emotion dysregulation (β=0.446, P<0.001) and emotion dysregulation was significantly associated with increasing anxiety (β=0.499, P<0.001) and depression (β=0.478, P<0.001), and then anxiety and depression with other variables, such as worry (β=0.245, P<0.001; β=0.004, P=0.935), rumination (β=0.046, P=0.424; β=0.418, P<0.001) and experiential avoidance (β=0.277, P<0.001; β=0.319, P<0.001) related to procrastination. Finally, worry has the most significant increasing effect on procrastination. The very small root mean square error of approximation (RMSEA=0.038), together with large values of comparative fit index (CFI=0.985), relative fit index (RFI=0.917), and normed fit index (NFI=0.979) indicated that the model was well fit.
ConclusionPerfectionism, emotion dysregulation, negative affects, worry, rumination, and experiential avoidance, known as transdiagnostic factors, had a causal relationship with procrastination, and reducing each transdiagnostic factor will improve procrastination. This study could be considered as a cornerstone for further studies on procrastination from a transdiagnostic approach.
Keywords: Procrastination, Emotion Dysregulation, Transdiagnostic Factors, Structural Equation Modeling -
Pages 906-912Background
Congenital hypothyroidism is a disease able to cause severe mental retardation and developmental delays. However, timely diagnosis and treatment of infants with this disease could prevent relevant complications. This study aims to investigate the effects of the implementation of the Six Sigma model on reducing the treatment initiation time in infants with congenital hypothyroidism in the population chosen from Samen Health Center in Mashhad.
MethodsIn this quasi-experimental study, the referral process of infants for congenital hypothyroidism screening and treatment was evaluated for the time period starting from March 20, 2017, to March 19, 2018, using the standard five-phase quality strategy, description, measurement, analysis, improvement and control phase (DMAIC), based on Six Sigma. Data were collected using the sampling form of the national screening program for congenital hypothyroidism. To analyze the data, software including Expert Choice V11, Microsoft Excel 2013, and SPSS 18, were utilized. In addition, a p-value less than 0.05 was considered statistically significant.
ResultsThe number of infants who entered the intervention process was 4,574, of whom 51.3% (2346 infants) were boys. The mean time to start treatment before the implementation of the model was 21.72±7.72 days, which decreased to 17.41±6.47 days after the implementation of the model (p≤ 0.05). Besides, 81.8% of the patients received treatment during infancy before the intervention, which increased to 94.1% after it. After the implementation of the Six Sigma model, the Sigma level of treatment initiation improved from 2.41 to 3.06.
ConclusionSix Sigma could be used as an intervention tool for improving indices of health intervention processes.
Keywords: Congenital Hypothyroidism, Mental Retardation, Six Sigma, DMAIC, Sigma Level, Analytical Hierarchy Process -
Pages 913-918Background
This study aimed to determine the level of communication skills in residents of Shahid Beheshti University of Medical Sciences in the final year of the main courses in accordance with the Calgary Cambridge Observation Guide for the purpose of improving their skills and improving the quality and correcting the existing problems.
MethodsIn this cross-sectional study, 190 residents of 14 majors were evaluated using a checklist of patient and physician communication skills based on the Calgary Cambridge Guide that has been localized in Persian language and culture using the cross-cultural adaptation standard in 6 stages. Content validity was verified by the primary author. The skills within the 71-item checklist were examined via a 3-point Likert-type rating scale, with scores ranging from 1 to 3 (good to poor) and the data were analyzed using the SPSS 16 software.
ResultsOf the190 residents, 161 were enrolled in the study. Of them 74 were internal and 87 surgical residents, and 89 were male and 72 were female. The mean score of the total communication skills in 14 major courses was 128.68±37.2264; it was 121.7±36.990 in the Department of Surgery, and 136.8±36.073 in the Department of Internal Medicine, with p=0.010, in female students 126.6 and in male student 130.3 with p=0.500.
ConclusionThe score of 71 communication skills points in the list was prepared using the Likert scale option 3. In the overall skills, the weak score is 71 to 118.33, the average score is 118.34 to 165.66, and the good score is 165.67 to 213. Based on the findings of the study and examining the educational curriculum, it can be stated that unlike in psychiatry with an average score of 168.83, which is at a good level, the other fields are not well-developed and overall the communication skills in the residents, with a mean score of 128.68, are moderately poor and therefore further education and training is needed in these fields for resident students.
Keywords: Calgary Cambridge Guide, Physician-Patient Relations, Communication Skills -
Pages 919-926Background
The need for informed policymaking highlights the importance of data on human immunodeficiency virus (HIV) prevalence on key populations. In this systematic review and meta-analysis, we aimed to provide an overview of HIV prevalence in men who have sex with men (MSM) in Iran.
MethodsWe searched literature published between January 2008 and December 2019 to identify studies reporting the prevalence of HIV infection or acquired immunodeficiency syndrome (AIDS) in a population of adult Iranian men with history of sexual contact with other men. We employed Metaprop command in Stata to pool proportions from different studies.
ResultsAmong the 16 studies retrieved, 2 were performed on MSM population directly, 7 among people who inject drugs, 4 among prisoners, 2 among the homeless, and 1 among methamphetamine users. HIV prevalence was 7% (95% CI, 5%-10%) based on the meta-analysis, although noticeable heterogeneity existed because of target population, study year, and study location, which imposed limitations to provide a robust summary measure for the prevalence of HIV.
ConclusionThere is a potential risk of observing a high prevalence of HIV in MSM that could hamper the results of various preventive strategies and their achievements in other subpopulations.
Keywords: Human Immunodeficiency Virus, Acquired Immunodeficiency Syndrome, Sexual, Gender Minorities, Key Population -
Pages 927-935Background
To identify and synthesize available published studies on the effect of local muscle vibration (LMV) on pain, stiffness, and function in individuals with knee OA.
MethodsFive databases were searched to find relevant papers on April 29, 2020, including, PubMed, Scopus, EMBASE (Ovid), Science Citation Index, and COCHRANE Central Register for Controlled Trials (CENTRAL). Randomized controlled trials (RCTs) and nonrandomized-controlled-trials (non-RCTs), such as interrupted time series and prospective cohort studies were included. Two independent reviewers screened articles and assessed inclusion through predefined criteria. Participants’ characteristics, study design, intervention characteristics, outcomes, and main results were collected independently by 2 reviewers. The risk of bias assessment of included studies was conducted using Cochrane risk of bias tools for RCTs and non-RCTs.
ResultsSix studies were included: 3 RCTs and 3 non-RCTs. The risk of bias in included studies was generally moderate to high. Improvement of pain, stiffness, and function following the application of LMV were reported in all studies.
ConclusionThis review revealed the promising effect of LMV on pain, stiffness, function, and knee range of motion (ROM) improvements for individuals with knee Osteoarthritis (OA) . However, further well-designed studies are required to have a convincing conclusion on the effect of LMV in individuals with knee OA.
Keywords: Knee Osteoarthritis, Local Muscle Vibration, Pain -
Pages 936-939Background
The survival of arteriovenous fistula (AVF) remains an important problem for hemodialysis patients, accounting for 20% of all hospitalizations related to AV access problems in western countries. We designed an observational prospective cohort study on 265 AVFs and evaluated their results after 4 months of fistula creation and its relation to laboratory tests as ESR and CRP levels.
MethodsWrist or antecubital AVFs were created for patients with End-Stage renal disease. All laboratory tests (ESR and CRP) were checked quantitatively. The patients were followed-upfor at least 4 months and failure or maturation of AVFs were recorded in a checklist.
Results177 (66.8%) males and 88 (33.2%) females were included. The surgeon created 161(60.8%) wrist and 98 (37%) antecubital AVFs. The mean age of patients was 53.18±17.1, ranged from 8 to 91 years old. CRP and total protein had significant differences between the two groups of failure and mature accesses (0.029 and 0.045 respectively).
ConclusionHigh CRP level is recognized as a reliable predictor for the survival of AVF.
Keywords: ESR, CRP, Arteriovenous fistula (AVF), Failure -
Pages 940-946Background
Previous studies have shown that children with cochlear implants have difficulty in grammar acquisition. Vocabulary acquisition and grammar abilities are important during language development. The purpose of this study was to investigate the effect of grammar therapy on the lexical ability of cochlear implanted children.
MethodsFive children with cochlear implants and grammatical problems were treated using a grammar task designed for the current study. Before and after the treatment, repeated evaluations were performed using the Mean Length of Utterance (MLU) and Persian Developmental Sentence Scoring (PDSS) indices for grammar and NDW and NTW indices for vocabulary abilities; these show the number of different words and the number of total words respectively.
ResultsGrammar intervention was successful in cochlear implanted children of the present study. In addition, treatment of grammatical problems increased the lexical ability of all children; NDW and NTW scores increased, which was confirmed by the effect size indices. In the follow-up phase, the cochlear implanted children were able to maintain the increase in NTW and NDW values.
ConclusionImproving grammar skills in cochlear implanted children also increased their lexical ability. Therefore, grammar therapy helps to increase the vocabulary of children too.
Keywords: Grammar, Lexical Ability, Children, Cochlear Implant, Language Therapy -
Pages 947-953Background
Promotion of nurses’ professional commitment is one of the strategies for retaining nurses and preventing their turnover. The aim of this study was the development and psychometric testing of the Nurses’ Professional Commitment Inventory.
MethodsThis mixed method study was performed in an item generation and a psychometric testing phase. In the first phase, a 34-item inventory was developed based on the results of a grounded theory and the existing literature. Search date was 2010 to May 2018. In the second phase, we recruited 272 clinical nurses and tested the psychometric properties of the inventory. Construct validity was tested via the exploratory factor analysis. Reliability testing was performed through test-retest stability and internal consistency testing. SPSS version 21.0 (SPPS Corp) was used for statistical analysis. Significance level was set at p<0.05.
ResultsIn the first phase, a 74-item pull was extracted. After reviewing, the primary version of the Nurses’ Professional Commitment Inventory (NPCI) with 34 items was developed. Eight items were deleted during psychometric testing. In factor analysis, the remaining 26 items were loaded on 3 factors, namely professional attachment, professional performance, and internalization of the profession. These factors explained 53.92% of the total variance of professional commitment. The Cronbach’s alpha and mean test-retest intraclass correlation coefficient for NPCI were 0.92 and 0.88, respectively.
ConclusionThe Nurses’ Professional Commitment Inventory has acceptable validity and reliability. This inventory includes dimensions that indicate the formation of professional commitment. The items of the scale can reveal nurses’ strengths and weaknesses related to professional commitment.
Keywords: Instrument development, Nurse, Professional commitment, Psychometric testing -
Pages 954-961Background
Analyzing and monitoring the spatial-temporal patterns of the new coronavirus disease (COVID-19) pandemic can assist local authorities and researchers in detecting disease outbreaks in the early stages. Because of different socioeconomic profiles in Tehranchr('39')s areas, we will provide a clear picture of the pandemic distribution in Tehranchr('39')s neighbourhoods during the first months of its spread from February to July 2020, employing a spatial-temporal analysis applying the geographical information system (GIS). Disease rates were estimated by location during the 5 months, and hot spots and cold spots were highlighted.
MethodsThis study was performed using the COVID-19 incident cases and deaths recorded in the Medical Care Monitoring Centre from February 20, to July 20, 2020. The local Getis-Ord Gi* method was applied to identify the hotspots where the infectious disease distribution had significantly clustered spatially. A statistical analysis for incidence and mortality rates and hot spots was conducted using ArcGIS 10.7 software.
ResultsThe addresses of 43,000 Tehrani patients (15,514 confirmed COVID-19 cases and 27,486 diagnosed as probable cases) were changed in its Geo-codes in the GIS. The highest incidence rate from February to July 2020 was 48 per 10,000 and the highest 5-month incidence rate belonged to central and eastern neighbourhoods. According to the Cumulative Population density of patients, the higher number is estimated by more than 2500 people in the area; however, the lower number is highlighted by about 500 people in the neighborhood. Also, the results from the local Getis-Ord Gi* method indicate that COVID-19 has formed a hotspot in the eastern, southeast, and central districts in Tehran since February. We also observed a death rate hot spot in eastern areas.
ConclusionBecause of the spread of COVID-19 disease throughout Tehranchr('39')s neighborhoods with different socioeconomic status, it seems essential to pay attention to health behaviors to prevent the next waves of the disease. The findings suggest that disease distribution has formed a hot spot in Tehranchr('39')s eastern and central regions.
Keywords: Spatial-temporal analysis, COVID-19 outbreak, Hotspot cases, GIS, Tehran, Iran -
Pages 962-968Background
A wide variety of cytokines are released from human amniotic membrane cells (hAMCs), which can increase the rate of differentiation of mesenchymal stem cells into the neurons. We studied the effect of Retinoic Acid (RA) on the differentiation rate of human Umbilical Cord Mesenchymal Stem Cells (hUMSCs) which were co-cultured with hAMCs.
MethodsIn this experimental study, both hUMSCs and hAMCs were isolated from postpartum human umbilical cords and placenta respectively. The expression of mesenchymal (CD73, CD90 and CD105), hematopoietic and endothelial (CD34 and CD45) markers in hUMSCs were confirmed by flow cytometry. The hUMSCs were cultured in four distinct groups: group 1) Control, group 2) Co-culture with hAMCs, group 3) RA treatment and group 4) Co-culture with hAMCs treated by RA. Twelve days after culturing, the expression of NSE, MAP2 and ChAT differentiation genes and their related proteins were examined by real-time PCR and immunocytochemistry respectively.
ResultsThe flow-cytometry analysis indicated increased expression of mesenchymal markers and a low expression of both hematopoietic and endothelial markers (CD73:98.24%, CD90: 97.32%, CD105: 90.75%, CD34: 2.96%, and CD45:1.74%). Moreover, the expression of both NSE and MAP2 markers was increased significantly in all studied groups in comparison to the control group On the other hand, the expression of ChAT had a significant increase in the group 2 and 4 (RA and RA+ co-culture).
ConclusionRA can be used as an effective inducer to differentiate hUMSCs into cholinergic-like cells, and hAMCs could increase the number of differentiated cells as an effective factor.
Keywords: Amniotic Membrane, Cell Differentiation, Mesenchymal Stem Cell, Neurons, Retinoic acid -
Pages 969-975Background
The COVID-19 epidemic is a newly emerging infectious disease. This study was conducted to design an appropriate psychometric questionnaire of cultural and social characteristics to evaluate beliefs and preventive behaviors toward COVID-19 among the Iranianchr('39')s population according to change behavior theory as health belief model (HBM).
MethodsThe study population included all those who had access to social networks and answered the questionnaire voluntarily. The sample size in this study was 350 people. In this cross-sectional study, a questionnaire was designed using scientific sources and based on the health belief model, and its face and content validity was determined by Content Validity Ratio (CVR), and reliability was determined by the internal consistency; Test-retest was applied to examine the internal consistency of the questionnaire. Data were analyzed using SPSS software version 19. Cronbach’s alpha and Intra-class Correlation Coefficient (ICC) were used for the assessment of the reliability of data.
ResultsInitially, the questionnaire was designed based on the literature reviews and expert’s opinion in the field of health education with 79 items. After that, 2 of them were deleted and corrected qualitatively by performing the face and content validity of some items. Therefore, finally, a questionnaire with 77 questions was approved. Based on the constructs of the health belief model, the domains of the questionnaire included perceived sensitivity , severity , benefits barrier , self-efficacy, knowledge and behavior .The content validity of the questionnaire was confirmed. The Cronbach’s alpha and ICC for each domain were greater than 0.7.
ConclusionThe Questionnaire of beliefs and preventive behaviors toward COVID-19 based on HBM is a valid and reliable instrument in the Iranian population that could be used in related research.
Keywords: COVID-19, Preventive behaviors, Health belief model, Validity -
Pages 976-986Background
COVID-19 has become a global pandemic and has inevitably affected the whole world. This effect is greater on people with ASD (ASD) and their families. Depression, attempts to cope with change, and having difficulty interacting with others are some of the challenges people with ASD often face. The aim of this study was to review the psycho-social consequences of COVID-19 in people with ASD and their families.
MethodsThis study is a Literature Review. Extensive electronic search results for the keywords ASD, COVID-19, Coronavirus, psychological, psychosocial, and consequence in Google Scholar, PubMed, Scopus, ProQuest, Science Direct, SID and Magiran in 2020, eventually provided a total of 130 articles. After reviewing the titles of the articles, we excluded 85 articles as they were duplicated and/or irrelevant. Finally, based on the inclusion and exclusion criteria, 17 articles remained.
ResultsIn general, the change in routine and uncertainty caused by COVID-19 have caused distress for people with ASD and will worsen their symptoms and mental health. Excessive stress worsens the mental health of caregivers, and as this burden increases, they report higher rates of social harm, depression, and anxiety that affect their daily functioning.
ConclusionThe COVID-19 epidemic affects all strata of society. People with ASD are particularly vulnerable to the psychosocial effects of this epidemic. COVID-19 increases anxiety, distress, depression, financial problems, loss of a job, and even marital conflict. Access to necessary services and transmission problems are also the result of rapid social and environmental changes.
Keywords: Autism Spectrum Disorder, COVID-19, Coronavirus, Psychological, Psychosocial, Consequence -
Pages 987-993Background
Evidence-based policymaking for the genetic preventive interventions at the community level requires information on the effectiveness of interventions in the operational areas taking into account the characteristics of health system and customer behaviour. These information are limited in many low- and middle-income countries. In this study, we estimated the effectiveness of preventive interventions for chromosomal disorders using the conceptual framework of Iran’s community genetics program (ICGP) using a Bayesian Network as a modeling method in limited access situation to the complete and accurate observational data.
MethodsExpert elicitation method based on global and national scientific evidences was applied to determine the structure of the Bayesian Network (BN) and to quantify the probability of nodes. The nomological and face validity of the network was checked. Also, a sensitivity analysis against the sources of uncertainty of probabilities was conducted.
ResultsBy ICGP interventions, 63% (95% CI, 0.55-0.71) of all chromosomal disorders can be prevented, which is responsible for 80% (95% CI, 0.76-0.84) and 38% (95% CI, 0.31-0.45) reduction of expected baseline birth prevalence of trisomis and other autosomal disorders, respectively. Improving the access to and the uptake of screening service can also result in a 12% and 11% increase in effectiveness, respectively.
ConclusionEffectiveness of ICGP’s intervention is between the same interventions’ effectiveness in Western Europe and the Eastern Mediterranean region. Opportunities for increasing the uptake of and the access to the interventions are strengthening the public genetic literacy and implantation of a system of laboratory sample transfer at the side of the utilization of telehealth for delivering the counseling services at remote areas.
Keywords: Bayesian Network, Effectiveness, Preventive Intervention, Congenital Disorder, Chromosomal Disorders, Iran’s Community Genetics Program -
Pages 994-1004Background
Recent changes in understanding of the nature of cancer allow us, in some cases, to consider it a chronic process that requires constant or periodic treatment. The purpose of this study was to assess the efficacy of the methods for diagnosis and treatment of non-small cell lung cancer (NSCLC) in the Republic of Kazakhstan and present scientifically proven methods for the improvement of existing diagnostic algorithms and treatment programs.
MethodsThis work was a retrospective study. A retrospective study using descriptive and analytical statistics was used as the main method. Reported data and medical records of the patients with NSCLC who were treated from 2015 to 2017 in 6 oncology clinics in the Republic of Kazakhstan were used as study materials. The methods used for histological studies and influence of the patientchr('39')s sex on the frequency of various histological forms of NSCLC were studied. Polymerase chain reaction (PCR) studies to determine the epidermal growth factor receptor (EGFR) gene status as well as surgical methods were also studied.
ResultsA comparative analysis of the compliance of oncologists from various regions of the republic with molecular genetic testing as an essential component of the diagnosis of NSCLC showed that the coverage of patients with immunohistochemical (IHC) and PCR studies in this country is low, 50.9% and 21.2%, respectively. The study included data on 423 patients. At the same time, the majority of studies, 64.2% (IHC) and 100% (PCR), were performed in patients in Almaty and only 35.8% of IHC studies were performed in other 5 regions included in this study.
ConclusionThe morphological verification of malignant neoplasms in the lungs was based on histological studies. IHC and PCR coverage of the patients in the country was low. Most of the patients received pharmacotherapy. Surgical interventions were rarely performed. Also, the lack of IHC status data were a risk factor for the patients with NSCLC.
Keywords: Chronic Process, Histological Type, Malignant Process, Gene, Drug Therapy -
Pages 1005-1013Background
Despite this seemingly simple definition of value in different perspectives, the definition of value-based procurement for medical devices is still unclear. This study aimed to delineate the definition of value-based procurement for medical devices and its characteristics.
MethodsAccording to the systematic method for scoping review described by Arksey and O’Malley, we reviewed related literature through target databases (PUBMED, ProQuest, Web of Science, Scopus, and Science Direct) during 2004-2020. The publications that focused on the procurement of medical devices and address the issue of value in procurement were selected. The publications whose full-text was not available and were not in English were excluded. By using data charting tables, selected articles were reviewed and concepts and definitions were extracted
ResultsAccording to the eligibility criteria and reference checking, 24 documents were selected. There are different definition and understanding for value-based procurement (VBP). Identified characteristics of VBP are information, actors Collaboration, patient experience, value analysis team, ability to evaluate alternatives, value proposition, competitive dialogue, and weighing evaluation criteria.
ConclusionVBP is a framework that guides the review and decision-making to procure medical devices. In this framework, all dimensions of the value equation (outcome/related costs) must be considered and weighted. Health systems need to work on identified aspects.
Keywords: Value, Value-Based Health Care, Value-Based Procurement, Medical Devices -
Identification of the Requirements for the Effective Human Resource Development in the Health SystemPages 1014-1019Background
The ultimate goal of development from the perspective of human capital development is to have a long, healthy, and creative life. This study aimed to identify the requirements for the effective human resource development in the health system.
MethodsThis mixed method study was performed on 20 managers of Iran’s health sector in the qualitative part to reach data saturation in qualitative research. The standard questionnaire of the health system consisting of 15 questions was distributed and collected among 302 managers of the health sector (senior and intermediate managers) and faculty professors who were selected by the stratified random sampling method using the Morgan table. Finally, for data analysis in the quantitative part, confirmatory factor analysis and modeling with partial least squares were used.
ResultsThe results showed that 4 of the requirements affecting human resource development were financial requirements with 13 components, service requirements with 14 components, educational requirements with 14 components, and partnership requirements with 7 components.
ConclusionAccording to the results, it is suggested that in order to develop effective human resources in the health system, it is necessary to pay attention to the 4 financial, service, educational, and partnership requirements.
Keywords: Human Resource, Health System, Development -
Pages 1020-1027
Chickenpox is a highly communicable disease caused by Varicella Zoster Virus. Varicella rash commonly evolves into permanent depressed scars, documented in up to 18% of post varicella patients, leaving life-long cosmetic issues for patients. Although there is a lot of reviews on depressed scars, the viral etiology and the unique scar morphology of post varicella scar discriminate it from other depressed scars. Therefore it is required to assess the efficacy of scar removal modalities on these scars, specifically. Yet, despite the prevalence, there is no comprehensive review on chickenpox scars’ treatment, particularly. This review provides an overview and categorization of efficacy and adverse events of various methods used in the treatment of post varicella skin scars. A comprehensive literature search was performed on major databases, including all papers related to post varicella scar treatment until 2020. The results were categorized into topical treatment with tretinoin, systemic medical treatments with topiramate and isotretinoin, non-invasive procedures including chemical peelings, micro-needling and laser, invasive procedures including dermal grafting and subcision-suction method, and combination therapies. According to literature, chemical peeling with trichloroacetic acid was the most frequently used method in the treatment of chickenpox scar, revealing moderate to excellent response in patients. However, there is insufficient evidence to accurately compare the efficacy of other modalities on these scars specifically.
Keywords: Varicella-Zoster, Chickenpox, Scar treatment, Atrophic Scar -
Pages 1028-1031Background
The microRNA‐122 (miR‐122) is a liver‐specific microRNA that can be used as a potential molecular marker for predicting liver injury. There is a positive correlation between miR‐122 level in serum and hepatitis B virus (HBV) replication in patients infected with this virus. The present study was conducted to study the clinical importance and expression of miR-122 in asymptomatic and symptomatic patients with HBV infection in comparison to the healthy group.
MethodsThis study was performed on 60 samples to examine the presence of HBsAg and total HBc antibody (IgM-IgG) using an enzyme-linked immunosorbent assay. HBV-DNA extraction and real time polymerase chain reaction (PCR) assay were performed on all samples via the Real ART HBV LC PCR kit on a LightCycler instrument. RNA was extracted from the serum of all participants. Next, miRNA expression was assessed using quantitative real time reverse-transcription PCR. Also, ALT levels were measured as a surrogate parameter for liver injury using Pars Azmoon Biochemical assay Kit on Hitachi autoanalyzer. The Levene , Kruskal Wallis, Mann-Whitney and Spearman’s correlation tests were used for assessing the differences between the studied groups.
ResultsBased on the obtained results, miR-122 expression in patients with HBV without clinical symptoms was 1.6 times, while in patients with clinical symptoms was 2.7 times more than the control group (p=0.001). A significant increase was observed in the ALT enzyme of symptomatic patients (p=0.001). HBV DNA in the people with clinical symptoms was higher than 105 copies/mL and in the asymptomatic group was less than 103 copies/mL, suggesting a statistically significant increase in a group with clinical symptoms (p=0.001). Finally, it was found that the miR‐122 serum concentration correlated with HBV DNA and serum ALT (p=0.001).
ConclusionBased on the obtained results, measuring the miR-122 levels can serve as a biomarker and an indicator of hepatitis B replication, especially in cases where ALT levels are unchanged; however, more research and more samples are needed.
Keywords: MicroRNA, Hepatitis B, MiR-122, ALT -
Pages 1032-1036Background
Lamotrigine (LTG) is an antiepileptic drug used in the treatment of seizures, mood disorders, and cognitive problems. The cardiac effects of LTG, such as LTG toxicity and SUEDP, have been studied. This is an in vitro study examining the effect of LTG on isolated atria of guinea pigs.
MethodsThe atria of 21 male Guinea pigs were isolated and stabilized in Krebs-solution and physiologic condition. The rhythm of contraction, contractile force, and heart rate were recorded. In 7 atria, LTG at the doses of 2, 4, 8, and 16 mg/mL were added and the contractile forces and heart rates were recorded and compared together. In the next step, in 14 atria, 8 were pretreated with LTG, and 6 without pretreatment were exposed to ouabain, and the times of the onset of effect, arrhythmia, and asystole were recorded. The statistical comparisons were made by using Student’s t test and repeated measure analysis of variance followed by the Bonferroni method.
ResultsLamotrigine (4, 8, and 16 mg/mL) significantly decreased the heart rate and contractile force of the isolated guinea pigs’ atria (P < .001). Pretreatment with LTG significantly increased the mean time of onset of the effect of ouabain, the onset of ouabain-induced arrhythmia, and time of ouabain-induced asystole (P < .001).
ConclusionLTG reduces the heart rate and contractile force, and also inhibit ouabain induced-arrhythmia of the isolated atria of guinea pigs.
Keywords: Lamotrigine, Arrhythmia, Sudden Unexpected Death in Epilepsy, Cardiac Effect, Cardiac Arrest -
Pages 1037-1042
SARS-CoV-2 is a newly identified virus that causes COVID 19, spreading very fast in the world. Uncontrolled diabetes in pregnancy can increase the risk of pregnancy outcomes. Pregnant women are at high risk of developing a viral infection, like SARS-COV and on the other hand, diabetes ketoacidosis (DKA) which is coupled with COVID-19, can increase maternal mortality. The patient was a 27-years-old female G3P1L1Ab1 with a history of a previous cesarean section. On 26 March 2020, a fetal ultrasound revealed intra-uterine fetal death (IUFD) and also diagnosis of DKA and COVID-19 in the patient that she was expired eventually due to the uncontrolled DKA. In this case report, a pregnant woman with a diagnosis of IUFD, DKA, and COVID-19 simultaneously is described. To the best of the authors of this paperchr('39')s knowledge, no previous work has been reported for the comorbidity of diabetes and COVID-19 in pregnancy, but it seems that the coincidence of the above-mentioned diseases can delay the recovery period and also can increases maternal and fetal mortality. When DKA and COVID-19 appear in the patient simultaneously, we cannot control DKA by the routine protocol treatments of DKA which were used formerly.
Keywords: COVID-19, IUFD, Diabetes ketoacidosis, Pregnancy -
Pages 1043-1047Background
Neoadjuvant chemoradiation is one of the main treatment approaches in esophageal cancer treatment, which can improve outcomes of a patient with esophageal cancer. In the current study, we aimed to compare the response rate and side effects of 2 distinctive neoadjuvant chemoradiation protocols.
MethodsThe study was a randomized clinical trial that was performed on 70 patients with esophageal and gastroesophageal junction cancer in Iran. The study participants were randomly assigned to 1 of our treatment groups. The first group received capecitabine (625 mg/m2/TID) and oxaliplatin (50 mg/m2/weekly), while the second group was given a combination of carboplatin (AUC:2/weekly) and paclitaxel (75mg/m2/weekly). Both groups were given weekly 50.4-54 Gy dose of RT. Chi square and Fisher exact tests have been used for data analysis. All statistical tests were performed using SPSS software Version 22.0 and the significance level was set at 0.05.
ResultsComplete pathological response was detected in 18(51.4%) of patients in group I and 8 (22.8%) in group II (p=0.013). We also observed higher thrombocytopenia in CarTax arm 19 (54.2%) in comparison to CapOX arm 8(22.8%), and the difference was statistically significant (p=0.007). No statistical difference was found regarding neutropenia, fatigue, anorexia, esophagitis, and diarrhea.
ConclusionThe CapOxRT regime provides more favorable outcomes and also it is more tolerated by patients.
Keywords: Neoadjuvant, Chemoradiotherapy, Esophagogastric, Cancer -
Pages 1048-1059Background
Investing in the R&D sector of new medical technologies is associated with the risk of being rejected by paying organizations because of the lack of value-for-money. The purpose of this study is to investigate the different methods of evaluating the impacts of emerging medical technologies.
MethodsUsing scoping review method, we analyzed studies that investigated methods for assessing the impacts of emerging medical technologies on development. To find these studies, the Cochran Library, ISI Web of Knowledge, Embase, Ebsco and Pubmed databases from 2000 to 2018 were searched. The methodological quality of the studies was assessed using the STROBE Checklist. Two reviewers independently selected the qualified studies. Charting and collating the data were used based on the method proposed by Arksey and Ochr('39')Malley.
ResultsOverall, 38 studies met the inclusion criteria. Sixteen methods were identified and put in five distinct categories: forecasting, Pro-HTA, Early-HTA, priority setting, and HHS were found to measure the impact of emerging technologies. The quality of these studies was acceptable. Few studies were conducted on emerging pharmaceutical technologies, and they were mostly on emerging medical devices. The Early HTA methods were often used to measure the effects of pharmaceutical technologies and medical devices technologies. The Pro-HTA method used dynamic modeling to examine the impact of medical technologies on a broad range of dimensions, while the HTA and Early-HTA methods used cost-effectiveness techniques throughout the development process. The HHS method used a multivariate decision-making technique.
ConclusionDifferent methods were used to investigate the impacts of emerging medical technologies. Chronologically Pro-HTA methods are new ways for investigating emerging medical technologies beyond clinical and economic impacts. Assessing the feasibility of implementing Pro-HTA in real environments deserves further research.
Keywords: Early Stages of Technology Development, New Medical Technologies, Health Technology Assessment, Emerging Pharmaceuticals -
Pages 1060-1064Background
The response time is considered as one of the most important criteria for the quality of given care to the injured. This research aimed to investigate the frequency and causes of prehospital emergency delays in the 115 emergency center, in city of Mashhad, in 2015.
MethodsIn this cross-sectional study, 21,142 missions performed in 2015 were investigated, from among which 640 missions with delays in systematic sampling were recognized. For data analysis purposes, descriptive statistics (frequency, mean and SD) in Excel 2013 software was implemented.
ResultsNearly 60% of the injured were men, 23% women, and the gender of 17% was not recorded in their profiles. The mean age of the injured was 29.8+15.9 years and 30% of the injured were in the age group of 16 to 25. The mean response time was 9:01+2:46. The most prevalent causes related to missions out of the operational zone (29.3%) and the second cause has been related to traffic groups (24.2%).
ConclusionEstablishing new bases and completing the number of ambulances and human recourses, intervention in traffic causing factors, and training the public about emergency cases can be effective in reducing the number of missions and the pace and quality of services provided to the injured.
Keywords: Response Time, Causes of Delay, Prehospital Emergency, Iran -
Pages 1065-1069Background
Following the development of new hearing technologies, assessment of speech intelligibility in hearing-impaired children is of great interest. The main purpose of this study was to compare speech intelligibility and auditory perception abilities in children with normal-hearing (NH) and children with hearing aid (HA) and cochlear implant (CI).
MethodsThis analytic cross-sectional study consisted of 60 Persian-speaking children aged 5 to 7-years. Participants were classified into 3 groups of 20 people, including NH (mean age, 71.70±5.05 months), CI (mean age, 72.60±8.20 months), and HA (mean age, 71.45±10.56 months) children. The speech intelligibility rating (SIR) and categories of auditory performance (CAP) tests were conducted for all children to measure their speech intelligibility and auditory perception, respectively. A one-way analysis of variance (ANOVA) test was used to compare CAP and SIR scores among the 3 groups.
ResultsThe mean SIR score in the NH children was significantly higher than the HA (p=0.002) and CI (p=0.009) groups. However, these differences between the HA and CI children were not significant (p=0.885). We found a significant difference between the CAP scores in the 3 groups (p=0.038). Furthermore, the post hoc analysis results indicated that the mean CAP scores in NH children were significantly higher than the HA and CI participants. Based on the results, the speech intelligibility and auditory performance abilities in NH children were significantly greater than the hearing-impaired (CI and HA) children. However, these abilities between HA and CI users were not significantly different.
ConclusionBased on the results, the early acoustical amplification on auditory and speech functions in children with hearing loss is of paramount importance.
Keywords: Speech Intelligibility, Hearing Aids, Cochlear Implant, Auditory Performance -
Pages 1070-1082Background
The evaluation of reinfection and the genetic structure of all human and virus genomes could help to develop programs and protocols for providing services and ultimately to prevent the disease by producing more effective vaccines. Therefore, the aim of this study was to investigate the presence and occurrence of COVID-19 reinfection through a narrative review study.
MethodsWe searched the Medline (PubMed), Embase, Scopus, Web of Science, Cochrane library, Ovid, and CINHAL databases. Inclusion criteria included all studies whose main purpose was to provide information about the occurrence or presence of reinfection in patients with COVID-19. An independent samples t test was used to compare the continuous outcomes between the 2 groups.
ResultsThe mean duration of the first episode in the group with mild or moderate COVID-19 was 24.42±1.67 days, and it was 21.80±3.79 days in the group with severe COVID-19. The mean duration of the second episode (reinfection) in patients with mild or moderate form was 15.38 ± 5.57 days, and it was 19.20±2.98 days in patients with severe form. In both episodes, the duration of the disease did not significantly differ between the 2 groups (p=0.484 in the first episode; p=0.675 in the second episode), but the interval to the occurrence of reinfection in patients with the mild or moderate form was significantly longer than those with the severe form (p<0.001). In this instance, the time interval in patients with the mild or moderate form was 36.63±5.71 days while in those with the severe form of the disease it was 29.70±5.65 days. Besides, the genomes of the viruses isolated from the first and second episode were different.
ConclusionAccording to the results, all patients should be very careful about the severity of the second episode because of the more need for medical interventions for saving the patients. The interval between the first end and the second episode as well as the duration of each episode is highly important for better management of the disease.
Keywords: Reinfection, COVID-19, Narrative Review -
Pages 1083-1089Background
Graft-versus-host disease (GVHD) is a serious complication associated with allogeneic hematopoietic stem cell transplantation (allo-HSCT). Thus, it is necessary to evaluate the risk factors of GVHD in allo-HSCT. Herein, we studied the effects of some risk factors on GVHD incidence in patients with allo-HSCT.
MethodsWe retrospectively evaluated the GVHD incidences and risk factors in 199 patients diagnosed with hematological disorders who underwent allo-HSCT in Taleghani hospital, Tehran, Iran, between 2007 and 2017. The univariable and multivariable analyses of time to event data were performed using the Logistic regression model. Computations were performed using SAS, and the level of statistical significance for univariable and multivariable analyses was set at 20% and 10%, respectively.
ResultsAcute GVHD (aGVHD) was seen in 59 (29.6%) patients, and 18 (9%) patients developed chronic GVHD (cGVHD). The odds of GVHD incidence in male to female transplants was 3.49 times greater than the male-to-male transplantations (CI, 1.16, 11.5; p<0.001). The patients with body mass index (BMI) below 18.5 had 96% lower odds of GVHD incidence compared with those with BMI above 30 (CI, 0.007-0.27; p=0.013). The odds of GVHD incidence in patients who were negative for cytomegalovirus (CMV) antigen was 76% lower than patients with positive CMV antigen (CI, 0.06-0.93; p=0.081).
ConclusionIn a nutshell, our results indicated that the donor-recipient gender disparity, the recipientchr('39')s BMI, and CMV infection/reactivation status might be pivotal risk factors, which should be taken into account for prevention and management of GVHD.
Keywords: Hematopoietic Stem Cell Transplantation, Graft-Versus-Host Disease, Body Mass Index, Cytomegalovirus -
Pages 1090-1095Background
Epidermolysis bullosa (EB) is prevalent in Iran and incurs direct and indirect costs on the health care system and the patient.Therefore, this study was conducted to estimate the economic burden of this disease in Iran.
MethodsThis study includes all patients with EB disease who had been referred to the medical centers of Iran in 2019-2020 for treatment of their disease, especially Hazrat Fatimah Hospital and their medical records are available in Iran EB Patients Association (IEBPA). In estimating the economic burden of diseases and costing studies, we calculated the average direct and indirect costs for a patient and used it to estimate the costs of the patient population. In this study, a prevalence approach was used to calculate the economic burden of this disease. For this purpose, the existing cases of the disease in 2019-2020 were calculated. The data collected from the questionnaires that were completed through interviews with patients as well as the data extracted from the review of their files were entered into Excel software and analyzed.
ResultsThe total direct medical costs of direct non-medical and indirect are equal to 7.319.428.315 & 5.390.440.775 and 45.875.654.514 Rials respectively, and the total economic burden of the disease and the average of each patient is 58.585.514.604 and 155.890.789 respectively.
ConclusionHigh indirect costs, especially informal care, represent the socio-economic burden of this disease and constitute more than half of the total indirect costs. Therefore, the obvious gap and hidden social costs of this disease are related to health policymakers, especially when they want to study the impact of this disease on different income classes of families.
Keywords: Economic Burden, Epidermolysis Bullosa, EB, Iran -
Pages 1096-1103Background
Traumatic brain injury is now regarded as the silent epidemic. This disease can cause some physical, cognitive, and psychological impairments that require proper and early rehabilitation interventions. Therefore, the aim of this study was to explore the factors affecting early rehabilitation care in patients with traumatic brain injury based on the experiences of the rehabilitation team.
MethodsThis qualitative study was conducted as a conventional content analysis from September 2019 to August 2020. For this purpose and given the maximum diversity, 22 members of the rehabilitation team, patients, and their caregivers in trauma level 1 hospitals affiliated with Tehran University of Medical Sciences were selected based on a purposeful sampling method. The data were also collected using semi-structured interviews until data saturation is obtained. Graneheim and Lundmanchr('39')s content analysis method was performed to analyze the data.
ResultsThe data analysis results eventually led to the introduction of three main themes and eight categories. The main themes were associated with early rehabilitation barriers, which included cultural factors and rehabilitation infrastructures. Rehabilitation management was regarded as the main theme regarding the early rehabilitation facilitator.
ConclusionEarly rehabilitation is considered a vital rehabilitation stage for patients with traumatic brain injury. Hence, accurate identification of the influential factors on early rehabilitation can help the rehabilitation team promote early rehabilitation care among these patients; it can lead to the revival of the patientschr('39') abilities and the improvement of their quality of life.
Keywords: Traumatic Brain Injury, Early Rehabilitation, Qualitative Research, Content Analysis -
Pages 1104-1112Background
GD2 synthase (GD2S) is the key enzyme required for ganglioside GD2 synthesis. It is commonly expressed in normal tissues and various cancers. Ganglioside GD2 is identified as a breast cancer stem cells (BCSCs) marker that promotes tumorigenesis. As GD2S has been found to be a useful molecular marker in neuroblastoma and retinoblastoma tumors, we suggest that it can be considered as a suitable candidate for the detection of CSCs in breast cancer tissues.
MethodsExpression of GD2S was examined in 65 breast tumors compared to adjacent normal tissues, applying quantitative real-time PCR (qRT-PCR) and enzyme-linked immunosorbent assay (ELISA). The association between GD2S expression level and patients’ clinical characteristics was also assessed.
ResultsOur findings showed that GD2S mRNA expression was significantly higher in breast cancer tissues in comparison to normal adjacent tissue samples (4.92-fold change, p<0.001) in advanced grades (p<0.001) and stages (p<0.001). It was also shown that GD2S protein expression was significantly higher in breast cancer tissues in comparison to normal adjacent tissues (4.86-fold change, p=0.010) in advanced grades (p=0.010), stages (p=0.005) and larger tumor size (p=0.002).
ConclusionThe current study showed that increased expression of GD2S in advanced breast cancer potentiates it as a promising tumor marker in these patients.
Keywords: Breast cancer, Cancer Stem Cells, ELISA, GD2 Synthase, qRT-PCR -
Pages 1113-1119Background
Tooth decay and periodontal disease are the most common chronic human and oral diseases, respectively, and bacterial plaque has a major role in their occurrence. Because of the importance of plaque control, this study was done to compare the antimicrobial effects of Nigella sativa nanoparticles and chlorhexidine emulsion on the most common dental cariogenicic bacteria.
MethodsIn this experimental study, the effects of 0.2% chlorhexidine mouthwash and Nigella sativa nanoparticle with different dilutions on Streptococcus mutans, Streptococcus sobrinus, Streptococcus salivarius, Lactobacillus acidophilus, Minococcal fecalis, and Enterococcus fecalis were compared using minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) assessment. Data were analyzed by SPSS Version 16.0 software, and statistical tests, including an independent sample t test.
ResultsMean diameters of growth inhibition zone because of the nanoemulsion of Nigella sativa nanoparticle was close to each other in different bacteria (p=0.665). In addition, there was no significant difference between these values because of different dilutions of nanoemulsion even in different microbial species (p=0.778). The MIC and lethal concentrations of Nigella sativa nanoemulsion were similar for Enterococcus faecalis and Streptococcus mutans, and it was higher than other bacteria. In comparison, the MIC and MBC values of all bacteria in chlorhexidine were lower than those of the nanoemulsion.
ConclusionMIC and MBC values showed that Nigella sativa nanoemulsion affects tooth cariogenicic bacteria. Enterococcus faecalis and Lactobacillus acidophilus were the most resistant and susceptible bacteria to this nanoparticle, respectively, while the antimicrobial effects of Nigella sativa nanoemulsion were weaker than the chlorhexidine mouthwash.
Keywords: Nigella sativa, Nanoemulsion, Chlorhexidine, Dental Caries, Bacteria, Antimicrobial -
Pages 1120-1125Background
Acute kidney injury (AKI) is frequent in hospitalized patients with critical illness and presents in up to one-quarter of patients with non-severe community-acquired pneumonia (CAP), resulting in increased short and long-term mortality. There is a paucity of literature from resource-limited settings regarding the incidence and risk factors for AKI in patients with CAP. In this study, we looked at the incidence and risk factors for AKI in patients hospitalized with CAP in a resource-limited setting
MethodsThis prospective observational study conducted over 1 year period included patients ≥ 18 years of age diagnosed with CAP admitted to a tertiary care center. The differences in baseline characteristics between hospitalized CAP patients with and without AKI; and risk factors for AKI and the need for renal replacement therapy (RRT) were analyzed using Chi-square test, t-test, Mann-Whitney U test, and logistic regression with p-value <0.05 considered statistically significant.
ResultsWe observed 27.6 % (58/210) of patients had AKI in our study. Patients with AKI had significantly higher baseline comorbidities of chronic kidney disease (p=0.005) and coronary artery disease (p=0.032), and significantly higher uric acid (p=0.002), lower albumin (p=0.005), lower total protein (p=0.015), higher bilirubin (p=0.001), higher LDH (p=0.041), and higher CURB-65 score (p<0.001) in addition to elevated creatinine, BUN (p<0.001) compared to the no-AKI group. The patient group requiring RRT had significantly more males (p=0.019), with significantly higher phosphorus (p=0.038), lower ALT (p=0.022), and expectedly higher creatinine (p<0.001) and blood urea nitrogen (p=0.016). The adjusted logistic regression analysis revealed that patients with higher CURB-65 scores were at increased odds of undergoing RRT (OR 8.74, 95% CI 5.27 to 12.21, p=0.039).
ConclusionThere is a high incidence of AKI in patients hospitalized for CAP in developing countries. Clinicians should be alert for the prevention and early detection of AKI in CAP patients.
Keywords: Kidney Injury, Pneumonia, Dialysis, CURB-65 -
Pages 1121-1129Background
To our knowledge, no study has examined the kinematics of lumbopelvic-hip complex of individuals with chronic low back pain (CLBP) who had lumbar flexion+rotation (F+R) syndrome during sit to stand (SiToSt) and stand to sit (StToSi) activities. Thus, this study aimed to examine movement patterns of the lumbopelvic-hip complex in participants with CLBP classified into F+R syndrome subgroup.
MethodsThis was a cross sectional study. A 3-dimensional motion capture system was used to record movements of the lumbar spine and hips during SiToSt and StToSi. Participants were 20 patients with LBP classified in lumbar F+R subgroup, based on the movement impairment system model, and 20 asymptomatic individuals. The study was approved by Shahid Beheshti University of Medical Sciences (IR, SBMU.RETECH, and REC.1395.365).
ResultsGreater and significant lumbar flexion, with SiToSt, and lumbar extension, with StToSi, were observed in the patients. In addition, the patients exhibited a greater magnitude of lumbar rotation during SiToSt. No significant difference was observed between the 2 groups in hip motions.
ConclusionThe patients with lumbar F+R syndrome tend to move their lumbopelvic region to a greater extent in sagittal and horizontal planes during SiToSt and StToSi compared with participants without low back pain.
Keywords: Low Back Pain, Lumbopelvic, Hip, Kinematics, Rotation -
Pages 1126-1135Background
The Health Transformation Plan (HTP), the latest reform in Iranchr('39')s health system to achieve the 3 main goals of financial protection, equity, and quality of health care, was started on May 5, 2014. This study aimed to review all available literature regarding the achievements and outcomes of this reform after 6 years of its implementation.
MethodsThe 5 English databases were examined by using appropriate keywords to find documents published on the HTP between June 5, 2014, and the end of April 2020. Out of 532 recovered articles, 137 were included in the study. The studychr('39')s organization was based on the Arkesy and Ochr('39')Malley framework and data analysis was done using the content analysis method.
ResultsThe findings of the study were divided into 11 sections. Studies on the planchr('39')s impact on financial protection (22.6%), performance indicators (14.5%), and natural delivery promotion (14.5%) were the most frequent, respectively. Regarding the impact of the HTP on patient satisfaction ,performance indicators, and efficiency, mostly positive results have been obtained. However, in terms of the impact of the HTP on financial protection and informal payments, the outcomes have been different, contradictory, and sometimes negative.
ConclusionAlthough the HTP has successfully achieved a number of its goals, in some of the goals, the results are not significant. Given the changing health conditions and funding constraints, it is better to consider measures to fundamentally review the HTP and executive packages.
Keywords: Heath Transformation Plan, Health Reform, Health System, Iran -
Pages 1130-1135Background
Thyroid dysfunction is accompanied with significant metabolic alterations that affect body weight, appetite, and energy expenditure, as well as lipid and carbohydrate metabolism. Leptin, an adipokine produced by adipocytes, regulates food intake and energy storage. Thyroid hormones and leptin share some physiological effects. Changes in leptin have been shown in patients with dysfunction of the thyroid; however, the results are contradictory. The aim of this study was to evaluate the circulating levels of leptin in patients with Graves disease (GD) and Hashimoto thyroiditis (HT) before and after normalization of thyroid function compared with the control group.
MethodsNewly diagnosed adult patients with GD, HT, and healthy euthyroid controls were recruited. Various clinical and biochemical parameters, including thyroid function tests and serum leptin level, were assessed before and after treatment and compared between groups.
ResultsData from 56 patients with HT, 54 patients with GD, and 54 healthy controls were analyzed. Serum leptin levels of patients with HT (30.96 ± 3.88 ng/mL) were found to be significantly higher than the controls (22.35 ± 4.72 ng/mL) (p<0.001), whereas patients with Graves had lower serum leptin levels (14 ± 4.54 ng/mL) (p<0.001). In patients with HT, serum leptin levels showed a significant decrease after treatment (31 vs 27 ng/mL; p<0.001), while in patients with GD, leptin increased significantly after treatment (14 vs 17 ng/mL; p<0.001).
ConclusionThe present study showed that serum leptin levels increased in patients with HT and decreased in those with GD than the control group. However, after treatment, leptin decreased in the Hashimoto group and increased in the Graves group, although it was still significantly different from the control group.
Keywords: Graves Disease, Hashimoto Disease, Leptin -
Pages 1136-1140Background
Shoulder joint dislocation and displacement is a common clinical condition. The present research aims to compare the clinical efficacy of ketamine versus dexmedetomidine during shoulder joint reduction.
MethodsIn this randomized clinical double-blind trial method, patients aged 18 to 65 years with shoulder dislocation referred to the Emergency Hospital of Imam Khomeini Hospital in Ahvaz, Iran, were enrolled. Patients were separated into two groups, patients in group A received 1mg/kg nebu-lized ketamine and patients in group B received 1 μg/kg nebulized dexmedetomidine. Pain score was recorded at 5 different time points: Zero (before intervention), 10 minutes, 20 minutes, 30 minutes, and 60 minutes after intervention., The pain score was evaluated using the visual analog scale (VAS) test. A linear regression test was carried out to compare the slopes. Also, ANOVA repeated measures test variables differences between groups. Then Tukeychr('39')s multiple comparisons as post-hock were applied to compare the pains at different time points. Using IBM SPSS version 19.0 software, all analyzes were accomplished.
ResultsThe pain score in both groups significantly decreased during different time points. The pain reduction slope in the group that received dexmedetomidine is meaningfully upper than that of ketamine (-0.08 vs. -0.06, p=0.012). The ketamine action onset time was 20 minutes after the in-tervention. In comparison, the effect of dexmedetomidine has an onset of 10 minutes after the in-tervention.
ConclusionOverall, the results of current research demonstrated that although nebulized dexme-detomidine and nebulized ketamine produce a significant decrease in pain score, dexmedetomidine provides a faster effect. Therefore, nebulized dexmedetomidine seems to be used as an appropriate choice to induce sedation during shoulder joint reduction in emergency departments.
Keywords: Dexmedetomidine, Ketamine, Nebulized, Shoulder Dislocation, Trial, Reduction -
Pages 1136-1141Background
Prevalence and clinical significance of hyperprolactinemia in subclinical hypothyroidism have been reported in few studies. The upper limit of the normal range for TSH used to diagnose subclinical hypothyroidism is a matter of controversy. Some experts believe that the upper limit of the normal TSH range should be reduced from 4.2 to 2.5 mIU/L. Some evidence suggests a positive relationship between TSH > 2.5 mIU/L and cortisol as an indicator of metabolic stress. With this view prolactin as a stress hormone can be elevated in TSH >2.5 in comparison to TSH< 2.5. Hence the aim of this study was to evaluate the relationship between TSH and prolactin levels in the TSH range <10.
MethodsThis cross-sectional study was performed on apparently healthy subjects with TSH<10 mIU/L. Subjects with the age of 18 to 35 years were enrolled. The sera were analyzed for prolactin, FT3, FT4, TSH, TPO-Ab and Tg-Ab.
ResultsFrom the total number of 519 participants, in 65 subjects (12.5%) TSH was < 2.5. Seventy-nine subjects (15.2%) had TSH: 2.5-4.2 and 375 (72.3%) of the participants had TSH> 4.2 mIU/L. The mean age, weight and BMI of subjects in the three TSH groups were not significantly different. In the three TSH groups, the prevalence of hyperprolactinemia was zero, 3.8 and 30.7%, respectively. There was a positive and significant correlation between prolactin and TSH levels (r=0.613).
ConclusionHyperprolactinemia is common in patients with subclinical hypothyroidism (30.7%) and there is a positive correlation between TSH and PRL in subjects with TSH<10 mIU/l.
Keywords: Thyrotropin, Prolactin, Hypothyroidism -
Pages 1141-1148Background
Psychophysical tests are typically used for clinical assessment of human smelling function. Given that olfactory identification is linked to the regional culture, the main aim of this study was to provide the comprehensive “sniffin’ sticks” olfactory test, culturally adapted on the Iranian population as well as to examine the discriminatory power of this test between normal people and patients with olfactory disorder.
MethodsThis cross-sectional study consisted of 3 steps. A total of 200 healthy people were recruited to determine odor familiarity (using Likert- scale) for the first step. In the second step, based on the original sniffin’ sticks test and odor familiarity, 16 odor items were selected. Odor modification was performed and the identification part of the sniffin’ sticks test was created. Then, 99 patients with olfactory disorders and 214 healthy participants were tested using the Iranian sniffin’ sticks test (Ir-SST). After 2 to 4 weeks, participants were reexamined and test reliability was evaluated by using a Pearson correlation coefficient test.
ResultsThe Ir-SST showed that scores of patients with smell loss were significantly lower than normosmic participants (13.6 ± 5.24 vs 34.3 ± 3.41, P < 0.001). The sensitivity (95.2%) and specificity (93.5%) of the test were also found to be high. Test-retest reliability was as follows: composite score: r = 0.8; odor identification: r = 0.83; odor threshold: r = 0.77; and odor discrimination test: r = 0.56; P < 0.001.
ConclusionThe results suggest that the Ir-SST can be effectively adapted to the Iranian population. The current study validates that the sniffinchr('39') sticks olfactory test is applicable as a useful screening tool for comprehensive assessment of olfactory function in an Iranian population.
Keywords: Olfaction, Sense of Smell, Smell Disorders, Cultural Adaptation, Sniffin’ Sticks Test -
Pages 1142-1147Background
Diabetes mellitus is one of the major global health threats. Diabetes can cause adverse cytopathological changes in cells and predispose them to pathological lesions. The present study aimed to investigate the cytopathological changes of oral mucosal cells in type 1 and 2 diabetes patients and its relationship with blood sugar status.
MethodsThis study descriptive-analytical was performed on 40 type-1 diabetes patients, 40 type-2 diabetic patients, and 20 non-diabetic individuals (control group) with simple sampling in Zahedan (2019). Their buccal mucosa was sampled by a cytobrush and the microscope slides were prepared with Papanicolaou staining. The nuclear and cytoplasmic area and cytoplasmic-nuclear ratio were calculated. Furthermore, the relationship of hemoglobin A1C and fasting blood sugar with these parameters were also examined. Data was analyzed with one-way-ANOVA, Kruskal-Wallis, Post Hoc Tukey, Mann-Whitney, Pearson correlation and Spearman correlation tests. In this regard, the statistical software SPSS (version 21) was used and a p-value <0.05 was considered statistically significant.
ResultsBased on the findings, only the nuclear area was significantly larger in type 1 and type 2 diabetes patients, compared to the control group (p<0.001 and p=0.010), respectively. Moreover, the comparison of cytomorphometric changes between type 1 and type 2 diabetes patients did not show a significant difference. In addition, the hemoglobin A1C levels were merely associated with the cytoplasmic area in type 2 diabetes patients (p=0.011), while fasting blood sugar levels were not associated with any of the parameters in type 1 and type 2 diabetes patients (p>0.050).
ConclusionDiabetes, as an independent factor, can cause cytomorphometric changes in the buccal mucosal cells of type 1 and type 2 diabetes patients. It seems that the type of diabetes does not affect these changes. hemoglobin A1C levels were correlated with cytoplasmic area in type 2 diabetes patients.
Keywords: Diabetes mellitus, Cytology, Glycemic Index, Papanicolaou Test -
Pages 1148-1152Background
As a soccer referee or an assistant referee, having perfect visual skills is mandatory, which will help make quick and accurate decisions in the field of the play and during matches; however, this skill is not well studied among referrers. This study aimed to assess the visual skills of referees and assistant referees.
MethodsMen’s professional referees and assistant referees working for the Iran football federation were investigated in 2019. The visual skill investigation consists of the evaluation of static visual acuity, color vision, stereoacuity, intraocular pressure, confrontation test, and eye anatomical assessment with slit lamp. The statistical analysis was performed using the SPSS software Version 18.
ResultsIn this study, 159 men’s professional referees and assistant referees with a mean age of 35.52±5.39 were selected. The results of this study showed that 1.88% of the referees and assistant referees had color blindness dyschromatopsia) and 3.14% of them needed more follow-up examinations. The mean spherical equivalent of examined eyes was -0.42D in the right eye and -0.16 D in the left eye.
ConclusionOur results showed that referees and assistant referees both had some kind of visual skill deficiencies. As visual skills are among the fundamental skills for success in referees in dynamic sports such as soccer, all of them must undergo visual skill assessments during the precompetition period to avoid any errors in judgment due to visual disturbances.
Keywords: Visual, Soccer, Sports -
Pages 1149-1152Background
Adrenal insufficiency (AI) is associated with an increase in the risk of mortality in ICU-admitted septic patients. It should be suspected not only in patients with septic shock but also in those with sepsis. The aim of this study was to investigate the prevalence of AI in the spectrum of septic patients and determine the main predictors of this condition.
MethodsThis study included 99 patients with the diagnosis of sepsis, severe sepsis, or septic shock. Patients with basal cortisol < 10 μg/dl or those with ∆ cortisol < 9 μg/dl after the cosyntropin test were considered as having AI. Appropriate statistical tests were used for comparing the variables between the two groups. A logistic regression model was applied to determine the predictors of AI. The P-value <0.05 was considered as a significant level.
ResultsAI was found in 25 (25.3%) of these patients. There was no significant difference in the occurrence of AI in patients with sepsis, severe sepsis, or septic shock. Patients with positive blood culture (OR (95% CI); 7.8 (3.5-9.1); p=0.021) or those with CRP≥ 3+ (OR (95% CI); 14.1 8 (5.7-16.2); p<0.001) were more likely to develop AI.
ConclusionAI is prevalent among ICU admitted septic patients even in the absence of septic shock. The main predictors of AI are high levels of CRP and positive blood culture.
Keywords: Adrenal Insufficiency, Sepsis, Septic Shock, C-Reactive Protein (CRP) -
Pages 1153-1158Background
Endometrial cancer is the fourth most widespread cancer among females, with a growing prevalence in recent years. Management by combined therapies along with surgery, radiotherapy, and chemotherapy have improved patients’ prognoses. Besides, the development of new therapies helps preserve fertility and prognosis in aggressive tumors.The purpose of this research was to identify the efficacy of metformin on the H19 long non-coding RNA expression in endometrial cancer to provide further insight into the pathogenesis and treatment of the disease.
MethodsA total of 23 patients with endometrial cancer, diagnosed by biopsy or diagnostic curettage, were recruited and divided into three groups, before and after metformin treatment and placebo. Real-time PCR was used to evaluate the H19 expression in cancer tissue in all patients.
ResultsIt has been observed that in endometrial tissue of the “after-metformin” treatment group, the H19 expression level was significantly reduced, compared with the “before-metformin” treatment group, but not in comparison with the placebo. These findings indicate that metformin reduced the H19 expression in endometrial cancer.
ConclusionAnti-diabetic drugs, such as metformin, may be beneficial by reducing the H19 expression in endometrial cancer due to the H19 relation to cancer progression.
Keywords: Endometrial Cancer, Non-Coding RNA, H19 Gene, Metformin -
Pages 1154-1157Background
A few studies have been published on the clinical efficacy and safety of nasal tip defatting plus rhinoplasty, particularly among people with bulbous noses. Therefore, the present study aimed to assess the consequences of nasal tip defatting for skin thickness reduction.
MethodsThis quasi-experimental study was performed on 72 consecutive patients, candidates for aesthetic rhinoplasty. Twenty-seven patients were scheduled for nasal tip defatting with routine open rhinoplasty concomitantly. Besides, 45 patients underwent rhinoplasty without nasal tip defatting method. Tip and supra-tip skin thickness were assessed before and 12 months after the operation using ultrasonography. The patients' and surgeon's satisfaction with aesthetic results after the operation were also evaluated based on visual analog scaling (VAS). SPSS version 16.0 (SPSS Inc., Chicago, IL., USA) was used for the analyses. P values below 0.05 were considered statistically significant.
ResultsSeventy-two patients (4 men, 68 women; mean age 26.40 ± 4.61 years) entered the study. Twenty-seven candidates underwent rhinoplasty plus nasal tip defatting (group A). Open rhinoplasty alone was performed for the other 45 patients (group B). The mean nasal tip thickness was 3.98±0.84 mm in group A and 3.69±0.64 mm in group B before the surgery (p=0.059). Preoperative nasal supra-tip thickness of the patients was also assessed using ultrasonography (3.54±0.72 mm in group A versus 3.73±0.54 mm in group B; p=0.065). Both preoperative tip and supra-tip thickness did not statistically differ between the two groups. No significant difference in postoperative tip skin thickness was obtained between two groups after 12 months (3.24±1 mm in group A versus 3.25±0.625 mm in group B; p=0.960), while postoperative supra-tip skin thickness differed significantly according to ultrasonography assessments (2.86±0.60 mm in group A versus 3.25±0.71 mm in group B; p=0.016). Postoperative satisfaction of the candidates was obtained using theVAS scoring system 12 months after the operation in both groups (8±1 in group A, 7.5±1 in group B; p=0.021). Surgeon’s satisfaction in terms of the aesthetic outcome was also assessed based on the VAS system which did not statistically differ between the two groups as well as the patients’ satisfaction (7.84±1.42 in group A, 7±1.61 in group B; p=0.014).
ConclusionNasal tip skin defatting is the main component in aesthetic rhinoplasty, but its significant effect on the reduction of tip skin thickness is controversial. However, in patients with moderate or thick nasal tip skin, such a procedure can result in higher postoperative satisfaction with the aesthetic outcome compared to rhinoplasty alone.
Keywords: Rhinoplasty, Nasal Tip, Nasal Tip Defatting, Nasal Skin, Nasal Skin Thickness -
Pages 1158-1168Background
The complexity of health and the role of its relevant socioeconomic factors have led countries to adopt new approaches to promote health, including the socialization of health. This comparative study aimed at examining the patterns of the social approach to health in 9 selected countries.
MethodsUsing the scoping review method, we collected the data by searching published articles in databases and the websites of the World Health Organization, the United Nations, and the World Bank. A total of 66 articles were included in the study based on the PRISMA protocol.
ResultsThe thematic analysis showed that the most efficient model among middle-income countries was the one that consisted of good governance, effective social participation, and empowerment of mothers and children. The study findings also revealed that considering social welfare, governance, social participation, empowerment, and health literacy, Ecuador, Bulgaria, Egypt, and Cuba had the highest scores among the selected countries, respectively.
We define socialization of health as public engagement in maintaining and promoting individual and social and psychological health in the society, a part of which is achieved through community-based medical education.ConclusionIn Iran, the centralized structure of the health system and inadequate transparency and accountability of the government have led to restricted public participation and poor intersectoral collaboration. We propose empowering civil society, setting up free political parties, and implementing the family medicine project as an effective policy for improving the socialization of health to achieve sustainable development goals in Iran.
Keywords: Social Approach to Health, Health Promotion, Health Socialization, Iran -
Pages 1159-1165Background
Treatment of patients with anosmia is a major therapeutic challenge. The present study evaluated the efficacy of platelet-rich plasma (PRP) in the treatment of anosmia in patients with sinonasal polyposis.
MethodsIn the present clinical trial, atotal of 48 patients with sinonasal polyposis with theIran Smell Identification Test (I-SIT) score of <6 who completed the medical treatment and were observed 3 months after the sinus surgery were included and randomly divided in to 2groups. After endoscopic sinus surgery, the intranasal injection of 1 mL PRP and normal saline was performed in the olfactory region in the intervention and control groups, respectively. Odor function was assessed using the I-SIT at the baseline and at the end of the studyby an independent samples ttest.
ResultsBased on the findings of the present study, the I-SIT improved in both groups during the follow-up, as it reached from 2.63 ± 2.63 to 5.85 ± 2.46 after oral steroid administration and 18.93 ± 1.14 after surgery in the intervention group and from the baseline of 2.10 ± 2.83 to 5.62 ± 2.99 after receiving standard medical treatment and 18.43 ± 1.36in the control groupafter surgery. Although this improvement was significant in both groups in either time interval (all with p<0.001), there was no significant difference between the 2groups in terms of changes in the I-SIT score (p=0.802).
ConclusionAccording to the current study, PRP injection showed no short-term effect on the recovery of olfactory function in patients with sinonasal polyposis.
Keywords: Anosmia, Platelet-Rich Plasma, Olfactory Epithelium, Sinonasal Polyposis -
Pages 1166-1167
The Iran health system has implemented various reforms to provide equitable access to health care for citizens. In addition to its achievements in improving health outcomes, it faced problems, particularly following sanctions and the outbreak of COVID-19. These challenges must be addressed as the high-priority agenda by the new administration in Iran. In this commentary, we introduce the most critical challenges faced by the country. We then describe the main strategies that should be considered to address these challenges.
Keywords: Health System, Governance, Planning, Iran -
Pages 1168-1174Background
Breast cancer is the most common type of cancer among women worldwide. Traditional treatments, including chemotherapy, surgery, mastectomy, and radiotherapy, are commonly used. Because of the limitation of the aforementioned methods, novel treatment strategies are needed. Methotrexate is a chemotherapeutic drug, which is commonly used to treat breast cancer. Because of the side effects of the free drug, the liposomal form of the drug is suggested.
MethodsLiposomal methotrexate was prepared and the encapsulation efficiency was measured. Moreover, the particle size and the zeta potential were measured. The liposome morphology was confirmed using transmission electron microscopy. The MTT assay was done to examine the cytotoxicity of free and encapsulated methotrexate on BT-474 cell line. The Annexin-V/PI dual staining assay was performed to assess the apoptosis in BT-474 breast cancer cells via the flow cytometry method.
ResultsThe transmission electron microscopy results confirmed the integrated and spherical structure of the nanoparticles. The results of drug release showed that in acidic pH (5.4), more than 90% of the drug was released after 24 hours, which was higher than 2 other pHs. Furthermore, the IC50 value of liposomal methotrexate was determined as 2.15 and 0.82 mg/mL for 24 and 48 hours. The flow cytometry results confirmed that liposomal methotrexate had a greater cytotoxic effect on cancer cells compared with free methotrexate.
ConclusionBecause of the advantages of liposomal based nanocarriers, in this study, liposomal methotrexate could be suggested as an appropriate candidate to treat breast cancer.
Keywords: Liposome, Methotrexate, BT-474, Breast Cancer, Nanocarriers -
Pages 1169-1177Background
The burn wound is one of the health problems in the world that affects physical and mental health. Today, adipose-derived mesenchymal stem cells (ADSCs) have received medical attention for their accessibility and the ability to reproduce and repair. The present study was designed to investigate the effect of ADSCs on burn wound healing.
MethodsThe present experimental study was performed on 36 male Wistar rats divided into 1 control group and 3 experimental groups. The second-degree burns with a radius of 10 mm were induced after anesthesia. ADSCs and Dulbecco's Modified Eagle Medium (DMEM) were injected into the dermis around the burn area in the ADSCs and DMEM groups, respectively. Silver sulfadiazine (SSD) ointment was applied topically once daily as the SSD group. The control group did not receive any treatment. The rats were evaluated for 21 days. Wound healing rate, histopathological parameters, and the number of fibroblasts were evaluated by the immunofluorescence technique and vascular endothelial growth factor and transforming growth factor β (TGF-β) gene expression by reverse transcription-polymerase chain reaction. The results were entered into SPSS software (SPSS Inc) and analyzed with 1-way analysis of variance and repeated measures analysis.
ResultsThe number of fibroblasts, the number of vessels, TGF-β, and VEGF gene expression in the burn area were significantly higher in the ADSCs group than in the SSD, DMEM, and control groups. The results also showed that the amount of inflammation was significantly lower in the ADSCs group compared with the control group (p<0.001). Moreover, the percentage of wound recovery was significantly higher in the ADSCs group compared with other groups (p<0.001).
ConclusionADSCs accelerate and improve burn wound healing by affecting fibroblasts, keratinocytes, and inflammatory cells as well as increasing the expression of the TGF-β and VEGF genes, and thus increase in angiogenesis.
Keywords: Stem Cells, Second-Degree Burns, Silver Sulfadiazine, Wound Healing, Rat -
Pages 1175-1181Background
Despite global efforts, human immunodeficiency virus/ acquired immunodeficiency syndrome (HIV/AIDS) is still one of the major public health problems in the entire world. In this context, assessing the burden of this disease in different parts of the world is of great importance. In this study, we aimed to investigate the trends of HIV/AIDS incidence and mortality in Iran during 1990 and 2017.
MethodsThe HIV/AIDS burden data, including the age-standardized incidence rate (ASIR) and the mortality rate (ASMR), was extracted from the Global Burden of Diseases 2017 study for the total Iranian population and by gender from 1990 to 2017. The trend analysis was performed using joinpoint regression modeling approach.
ResultsThe obtained results showed that in 2017, the HIV/AIDS ASIR and ASMR were, respectively, more than 12 and 10 times of these rates in 1990. Also, the estimated average annual percent change (AAPC) was 9.8% and 8.7%, respectively for the ASIR and the ASMR. In this period, women have experienced a sharper slope of ASIR and ASMR trends compared with Iranian men.
ConclusionThe increasing trend of HIV/AIDS burden is a serious alarm for the Iranian health policymakers. To achieve the United Nations Programme on HIV and AIDS goals, there is an urgent need for an efficient national action plan that breaks the HIV/AIDS taboo in the society, promote access to HIV testing and prevention facilities, especially among the key populations, and provide care and treatments for all infected people.
Keywords: HIV, AIDS, Incidence, Mortality, Trend Analysis, Iran -
Pages 1178-1183Background
Some classification systems have been designed to measure domains of function of children with cerebral palsy (CP), including the Gross Motor Function Classification System (GMFCS), Manual Ability Classification System (MACS), Eating and Drinking Ability Classification System (EDACS), and Communication Function Classification System (CFCS). The purpose of the present study was to develop a Social Participation Classification System for children with cerebral palsy (SPCS) with a 5-level sequential scale (level 1 the lowest and level 5 the highest level of participation) and assess its reliability.
MethodsIn this cross-sectional analytic study, 274 parents of 6 to 12 year-old children with CP were asked to complete the questionnaires (CPAS-P, MACS, GMFCS, and CFCS) for their child. The expert review consisting of 10 occupational therapists with at least 5 years of experience working with children with CP was asked to rate the level of social participation with a 5-level sequential scale (level 1 the lowest and level 5 the highest level of participation) of these children according to the variables (intelligent quotient [IQ], CP type, walking ability, GMFCS, CFCS, and MACS). Then, these data were analyzed using the polynomial discriminant function. After performing discriminant function, a flowchart model was determined for the level of children's social participation. To calculate the reliability of the model, 53 new samples were collected and their level of social participation was determined based on the flowchart model. The experts were then asked to determine the social participation level of these 53 new samples in the same manner as before, and then to calculate reliability, intraclass correlation coefficient (ICC) and Cronbach alpha. The SPSS Version 22 (SPSS Inc) and discriminant function model analysis was used for statistical analysis.
ResultsBased on the discriminant function model, the results between the predicted classification and expert review are over 88% consistent. The ICC and Cronbach alpha values were 0.952 and 0.975, respectively, with absolute agreement and multivariate mixed effects.
ConclusionBased on the results of the present study, the SPCS was developed in 5 levels (very low, low, moderate, high, and very high) and to determine it, the GMFCS, MACS, and CFCS scores, CP type, and IQ level should be calculated.
Keywords: Cerebral Palsy, Social Participation, Classification System -
Pages 1182-1184
The occurrence rate of nephrolithiasis has increased steadily. The development of stone in children depends on certain physicochemical factors. Kidney stones are one of the challenges of pediatric nephrology. We brief reviewed the current literature on the best diagnostic imaging to decrease the complication of nephrolithiasis, and we considered the areas that need future research.
Keywords: Nephrolithiasis, Children, Physicochemical Factors -
Pages 1184-1189Background
The most common malignant tumor in women is breast cancer (BC). The ability of regulatory cells to inhibit cellular immune response as well as to participate in the modulation of antitumor immunity has attracted much interest of scientists. The purpose of this study was to assess the correlation between the specific and nonspecific vaginal immunity in women with BC.
MethodsThis was an experimental study. The study involved 278 women, 174 of whom received chemotherapy. The sampling was performed using a universal probe. The qualitative and quantitative assessment of the vaginal microflora was done using the polymerase chain reaction method. Statistical processing of the analysis was performed using the Statistica 10.0 licensed software. The parameters of the immune status before and after chemotherapy were analyzed, and the correlation between the number of cells in the main populations of lymphocytes before and after chemotherapy was investigated.
ResultsThe study of the correlation between the number of cells of the main lymphocyte populations before and after chemotherapy showed an inhibition of B-lymphocytes (CD3-CD19+) in the study group, as the subpopulations of T-cytotoxic (CD4-CD8+) and CD3+HLA-DR+ (activated E-lymphocytes) were increased in both groups. Direct correlations were observed between local vaginal immunity and the immune status of the examined women in the study group between Megasphaera spp. and Enterobacteriaceae, with a certain population of immunocompetent cells.
ConclusionIt was concluded that impaired biocenosis and suppression of local immune responses in women with BC were the reason for the active involvement of the components of the immune system.
Keywords: Malignant Neoplasms, Immunoediting, Vaginal Immunity, Normal Flora, Obligate Anaerobes, Biocenosis -
Pages 1185-1189Background
There has been considerable interest in target immunotherapy in patients with diabetes. This study was designed to identify the effect of BCG vaccination in the treatment of Iranian patients with longstanding diabetes mellitus type 1.
MethodsAfter approval of the cross-sectional study protocol by the ethics committee under number IRCT2017042919940N2, a total of 19 Iranian volunteers with diabetes mellitus type 1 completed this 48-month study. These patients received three 0.1 ml intradermal injections of BCG vaccination in weeks 0, 4 and 24. The serum level of glucose, HgbA1C and c-peptide was measured before and serially after the interventions. Insulin requirements were recorded for each patient in different weeks as the mean and standard deviation..
ResultsThis study showed a decrease in the blood sugar level of 171.15±75.54 mg/dL in baseline to 133.77±76.97 mg/dL in 12 weeks after the first dose of BCG vaccination in these patients. There was no significant change in the mean± SD of serum blood sugar, HgbA1C and c-peptide after BCG vaccination in the baseline and week 48.
ConclusionOur results showed that small doses of BCG vaccination were not effective in long-term treatment of Iranian patients with diabetes mellitus type 1 up to 48 weeks.
Keywords: BCG Vaccine, Iran, DIABETES Mellitus, Glycated Hemoglobin A, C-peptide -
Pages 1190-1201Background
To date, comprehensive data on drug utilization in Iranian people are lacking. The purpose of this study was to graphically describe drug prescription, polypharmacy, and pharmaceutical spending in > 3 million Iranian elderly people.
MethodsIn this multilevel cross-sectional study, using administrative claims data provided by the Iran Health Insurance Organization (IHIO), we assessed drug claims and drug costs in 2018 in >3 million individuals living in Iran and who have been insured with health insurance (Bimeh Salamat). In particular, we analyzed the prevalence of polypharmacy and pharmaceutical spending use according to the annual Report of Iranian Health Insurance Organization. Multilevel ordinal logistic and multilevel beta regression models were used to analyze the data. Significance level was set as P ≤ .05 and CI at 95%.
ResultsNationally, the mean number of drug prescriptions per patient was 1.46 (SD, 0.81). The mean number of prescribed drugs per patient was 4.32 (SD, = 3.04). The drug cost for each elderly patient was $6.86 (interquartile range (IQR), 12.26), with $4.96 and $1.76 for the insurance and the insured shares, respectively. For elderly women, the odds of polypharmacy (excessive and nonexcessive vs no polypharmacy) were 1.164 (95% CI, 1.142 to 1.186) times that of elderly men. In addition, in the spring season, the odds of polypharmacy were 1.274 (95% CI, 1.241 to 1.309) times that of the winter. Similarly, polypharmacy was strongly higher among patients who had noncommunicable diseases (OR, 2.174; 95% CI, 2.069 to 2.275 (P < 0.001)).
ConclusionThe high prevalence of hyper prescription in Iran elderly people may indicate a need for interventions aiming at deprescribing drugs with an unfavorable benefit-risk profile. The best practice guidelines should be developed for improved medical practice in the prescription of medications for such a vulnerable population.
Keywords: Drug Prescription, Polypharmacy, Pharmaceutical Spending, Multilevel, Claim Data -
Pages 1191-1193Background
Breast cancer is one of the most common cancers. Researchers are trying to diagnose the disease through easier and safer methods. Serum markers such as ferritin and vitamin D level would be very helpful. This research could pave the way for more comprehensive studies on how to use this serum factor in breast cancer screening, as well as early detection of the disease in its early stages.
MethodsThis study consisted of two groups, the first group comprising patients diagnosed with breast cancer before undergoing any treatment and the second group as control were healthy people. Serum ferritin and vitamin D levels were measured. Pathological information of the patientchr('39')s tumor, including ER, HER2, KI67, lymphovascular invasion, and disease stage, were collected as well. Data were analyzed by IBM SPSS advanced statistics version 23.0 (SPSS Inc., Chicago, IL). P-value of ≤0.05 was considered significant.
ResultsEighty-eight subjects were enrolled in this study, 29 (33%) breast cancer patients and 59 (67%) healthy women. In breast cancer patients, serum ferritin levels were 106.55±111.25, which were higher than healthy women’s serum ferritin 52.71±36.95 (p=0.083). Furthermore, 18 (66.7%) of breast cancer patients and 55 (93.2%) of healthy women had low serum ferritin levels (p=0.001). 3 (11.1%) patients in the cancer group had serum vitamin D deficiency, while all subjects in the control group had serum vitamin D higher than 10 ng/dl (p =0.009).
ConclusionThe results of this study showed a correlation between breast cancer and vitamin D deficiency, and elevated ferritin. Perhaps with further studies, there could be a role in predicting the prognosis and screening of breast cancer for these associations.
Keywords: Ferritin, Vitamin D, Breast Cancer -
Pages 1194-1201Background
Medical error is one of the most important causes of mortality and morbidity in the health care system. Considering the significance of medical error management in the healthcare system, error disclosure is an imperative moral responsibility of medical and healthcare professionals from medical ethics experts’ perspective. In literature, no or inadequate protocols were suggested for disclosing colleague’s medical error; and hence, this study was conducted to provide two algorithms for colleague’s medical error disclosure at individual and organizational levels.
MethodsThis study conducted a narrative review on several valid Internet databases, including PubMed, Science Direct, and Scopus. First, the literature on the colleague’s error was reviewed using articles of the last 20 years focusing on medical errors and error disclosure keywords. Next, two algorithms were developed for the colleague’s error disclosure for individuals and with the assistance of organizations, respectively.
ResultsIf we personally notice a colleaguechr('39')s error at an individual level, we should plan for a conversation to encourage the colleague to inform the patient or the related organization about the error. If we notice a medical error from a colleague relating to an organization, we should decide based on circumstances considering the organization’s responsible parties for handling error disclosure.
ConclusionThis study proposes a simple protocol for detecting peer error at the individual level and at the organizational level, using the existing literature. However, the improvement of these types of methods requires analysis of the specific conditions of each health system.
Keywords: Medical Error, Colleague Medical Error, Medical Error Disclosure, Healthcare System -
Pages 1202-1206Background
The oncological outcomes of bladder cancer are directly associated with disease pathology and surgical technique. Therefore, we investigated the pathologic factors of radical cystectomy (RC) specimens.
MethodsIn this retrospective study, 365 patients who underwent RC between March 2013 to March 2018 in hospitals affiliated to Shiraz University were enrolled. The patients’ clinicopathological parameters, such as tumor type, tumor grade, carcinoma in situ, lymph node (LN) involvement, lymphovascular invasion (LVI), perineural invasion (PNI), and age, were recorded from their pathology reports. For comparison of variables, an independent t test was used. P < 0.05 was regarded as significant. The statistical software SPSS version 22 was used to examine the data.
ResultsThe participants’ mean age was 64.52 ± 11.54 years, and 320 (87.7%) patients were men and 45 (12.3%) were women. The mean dissected LN was 9.69 ± 8.70 nodes and 1.06 ±3.49 of the dissected LNs were involved by tumor. PNI and perivesical invasion were presented in 148 (40.5%) and 96 (26.3%) patients, respectively. Ureteral, urethral, and prostate involvements were seen in 23 (6.3%), 50 (13.7%), and 66 (18.1%) patients. Most patients had pathologic tumor stage 2 (36.4%). Factors such as LVI, PNI, perivesical invasion, and prostate involvement, were strongly correlated with positive LN (P ≤ 0.05).
ConclusionThe examination of the RC specimen is critical for patient care, outcome, and justification of adjuvant therapy. Factors such as LVI, perineural invasion, perivesical invasion, and prostate involvement were strongly correlated with positive LN.
Keywords: Bladder Cancer, Radical Cystectomy, Pathology, Lymph Node -
Pages 1207-1213Background
Type 2 diabetes (T2D) is a progressive disease that should be managed with insulin in case of oral glucose lowering drugs (OGLDs) failure. If basal insulin is not sufficient, rapid acting insulin will be added before the largest meal. We assessed the impact of adding one prandial insulin to a basal based regimen and insulin glargine in patients with type 2 diabetes to measure the percentage of subjects achieving the HbA1c target by the end of 24 weeks of treatment in routine clinical practice.
MethodsThis study was a 24-week observational study of patients with T2D not adequately controlled with OGLDs and basal insulin, for whom the physician had decided to initiate prandial insulin. The study endpoint was assessed at visit 1 (baseline), visit 2 at week 12 (±1 week) and visit 3 at week 24 (±1 week). The percentage of patients who achieved HbA1c targets was assessed at week 24. Statistical analyses were performed using IBM SPSS for Windows v 19 (IBM, Armonk, New York, USA). Logistic regression analysis was used to detect predicting factors of achieving the HbA1c target by week 24. P<0.05 was considered as significant level.
ResultsFour hundred and eighteen patients with a mean±SD age of 56.24±9.85 years and a mean±SD duration of diabetes of 12.50±7.16 years were included. The median total daily dose of basal insulin was 24 units, while prandial insulin was started with 6 (4, 10) U/day, titrating up to 10 (8, 18) U/day at week 24. The daily dose of prandial insulin was the only factor that could significantly predict achieving targeted HbA1c by week 24 [OR: 1.04; 95% CI: 1.007,1.079; p-value: 0.019]. At week 24, 96 (22.9%) subjects achieved the HbA1c target with one prandial insulin.
ConclusionThe results of our study suggest that “basal plus therapy” can lead to good glycemic control with a low risk of hypoglycemia and weight gain in patients with type 2 diabetes.
Keywords: Safety, Treatment Outcome, Diabetes Mellitus type 2, Insulin, Short-Acting, Glycated Hemoglobin A -
Pages 1214-1220Background
Various studies have shown the benefits of using glucocorticoids following surgery. However, side effects associated with drug administration have been investigated sufficiently. We aimed to evaluate the effects of different doses of dexamethasone on blood glucose concentration in patients undergoing elective abdominal surgery.
MethodsThis double-blind clinical trial design study was conducted among 90 candidates of elective abdominal surgery referred to RasoolAkram Medical Complex in Tehran ,Iran, 2017-218. Patients included two groups of intervention: group I, received 4 mg dexamethasone; group II, received 8-10 mg dexamethasone; and group III (control group), received ondansetron after induction of general anesthesia. Data were analyzed using ANOVA, Kruskal-Wallis test, and repeated measures. α=0.05 was considered as a statistically significant level.
ResultsThe highest increase in blood glucose concentrations in all three groups occurred in the first 6 hours after the surgery. The lowest intensity of pain in all the groups occurred in the first 24 hours after the surgery. All the groups showed statistically significant changes in blood glucose concentration and pain intensity. Comparing among the mean blood glucose concentrations over time, there were statistically significant changes in time and group/time (p<0.001). Comparing the mean intensity of pain over time, statistically, significant changes were observed in time and group / time (p<0.001).
ConclusionIn general, change trends in blood glucose concentration and pain intensity could be dependent on the medication used and its dose, as well as the time of drug administration. Changes in blood glucose levels in the control group can be attributed to metabolic changes caused by surgical trauma.
Keywords: Dexamethasone, Blood Glucose, Pain, Nausea, Abdominal Surgery -
Pages 1221-1226Background
Carpal tunnel syndrome is a common condition that causes pain, sensory and motor symptoms in the hands, especially in the thumb, index, and middle fingers due to the compression of the median nerve in the carpal tunnel. The purpose of this research was to investigate the effect of the shock wave and phonophoresis in the improvement of clinical symptoms and function of patients with mild to moderate carpal tunnel syndrome.
MethodsThe present research has employed a double-blind randomized clinical trial on 60 patients in Isfahan, Iran. Patients were randomly divided into 3 treatment groups of shock, phonophoresis, and control, and all patients received conservative treatments. Wrist thermoplastic splint, vitamin B1, and celecoxib were prescribed for all patients. The shock group received their intervention in four sessions of shock once a week for 4 weeks. Patients in the phonophoresis group received phonophoresis (pulse 1:4) 15 minutes every other day for 2 weeks. Pain scores were assessed based on the visual analog pain scale, and the Boston questionnaire severity scale was completed for each patient before, 1 and 2 months after the intervention. The used analytic tests included Fisher's exact tests, 1-way analysis of variance, and repeated measures analysis.
ResultsShock wave and phonophoresis showed a significant decrease in pain, symptom severity index (p<0.001), and functional status (p<0.001). This reduction was more persistent in the phonophoresis group.
ConclusionThe use of noninvasive shock wave and phonophoresis methods were good alternatives in the treatment of carpal tunnel syndrome.
Keywords: Shock Wave, Phonophoresis, Carpal Tunnel Syndrome -
Pages 1227-1236Background
Despite regulations to facilitate the purchase of medical equipment, the process is now faced with severe challenges due to the sanctions. This study focuses on the effects of the international sanctions on the process of procuring capital medical equipment in the Iranian health system.
MethodsA qualitative study using a content analysis approach was designed to investigate the effects of the international sanctions on capital medical equipment from January 2018 to June 2019. The data were gathered through 32 face-to-face, semi-structured interviews according to an interview guide. All the interviews were transcribed verbatim and analyzed accordingly. Thematic analysis with an inductive approach was employed for analyzing the data.
ResultsAfter a comprehensive analysis of open codes, two themes and 9 sub-themes were formulated. Based on our findings, the challenges facing the Iranian health sector during international sanctions included: “procurement of capital medical equipment” (with 6 sub-themes: Capital medical equipment suppliers, Monetary and interbank transactions, Suppliers and importers of the capital medical equipment, The process of procurement of capital medical equipment, Healthcare providers and Service receivers) and “repairing and after-sales services of capital medical equipment,” (with 3 sub-themes: Software and spare parts dependent repair, Specialized human resources dependent repairing and after-sales services).
ConclusionEven though the sanction has made Iranian scientists and technicians capable of re-engineering and producing some of the medical equipment and accessories, the study confirms the adverse effects of sanctions on the quality and quantity of medical equipment procurement, hence, delivering adequate and on-time medical services. In many cases, for money transfer issues, international companies were not sure they could have their money back if they sold the facilities to Iran. Fear of losing the US market was the other main consideration for the international companies.
Keywords: Sanction, Medical Equipment, Health System, Iran -
Pages 1239-1244Background
Cigarette smoke causes various health problems. Therefore, it is necessary to overcome the problem. One solution to these problems is biofilters' use to capture free radicals from cigarette smoke. This study aims to discover the effect of cigarette smoke exposure through a biofilter made from dates, olives, and pomegranates on mice‘s MDA levels.
MethodsThe experimental study was performed to compare the result of five different treatments. Exposure of 150 ml of cigarette smoke was given every day using a suction tool (15 times each mouse) for 28 days. It was performed with five controls treatment: negative, positive, date biofilter, pomegranate biofilter, and olive biofilter. Furthermore, the data were analyzed using the one-way ANOVA followed by the Duncan test to discover differences in mice’s MDA levels from each treatment.
ResultsThe measurement of MDA levels is using the TBA (Thiobarbitaric Acid) test. The sample is obtained from 1.8 grams of the mices' liver in each treatment.The results showed an effect of using date, pomegranate, and olive biofilters on mice's MDA levels. It shows that the best MDA levels were found in date biofilter treatment with a value of 224 ng/ml with a p-value of 0.023.
ConclusionThe results showed that the MDA levels with the Dates and Olives biofilter treatment were better than the negative control. Therefore, these treatment makes the harmful content of cigarette smoke can be minimized.
Keywords: Cigarette Smoke, Biofilters, Mice MDA Level -
Pages 1245-1252Background
More than 6.8% of the world's population suffer from disabling hearing impairment. Hearing impairment can cause lifelong or even life-threatening problems and has a significant impact on the health and quality of life. This study aimed to analyze the current situation of the ear and hearing care (EHC) in the frame of Iran health system.
MethodsThis situation analysis was performed over a 5-year period (2013-2017) using the Strengths, Weaknesses, Opportunities, and Threats analysis method. First, after formation of the steering committee, all relevant published and unpublished articles and reports were reviewed and analyzed. In the next step, focused group discussion sessions (FGDs) were held with the participation of the experts, stakeholders, and Steering Committee members. Through the scissor-and-sort technique, the relevant data were highlighted and main categories evolved.
ResultsThe main challenges included inadequate health literacy, weak intrasectoral and intersectoral cooperation, the inadequacy of policy responses, nonintegration of the EHC in the primary health care system, poor standard processes, and resources of EHC, and lack of EHC surveillance system. The 6 major interventions and strategies extracted as identifying the capacities of both the public and private sectors, reinforcement of intersectoral cooperation and intersectoral collaboration, standardizing the processes and integrating of EHC services in the PHC, reorganizing the referral system, promoting hearing health literacy, and minimizing hearing loss risk factors.
ConclusionImplementing the proposed interventions and strategies is essential to improve the situation of Iran EHC management system during the next 5 years.
Keywords: Hearing Care, Hearing Impairment, Hearing Loss, Situation Analysis, PHC, Iran -
Pages 1253-1268Background
Although the systematic reviews regarding telemedicine have increased in recent decades, no comprehensive studies have been conducted to review these systematic reviews. The present study aimed to review the published systematic reviews regarding telemedicine applications for the report and appraisal of several aspects.
MethodsThe literature search was performed in the PubMed database for the systematic reviews published during January 2010-June 2020 in the field of telemedicine using “telemedicine” Mesh terms. The extracted data from the selected articles were the year of publication, telemedicine specialty, clinical outcomes, cost evaluation, and satisfaction assessment. Data analysis was performed using descriptive statistics.
ResultsAmong 746 retrieved articles, 191 cases were selected and reviewed. Most of the studies were focused on telemedicine (n=35; 18.3%), followed by telerehabilitation (n=22; 11.5%), tele-diabetes (n=18; 9.4%), telecardiology (n=16; 8.3%), home telecare (n=13; 6.8%), telepsychiatry (n=12; 6.3%), teledermatology (n=11; 5.7%), and teleneurology (n=9; 4.7%). The selected studies were primarily focused on clinical outcomes (72.7%), followed by cost-effectiveness (32.4%) and user satisfaction (29.3%). In addition, they mostly indicated that telemedicine services yielded acceptable clinical outcomes (72.5%), cost-effectiveness (67.7%), and healthcare provider/patient satisfaction (83.9%).
ConclusionAlthough telerehabilitation, tele-diabetes, telecardiology, home telecare, and telepsychiatry were studied further, there are still some specific specialties such as teleradiology, telepathology, and telepediatric that should be considered more. Moreover, investigation of various outcomes could result in a more comprehensive view of this field. Therefore, further investigations in this regard would improve telemedicine applications and encourage potential telemedicine providers to initiate these applications.
Keywords: Telemedicine, Telehealth, Systematic Review, Analysis -
Pages 1269-1274Background
Prisoners are at higher risk for sexually transmitted infections (STIs) than the general population. This study reported the prevalence and correlated factors of STI-related symptoms among male prisoners in Iran.
MethodsParticipants were selected from 27 prisons across 16 Iranian provinces in 2013 using a multistage cluster sampling (N = 5490). Men aged ≥18 years who spent at least one week in prison and self-reported having had sex during the previous year were eligible and asked if they have had penile discharge (PD) or genital ulcers (GU) within the last year. Demographic variables, HIV/STIs-related knowledge, STIs care-seeking practices, HIV self-perceived risk, history of substance use, and sexual behaviors were collected by face-to-face interviews. HIV tests were completed using the ELISA method. Factors associated with STIs-related symptoms were examined using logistic regression models, and adjusted odds ratios (AOR) along with their 95% confidence intervals (CI) were reported.
ResultsOf 2,620 eligible male prisoners (mean age ± SD = 35.7 ± 8.9), 6.9% reported symptoms for PD, GU, or both; of whom 36.2% had not sought STIs care inside prison. A history of injection drug use (AOR = 2.14; 95% CI: 1.45, 3.14), having access to condoms inside prison (AOR = 1.57, 95% CI: 1.08, 2.82), self-perceived risk of HIV (AOR = 1.52, 95% CI: 1.03, 2.24), and HIV-seropositivity (AOR = 3.30, 95% CI: 1.02, 10.61) were positively and having sufficient STIs-related knowledge (AOR = 0.63, 95% CI: 0.44, 0.89) was negatively associated with reporting STIs-related symptoms.
ConclusionDespite the low prevalence of STIs among Iranian prisoners, initiation of screening among high-risk prisoners, including people who inject drugs and prisoners living with HIV, may prevent subsequent health effects. Current HIV/STIs prevention policies across Iranian prisons to help improve prisoners’ HIV/STIs knowledge and encourage their HIV/STIs preventive practices should be reinforced.
Keywords: Sexually Transmitted Infections, Symptoms, Prisoners, Surveillance, Iran -
Pages 1275-1278
Diabetic retinopathy (DR) is one of the most common complications of diabetes. The known risk factors for microvascular complications are uncontrolled diabetes, duration of diabetes, dyslipidemia, and hypertension. In addition to these conventional risk factors, other risk factors, such as hypothyroidism have recently been suggested. Adult patients with type 2 diabetes mellitus (T2DM) were recruited. All patients were evaluated for retinopathy. Various clinical and biochemical parameters, including thyroid function tests, were assessed and compared between groups. In this study, 928 patients with (T2DM) were included. Of all patients, 376 (40.52%) had DR. In patients with retinopathy, 115 (30.58%) had proliferative and 261 (69.42%) had nonproliferative retinopathy. In patients with nonproliferative DR, 34.48%, 32.95%, and 32.57% had mild, moderate, and severe nonproliferative DR, respectively. Of all patients, 91 (9.8%) had subclinical hypothyroidism. There was a significant relationship between subclinical hypothyroidism (SCH) and DR in these patients. In patients with retinopathy, 14.4% and in patients without retinopathy, 6.7% had SCH (p<0.001). In univariate logistic regression analysis, the chance of developing DR in patients with SCH was 2.33 times higher than patients without subclinical hypothyroidism, each unit increase in the thyroid-stimulating hormone significantly increases the chance of developing DR by 13%. The present study showed that in the population of patients with (T2DM), SCH is associated with DR, regardless of the conventional risk factors.
Keywords: Diabetes Mellitus Type 2, Hypothyroidism, Diabetic Retinopathy -
Pages 1279-1286Background
Ischemic cardiomyopathies are the leading causes of mortality and morbidity. Stem cell therapy using amniotic membrane mesenchymal stem cells have emerged as a promising cardiac regeneration modality. They have shown great immunological advantage when used in allogeneic or xenogeneic transplantation. The aim of the current study is to accumulate evidence from published preclinical studies on the application of amniotic membrane derived mesenchymal stem cells (AMSCs) in the treatment of ischemic cardiomyopathies including myocardial ischemia and heart failure. The aim is to define if there is enough high-quality current evidence to support starting the use of these cells in clinical trials.
MethodsPubMed, SCOPUS, EMBASE, and ISI Web of Science databases were searched without temporal and language restrictions. Data were extracted from selected studies. The primary outcomes were left ventricular ejection fraction (LVEF) and LV fibrosis. The risk of bias (ROB) assessment was performed using SYRCLE’s ROB tool. After qualitative synthesis, provided that data meets the criteria for quantitative analysis, a meta-analysis was performed using Stata software V12 to investigate the heterogeneity of the data and to get an overall estimate of the effect size of the treatment on each outcome.
ResultsOn primary search, 438 citations were retrieved. After screening, three studies were selected for quantitative analysis of each of the outcomes LVEF and LV fibrosis. Their administration in acute and chronic MI alleviates heart failure and improves LVEF (SMD=3.56, 95% CI: 2.24-4.87, I-squared=83.1%, p=0.003) and reduces infarct size (SMD= -4.41, 95% CI: (-5.68)-(-3.14), I-squared=79.0%, p=0.009). These observations were achieved in the acute MI model, HF following ischemia due to coronary artery stenosis and coronary artery occlusion with the early restoration of the perfusion.
ConclusionPresent low and medium quality evidence from preclinical studies confirm the efficacy of the AMSCs in the preclinical models of acute MI and HF following ischemia due to coronary artery stenosis and permanent/temporary coronary artery occlusion. High-quality preclinical studies are indicated to bridge the gaps in translation of the current findings of AMSCs research for the treatment of patients with acute and chronic myocardial ischemia and heart failure.
Keywords: Preclinical Studies, Ischemic Cardiomyopathy, Myocardial Ischemia, Heart Failure, Ischemic Heart Diseases, Mesenchymal Stem Cells, Stem Cell Therapy, Amniotic Membrane, Amnion -
Pages 1287-1295Background
Social capital (SC) is an essential concept of communities, and there is more SC inequality. In the current study, we studied SC Inequality concerning the explanatory socioeconomic factors.
MethodsIn a cross-sectional observational study, the household data were retrieved from an Urban Health Equity Assessment and Response Tool survey in 2011. Over 5000 elderlies in Tehran (> 60 years old) consented to participate in the study and filled out 2 SC questionnaires (SCQ) and a household properties questionnaire (HPQ). Subsequently, the collected HPQ data were then statistically analyzed and used to measure the economic status of households. Besides, the statistical concentration index of the SC was applied to measure socioeconomic inequality and decomposed into its determinants using both SCQ and HPQ data collections. The concentration index and the decomposition analysis were used to analyze the study data.
ResultsThe overall concentration index of the SC in Tehran senior citizens was 0.059 (95%CI,0.044-0.076). Among the SC dimensions, collective activity, social coherence, voluntary help, and social network were more concentrated in the poor older adults. Simultaneously, reciprocity was more focused on the wealthy class, and there was no inequality in trust. The decomposition of the concentration index showed that economic status made the most considerable contribution to the SC inequality among citizens (69.11%), followed by the level of education (12.695) and the elderlies'job type (9.58%).
ConclusionGiven that the economic status and level of education are the 2 main determinants of SC inequality, a holistic policy approach should be adopted to address the socioeconomic inequalities that are taken root in Tehran's senior communities.
Keywords: Social Capital, Socioeconomic Determinants, Inequality, Older Adults -
Pages 1296-1305Background
As a newly-emerged metric for evaluating scientific research, altmetrics captures the online activity regarding individual scientific items and is increasingly used in disseminating scientific information in a real-time span. This study aimed to conduct an altmetrics analysis of articles published in the Medical Journal of the Islamic Republic of Iran (MJIRI) during 1987-2020.
MethodsUsing the archives of MJIRI's articles (during 1987-2020) and the four databases of Google Scholar, Scopus, Dimensions, and Altmetrics needed data on received citations as well as altmetric indicators and altmetric attention scores of these articles were extracted manually in December 2020. Data analysis was done in Excell and SPSS-25.
ResultsOnly 1274 MJIRI articles (about 51%) were present in the Altmetric Institute and had an altmetric attention score. Only 109 papers (8.5%) were shared at least once on online social media. Twitter was the most frequent social medium used for sharing the articles (n=91, 7.14%). These articles were twitted 171 times in total and the mean rate of twitting them was 1.88 per paper. Users from 21 countries in the world tweeted the articles. The top three twitting courtiers/regions were the United States (n=47), the United Kingdom (n=14) and India (n=3), respectively. Regarding twitters' membership status, the top three ranks were dedicated to the members of the public with 137 twits, practitioners (doctors and other healthcare professionals) with 18 twits and scientists with 16 twits. In Mendeley, the top three ranks were dedicated to master students (n=284), bachelor students (n=240) and Ph.D. students (n=155), respectively. The top three disciplines in this regard were medicine and dentistry (n=335), nursing and health profession (n=190), and biochemistry, genetics and molecular biology (n=68). Most of the highly-mentioned articles were review papers. The relationship between the altmetric attention score and citation performance of MJIR articles was not significant (p>0.05).
ConclusionThis study is one of the first studies to investigate the altmetrics indicators of articles published in an Iranian high-prestigious internationally-wide medical journal. Using social media tools can certainly promote medical scholars' scientific interactions and make added value for research published in medical journals. Editorial boards, including that of MJIRI can use altmetrics for detecting research trends and publishing approaches and consequently increased citation counts and research impact.
Keywords: Medical Journal of the Islamic Republic of Iran, Bibliometrics, Altmetrics, Social Media, Highly-Cited Articles, Highly-mentioned Articles -
Pages 1306-1319Background
Stress is an influential factor in mental health; and can lead to psychological disorders. Thus, it has always been a concern for the medical personnel, and particularly dental students. This systematic review aimed to assess the dental environment stress and the related factors in the Iranian dental students.
MethodsIn this systematic review, an electronic search of the literature was carried out in the Iranian and international databases, and all possible combinations of relevant keywords were searched using the Boolean operators. Data were analyzed using STATA SE 13.1 meta-analysis software. Heterogeneity of the data was evaluated using the I2 statistics, and the correlation between age and level of stress was analyzed by meta-regression. In the Chi-square (X2) heterogeneity test, P-value < 0.05 was considered significant.
ResultsA total of 16 eligible articles (3,521 dental students) out of 821 retrieved studies were reviewed in this systematic review. The mean overall stress level of the Iranian dental students was 2.18 (95% CI:1.87-2.49). The maximum (2.21) and minimum (2.10) mean overall stress values of the Iranian dental students were associated with the dental environment stress (DES) questionnaire and the depression, anxiety and stress scale (DASS-21), respectively (P>0.05). Also, the 4th and 5th year dental students had the maximum (2.24) and minimum (2.01) mean overall stress levels, respectively (P>0.05). Gender had no correlation with the stress level (P=0.520).
ConclusionThe mean stress level of the Iranian dental students is moderate to high. Since stress reduction is directly correlated with the promotion of mental health and function, the authorities are required to revise the educational curricula following consultation with the counselors and implement effective programs to minimize the stress level of dental students. Also, achieving efficient communication between dental students and instructors can greatly improve the quality of clinical education.
Keywords: Dental Stress Analysis, Dental Students, Dentistry, Meta-Analysis, Environment, Psychological Stress -
Pages 1320-1354Background
The Universal Health Coverage (UHC) is a very important and effective policy in the health system of countries worldwide. Using the experiences and learning from the best practices of successful countries in the UHC can be very helpful. Therefore, the aim of the present study is to provide a scoping review of successful global interventions and practices in achieving UHC.
MethodsThis is a scoping review study that has been conducted using the Arkesy and O'Malley framework. To gather information, Embase, PubMed, The Cochrane Library, Scopus, Scientific Information Database, and MagIran were searched using relevant keywords from 2000 to 2019. Studies about different reforms in health systems and case studies, which have examined successful interventions and reforms on the path to UHC, were included. Articles and abstracts presented at conferences and congresses were excluded. Framework Analysis was also used to analyze the data.
ResultsOut of 4257 articles, 57 finally included in the study. The results showed that of the 40 countries that had successful interventions, most were Asian. The interventions were financial protection (40 interventions that were categorized into 14 items), service coverage (31 interventions categorized into 7 items), population coverage (36 interventions categorized into 9 items), and quality (18 interventions categorized into 7 items), respectively. Also, the positive results of interventions on the way to achieving UHC were financial protection (14 interventions), service coverage (7 interventions), population coverage (9 interventions), and quality (7 interventions), respectively.
ConclusionThis study provides a comprehensive and clear view of successful interventions in achieving the UHC. Therefore, with consideration to lessons learned from successful interventions, policymakers can design appropriate interventions for their country.
Keywords: Universal Health Coverage, Health Care Reform, Financing, Services Coverage, Quality, Scoping Review -
Pages 1355-1359Background
Severe indirect hyperbilirubinemia causes neurotoxicity, leading to potential permanent injuries to the neonatal nervous system. The present study intended to compare the effectiveness and complications of Single-Surface Intensive Phototherapy (SSIP) and Double-Surface Intensive Phototherapy (DSIP) in treating non-hemolytic hyperbilirubinemia in the neonatal ward of the Besat Hospital, Hamadan, Iran.
MethodsIn this prospective randomized clinical trial, 150 healthy full-term neonates born between 37-42 weeks gestation with ages <14 days old and birth weights ≥2500 gr who were affected by non-hemolytic hyperbilirubinemia with total serum bilirubin of 15-20 mg/dL were randomly allocated to two groups. Each group (n=75) underwent either SSIP or DSIP. Demographics, bilirubin level alterations, weight, platelet count, number of defecation per day, and body temperature of the patients were monitored and recorded in a specific questionnaire. Data analysis was performed using SPSS version 26.0 software, with the Chi-square and independent t-test.
ResultsThe pre-intervention levels of indirect bilirubin were 17.07±1.46 mg/dL in the SSIP group and 17.10±1.54 mg/dL in the DSIP group (P-value = 0.853). After 24 and 48 hours of treatment, the mean indirect bilirubin level of the SSIP group reduced to 13.12±1.71 mg/dL and 9.69±1.68 mg/dL, respectively. In the DSIP group, the levels were 11.85±2.17 mg/dL and 8.43±1.56 mg/dL after 24 and 48 hours of treatment, respectively. The absolute reductions of indirect bilirubin were 7.76±3.28 mg/dL for the SSIP group and 8.96±4.49 mg/dL for the DSIP group (P-value = 0.458). Therefore, the indirect bilirubin levels were significantly different between the groups after 24 and 48 hours of treatment and at the time of discharge (P<0.05). There were no significant inter-group differences in weight, platelet count, and incidence of skin rash, while the number of defecation and body temperature were higher in the DSIP group (P <0.05). However, body temperature alterations had no clinical relevance.
ConclusionCompared to the SSIP, the DSIP showed faster effectiveness and led to a shorter hospital stay, while it did not entail higher levels of complications.
Keywords: Neonates, Non-hemolytic Hyperbilirubinemia, Single-Surface Intensive Phototherapy, Double-Surface Intensive Phototherapy -
Pages 1360-1369Background
Action Observation Therapy (AOT) is a top-down approach that has been recently introduced in the rehabilitation of neurological disorders mainly after stroke. The main goal of this study was to investigate the effects and feasibility of a new technique in AOT procedure (called self-AOT) following periods of no treatment and routine AOT intervention on upper limb motor function, occupational performance and neurophysiological changes in a stroke patient.
MethodsA single-subject A-B-A-C design was used and a 58-year-old woman with a 3-year history of left hemiplegia poststroke participated in this study. In the baseline (A1, A2) phases, the patient received no treatment. In the first intervention (B phase), she received a 4-week AOT, and in the second intervention (C phase), a 4 week of Self-AOT was practiced. In all phases, upper limb motor recovery as a target outcome was evaluated on 4 occasions using the Fugl-Meyer assessment. Upper limb function, dexterity and spasticity were assessed using Action Research Arm Test, Box-Block Test and Modified Modified Ashworth Scale respectively. Occupational Performance/Satisfaction was assessed with Canadian Occupational Performance Measure and to assess neuroplasticity, Motor Evoked Potential was recorded by Transcranial Magnetic Stimulation. Visual analysis, slope, and percentage of non-overlapping data were used for assessing the changes between phases.
ResultsPercentage of non-overlapping data and slopes indicated that motor recovery had clinically relevant improvements after both interventions compared to baselines. Other outcomes also showed improvements except for spasticity of wrist/elbow flexors and Motor Evoked Potential of opponens indicis.
ConclusionSelf-AOT may be as effective as other procedures of AOT for improving upper limb motor function, occupational performance/satisfaction, and cortical excitability post-stroke.
Keywords: Action Observation Therapy, Mirror Neurons, Neuroplasticity, Stroke, Upper Limb -
Pages 1370-1381Background
Social network analysis (SNA) evaluates the connections and behavior of individuals in social groups. The scientific collaboration network is a kind of SNAs. A social network could be defined as a collection of nodes (social existence) and links (connections) associated with the nodes. The aim of this study was to evaluate the scientific outputs and collaboration networks of the countries and authors using indicators of SNA in the field of pituitary disorders between 2000 and 2020.
MethodsThis is a practical study performed by applying a scientometric approach and SNA. We retrieved 31257 papers in the field of pituitary disorders between 2000 and 2020. Data were analyzed using scientific software, namely, VOSviewer, UciNet, and Netdarw.
ResultsBased on degree centrality, Colao and Pivonello in the world, Shimon and Kadioghlu in the Middle-East (ME), and Khamseh, Ghorbani in Iran achieved the top ranking. Based on the betweenness centrality, Pivonello, Colao, and Chanson in the world, Laws, and Kadioghlu in the Middle-East, and Larijani, Mohseni, and Khamseh in Iran were known as the top authors. According to closeness centrality, Pivonello, Colao, and Chanson in the world, Kadioghlu and Kelestimur in the Middle-East, and Mohseni, Khamseh, and Larijani in Iran were the top authors. The map of the authors’ collaboration in the field of pituitary disorders consists of 92 nodes. A total number of 77313 authors had global collaboration. The global collaboration network was comprised of 129 nodes (country) and 2694 links (country’s collaboration). The Middle-East collaboration network revealed 69 nodes and 1708 links. The collaboration network of the Middle-East countries consists of 13 nodes and 50 links.
ConclusionAuthors with a higher degree, betweenness and closeness centrality have greater efficiency (the number of articles) and effectiveness (the number of received citations). Moreover, the authors and countries that published more scientific products received more citations. In addition, in the Middle-East countries, the interdisciplinary scientific collaboration between the researchers in the fields of endocrinology, neurosurgery, pathology, and radiology has a significant impact on improving scientific outputs.
Keywords: Scientometric, Scientific Collaboration Network, Co-Authorship, Social Network Analysis (SNA), Pituitary Disorders -
Pages 1382-1388Background
The emergence of the coronavirus disease 2019 (COVID-19) pandemic has created unprecedented challenges across the globe. In addition to its debilitating impacts on health, the pandemic has also resulted in sudden changes in the quality of life. Our study aims to assess and highlight the alterations in lifestyle, health practices, and perceived anxiety in amongst the Pakistani denizens during the categorical lockdown across the country.
MethodsA cross-sectional study was conducted during April 2020 through an online self-administered questionnaire using the snowball sampling technique. The online survey included a diversified set of questions ranging from the demographics, participants’ sleeping routine, physical activity, hygiene habits, daily routine, and dietary habits during the quarantine period. It also assessed their anxiety through a series of questions, stretching from their own apprehension of their mental health to their assumption regarding the uncertainty of the future. SPSS v23 was used for data analysis, and chi-square test was applied.
ResultsA total of 384 respondents were included in the study. The mean age of the participants was 21.26 ± 4.267 years. It was observed that 203 (52.9%) individuals spent most of their time in self-isolation on social media, and 167 (43.5%) of participants claimed to be undertaking online classes or watching television. Furthermore, half of the participants noted that their sleep duration had increased 194 (50.5%), along with increased levels of perceived anxiety 242 (63%).
ConclusionThe imposed nationwide lockdown due to COVID-19 has extensively affected the daily routine of the people living in Pakistan, eliciting profound changes in their sleeping patterns, dietary habits, mental health, and physical activity. Therefore, addressing the issues that arise amidst the lockdown remains pivotal.
Keywords: COVID-19, Anxiety, Lifestyle, Public Health Practices -
Pages 1389-1397Background
Refugees are the most vulnerable to mental health problems of all migrant groups. Epidemiological studies measuring the prevalence of mental health disorders in resettled refugee populations have found high rates of psychiatric disorders, including post-traumatic stress disorder (PTSD), depression, and anxiety. To investigate the evidence of Social Determinant of Mental Health in Immigrants and Refugees
MethodsWe searched PubMed, Web of Science, Embase, Scopus, Cochrane Library, and ProQuest databases electronically. The interval selected for searching articles was between 2000-2021. After selecting articles based on inclusion and exclusion criteria, data were extracted, and the results were summarized.
ResultsAmong 306 initial studies, 11 studies were the inclusion criteria. In these studies, the target population was people who had immigrated to countries or become refugees for various reasons. In 7 of 11 studies, social factors affecting the mental health of refugees were examined. In four studies, these factors were examined in immigrants. In most studies, social determinants of mental health were common among refugees and migrants.
ConclusionImproving each of the determinants of health plays an important role in increasing the level of mental health of immigrants and refugees.
Keywords: Social Determinant, Mental Health, Refugee, Immigrant -
Pages 1398-1402Background
A successful delivery depends on the coordinated work of all medical personnel. Compliance with the basic principles of teamwork is the key to the quality of medical care. The purpose of this study was to investigate the issues of teamwork of healthcare professionals during delivery.
MethodsThis descriptive study was conducted in 2019 in Almaty, Republic of Kazakhstan. A total of 40 doctors and 40 midwives who provide inpatient care for women during childbirth took part in the study. Based on the questionnaire, the authors conducted a standardized survey. The tools for statistical processing of the obtained data were Microsoft Excel and Software IBM SPSS Statistics 25.0. The authors used the Student's t-test to calculate the significance of differences.
ResultsThe results of the study showed that 85% of the respondents believed that the size of the team did not require changes. Approximately 2/3 of the respondents evaluated the efficacy of delivery techniques used by the team as “medium” and “low”. Compliance with the general approach based on mutually agreed principles was partial. The opinions of the doctors and midwives differed significantly regarding fair distribution of responsibilities in the team and the level of trust in the team.
ConclusionAs a result of the study, it was concluded that there is an urgent need to introduce modern team-building technologies into the daily practice of healthcare professionals of the obstetrician-gynecological service.
Keywords: Health Care, Treatment Efficacy, Non-Specific Microorganisms, Antibacterial Drugs -
Pages 1403-1411Background
Ensuring integrated people-centred health services (IPCHS) that offer universal access, social equity, and financial protection within a primary health care method is important toward universal health coverage and health sustainable development goals. Hospitals are part of this ambitious agenda. The purpose is to review the health system and to list and summarize hospital interventions.
MethodsDocument review. As part of our review, we selected health systems reports for conceptualizing IPCHS frameworks at the country level as well as those focusing on the hospital sector. Our research team collected and analyzed data including governance, financing, human resource, provision service, and reforms based on the health system report of 14 countries.
ResultsThe review showed 26 challenges, most of which were in Eastern European countries, with 48 interventions in 3 themes and 13 subthemes.
ConclusionDue to the paradigm shift, there is a need for change. However, a much better positive view is needed to determine the role of hospitals in the service delivery system. The IPCHS framework provides guidance for countries in setting priorities, and formulating, implementing, and evaluating national policy/strategic plans for their hospital sector. Although the vision and interventions should be adapted to local context, different policy instruments may be needed to specifically tackle the most pressing local issues. Recognizing differences in countries’ contexts will help to develop realistic and applicable solutions.
Keywords: Hospitals, Integrated, People-Centred, Universal Health Coverage, European, Narrative Review -
Pages 1412-1417Background
According to the World Bank, the medical tourism industry in 2016 generated more than $100 billion revenue turnover for the destination countries. This study aims to investigate the developmental requirements of medical tourism industry in Iran to identify sustainable development strategies within this sector.
MethodsThe present study was an applied-analytical study performed in a cross-sectional manner. A total of 25 experts, including policy experts, decision-makers, and managers with over 10 years of experience in the health system and familiar with the process of attracting medical tourists from foreign countries were asked to compare options for the development of the medical tourism. Expert opinions were analyzed using a fuzzy analytical hierarchy process using the open-source R Studio software.
ResultsOut of the 5 items included in the questionnaire, the criterion of "government policy making and related entities" was ranked the first in terms of importance and prioritization for medical tourism development (0.249) through attracting domestic and foreign investments followed by advertising and marketing (0.241). Also, the criteria of "destination characteristics" and "facilities and status of service capacities with 0.111 and 0.185 weights had the lowest weight among the 5 items, respectively.
ConclusionIn general, governments play a key role in marketing and promoting the nascent medical tourism industry. Experts in the field believe that the role of government, policy and decision-makers in medical tourism can be an advantage for its prosperity and development.
Keywords: Medical tourism, AHP, Fuzzy, Iran -
Pages 1418-1422Background
Media literacy refers to a set of skills designed specially to help people make better health decisions while dealing with media tasks. The present study was conducted to investigate the relationship between media literacy and willingness to be vaccinated among medical students.
MethodsThis is a descriptive cross-sectional study. The statistical population consisted of all students at Iran University of Medical Sciences, among whom, 389 samples were recruited. Two questionnaires were used: (1) Media Literacy and (2) Willingness to be Vaccinated. The validity of these questionnaires was confirmed by the content validity method and consultation with experts. Data were analyzed using Pearson correlation, t test, and one-way analysis of variance using SPSS v. 20 (SPSS Inc).
ResultsThe willingness to be vaccinated was higher in men (23.04 ± 5.59) than in women (21.07 ± 3.77) and this difference was significant (P<.001). However, there was no significant difference between willingness to be vaccinated and marital status, educational level, and age. The findings showed a significant relationship between media literacy and willingness to be vaccinated.
ConclusionThe effect of media literacy on retrieving and recognizing accurate information is one of the crucial results of the present study. This skill affects an individual’s willingness to make the right decision on timely COVID-19 vaccination.
Keywords: Media literacy, COVID-19, Vaccine, Student