Iranian Journal of Medical Sciences
Year:2021 | Volume:46 | Issue:2|Papers Count:9

After almost one year of intense global struggle with SARS-CoV-2 since its first report in Dec. 2019, 1 the introduction of several vaccines for COVID-19 prevention has revived hopes in many people around the world. Several vaccines already approved or started to use in different countries are mostly developed based on the spike antigens of SARS-CoV-2, which not only is involved in cell receptor recognition and virulence, 2 but also is very antigenic. 3 The FDA or/and EMA approved vaccines include BNT162b2 (Pfizer and BioNTech), mRNA-1273 (Moderna, USA), AZD1222 (Oxford-AstraZeneca), Janssen COVID-19 Vaccine (Johnson & Johnson). Sputnik V (Gamaleya, Russia), BBIBP-CorV (Sinopharm, China), and CoronaVac (Sinovac, China) are accepted for use in some countries as well. Several others are also in Phase III clinical trials, which might be added to this list soon, such as NVX-CoV2373 (Novavax, USA), Ad5-nCoV (CanSinoBIO, China), and some others. The different approaches and platforms used in these vaccines have led to their varied performances, storage conditions, and prices. Though, the efficacy of these vaccines, despite some variations, are mostly far above the previous expectations; and the benefit of COVID-19 vaccination has been already reported in some countries based on the need for mechanical ventilation, as a sign of severe disease...

Background: Given the significance of the preparedness and responsiveness of healthcare systems in relation to epidemics, this study aimed to determine their influencing factors during epidemic crises with a view to utilizing the findings in the battle against the coronavirus disease 2019 (COVID-19) outbreak. Methods: This scoping study was conducted in 2020 via the Arksey and O’ Malley approach. A systematic search was conducted on five online databases from January 2000 to June 15, 2020. Initially, 1926 English articles were retrieved based on their abstracts. After the screening process, 60 articles were considered for the final analysis. Data were charted by applying Microsoft Office Excel 2013 and were synthesized via thematic analysis. Results: Five main factors have affected the responsiveness and preparedness of countries during the epidemics of severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), and COVID-19: community-related interventions, managerial interventions, socioeconomic factors, the readiness of hospitals and health centers, and environmental factors. These themes are associated with 38 related sub-themes. The thematic framework shows that interactions between these five determinantes can affect the preparedness and responsiveness of healthcare systems during pandemics/epidemics. Conclusion: According to the results, healthcare systems need to pay attention to their internal capacities, managerial interventions, and health centers to overcome the current pandemic. They should also consider such external factors as socioeconomic and environmental determinants that can affect their potential preparedness against pandemic/epidemic crises. Community-related interventions such as improvement of the community health literacy, teamwork, and social responsibility can enhance the readiness of healthcare systems against the COVID-19 outbreak.

Background: One of the main health problems in the world is hepatitis B virus (HBV) infection. Vaccination and other factors can affect HBV infection. As various effective factors have been reported in different regions and studies, this study aimed to investigate the association between HBV infection and routine vaccination and other effective factors 25 years since the launch of the national vaccination program in Iran. Methods: This cross-sectional study, conducted in 2017 in Shiraz (Iran), investigated factors such as demographic variables such as gender, education, and occupation, vaccination status, and the potential risk factors for HBV infection. Hepatitis B surface antigen (HBsAg) and anti-hepatitis B core antibody (HBc Ab) tests were performed to determine HBV infection status. The data were analyzed using R software (version 3. 5. 2), using multivariate logistic regressions and machine learning methods. The level of significance was considered below 0. 05. Results: A total of 2720 individuals were enrolled in the study (194 cases with HBV infection). Based on the logistic regression analyses, factors such as a family history of the disease (OR=2. 53, P<0. 001), vaccination (OR=0. 57, P=0. 004), a history of highrisk behaviors (OR=1. 48, P=0. 022), and occupation (OR=1. 80, P=0. 035) were significantly associated with HBV infection. Based on the conditional tree method, a family history of infection (P<0. 001) and vaccination (P=0. 023) were two important factors in classifying individuals for HBV infection. Conclusion: Based on the different methods applied in this study, HBV infection was affected by factors such as a family history of the disease, national HBV vaccination, and occupation. It appears that HBV vaccination, launched by the Iranian Ministry of Health and Medical Education in 1993, has reduced HBV infection.

Background: Multiple sclerosis (MS) is the most prevalent progressive sensory/neurological disability in young adults, with important psychological consequences. The present study was designed to assess the effectiveness of group counseling with a client-centered approach based on the GATHER principles on sexual satisfaction in women with MS. Methods: In this clinical trial, conducted from January 2018 to May 2019, in the MS Referral Center of Tehran (Iran), 72 eligible participants were assigned to intervention and control groups (36 in each group) via simple randomization. The intervention group received group counseling based on the client-centered approach, while the control group received routine counseling. Data were collected using the Larson Sexual Satisfaction Questionnaire (LSSQ) at three different time points: before the intervention, after the final session, and one month after the intervention. The collected data were analyzed in SPSS software (version 19). In order to analyze the obtained data, independent t test, Mann– Whitney U test, paired t test, Wilcoxon test, Chisquare test, Fisher exact test, and Friedman test were used. Results: The mean score of sexual satisfaction before the intervention showed no statistically significant difference between the two groups. Based on the Friedman test in the intervention group, the trend of changes in the mean score of sexual satisfaction had a significant difference before the intervention, after the final session, and one month after the intervention (P=0. 001); however, no significant difference was observed in the control group. Conclusion: Our results showed the effectiveness of group counseling with a client-centered approach based on the GATHER principles on sexual satisfaction and intimacy among women with MS.

Background: Detecting the latent dimensions of quality of life as affected by oral diseases is essential for promoting oral health in children. This study aimed to test the Early Childhood Oral Health Impact Scale (ECOHIS) via an appropriate method to detect its dimensions of quality of life as affected by oral diseases. Methods: An analytical cross-sectional study was carried out in Shiraz, Iran, between 2014 and 2015. A multistage stratified design was used to select 830 parents or the guardians of primary school children aged six years. The Farsi version of the Early Childhood Oral Health Impact Scale (F-ECOHIS) was used to evaluate the children’ s oral health-related quality of life. The parents were interviewed to collect data on ECOHIS. Mplus, version 7, was employed for descriptive and analytical analyses in the present study. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were performed to extract and verify the latent dimensions of ECOHIS. Results: Out of the 830 invited parents or guardians, 801 participated in this study. The mean ECOHIS score was 21. 95± 7. 45. The mean child impact score and the mean family impact score were 14. 25± 5. 72 and 7. 70± 3. 62, respectively. EFA yielded a 3-factor model: symptom and function, social interaction, and family impact. CFA confirmed the 3-dimensional model (root mean square error of approximation=0. 045). The fit indices of the 1-and 2-dimensional models (the child and family domains) were not within the acceptable range. Conclusion: F-ECOHIS is a 3-dimensional model rather than the hypothetical 6-dimensional model. ECOHIS appears to be a useful scale for measuring the multidimensional impact of oral diseases in children.

Background: Patients undergoing cardiac surgery are particularly prone to delirium. This study aimed to evaluate the effect of melatonin administration on the inhibition of postoperative delirium in patients undergoing open-heart surgery. Methods: This study was conducted as a double-blind randomized clinical trial in Golestan Hospital. Ahvaz, Iran, (September 2018 to March 2019). Sixty patients undergoing elective on-pump coronary artery bypass graft surgery were enrolled in the study, and they were randomly divided into a group receiving 3 mg of melatonin and a group receiving a placebo. The main outcomes were delirium occurrence and delirium intensity up to 48 hours after extubation. The data were analyzed using SPSS, version 22, (SPSS, Chicago, IL). Group comparisons were performed using the t test and the Chi-square test. Statistical significance was defined as a P value of less than 0. 05. Results: On the first postoperative day, delirium developed in four (13. 3%) patients in the melatonin group and 11 (36. 6%) patients in the control group; the difference between the groups was statistically significant (P=0. 037). On the second postoperative day, delirium developed in three (10%) patients in the melatonin group and 14 (46. 6%) patients in the control group, with the difference in the incidence of delirium between the groups constituting statistical significance (P=0. 029). The severity of delirium between group was significant on the first and second postoperative days (P=0. 003). Conclusion: Melatonin may be effective in reducing the severity of delirium after cardiac surgery. The effect of melatonin as a delirium prevention agent should be considered in patients admitted in the cardiovascular intensive care.

Background: One of the major indices of immunodeficiency is lymphoid organ atrophy. Some trace elements are candidates for the treatment of this defect. These conditions may induce structural changes in the sub-components of lymphoid organs. Therefore, this study evaluated the effect of selenium on volumetric changes in dexamethasone (DEX)-induced lymphoid organ atrophy in an animal model. Methods: This study was conducted at Histomorphometry and Stereology Research Centre, Shiraz University of Medical Sciences, Shiraz, Iran, in September 2016 to September 2017. Thirty-two male rats were divided into four groups: Group I; control (normal saline, 0. 5 mL/kg, intraperitoneally), Group II; DEX (0. 4 mg/kg; intraperitoneally), Group III; selenium plus DEX (similar to Group II and Group IV), and Group IV; selenium (0. 1 mg/kg; orally). At the end of the experiment, the rats’ thymus, spleen, and lymph nodes were removed, processed, and stained by hematoxylin and eosin (H&E). The volume and volume density of theses organs were estimated by stereology. The results were analyzed using the Mann– Whitney U-test and the Kruskal– Wallis test. Results: The volume of the thymus as well as its cortex and medulla; the volume of the spleen as well as the volume density of its white pulp, periarterial lymphatic sheath zone, and follicles; and the volume of the lymph nodes as well as their inner (P=0. 001) and outer (P=0. 007) cortices showed a significant reduction in the DEX-treated animals in comparison with the controls. In the DEX plus selenium-treated animals, maximum effects were observed on the increment in the thymic cortex (P=0. 001), the outer cortex of the lymph nodes (P=0. 012), and the splenic follicles (P=0. 018) in comparison with the DEX group. There was no significant difference between the animals receiving selenium treatment and the controls in terms of lymphoid organs. Conclusion: Selenium may improve lymphoid organ structures in an immunodeficiency rat model but has no effect on normal lymphoid tissues.

Background: Mebudipine, a dihydropyridine calcium-channel blocker (CCB), shows greater time-and voltage-dependent inhibitory effects than nifedipine. Its significant negative chronotropic effects without having considerable negative inotropic properties may make it a suitable candidate for the pharmacotherapy of heart failure (HF). This study aimed to investigate the possible beneficial action of mebudipine in a rat model of HF. Methods: The present study carried out in the Department of Pharmacology at the Iran University of Medical Sciences during the years of 2009-2011. An experimental model of HF was induced in male Wistar rats using doxorubicin (DOX). The rats were divided into five groups with seven animals in each group: normal control group, DOX-induced HF control groups, and treatment groups. The animals were administered DOX for 15 days. A consistent deterioration occurred after a four-week rest period. The animals were then treated with intraperitoneal mebudipine (0. 5 mg/kg) and intraperitoneal amlodipine (0. 35 mg/kg), as well as an equal volume of distilled water for 15 days. The plasma levels of big endothelin-1 (BET-1), creatine kinase-myocardial band (CKMB), lactate dehydrogenase (LDH), aspartate aminotransferase (AST), and alanine aminotransferase (ALT), as well as the clinical status (heart rate and blood pressure), were assessed before and after treatment. Statistical analysis was performed with SPSS software using parametric and nonparametric ANOVA. Results: Mebudipine and amlodipine reversed the increased plasma BET-1 values in the treated animals when compared with the HF control group (0. 103 and 0. 112 vs 0. 231 pg/ mL, respectively). The increased plasma levels of AST, ALT, CK-MB, and LDH were also reversed in the HF animals that received mebudipine or amlodipine. Conclusion: The administration of mebudipine to HF animals, akin to amlodipine, palliated the clinical and biochemical signs of the disease in the present study. The abstract was presented in the Iranian Congress of Physiology and Pharmacology as a poster and published in the Scientific Information Database as a supplement (2015; Vol 22).

Dear Editor Congenital uterine anomalies arise out of incomplete bilateral paramesonephric (i. e., Mü llerian) duct elongation, fusion, or canalization. The prevalence rate of such malformations has been reported at 5. 5% in the general population, increasing up to 24. 5% in women experiencing miscarriage and infertility. A bicornuate uterus describes a type of lateral fusion defect, classified as a type III uterine anomaly according to the American Society for Reproductive Medicine. It constitutes 26% of all uterine malformations and may similarly lead to infertility, and even adverse pregnancy outcomes such as recurrent pregnancy loss or preterm delivery...