Iranian Red Crescent Medical Journal
Year:2021 | Volume:23 | Issue:11|Papers Count:11

Background: Neural tube defects (NTDs) are classed as multifactorial birth defects of the brain and spinal cord that arise during embryonic development. Although the etiology is not well understood, NTDs are reported to be prevented by maternal folic acid supplementation before and during early pregnancy. Objectives: This meta-analysis study aimed to assess the association between fetal and maternal methylenetetrahydrofolate reductase (MTHFR) C677T and methionine synthase reductase (MTRR) A66G polymorphisms with the risk of NTDs. Methods: The PubMed, Scopus, and Springer Link databases were searched (from March 2000 to November 2020) for the literature on the association between MTHFR C677T and MTRR A66G polymorphisms with the risk of NTDs. Results: In total, 33 studies were reviewed in the present study, and it was revealed that, unlike MTRR A66G polymorphism, MTHFR C677T was statistically associated with the risk of NTDs in the overall population. The results of subgroup analysis showed that the Indian subcontinent subgroup with maternal MTHFR C677T polymorphism and the European subgroup with fetal MTHFR C677T polymorphism was significantly susceptible to NTDs. Conclusion: The obtained results revealed that, unlike MTRR A66G, maternal and fetal MTHFR C677T polymorphisms were significantly associated with NTDs. Subgroup analysis also demonstrated that folic acid deprivation can be considered the main cause of MTHFR C677T polymorphism in some areas.

Background: Trauma is considered an important issue in most countries. Identification of the factors affecting the length of stay (LOS) in the intensive care unit (ICU) plays a crucial role in controlling the costs and complications of prolonged hospitalization. Objectives: This study aimed to identify the factors affecting the LOS of trauma patients in the ICU using stepwise and new penalized variable selection methods in count data regression. Methods: The patients’,information was evaluated in Emtiaz Hospital and Shahid Rajaee trauma center in Shiraz from March 2016 to September 2017. Count regression model was used to determine the factors affecting the LOS of patients in the ICU using penalized variable selection including, Enet, Snet, and Mnet. Results: The mean age of the patients (n=382) was obtained at 36. 7±, 16. 7 years, and the majority (88. 4%) of the patients were male. The mean LOS in the ICU was determined at 6. 2±, 6. 6 days. Mnet with a negative binomial distribution outperformed the other penalized variable selection methods. A Glasgow Coma Scale (GCS) of less than 9 (IRR=1. 7), blunt brain trauma (IRR=1. 8), chest trauma (IRR=2. 2), and oxygen saturation of less than 90 (IRR=1. 2) increased the LOS of trauma patients in the ICU. Conclusion: Penalized variable selection methods effectively ignore or control the existing correlations between predictors. Amongst the penalized models, Mnet provided more acceptable results with smaller Akaike information criterion and fewer predictors. According to this penalty, the most important factors affecting the length of stay were chest trauma, blunt brain trauma, GCS, and oxygen saturation rate. Most clinical studies on trauma have also shown the importance of these factors.

Background: Acquired immunodeficiency syndrome (AIDS) is a pandemic and a health challenge in the world, posing a serious risk to people from all walks of life. Awareness Campaign has been increasingly used in recent years to convey persuasive messages to perform specific behaviors in the target group. The present study aimed to determine the effectiveness of AIDS prevention and awareness campaign in students using Kirkpatrick s Evaluation Model. Methods: This cross-sectional study was conducted in border areas of Sarvabad City, Iran, in 2018. A total of 564 high school students were randomly selected. This research was performed based on the Kirkpatrick model which considers the effectiveness of training programs in four levels of reaction, learning, behavior, and results. The required data were collected by a questionnaire based on the Kirkpatrick model. The media used in this campaign included: banners, pamphlets, videos, and training by health experts. Data were analyzed in SPSS software (version 20). Results: The most attractive media used in the awareness campaign for participants were training provided by health professionals (speech and Q&A session), as well as educational videos, pamphlets, and banners, respectively. Based on the results, students' awareness and behavior significantly improved after the campaign by 51. 6% and 25. 6%, respectively (P≤, 0. 00). Conclusion: As evidenced by the results of the present study, the Kirkpatrick model was effective and can be employed to evaluate the awareness campaign since it demonstrates the positive changes caused by training in reaction, learning, and behavior. Therefore, effectiveness evaluation in all subjects needed to be improved through the implementation of optimizing training design.

Background: A majority of colorectal neoplasms are adenocarcinomas,however, there is a small percentage of tumors from other histological cell lines. Objectives: This study aimed to examine the rare colon and rectum tumors to determine the clinicopathological features of rarely observed histological types and present them to the literature in a comparative way. Methods: A total of 1100 patients were applied for surgical treatment due to colorectal cancer at a general surgical clinic between 2010 and 2020. The selected patients were divided into four groups of Diffuse large B-cell lymphoma (DLBCL), Malignant melanoma (MM), Medullary carcinoma (MC), and Neuroendocrine tumor (NET). Following that, clinicopathological data of patients and their survival periods have been compared in this study. Results: A total of 20 patients were included in this study and were divided into the DLBCL (n=5), MM (n=4), MC (n=3), and NET (n=8) groups. The emergency application rate (60%) was the highest in the DLBCL group (P=0. 004). The mean age of the patients was above 50 years in all groups, and there was no difference among groups in this regard (P=0. 966). The mean tumor diameter values were 8, 6. 55, 5. 4, and 3. 75 cm, respectively (P=0. 73) in the groups. Furthermore, the numbers of lymph nodes dissected were 13, 14. 5, 19, and 19, respectively (P=0. 373), and the numbers of metastatic lymph nodes were determined at 0, 1. 5, 0, and 0. 5, respectively (P=0. 188). The survival rate was significantly the shortest in the MM group, and the longest survival rate was noted in the NET group (15. 625, 8. 5, 20, 40. 857, respectively,P=0. 001). Conclusion: Although clinicopathological features and postoperative follow-up results were similar, there were differences in the survival rates among patients. Malignant melanoma histopathological type had a worse prognosis than the other tumors.

Background: Xanthogranulomatous cholecystitis (XGC) is a rarely encountered chronic inflammatory condition presenting with severely proliferated fibrotic tissue. It usually spreads the neighboring organs, imitates gallbladder cancer, and may lead to difficulty in cholecystectomy. Objectives: This study aimed to review the clinical and radiological findings, as well as surgical treatment results of XGC. Methods: This retrospective study analyzed the clinical features of 36 cases with a diagnosis of XGC on pathology. The patients were operated on in our institute between 2012 and 2019. Results: The rate of XGC in cholecystectomy patients was found to be 0. 6 % (36/5999) in the hospital where this study was performed over seven years. The patients were aged 33-87 years, and the median age when the patients were diagnosed was 57 years. Moreover, the majority of the patients (52. 8%,n=19) were male (male to female ratio: 1/1. 11). The XGC was not accompanied by gallbladder carcinoma in any of these cases and could not be diagnosed in any of the patients prior to surgery. Radiological imaging performed before surgery demonstrated cholelithiasis, thickening of the gallbladder wall, and suspicious cancer in 29 (80. 6%), 28 (77. 8%), and 2 (5. 6%) patients, respectively. However, none of the cases of XGC had concomitant gallbladder cancer. In total, 9 (25%) patients underwent open cholecystectomy, and 27 (75%) cases were scheduled to have laparoscopic cholecystectomy,however, 6 (16, 8%) of these patients were converted to open cholecystectomy. Conclusion: Laparoscopic cholecystectomy for XGC is possible,however, it is often difficult due to severe inflammation. Patients with XGC have a higher rate of conversion to open surgery and complications, compared to those with other forms of cholecystitis. The XGC may resemble gallbladder cancer based on the diagnostic imaging findings, and intraoperative frozen section analysis is essential to avoid unnecessarily extended surgery.

Background: Fissure is a common chronic anorectal disease that causes symptoms such as pain, burning, bleeding, and psychiatric problems. One of the psychiatric complications is anxiety, which might be an etiologic factor or secondary to the disease. Objectives: The present study aimed to investigate the effect of anti-anxiety medications on the clinical symptoms of patients with anal fissures. Methods: A total of 160 patients with anal fissure were randomly divided into two groups (80 patients treated with anti-anxiety medications along with standard anal fissure treatment and 80 patients with standard anal fissure treatment alone) after obtaining patient consent and demographic data. Then, the symptoms have recorded after treatment. Results: The results of our study indicated that the administration of anti-anxiety medications in patients with anal fissures relieved pain and anxiety scores among all patients. The anti-anxiety medications were more effective on patients younger than 40 years, men with less than two weeks duration of illness, and baseline anxiety greater than 26. Conclusion: A high prevalence of anal fissures affects the quality of life of patients. Besides the lack of effective treatment that shortens the pain and recovers patients faster, anti-anxiety medications such as benzodiazepines can use along with standard anal fissure treatment to reduce pain and anxiety in patients with acute anal fissure.

Background: COVID-19 has raised a worldwide trajectory since it emerged in Wuhan, China in December 2019. The direct and indirect mortalities in the world and as well as in Iran have increased significantly after the occurrence of this pandemic. Objectives: In this study, Excess Mortality Rate (EMR) was estimated by multilevel poison regression method and then this estimation was compared to the historical trends to obtain total deaths related to COVID-19. Additionally, the geographic distribution of EMR has also been presented for Iran. Methods: All-cause mortality rates of each province of Iran from March 21, 2013 to September 22, 2021 was downloaded from National Organization for Civil Registration (NOCR). The data of COVID-19 pandemic period (spring 1399 SH (Mar 20, 2020) to summer 1400 SH (Sep 22, 2021)) was removed from the data and then the multilevel poison model was applied to estimate all-cause mortality in this period. Then, EMR= (real deaths-expected death)/(real deaths) ratio was calculated. Results: The results of this study showed that Iran’, s EMR in COVID-19 pandemic was 36% (Male=35%, Female=36%, P-value=0. 798). Our findings also revealed four category of EMR including low (EMR≤, 30%, n=9), moderate (30 %< EMR≤, 35%, n=8), high (35 %< EMR≤, 40%, n=10) and very high (40 %< EMR, n=4) in different provinces. Conclusion: Due to the diverse EMR in different provinces of Iran, the type of disease management of provinces with low and moderate EMR can be used as an appropriate model to control EMR in provinces with high and very high EMR.

Context: During the past three decades, the Middle East has experienced three major viral epidemics. Coronavirus disease 2019 (COVID-19) is a pulmonary disease which has been first reported in China in the early third decade of the 21st century and quickly infected people in Asia, the Middle East, and the entire world. This pandemic is life-threatening and has caused widespread financial losses,however, the exact extent of the damage is still unclear. Evidence Acquisition: This review study aimed to present the latest on the COVID-19 symptoms, pathogenicity, host immune responses, etiology and epidemiology, transmission routes in the Middle Eastern countries, especially Iran, and the role this country plays in the spread of the disease. The search was conducted using Google scholar, PubMed, Scopus, and ISI Web of Science to identify relevant studies published from 2019 to 2021. Results: Many countries do not have sufficient equipment to prevent, identify, and treat the disease and still have major challenges in controlling this deadly virus. In Iran, a Middle Eastern country, people faced widespread disease and deaths due to the lack of facilities caused by heavy economic and political sanctions. These challenges affect not only Iran but also many neighboring countries. Over time, mutations in the SARS-CoV-2 virus led to the emergence of various variants of the virus, such as Alpha (B. 1. 1. 7), Beta (B. 1. 351), Gamma (B. 1. 1. 28. 1), and Delta (B. 1. 617. 2). Conclusion: Different variants of SARS-CoV-2 virus pose a substantial menace to public health due to their high transmissibility and ability to escape the immune system. Recently, concerns have increased about the risk of hospitalization and the high spread rate of the COVID-19 delta variant.

Introduction: Pulsating varicose vein is a very rare clinical manifestation and mostly has been reported with tricuspid regurgitation or right ventricular dysfunction. The exact etiology and treatment options for this disease are rarely reported in the literature. Case Presentation: This article presents the case of a 45-year-old woman with varicose veins in both her lower limbs when she came to our department. Venous ultrasound showed arterial-like pulsations in both superficial and deep veins of the lower extremities, and echocardiography showed severe tricuspid regurgitation. We administered compression therapy with elastic stockings, and the symptoms of the patient were significantly relieved. In addition, in this article, we reviewed other cases reported in the current literature and discussed appropriate treatment options for this disease. Conclusion: Pulsating varicose veins are very rare clinical manifestations and mostly have been reported with tricuspid regurgitation or right ventricular dysfunction. For the treatment of this disease, multidisciplinary teams in cardiology, vascular surgery, and anesthesia are the best choices.

Background: Export orientation is one of the main approaches in developing the Iranian pharmaceutical industry as a key health-related part of industries. It is necessary to identify, formulate, and implement some foresightful strategies and strategic plans toward adopting the export approach in the Iranian pharmaceutical industry. Objectives: This paper aimed to identify, prioritize, and develop a structural model of foresightful export-oriented strategies and strategic plans for the Iranian pharmaceutical industry. Methods: Data gathering for identifying strategies was conducted through literature review and some interviews with pharmaceutical industry experts were analyzed through qualitative content analysis. Afterward, the fuzzy DEMATEL technique was used to prioritize and develop cause and effect and structure the model of identified strategies. Results: Policy modification, privatization, smart self-sufficiency in production, knowledge management at both national policy and industry firm levels, and quality improvement in all aspects of production and products were identified as foresightful export-oriented strategies and plans for the Iranian pharmaceutical industry. Conclusion: Privatization is the most effective and important foresightful export-oriented strategy in the Iranian pharmaceutical industry.

Background: The potential impact of the novel coronavirus pandemic on social mental health has become a great concern, and the current situation can cause different mental disorders. Objectives: According to the importance of mental health, this study was conducted to evaluate the mental health status of the general population of Iran in Razavi Khorasan Province, Iran. Methods: An online survey was conducted and made available for the general population of Razavi Khorasan through the snowball sampling technique within a week. The demographic information, contact history with COVID-19, and physical symptoms history of COVID-19 were collected by the survey. To maintain the population's mental health status, the Depression, Anxiety, and Stress Scale-21, which was developed by Lovibond and Lovibond (1995), was used. To reduce the risk of bias, the online survey was supposed to be filled with a maximum of two members of a family. The data were analyzed in SPSS software (version 21) by calculating descriptive statistics and using the Chi-square test. The significance level was considered at the p-value of < 0. 05 in all analyses. Results: Finally, 461 responders from Razavi Khorasan Province were included in this study. In total, 41. 8%, 32. 1%, and 34. 5% of the responders had depression symptoms, were in anxiety mood, and had stress symptoms, respectively. The ratio of men to women was approximately 1: 2. Most participants were in the age range of 30-40 years, and the most frequent marital status was being single. Families with 3-5 members constituted 81. 5% of the responders. Near one-third of the studied population had a bachelor's degree. Conclusion: According to the results of our study, it is important to pay attention to the general population’, s mental health status during the COVID-19 pandemic and conduct protocols to prevent or reduce the risk of mental disorders that can be caused by the current situation.