Iranian Red Crescent Medical Journal
Year:2014 | Volume:16 | Issue:10|Papers Count:20

Background: Low back pain (LBP) is a common complaint in population that lowers the quality of life. The main etiology of LBP is recognized in about 20% of patients while it is attributed to lumbar disk herniation (LDH) in 80% of cases and causes some unnecessary lumbar surgeries without realizing the definite cause.Objectives: This study was planned to evaluate the etiologies of LBP in patients who had LDH to clarify whether the disc herniation is the main cause of patients’ pain or other diseases were responsible for this kind of pain.Materials and Methods: In this cross-sectional study, we analyzed the medical profiles of the patients with proven LDH in a private clinic in Mashhad City, Iran, between 2005 and 2012, for demographic and the etiologies of LBP with clinical and paraclinical studies. We also calculated the incidence of each etiology by SPSS 13.Results: In our study, among 1250 patients with proven LDH by MRI, 500 patients (40%) had chronic LBP and the most common causes of LBP were heavy constant working (40.2%), osteoporosis (35.6%), and sacroiliac joint pain (34.6%), consecutively. Interestingly, LDH had the ninth rank among the common cause of LBP.Conclusions: In this study, we found that in spite of previous beliefs, discopathies were not common etiologies of LBP. Thus, even in patients with proven LDH by imaging studies, the physician should perform a thorough evaluation for other causes of LBP to avoid unnecessary lumbar surgeries.

Background: Financial management and accounting reform in the public sectors was started in 2000. Moving from cash-based to accrual-based is considered as the key component of these reforms and adjustments in the public sector. Performing this reform in the health system is a part of a bigger reform under the new public management.Objectives: The current study aimed to analyze the movement from cash-based to accrual-based accounting in the health sector in Iran.Patients and Methods: This comparative study was conducted in 2013 to compare financial management and movement from cash-based to accrual-based accounting in health sector in the countries such as the United States, Britain, Canada, Australia, New Zealand, and Iran. Library resources and reputable databases such as Medline, Elsevier, Index Copernicus, DOAJ, EBSCO-CINAHL and SID, and Iranmedex were searched. Fish cards were used to collect the data. Data were compared and analyzed using comparative tables.Results: Developed countries have implemented accrual-based accounting and utilized the valid, reliable and practical information in accrual-based reporting in different areas such as price and tariffs setting, operational budgeting, public accounting, performance evaluation and comparison and evidence based decision making. In Iran, however, only a few public organizations such as the municipalities and the universities of medical sciences use accrual-based accounting, but despite what is required by law, the other public organizations do not use accrual-based accounting.Conclusions: There are advantages in applying accrual-based accounting in the public sector which certainly depends on how this system is implemented in the sector.

Background: Nursing teachers have difficulties fulfilling multiple roles expectations and balancing the various dimensions of their roles that may lead to role strain. In order to lack of culturally and academically proper scale in Iran to measure role strain in nursing teachers, localizing a foreign scale in this field is necessary.Objectives: The objective of this study was psychometric evaluation of the Role Strain Scale (RSS) and confirming its structural model in an Iranian population.Materials and Methods: The present cross- sectional study was conducted in 2012, comprising 302 nursing teachers from around the country who were selected using stratified- cluster sampling. Psychometric evaluation process of the RSS was carried out by Face, content and constructs validity (confirmatory and exploratory factor analysis). Reliability was examined using test-retest and Cronbach's alpha for internal consistency reliability.Results: In the primary results, in spite of being approved by face and content validity, in Construct validity, fitness indices of original Role Strain Scale showed no satisfactory findings in Iranian data. Therefore, some items from the structural model of original version were extracted by exploratory factor analysis and a five-factor model with 33 items was obtained. These factors were role conflict, role ambiguity, role overload, role incompetence, and role incongruity. New model as Persian version of RSS was confirmed by calculating fitness indices such as GFI=0.93, AGFI=0.94, NFI=0.91, RMSEA=0.093. Internal consistency reliability for the total scale and subscales were respectively 0.92, and 0.71-0.84. Results from Pearson correlation test indicate a high degree of test-retest reliability (r=0.89). ICC was also 0.91.Conclusions: This reliable and valid scale is academically appropriate for nursing teachers to measure role strain and helps detect and predict a multiplicity of role problems and consequently make educational managers aware of nursing teachers’ difficulties while facing with multiple roles and possible future challenges.

Background: Demand for ICU beds is exceeding its supply. Since the sources are limited in some centers, it is necessary to design a model to identify the patients who benefit more from ICU beds.Objectives: The present study aimed to develop a model to prioritize adult patients according to their clinical indications by a three rounded Delphi method study.Patients and Methods: In this study, 22 physicians who practiced in a source limited hospital in southern Iran were invited to participate in a three phase Delphi survey.Results: At first, the panelists recommended 30 indications. The indications in the first checklist plus those obtained by literature review formed the second checklist which contained 36 items. The items were scored from 0 to 10 by the panelists. According to the scores, the indications were categorized into three priority levels, which were confirmed by the panelists in the third round.Conclusions: This simple checklist contains the indications for ICU admission categorized into three priority levels. This checklist can be considered as a guide for physicians who practice in hospitals with limited number of ICU beds.

Background: Wound healing is a complex process. Different types of skin cells, extracellular matrix and variety of growth factors are involved in wound healing. The use of recombinant growth factors in researches and production of skin substitutes are still a challenge.Objectives: Much research has been done on the effects of gene therapy and cell therapy on wound healing. In this experimental study, the effect of insulin-like growth factor (IGF-1) gene transfer in fibroblast cells was assessed on acute dermal wound healing.Materials and Methods: Fibroblasts were cultured and transfected with IGF-1. Lipofectamine 2000 was used as a reagent of transfection. Transgene expression levels were measured by the enzyme linked immunosorbent assay (ELISA). To study in vivo, rats (weighing 170-200 g) were randomly divided into three groups (five/group) and full-thickness wounds were created on the dorsum region. Suspensions of transfected fibroblast cells were injected into the wound and were compared with wounds treated with native fibroblast cells and normal saline. For the microscopic examination, biopsy was performed on day seven.Results: In vitro, the maximum expression of IGF1 (96.95 pg/mL) in transfected fibroblast cells was 24 hours after gene transfer. In vivo, it was clear that IGF-1 gene therapy caused an increase in the number of keratinocyte cells during the wound healing process (mean of group A vs. group B with P value=0.01, mean of group A vs. group C with P value=0.000). Granulation of tissue formation in the transfected fibroblast group was more organized when compared with the normal saline group and native fibroblast cells.Conclusions: This study indicated that the optimization of gene transfer increases the expression of IGF-1. High concentrations of IGF-1, in combination with cell therapy, have a significant effect on wound healing.

Background: Several studies indicated that there is a high prevalence of vitamin D deficiency in Middle East countries.Objectives: The aim of this study was to determine the prevalence and assess some risk factors of vitamin D deficiency among women attending our clinics in Tehran, the capital of Iran.Patients and Methods: Five hundred and thirty-eight women aged 20-80 years were entered in this cross-sectional study from 2011 to 2012. Serum 25-hydroxy vitamin D levels were measured in all participants after recruiting their demographic and anthropometric data and past medical histories. Deficiency was defined as levels less than 35 nmol/L and classified as mild (³ 25 nmol/L), moderate (12.5-25 nmol/L) and severe (£ 12.5 nmol/L).Results: The prevalence of vitamin D deficiency was 69%; mild, moderate and severe degrees were seen in %10.4, %38.3, and %20.3 respectively. Analysis of logistic regression shows that age (OR: 0.96, CI: 0.93-0.97), menopause (OR: 0.44, CI: 0.21-0.99) and consumption of multivitamin supplements (OR: 2.67, CI: 1.4-5) were independent predictive factors for Vitamin D deficiency.Conclusions: This study showed a high prevalence of vitamin D deficiency among Iranian women especially in reproductive ages.

Background: The need for effective management of intellectual and academic assets is constantly growing. The nursing educational system should be considered as a storage of knowledge since it is deposited in the nursing educational system in the form of intellectual investment.Objectives: The purpose of the present study was to explore nursing knowledge storage in the nursing educational system.Materials and Methods: The participants of this study consisted of eight nursing educators and five students. The inductive content analysis method was used in this research. Participants were interviewed through the semi-structured method. Data analysis was done by five stage framework approaches. The trustworthiness of the study was ensured through validity and acceptability criteria.Results: Data analysis showed that nursing educators and students were involve in teaching and learning activities by storing knowledge in subjective and objective forms. Knowledge was gained through the different educational activities of the nursing educators and through contact with their peers. Moreover, the nursing students gained knowledge for better learning and a more knowledgeable and advanced performance with the help of the educators.Conclusions: This study revealed the main components of knowledge storage. An enhanced preservation of explicit knowledge is recommended in the nursing educational system so that in the future, students and educators can easily access the same knowledge from storage sources and not from individuals who might be carrying only a single experience of the subject.

Background: Researchers have regarded moral distress as a major concern in the health care system. Symptoms associated with moral distress may manifest as frustration, dissatisfaction, and anxiety and may lead to burnout, job leaving, and finally, failure to provide safe and competent care to patients. Proper management of this phenomenon can be fulfilled through study of its causes at different levels of health services and taking necessary measures to solve them.Objectives: This study aimed to determine the status of moral distress in physicians practicing in hospitals affiliated to Medical Sciences Universities in Tehran.Materials and Methods: This cross-sectional study was carried out using the Standard Hamric Scale to collect data after modification and evaluation of its reliability and validity. A total of 399 physicians responded to the scale. Data analysis was performed using descriptive and correlation statistics with respect to the variables.Results: Results showed that the frequency of moral distress of physicians was 1.24±0.63 and the intensity of moral distress and composite score of moral distress were 2.14±0.80 and 2.94±2.38, respectively. A significant negative correlation existed between age and frequency and composite score (r=-0.15, P<0.01 and r=-0.16, P<0.01, respectively) as well as years of experience and composite score (r=-0.11, P=0.04). Moral distress composite score in adults specialists was higher than pediatricians (P=0.002), but lower in physicians participated in medical ethics training courses compared to those not participated.Conclusions: Physicians may encounter moral distress during their practice; therefore, the common causes of distress should be identified in order to prevent its occurrence.

Background: Praziquantel, an antischistosomal compound, is used as first-line drug for chemotherapy of Schistosoma japonicum since 1984. In this article, we conducted a systematic review and mete-analysis to evaluate the efficacy and safety of different dosages of praziquantel (PZQ) for treatment of Schistosoma japonicum.Evidence Acquisition: A number of six articles published in peer-reviewed journals before December 2012 were selected for analysis after searching the following literature databases: PubMed/Medline, the Chinese WanFang Literature Database, China National Knowledge Infrastructure (1994-2012.12), and the Chinese Biomedical Literature (1978-2012.12).Results: The meta-analyses showed that there is no statistically significant difference of the negative rate on the egg using 40 mg/kg compared to 60 mg/kg PZQ for S. japonicum treatment (RR 0.79, 95% CI 0.46 1.35; P<0.39). The meta-analysis showed that there is no statistically significant difference of the side effects using 30 mg/kg compared with 40 mg/kg (RR 0.97, 95% CI 0.68 1.38; P=0.87), 40 mg/kg compared with 60 mg/kg (RR 0.79, 95% CI 0.46 1.35; P=0.39) and 50 mg/kg compared with 60 mg/kg (RR 0.89, 95% CI 0.56 1.42; P=0.63).Conclusions: According to the results, there is no statistically significant difference in different doses of PZQ for treating S. japonicum.

Background: Renal ischemia/reperfusion injury (IRI) is a major problem in renal transplantation, which occurs during the process of organ retrieval and storage, and is closely associated with acute rejection episodes and late allograft failure. Recent studies have revealed a new phenomenon called "chemical preconditioning" that can induce tolerance against the ischemic stress via a variety of proposed pathways especially nitric oxide (NO) system. Propylthiouracil (PTU) is suggested to modulate the intracellular NO signaling.Objectives: In this study, we investigated the preconditioning properties of chronic pretreatment with PTU in preventing renal IRI. In addition, we evaluated the involvement of NO pathway.Materials and Methods: Sixty adult male Wistar rats were allocated into six groups. All groups underwent right nephrectomy 15 days before intervention. In groups 1 (Chronic PTU+L-NG-nitro arginine methyl ester [L-NAME]) and 2 (Chronic PTU) oral PTU (500 mg/L in water) treatment was started 15 days before right nephrectomy to achieve the therapeutic plasma level of PTU. Fourteen days after nephrectomy, animals received either L-NAME (10 mg/kg) or its vehicle and renal IRI was induced 45 minutes later. Groups 3 and 4 (Control) received respectively L-NAME (10 mg/kg) and its vehicle 45 minutes before IRI. The last two groups were normal sham operated rats and PTU+sham. Rats were killed 24 hours after IRI. The blood samples were collected and assessed for serum blood urea nitrogen (BUN) and creatinine (Cr) level, and tissue samples were fixed in formalin for histopathologic scoring of tubular damage (H-score).Results: The mean BUN, Cr, and H-score of control group were 176.66±12.24 mmol/L, 4.45±0.44 mmol/L, and 83.5%±3.5%, respectively. Chronic pretreatment with PTU significantly improved BUN (40.4±6.1 mmol/L), Cr (0.96±0.068 mmol/L), and H-score (7.83%±4.02%) in IRI animals in comparison to those that were not treated with chronic PTU (P<0.001) and L-NAME; however, it did not completely reversed the chronic PTU-induced protection (BUN, 93.33±12.22 mmol/L; Cr, 2.7±1.15 mmol/L, and H-score, 24.83%±3.5%). There was no significant difference between rats that were treated with L-NAME alone (group 5) and the control group.Conclusions: Our study demonstrates that preconditioning of kidney with chronic PTU administration protects renal tissue against IRI and this phenomenon was mediated through NO system. The results suggest a potential indication for using PTU to protect the kidney before transplantations and to reduce the risk of tissue rejection afterwards.

Background: Menopause is a period of women’s lives with changes and symptoms that affect their work, sleep and quality of life. Therefore, it is important to overcome these symptoms.Objectives: The aim of the present study was to compare the effects of Calci soya balance and Vitagnus on menopausal symptoms.Patients and Methods: This double-blinded controlled trial study was performed in public health centers of Tehran University of Medical Sciences (2011-2012). Seventy postmenopausal women with menopausal symptoms were randomly divided into two groups of treatments with Vitagnus and Calci soya balance. Data were collected using interviews, answering Cooperman’s index questionnaires before four and eight weeks after the treatment. Descriptive and analytic statistics were used for analyzing the data.Results: In both groups, Wilcoxon test showed a significant decrease in the mean of Cooperman's menopausal index as well as after four and eight weeks of treatment (P=0.000). Mann-Whitney test did not show any significant differences between the two groups, before and after four and eight weeks of treatment.Conclusions: The results showed that both Vitagnus and Calci soya balance were effective on reduction of menopausal symptoms to a similar extent and medical community can administer each of these two drugs based on patients' conditions and costs.

Background: The most common hospital-acquired pathogen is Pseudomonas aeruginosa. It is a multidrug resistant bacterium causing systemic infections.Objectives: The present study was carried out in order to investigate the distribution of virulence factors and antibiotic resistance properties of Pseudomonas aeruginosa isolated from various types of hospital infections in Iran.Patients and Methods: Two-hundred and seventeen human infection specimens were collected from Baqiyatallah and Payambaran hospitals in Tehran, Iran. The clinical samples were cultured immediately and samples positive for P. aeruginosa were analyzed for the presence of antibiotic resistance and bacterial virulence genes using PCR (polymerase chain reaction). Antimicrobial susceptibility testing was performed using disk diffusion methodology with Mueller-Hinton agar.Results: Fifty-eight out of 127 (45.66%) male infection specimens and 44 out of 90 (48.88%) female infection specimens harbored P. aeruginosa. Also, 65% (in male specimens) and 21% (in female specimens) of respiratory system infections were positive for P. aeruginosa, which was a high rate. The genes encoding exoenzyme S (67.64%) and phospholipases C (45.09%) were the most common virulence genes found among the strains. The incidences of various b-lactams encoding genes, including bla TEM, bla SHV, bla OXA, bla CTX-M, bla DHA, and bla VEB were 94.11%, 16.66%, 15.68%, 18.62%, 21.56%, and 17.64%, respectively. The most commonly detected fluoroquinolones encoding gene was gyrA (15.68%). High resistance levels to penicillin (100%), tetracycline (90.19%), streptomycin (64.70%), and erythromycin (43.13%) were observed too.Conclusions: Our findings should raise awareness about antibiotic resistance in hospitalized patients in Iran. Clinicians should exercise caution in prescribing antibiotics, especially in cases of human infections.

Background: Empowerment of children and adolescents in terms of social skills is critical for promoting their social health.Objectives: This study attempts to explore a framework of influential factors on empowering primary school students by means of peer mediation from the stakeholders' point of view, as a qualitative content analysis design.Patients and Methods: This study was a qualitative content analysis (conventional method). Seven focused group discussions and six in-depth interviews were conducted with schoolchildren, parents and education authorities. Following each interview, recordings were entered to an open code software and analyzed. Data collection was continued up to data saturation.Results: Within the provided framework, the participants' views and comments were classified into two major categories "educational empowerment" and "social empowerment", and into two themes; "program" and "advocacy". The "program" theme included factors such as design and implementation, development, maintenance and improvement, and individual and social impact. The "advocacy" theme included factors such as social, emotional and physical support.Conclusions: The explained framework components regarding peer mediation are useful to design peace education programs and to empower school-age children in peer mediation.

Background: During the past decade, incidence of asthma has increased, which might have been due to environmental exposures.Objectives: Considering the expansion of cable manufacturing industry in Iran, the present study was conducted to evaluate the prevalence of occupational asthma in a cable manufacturing company in Iran as well as its related factors.Patients and Methods: This study was conducted on employees of a cable manufacturing company in Yazd, Iran, in 2012. The workers were divided into two groups of exposure (to toluene diisocyanate, polyvinyl chloride, polyethylene or polypropylene) and without exposure. Diagnosis of occupational asthma was made based on the subjects’ medical history, spirometry and peak flowmetry, and its frequency was compared between the two groups.Results: The overall prevalence of occupational asthma was 9.7%. This rate was 13.8% in the exposed group. Logistic regression analysis showed that even after adjustment for confounding factors, a significant correlation existed between the frequency of occupational asthma and exposure to the produced dust particles (P<0.05). In addition, age, work experience, body mass index, cigarette smoking and shift work had significant correlations with the prevalence of occupational asthma (P<0.05).Conclusions: Considering the high prevalence of occupational asthma among cable manufacturing company workers in Iran, this issue needs to be addressed immediately in addition to reduction of exposure among subjects. Reduction in work shift duration, implementation of tobacco control and cessation programs for the personnel, and performing spirometry tests and respiratory examinations in shorter periods may be among effective measures for reducing the incidence of occupational asthma in this industry.

Introduction: Superior mesenteric artery syndrome is an uncommon cause of duodenal obstruction, and its manifestations are generally associated with compression on the third part of the duodenum between the abdominal aorta and superior mesenteric artery.Case Presentation: In this report, a patient is described presenting with epigastric pain and weight loss due to superior mesenteric artery syndrome. The patient has also nutcracker syndrome, which is the compression of the left renal vein between the aorta and the superior mesenteric artery at its origin.Conclusions: In addition to an appropriate clinical history, CT findings indicating decreased aortomesenteric angle and a shortened aortomesenteric distance can suggest the diagnosis for both the superior mesenteric artery syndrome and accompanying nutcracker syndrome.

Background: Development of noise-induced hearing loss is reliant on a few factors such as frequency, intensity, and duration of noise exposure. The occurrence of this occupational malady has doubled from 120 million to 250 million in a decade. Countries such as Malaysia, India, and the US have adopted 90 dBA as the permissible exposure limit. According to the US Occupational Safety and Health Administration (OSHA), the exposure limit for noise is 90 dBA, while that of the US National Institute of Occupational Safety and Health (NIOSH) is 85 dBA for 8 hours of noise exposure.Objectives: This study aimed to assess the development of hearing threshold levels beyond 25 dBA on adoption of 85 dBA as the permissible exposure limit compared to 90 dBA.Patients and Methods: This is an intervention study done on two automobile factories. There were 203 employees exposed to noise levels beyond the action level. Hearing protection devices were distributed to reduce noise levels to a level between the permissible exposure limit and action level. The permissible exposure limits were 90 and 85 dBA in factories 1 and 2, respectively, while the action levels were 85 and 80 dBA, respectively. The hearing threshold levels of participants were measured at baseline and at first month of postshift exposure of noise. The outcome was measured by a manual audiometer. McNemar and chi-square tests were used in the statistical analysis.Results: We found that hearing threshold levels of more than 25 dBA has changed significantly from pre-intervention to post-intervention among participants from both factories (3000 Hz for the right ear and 2000 Hz for the left ear). There was a statistically significant association between participants at 3000 Hz on the right ear at 'deteriorated' level (c2(1) =4.08, j=- 0.142, P=0.043), whereas there was worsening of hearing threshold beyond 25 dBA among those embraced 90 dBA.Conclusions: The adoption of 85 dBA as the permissible exposure limit has preserved hearing threshold level among participants at 3000 Hz compared to those who embraced 90 dBA.

Background: About one third of unwanted reported medication consequences are due to medication errors, resulting in one-fifth of hospital injuries.Objectives: The aim of this study was determined formal and informal medication errors of nurses and the level of importance of factors in refusal to report medication errors among nurses.Patients and Methods: The cross-sectional study was done on the nursing staff of Shohada Tajrish Hospital, Tehran, Iran in 2012. The data was gathered through a questionnaire, made by the researchers. The questionnaires' face and content validity was confirmed by experts and for measuring its reliability test-retest was used. The data was analyzed by descriptive statistics. We used SPSS for related statistical analyses.Results: The most important factors in refusal to report medication errors respectively were: lack of medication error recording and reporting system in the hospital (3.3%), non-significant error reporting to hospital authorities and lack of appropriate feedback (3.1%), and lack of a clear definition for a medication error (3%). There were both formal and informal reporting of medication errors in this study.Conclusions: Factors pertaining to management in hospitals as well as the fear of the consequences of reporting are two broad fields among the factors that make nurses not report their medication errors. In this regard, providing enough education to nurses, boosting the job security for nurses, management support and revising related processes and definitions are some factors that can help decreasing medication errors and increasing their report in case of occurrence.

Background: Arnebia euchroma ointment (AEO) has been used in Iranian traditional medicine for burn wound healing.Objectives: The aim of this study is to evaluate wound healing efficacy of AEO in burn wounds after fractional Co2 laser.Patients and Methods: This split-face, single-blinded, single-center clinical study was performed in Shohada-e-Tajrish Hospital, Tehran, Iran. A total of 26 subjects with facial acne scar, who were to receive fractional CO2 laser resurfacing were recruited. After laser procedure, AEO was applied to one side of the face and petrolatum on the other side for wound healing. Digital photographs were taken from acne scar area before resurfacing and on each of the assessment sessions. Three researchers, who were unaware of the applied medications, assessed these digital photographs for erythema, edema, epithelial confluence, crusting/scabbing, and general wound appearance. Subject’s irritations such as dryness and itching were evaluated on the second, fifth, and seventh days.Results: Our study indicated higher epithelial confluence and general wound appearance scores (P=0.045 for both) and less erythema and edema on fifth day in petrolatum (P=0.009 and P=0.034, respectively). The results showed less crusting and erythema (P=0.016 and P=0.035, respectively) and higher general wound appearance scores in petrolatum on the second day (P=0.035 and P=0.001, respectively). Dryness was the most common subjective complaint in both groups; however, it was more severe in AEO, especially on the second day (P=0.023).Conclusions: Despite the healing effects of AEO in burn wounds, petrolatum was more effective than AEO in post-laser wound.

Background: Wart is a skin disease with circular appendages, which is called "suloul" in Iranian traditional medicine (ITM). According to ITM literature, warts have different types and causes. The most important mechanism is excretion of materials (Khelt) from body to skin and mucus; its causative material is often phlegm, black bile or a combination of them. To treat warts, it is necessary to consider the patient’s life style, modify his dietary intake and moisturize his temperament.Objectives: This study aimed to compare Myrtus communis L. and Descurainia sophia L. as a method of ITM, versus salicylic acid in treatment of wart.Patients and Methods: In this study, conducted in Yazd, Iran, 100 patients were selected and randomly divided into four groups. Group 1) salicylic acid, group 2) salicylic acid and D. sophia L. group 3) M. communis L. group 4) M. communis L. and D. sophia L. Numbers, sizes of lesions and symptoms, on days 0, 20, 40 and 90 were examined and analyzed. The relapse rate was investigated three months after. Changes of sizes and numbers of warts in each period of time in each group, compared to baseline, were assessed by Wilcoxon Signed Rank test. To compare these changes between the groups, Kruskal Wallis test was used.Results: In this study 100 patients participated, 69% of which were female. Compared to baseline, mean±SD of changes for the number of warts in day 40 were 1.12±4.2, 0.96±2.5, 1.32±5.1 and 0.04±0.2 respectively in the four groups (P=0.02). Mean±SD of changes for the number of warts in day 90 were 1.84±4.5, 1.56±2.8, 1.24±5.1 and 0.04±0.6 respectively in the four groups (P=0.03). In addition mean±SD of changes for the size of warts in day 40 were 0.96±1.8, 1.03±2.4, 2.47±3.0 and 0.45±1.7 respectively in the four groups (P<0.001). Mean±SD of changes for the size of warts in day 90 were 1.24±2.1, 1.3±2.3, 2.45±3.1 and 0.45±1.7 respectively in the four groups (P<0.001). Relapse was not seen in any groups after three months. The frequency of side effects was similar after three months.Conclusions: M. communis L. can be used as a topical treatment for warts. It not only shows more rapid response than salicylic acid, but also has fewer side effects. It seems that D. sophia L. can modify the digestion process and patients can excrete large amounts of the substance that causes warts. Therefore, it is better to use it more than 40 days. According to our investigation, in ITM, considering the cause and mechanism of disease generation and the causing materials of the disease, different treatments should be applied for each patient. Although applying an appropriate treatment is necessary, a unique treatment for all the patients cannot be available.

Background: Abortions are of major public health concern in developing countries. In settings in which abortion is highly prohibited, the direct interview is not a reliable method to estimate the abortion rate. The indirect estimation methods to measure the rate of abortion might overcome this dilemma; They are practical methods to estimate the size of the hidden group who do not agree to participate in a direct interview.Objectives: The aim of this study was to explore the practicality of an indirect method for estimating the abortion rate, Known as Network Scale-up, and to provide an estimate about the episode of abortion with and without medical indications (AWMI+and AWMI-) in Iran.Materials and Methods: This cross-sectional study was conducted in 31 provinces of Iran in 2012. A random sample between 200 and 1000 was selected in each province by the multistage sampling method that 75% of the data were collected from the capital and 25% from one main city. We selected samples from urban people more than 18 years old (12960) and we asked them about the number of abortion in women they knew who had experienced the medical and non-medical abortions in the past year. A range for the transparency factor was estimated based on the expert opinion.Results: The range of the transparency factors for AWMI+and AWOMI- were 0.43-0.75 and 0.2-0.34, respectively. Regarding the AWMI+, our minimum and maximum estimations (per 1000 pregnancies) were 70.54 and 116.9, respectively. The corresponding figures for AWMI- were 93.18, and 148.7.Conclusions: The frequency rates for AWMI+and AWMI- were relatively high. Therefore, the system has to address to this hidden problem using the appropriate preventive policies.