Iranian Red Crescent Medical Journal
Year:2015 | Volume:17 | Issue:4|Papers Count:20

Background: Primary dysmenorrhea with interferes in daily activities can have adverse effects on quality of life of women.Objectives: Regarding the use of herbal medicine, the aim of this study was to assess the effect of cinnamon on primary dysmenorrhea in a sample of Iranian female college students from Ilam University of Medical Sciences (west of Iran) during 2013-2014.Patients and Methods: In a randomized double-blind trial, 76 female student received placebo (n=38, capsules containing starch, three times a day (TDS)) or cinnamon (n=38, capsules containing 420 mg cinnamon, TDS) in 24 hours. Visual analogue scale (VAS) was used to determine the severity of pain and nausea. Vomiting and menstrual bleeding were assessed by counting the number of saturated pads. The parameters were recorded in the group during the first 72 hours of the cycle.Results: The mean amount of menstrual bleeding in the cinnamon group was significantly lower than the placebo group (P<0.05 and P<0.001, respectively). The mean pain severity score in the cinnamon group was less than the placebo group at various intervals (4.1±0.5 vs.6.1±0.4 at 24 hours, 3.2±0.6 vs.6.1±0.4 at 48 hours, and 1.8±0.4 vs.4.0±0.3 at 72 hours, respectively) (P<0.001). The mean severity of nausea and the frequencies of vomiting significantly decreased in the cinnamon group compared with the placebo group at various intervals (P<0.001, P<0.05).Conclusions: Regarding the significant effect of cinnamon on reduction of pain, menstrual bleeding, nausea and vomiting with primary dysmenorrhea without side effects, it can be regarded as a safe and effective treatment for dysmenorrhea in young women.

Background: Diazinon (0, 0-Diethyl 0- (1-6-methyl-2-isoprophyl 4 pyrimidinyl) phosphorothioate) (DI) is a very effective organophosphate pesticide, used widely in agriculture. Consequently, data on poisoning cases secondary to DI exposure are important. The DI may affect a variety of tissues, including liver. Silibinin is a pharmacologically active constitute of Silybum marianum, with documented antioxidant activity.Objectives: The aim of our study was to evaluate both histopathologically and biochemically whether silibinin is protective in DI induced liver damage.Materials and Methods: Thirty two Wistar albino rats were divided into four groups, as follows: 1) control group - oral corn oil was given; 2) DI group - rats were administered orally 335 mg/kg in the corn oil solution; 3) Silibinin group - 100 mg/kg/day silibinin was given alone orally, every 24 hours for 7 days; 4) Silibinin+DI group - DI plus silibinin was given. All rats were sacrificed at the end of experiment. Superoxide dismutases (SOD), glutathione peroxidase (GPX), nitric oxide (NO) and myeloperoxidase (MPO) were investigated in serum and liver tissue. In addition, serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) enzyme activities were evaluated. The liver tissue was evaluated histopathologically with Hematoxilin & Eosin dye.Results: Biochemically, ALT, AST, NO, MPO in serum and NO, MPO in liver tissue were found to be significantly higher in DI group, compared to control group (P<0.001). In Group Silibinin+DI, serum AST, ALT, NO, MPO levels were significantly lower (P<0.01), and both serum and tissue SOD activities were significantly higher, compared to DI group (P<0.001). Diazinon induced histopathological changes in liver tissue were: severe sinusoidal dilatation, moderate disruption of the radial alignment of hepatocytes around the central vein, severe vacuolization in the hepatocyte cytoplasm, inflammation around central vein and portal region. In rats receiving both DI and silibinin, the DI induced changes accounted for less sinusoidal dilatation, vacuolization in the hepatocyte cytoplasm and the inflammation around central vein and portal region (P<0.05).Conclusions: The DI was found to induce liver damage by oxidative stress mechanisms. Silibinin reduced the oxidative stress by inducing antioxidant mechanisms, thereby showing protective effect against DI induced liver damage. Further studies with silibinin should be performed regarding DI toxicity.

Background: Labor and delivery is a stressful stage for mothers. During these periods, sleep-related disorders have been reported. The problems of inadequate sleep include decrease in concentration, judgment, difficulty in performing daily activities, and an increase in irritability. Even the effects of moderate sleep loss on life and health quality can be similar to sleep deprivation. some research aggravated by aromatherapy on sleep quality in different periods of life so might be useful for the improve of sleep quality in postpartum women.Objectives: This study aimed to determine the effect of aromatherapy on the quality of sleep in postpartum women. The sample was recruited from medical health centers of Zanjan University of Medical Sciences.Patients and Methods: This study was a randomized clinical trial with the control group. A total of 158 mothers in postpartum period (with certain inclusion criteria) were enrolled in the study and assigned randomly to two groups of control and intervention. Lavender fragrance (made by Barij Essence Pharmaceutical Co.) was used by participants in the intervention group nightly before sleeping.The fragrance was dropped on cotton balls, which were placed on a cylindrical container at mothers’ disposal. Keeping the container at a projected distance of 20 cm, the participants inhaled 10 deep breaths and then the container was placed beside their pillow until morning. This procedure was done 4 times a week for 8 weeks. For the control group, the same intervention was done with the placebo. The instrument for collecting data was Pittsburgh sleep quality index, which was completed at the baseline, fourth, and eighth weeks after the intervention. Data were analyzed using independent t test and repeated measures analysis of variance calculated by SPSS16.Results: Before the intervention, there were no significant differences between mothers in two groups (P>0.05). After 8 weeks follow up, a significant improvement appeared in mothers’ sleep quality in the intervention group. Aromatherapy increased sleep quality mean score (±SD) from 8.2911 (±2.1192) to 6.7975 (±2.3663) (P<0.05), but in the control group sleep quality mean score (±SD) changes from 8.4557 (±2.3027) to 7.5696 (±1.1464) (P>0.05). Comparing sleep quality between control and intervention groups after 8 weeks from the beginning of the intervention indicated that aromatherapy was effective in the improvement of mothers’ sleep quality (P<0.05).Conclusions: Considering the effects of aromatherapy on the improvement of mother’s sleep quality during postpartum period, aromatherapy has been suggested as a non-pharmacological method for the improvement of the maternal health.

Background: Tuberculosis (TB) is a major global health problem, which has been ranked as the second leading cause of death from an infectious disease worldwide. Diagnosis based on cultured specimens is the reference standard, however results take weeks to process. Scientists are looking for early detection strategies, which remain the cornerstone of tuberculosis control. Consequently there is a need to develop an expert system that helps medical professionals to accurately and quickly diagnose the disease. Artificial Immune Recognition System (AIRS) has been used successfully for diagnosing various diseases. However, little effort has been undertaken to improve its classification accuracy.Objectives: In order to increase the classification accuracy of AIRS, this study introduces a new hybrid system that incorporates a support vector machine into AIRS for diagnosing tuberculosis.Patients and Methods: Patient epacris reports obtained from the Pasteur laboratory of Iran were used as the benchmark data set, with the sample size of 175 (114 positive samples for TB and 60 samples in the negative group). The strategy of this study was to ensure representativeness, thus it was important to have an adequate number of instances for both TB and non-TB cases. The classification performance was measured through 10-fold cross-validation, Root Mean Squared Error (RMSE), sensitivity and specificity, Youden’s Index, and Area Under the Curve (AUC). Statistical analysis was done using the Waikato Environment for Knowledge Analysis (WEKA), a machine learning program for windows.Results: With an accuracy of 100%, sensitivity of 100%, specificity of 100%, Youden’s Index of 1, Area Under the Curve of 1, and RMSE of 0, the proposed method was able to successfully classify tuberculosis patients.Conclusions: There have been many researches that aimed at diagnosing tuberculosis faster and more accurately. Our results described a model for diagnosing tuberculosis with 100% sensitivity and 100% specificity. This model can be used as an additional tool for experts in medicine to diagnose TBC more accurately and quickly.

Background: Chronic Nonbacterial Prostatitis (CNBP) is a condition that frequently causes long-term pain and a significant decrease in the quality of life.Objectives: The present study aimed to examine the analgesic effects of oligonol, acupuncture, quantum light therapy and their combinations on estrogen-induced CNBP in rats.Materials and Methods: This experimental study was conducted in Edirne, Turkey, using a simple randomized allocation. A total of 90 adult male Wistar rats were randomized into 9 groups of 10 rats each: Group I, control; Group II, CNBP, Group III, oligonol only, Group IV, acupuncture only; Group V, quantum only; Group VI, oligonol+quantum; Group VII, acupuncture+oligonol; Group VIII, quantum+acupuncture; Group IX, acupuncture+quantum+oligonol. Oligonol treatment was given at a dose of 60 mg/day for 6 weeks. Conceptual vessels (CV) 3 and 4, and bilaterally urinary bladder (Bl) 32 and 34 points were targeted with 1-hour acupuncture stimulation. The quantum light therapy was applied in 5-minute sessions for 6 weeks (3-times/a week). For pain measurements, mechanical pressure was applied to a point 2 cm distal to the root of the tail to elicit pain and consequent parameters (peak force, latency time of response and total length of measurement) were assessed.Results: Analgesic effects were observed with all treatment regimens; however, the most prominent median analgesic effect was shown in the quantum light therapy in combination with acupuncture for estrogen-induced CNBP (PF1=663.9, PF2=403.4) (P=0.012). Furthermore, we observed that monotherapy with quantum light showed a better analgesic efficacy as compared to oligonol and acupuncture monotherapies (PF1=1044.6, PF2=661.2) (P=0.018, P=0.008, P=0.018; respectively).Conclusions: All treatment modalities showed a significant analgesic effect on CNBP in rats, being most prominent with the quantum light therapy.

Background: Gossypiboma is the term for forgotten textile products such as a surgical sponge and compress in the body cavity after a surgical procedure.Objectives: The aim of this study was to evaluate previously published articles related to post cholecystectomy gossypiboma.Materials and Methods: We conducted a systematic search using PubMed, Medline, Google and Google Scholar on post cholecystectomy gossypiboma. The keywords used were: gossypiboma and cholecystectomy, textiloma and cholecystectomy and post cholecystectomy gossypiboma. Furthermore, we also present a new case of post cholecystectomy gossypiboma.Results: A total of 32 articles concerning 38 patients with post cholecystectomy gossypiboma that met the aforementioned criteria were included. Detailed intraoperative findings and surgical management were provided. The patients were aged from 26 to 79 years (Mean±SD: 47±13.6 years); 32 were female and six were male. The time from the causative operation to presentation with a retained surgical sponge ranged from one to 480 months (Mean±SD: 56.5±93.5 months).Conclusions: Gossypiboma may not be symptomatic for many years or could be symptomatic for a short duration of time. Besides being a rare surgical complication, gossypiboma can lead to serious morbidity and mortality that may cause medico-legal problems. Diagnosis with imaging methods is difficult.

Background: Aerial firing is shooting, using fire arm, into the air usually during a celebration.Objectives: This observational study aimed to quantify magnitude and impact of stray bullet injuries by aerial firing at surgical emergencies of the Liaquat University Hospital (a university hospital), Hyderabad, Sindh, Pakistan from January 2009 to December 2010 (2 years).Patients and Methods: During the study period, 144 firearm injuries due to stray bullet reported to the A and E departments of the university hospital. All patients referred to surgical unit providing emergency cover on that day irrespective of the severity of the injury for medico-legal reasons. For this study, the cases were divided into those having trivial injury and do not require any active surgical intervention and those having serious injury mandating surgical intervention. One hundred and two cases of stray bullet injury sustained trivial injury and followed as outpatients after an overnight period of indoor hospitalization; however, 42 patients with stray bullet injuries requiring surgical intervention were hospitalized.Results: The most common events leading to aerial firing and stray bullet injuries were marriage ceremonies, followed by a political rallies and New Year celebrations. Stray bullet injury also reported after aerial firing on cricket/hockey team victories, Pakistan Independence Day (14th August), cultural day in Sindh and Basant (Kite) festival in Punjab. The most frequent sites with serious stray bullet injury were chest (15), head and neck (10), abdomen (9) and limbs (8), respectively. Surgical interventions performed included chest intubation, exploration of wound tract to retrieve bullet if lodged superficially and was palpable, laparotomy to managed intra-abdominal injury, reduction of fracture site followed by reconstruction, flap reconstruction and graft for nonhealing wound. The mean duration of hospital stay was 19 days. No mortality was observed in this series of patients.Conclusions: We conclude that the prevalence of aerial firing resulting in stray bullet injuries is alarmingly on rise in our country. Above all, those doing aerial firing do not considered it as crime, instead taken it as they are privileged to do anything when celebrating. Awareness of the consequences must be propagated by every means to condemn this social crime.

Background: Despite the significant contribution of cultural factors to sexual satisfaction, most of the current sexual satisfaction scales pay little attention, if any, to cultural factors and marital status.Objectives: The current study aimed to develop and validate the Iranian Married Women’s Sexual Satisfaction Scale.Patients and Methods: The current methodological study went through three consecutive phases. In the first phase, the concept of sexual satisfaction was defined and analyzed by the hybrid model approach. In the second phase, an item pool was generated by the findings of the first phase. Finally, the psychometric properties of the scale were evaluated in the third phase. All data analyses were performed by the SPSS version 19.0.Results: A 78-item pool was generated based on the findings of the concept analysis phase. After assessing and confirming its face and content validity, 27 items remained in the final version of the scale. The exploratory factor analysis revealed a four-factor structure for the scale. The results of the known-groups comparison showed that females with lower educational status had significantly lower sexual satisfaction. Moreover, there was a significant correlation between the scores of the finalized scale and those of the ENRICH Marital Satisfaction Scale (r=0.706, P=0.01). The interclass correlation between the test and the retest measurements was also statistically significant (ICC=0.939, P value=0.001).Conclusions: The 27-item Iranian Married Women’s Sexual Satisfaction Scale is a simple, valid, and reliable tool to assess married women’s sexual satisfaction.

Background: Experimental approaches have been promising with the use of therapeutic hypothermia after Traumatic Brain Injury (TBI) whereas clinical data have not supported its efficacy.Objectives: This study aimed to investigate whether using selective deeper brain cooling correlates with a more neuroprotective effect on Intracranial Pressure (ICP) increments following TBI in rats.Materials and Methods: Adult male Sprague-Dawley rats (mean weight=300 g; n=25) were subjected to brain injury using a modified Marmarou method. Immediately after the onset of TBI, rats were randomized into three groups. Selective brain cooling was applied around the head using ice packages. Intracranial Temperature (ICT) and ICP were continuously measured at 0, 30, 60, 120, and 180 minutes and recorded for all groups. Group 1 (n=5) was normothermia and was assigned as the control group. Group 2 (n=10) received moderate hypothermia with a target ICT of between 32oC – 33oC and Group 3 (n=10) was given a deeper hypothermia with a target ICT of below 32oC.Results: All subjects reached the target ICT by the 30th minute of hypothermia induction. The ICT was significantly different in Group 2 compared to Group 1 only at the 120th minute (P=0.017), while ICP was significantly lower starting from the 30th minute (P=0.015). The ICT was significantly lower in Group 3 compared to Groups 1 and 2 starting from the 30th minute (P=0.001 and P=0.003, respectively). The ICP was significantly lower in Group 3 compared to Group 1 starting from 30th minute (P=0.001); however, a significant difference in ICP between Group 3 and Group 2 was observed only at the 180th minute (P=0.047).Conclusions: Results of this study indicate that selective brain cooling is an effective method of decreasing ICP in rats; however, the deeper hypothermia caused a greater decrease in ICP three hours after hypothermia induction.

Background: Establishing professional communication between physicians and nurses regarding their supplemental roles in health care for patients is unavoidable. Existing studies have reported on related problems concerning ineffective professional collaboration among health care providers.Objectives: The aim of this study was to determine Iranian bachelor of nursing students’ attitudes regarding collaboration between physicians and nurses at Tehran University of Medical Sciences.Patients and Methods: This study was an inferential cross sectional study. The study population consisted of all first and fourth academic-year Iranian bachelor of nursing students at Tehran University of Medical Sciences (277 individuals), who were selected by convenience sampling. The participation rate was 97.47% (270 individuals). A questionnaire including demographic information and professional experience was used to gather information (included 12 questions). Additionally, the Jefferson Scale of Attitudes toward Physician-Nurse Collaboration (JSAPNC) was also used (included 15 questions). Data were analyzed using the SPSS software. The applied statistical tests included: c2, t student and ANOVA test.Results: The obtained mean attitude score for the first academic year (51.28±4.98) was higher than the mean attitude score of the fourth academic year nursing students (50.56±4.05). However, the results of the independent statistical t-test showed no significant difference between the two groups of students (P=0.322). In the four dimensions of JSAPNC, concerning only the dimension of physician authority, there were significant differences between the two groups of students (P<0.05). The obtained means for the first and fourth academic year of bachelor nursing students reflected their positive attitudes about collaboration between physicians and nurses.Conclusions: The positive attitude of most nursing students found in this study showed the need for appropriate and effective collaboration between medical staff; this collaboration will give patients and prospective patients the best possible care.

Background: Still there is no consensus on the best treatment for abdominal pain-related functional Gastrointestinal Disorders (FGIDs).Objectives: The purpose of this study was to compare the effects of a synbiotic Lactol (Bacillus coagulans+fructooligosaccharide (FOS)), peppermint oil (Colpermin) and placebo (folic acid) on abdominal pain-related FGIDs except for abdominal migraine.Patients and Methods: This placebo-controlled study was conducted on 120 children aged 4 - 13 years to compare the efficacy of pH-dependent peppermint oil (Colpermin) versus synbiotic Lactol (Bacillus coagulans+fructooligosaccharids (FOS)) in decreasing duration, severity and frequency of functional abdominal pain. The patients were randomly allocated into three equal groups (n=40 in each group) and each group received Colpermin or Lactol or placebo.Results: Eighty-eight out of 120 enrolled patients completed a one-month protocol and analyses were performed on 88 patients’ data. Analyses showed that improvement in pain duration, frequency and severity in the Colpermin group was better than the placebo group (P=0.0001, P=0.0001 and P=0.001, respectively). Moreover, pain duration and frequency were decreased in the Lactol group more than the placebo (P=0.012 and P=0.0001, respectively), but changes in pain severity were not significant (P=0.373). Colpermin was superior to Lactol in decreasing pain duration and severity (P=0.040 and P=0.013, respectively). No known side effects or intolerance were seen with Colpermin or Lactol.Conclusions: The pH-dependent peppermint oil capsule and Lactol tablet (Bacillus coagulans+FOS) as synbiotics seem to be superior to placebo in decreasing the severity, duration and frequency of pain in abdominal pain-related functional GI disorders.

Background: Success of any gene therapy protocol relies mostly on using an efficient carrier to direct nucleic acid to the place of action. The system should also have transfection ability at release site. Different routes are available for delivering genetic materials to the target organs, amongst them; oral delivery is particularly attractive for certain reasons. However, serious obstacles, like acidic environment of stomach and presence of protease and nuclease enzymes in gastrointestinal (GI) tract, make oral route a highly challenging option.Objectives: The present study suggests preparation of gene nanoparticles (NPs) of chitosan within a layer of Eudragit L100 for oral delivery of nucleic acid. The nanoparticles have some features both in size and polymer properties that can be penetrating enough to transfect epithelial layer cells of intestine and protect the entrapped materials against stomach harsh condition.Materials and Methods: In this experimental study, conducted in Iran, particles were prepared by coacervation technique followed by encapsulation of nanoparticle within a coat of Eudragit L100 using solvent evaporation technique. Formulation behavior was monitored both in vitro and in vivo. Stability of particle construction and release profile of DNA were examined at pH of±0.8 environ pKa of Eudragit. Size and zeta potential of particles were measured. To demonstrate transfection efficiency of the constructed carrier, reverse transcription polymerase chain reaction (RT-PCR) was carried out using human insulin specific primers on total RNA extracted from upper part of small intestine of 48-hour post-transfected rats (sampled by simple random selection, n=3).Results: The mean size and zeta potential of particles were 300±4 nm and 14±0.5 mV, respectively. Encapsulation of this system was 89.6±1.2%. DNA release from batches was less than 12% at pH=5.2 and more than 60% at pH=6.8 with significant difference of P<0.05. RT-PCR product confirmed the presence of insulin transcript of 437 bp in upper intestinal extracts of the transfected rats. No band of DNA was seen after RT-PCR of placebo form of nanoparticles received group.Conclusions: Eudragit coated nanoparticle of chitosan is an efficient choice for oral delivery of DNA to upper part of GI tract.

Background: China is a country with a high prevalence of hepatitis B. As a special population, migrant workers are more vulnerable to hepatitis B.Objectives: The present study was conducted to gain insight into the prevalence of hepatitis B and knowledge about hepatitis B among migrant workers in Shandong Province, China, as well as to explore a series of strategies for preventing and controlling the spread and prevalence of hepatitis B.Patients and Methods: A cross-sectional study was conducted without age restriction, in Shandong Province in China. The sample-size was determined scientifically. The study population was selected using the random multistage cluster sampling. Personal information, including sex, age, ethnicity, marital status, education level, years of duration of stay in Jinan and health insurance were obtained from 2065 migrant workers. Moreover, blood samples were collected for hepatitis B infection screening. Knowledge about hepatitis B was assessed using a self-administered questionnaire. Correct response rates were calculated.Results: Of 2065 migrant workers tested for Hepatitis B Surface Antigen (HBsAg), 167 (126 men and 41 women) tested positive for HBsAg; the overall prevalence was 8.1%. The prevalence rates in men and women were 9.6% and 5.4%, respectively. The prevalence rates in subjects 18 - 30 years old and 30 years older were 3.5% and 9.3%, respectively. There were statistically significant differences between those groups (P<0.05). Correct response rates for the transmission of hepatitis B questions were low, especially for a question regarding whether hepatitis B can be transferred by sexual contact (36.8%) and whether it can be transferred from mothers to infants (33.9%). A total of 80.9% of migrant workers correctly responded that vaccination is effective for hepatitis B. However, 68% of migrants also had the misconception that it is necessary to receive a booster vaccination.Conclusions: The hepatitis B virus infection rate in migrant workers is higher than average infection rates in China, and these workers’ knowledge regarding hepatitis B is poor. It is urgent that an appropriate program be undertaken for the prevention and control of hepatitis B among migrant workers.

Background: Depression is concomitantly presented in Hepatitis B Virus (HBV) -infected patients and decreases these patients’ quality of life. However, there are no laboratory-based methods to objectively diagnose this disorder.Objectives: The aim of this study was to investigate the alteration of urinary metabolites in depressed HBV-infected patients.Patients and Methods: In this study, 81 depressed HBV-infected patients, 68 non-depressed HBV-infected patients and 64 Healthy Controls (HC) were recruited. A nuclear magnetic resonance (NMR) -based urinary metabonomic method was used to characterize the urinary metabolic profiling of depressed and non-depressed subjects.Results: Seventeen differential urinary metabolites responsible for discriminating depressed HBV-infected patients from non-depressed HBV-infected patients and HC were identified. Among these metabolites, pyruvate, isobutyrate, N-methylnicotinamide, a-hydroxybutyrate, acetoacetate and malonate were identified as potential biomarkers for diagnosing depression in HBV-infected patients. A combined panel of these potential biomarkers could effectively discriminate depressed HBV-infected patients from non-depressed HBV-infected patients and HC, with an average accuracy of 89.6% in the training set and a predictive accuracy of 86.4% in the test set.Conclusions: These findings suggest that NMR-based urinary metabonomics approach might be a useful tool for the clinical diagnosis of depression in HBV-infected patients and the six potential biomarkers could be helpful for developing an objective diagnostic method. Limited by the number of recruited subjects, future studies are required to validate our conclusions.

Background: Despite effective diagnosis and treatment, prevalence of tuberculosis (TB) is still growing. The directly observed treatment, short-course (DOTS) strategy to treat TB was introduced by the World Health Organization more than a decade ago. Little is known about patients’ experience of TB treatment, according to DOTS, in Iran.Objectives: This study aimed to understand the patients’ experience of tuberculosis treatment according to DOTS in Iran.Patients and Methods: This study is a qualitative study, using content analysis to examine patients’ experience of TB treatment and to understand their compliance during DOTS. In this study, a semi-structured interview with open questions was answered by 40 patients, who had a diagnosis of pulmonary and extrapulmonary tuberculosis, and improved during the course of their treatment. The method of sampling was purposive sample and the interview process lasted until data saturation.Results: Data analysis resulted in the extraction of six themes, which reflect the experiences of the study participants. The themes are: 1) individual factors; 2) change of the attitudes and beliefs of patients on TB treatment; 3) support terms of patients with tuberculosis; 4) the role of health care professionals; 5) social factors and 6) the financial burden.Conclusions: Successful completion of TB treatment requires an effective partnership between the patient and health care professionals, and a harmony between the cultural context, attitude of the patient, family support and health literacy. Future health policies should address these issues to improve patients’ adherence to DOTS.

Background: Iron-loaded cardiac complication is the essential cause of mortality in patients with thalassemia. Early detection and treatment of cardiac over-load can reduce mortality.Objectives: The current study aimed to evaluate the relationship between serum ferritin levels and T2* magnetic resonance imaging (MRI) of heart and liver and liver iron concentration (LIC) to diagnose iron over load in countries with limited access.Patients and Methods: In the current cross-sectional study, 85 Iranian patients with thalassemia with the mean age of 22.7±7 years were randomly selected. All patients were on regular blood transfusion. Echocardiography of heart and liver T2* MRI, determination of serum ferritin levels, and LIC were performed in all subjects at the same time. The correlation of serum ferritin levels with T2*MRI of heart and liver, and LIC was assessed. P value<0.05 was considered statistically significant.Results: Abnormal myocardial iron load (T2* MRI<20 ms) was detected in 58% of the patients and among whom, 36% had severe myocardial iron load (T2* MRI<10 ms). Median and interquartile range of serum ferritin levels were 1434 and 2702 respectively in patients with thalassemia. Serum ferritin levels showed a statistically significant positive correlation with LIC (rs=0.718, P<0.001) and significant negative correlation with T2* Heart (rs=-0.329, P=0.002), and T2* Liver (rs=-0.698, P<0.001). However, Ejection fraction was not significantly correlated with serum ferritin levels in the patients (P=0.399).Conclusions: Serum ferritin levels can be used to diagnose iron over-load in patients with thalassemiaas an alternative method in areas where T2* MRI is not available.

Background: Atherosclerotic cardiovascular disease is currently a cause of mortality in some parts of the world. The ATP-Binding Cassette Transporter (ABCA1) gene prepares instructions to produce the ATP-binding cassette transporter protein whose operation is for export of phospholipids and cholesterol, outside cells where they are limited to Apolipoprotein A1 (apoA1). Increased ABCA1 activity could inhibit atherosclerosis.Objectives: In the present study, the effect of aerobic exercise was investigated on gene expression and biochemical parameters.Patients and Methods: The participants included 36 inactive women, which were randomly assigned to control (CON) and experimental (EX) groups. The EX group performed 12 weeks of aerobic exercise and the CON group remained inactive. Fasting blood samples were collected 24 hours before the first session and 48 hours after completion of the course. The ABCA1 and APOA1 gene expressions were measured using semi-quantitative-RT-PCR. Data were analyzed by the SPSS software (version 18).Results: A significant increase in blood ABCA1 (EX group P<0.002, t=- 9.876) and Apo A-I (EX group P<0.05, t=2.76) gene expression was shown following the 12 weeks of training. Plasma high-density lipoprotein-cholesterol (HDL-C) concentration increased (P<0.001, t=4.90 respectively) while plasma low-density lipoprotein-cholesterol (LDL-C) concentration decreased (P<0.001, t=4.27) in the EX group compared with the CON group.Conclusions: Aerobic exercises can increase ABCA1 and APO-A1 gene expression. Induction of these genes can effectively prevent cardiovascular disease.

Background: Acute cholecystitis is the most common complication of gallbladder stones. Today, Tokyo guidelines criteria are recommended for diagnosis, grading, and management of acute cholecystitis.Objectives: We aimed to evaluate the levels of C-reactive protein (CRP) at different cut-off values to predict the severity of the disease and its possible role in grading the disease with regard to the guideline.Patients and Methods: This is a retrospective study, analyzing 682 cases out of consecutive 892 patients with acute cholecystitis admitted to two different general surgery clinics in Istanbul, Turkey. Records of patients diagnosed with acute cholecystitis were screened retrospectively from the hospital computer database between January 2011 and July 2014. A total of 210 patients with concomitant diseases causing high CRP levels were excluded from the study. The criteria of Tokyo guidelines were used in grading the severity of acute cholecystitis, and patients were divided into 3 groups. CRP values at the time of admission were analyzed and compared among the groups.Results: Mean CRP levels of groups were found to be significantly different, 18.96 mg/L in Group I, 133.51 mg/L in Group II, and 237.23 mg/L in Group III (P<0.001). Having examined CRP values among the groups, they were found to be highly and significantly correlated with the disease grade (P<0.0001). After evaluating CRP levels according to the grade of the disease, group 2 was distinguished from group 1 with a cut-off CRP level of 70.65 mg/L, and from group 3 with a value of 198.95 mg/L. Those results were found to be statistically significant (P<0.001).Conclusions: CRP, a well-known acute phase reactant that increases rapidly in various inflammatory processes, can be accepted as a strong predictor in classifying different grades of the disease, and treatment can be reliably planned according to this classification.

Background: There is no legal requirement for Iranian military truck drivers to undergo regular visual checkups as compared to commercial truck drivers.Objectives: This study aimed to evaluate the impact of drivers’ visual checkups by comparing the visual function of Iranian military and commercial truck drivers.Patients and Methods: In this comparative cross-sectional study, two hundred military and 200 commercial truck drivers were recruited and their Visual Acuity (VA), Visual Field (VF), color vision and Contrast Sensitivity (CS) were assessed and compared using the Snellen chart, confrontation screening method, D15 test and Pelli-Robson letter chart, respectively. A questionnaire regarding driving exposure and history of motor-vehicle crashes (MVCs) was also filled by drivers. Results were analyzed using an independent samples t-test, one-way ANOVA (assessing difference in number of MVCs across different age groups), chi-square test and Pearson correlation at statistical significance level of P<0.05.Results: Mean age was 41.6±9.2 for the military truck drivers and 43.4±10.9 for commercial truck drivers (P>0.05). No significant difference between military and commercial drivers was found in terms of driving experience, number of MVCs, binocular VA, frequency of color vision defects and CS scores. In contrast, the last ocular examination was significantly earlier in military drivers than commercial drivers (P<0.001). In addition, 4% of military drivers did not meet the national standards to drive as opposed to 2% of commercial drivers. There was a significant but weak correlation between binocular VA and age (r=0.175, P<0.001). However, CS showed a significantly moderate correlation with age (r=-0.488, P<0.001).Conclusions: The absence of legal requirement for regular eye examination in military drivers caused the incompetent drivers to be missed in contrast to commercial drivers. The need for scientific revision of VA standard for Iranian drivers is also discussed. The CS measurement in visual checkups of older drivers deserves to be investigated more thoroughly.

Background: Recent years, lots of scientific studies are focused on the possible mechanism of inflammatory response and oxidative stress which are the mechanism related with tissue damage and exercise fatigue. It is well-known that free oxygen radicals may be induced under invitro conditions as well as oxidative stress by exhaustive physical exercise.Objectives: The aim of this study was to investigate the effects of anabolic steroids in conjunction with exercise in the process of spermatogenesis in the testes, using histological and stereological methods.Materials and Methods: Thirty-six male Sprague Dawley rats were divided to six groups, including the control group, the eccentric exercise administered group, the estrogen applied group, the estrogen applied and dissected one hour after eccentric exercise group, the no estrogen applied and dissected 48 hours after eccentric exercise group and the estrogen applied and dissected 48 hours after eccentric exercise group. Eccentric exercise was performed on a motorized rodent treadmill and the estrogen applied groups received daily physiological doses by subcutaneous injections. Testicular tissues were examined using specific histopathological, immunohistochemical and stereological methods. Sections of the testes tissue were stained using the TUNEL method to identify apoptotic cells. Apoptosis was calculated as the percentage of positive cells, using stereological analysis. A statistical analysis of the data was carried out with one-way analysis of variance (ANOVA) for the data obtained from stereological analysis.Results: Conventional light microscopic results revealed that testes tissues of the eccentric exercise administered group and the estrogen supplemented group exhibited slight impairment. In groups that were both eccentrically exercised and estrogen supplemented, more deterioration was detected in testes tissues. Likewise, immunohistochemistry findings were also more prominent in the eccentrically exercised and estrogen supplemented groups.Conclusions: The findings suggest that estrogen supplementation increases damage in testicular tissue due to eccentric exercise.