Iranian Red Crescent Medical Journal
Year:2017 | Volume:19 | Issue:3|Papers Count:20

Background: Myelin basic protein (MBP), a crucial neuro-auto antigen involved in the maintenance of the myelin sheath, is one of the biomarkers of therapeutic response in multiple sclerosis (MS).Objectives: The study examines prognostic biomarker and molecular mimicry hypothesis MS etiology by MBP.Methods: This study is convergence of three arms including in silico and in vitro (bioinformatics) with the in vivo (experimental). A novel methodology combining molecular techniques was used to confirm the antigenic properties of MBPand study its efficiency in increasing the susceptibility to MS. One hundred eighty MS patients and healthy subjects were recruited for the study from Jan 2013 to Feb 2016 in Iran. Age and sex-matched healthy volunteers and patients were analyzed using various quantitative and qualitative molecular laboratory techniques. Peripheral blood mononuclear cells (PBMCs) and plasma was used for the retrieval of MBP and IgG assay, respectively.Results: The optimum concentration of the MBP epitope for the immune system to react and facilitate prognostication was found to be 50 and 150 mg/mL in MS patients and healthy individuals, respectively (P<0.0001****). Combined results from ELISA and real time PCR showed that the total IgG and the ratio of gene expression for candidate human MBP epitope was higher in MS patients in all the three groups compared to that in healthy controls P<0.0001****).Conclusions: Molecular assays in the early stages of the disease could help in elucidating the effectiveness of the MBPas a prognostic factor in MS.

Introduction: Temporal arteritis (TA) is a chronic inflammatory vasculitis involving medium and large arteries, which mostly occurs after the age of 50 and involves one side of the body.Case Presentation: We present a 40-year-old male patient with simultaneous bilateral temporal arteritis along with a headache, mild fever, palpation of temporal arteries and anemia who responded to 1mg/kgoral daily prednisone for three months. This patient was referred to the Pars Hospital in Tehran, Iran on March 2016.Conclusions: Temporal arteritis should be kept in mind as an important curable differential diagnosis, not only in ages above 50, but also in lower ages and should be evaluated in both sides.

Background: After kidney transplantation, many risk factors can lead to graft rejection and force the patient to return to dialysis treatment.Objectives: This study aims to identify risk indicators of renal graft failure, such as serum creatinine, on long-term graft survival, using a novel statistical technique.Methods: In this historical cohort study, 129 patients who underwent kidney transplants were assessed and followed up from September 2003 to December 2014 in Urmia, Iran. The main outcome of the study was assessing the survival rate of kidney transplant in these subjects. In addition, the serum creatinine levels were measured repeatedly for one year after the operation, as the most important risk indicator of graft failure. In addition, the effect of other indicators on graft survival were assessed using a joint modeling of longitudinal and survival technique, using the R software, version 3.0.2.Results: One-, three-, five-, and ten-year graft survival was 93.8%, 86.8%, 76.6%, and 37.4%, respectively. The results of the joint model showed that risk indicators, such as serum creatinine level (P<0.0001, HR=1.82), patient’s age (P=0.006, HR=1.03), and antithymocytes globulin (P=0.019, HR=2.57) had a significant relationship to graft survival.Conclusions: In general, our study showed that short-term graft failure in Iran is almost equal to the reported rates in some developed countries, but its long-term failure is rather high compared to these same countries. In this context, monitoring the postoperative risk indicators of graft rejection, such as the serum creatinine level, plays an important role in increasing the survival rate of kidney transplantation. The present model can be used to design similarly structured datasets.

Background: Asthmatic chronic rhinosinusitis with nasal polyps (aCRSwNP) is a common disruptive eosinophilic disease. However, up to now, there is no effective medical treatment for the disease, which is partly due to that the molecular mechanism of aCRSwNP is still unknown.Objectives: The aim of this study was to facilitate the systematic discovery of diagnostic biomarkers of aCRSwNP based on integrating pathways, differentially expressed genes (DEGs), and mutual information networks (MINs).Methods: This was a foundation-application study carried out in Dongying, Shandong Province, P.R. China, in 2016. First, the gene expression profile of aCRSwNP composed of 13 normal samples and 21aCRSwNPsamples was recruited from the gene expression omnibus (GEO) database (http: //www.ncbi.nlm.nih.gov/geo/) and then, data preprocessing was performed. Second, the attract method was utilized to identify differential pathways. In the following, MINs were constructed and underwent topological analysis. Then, DEGs were examined in aCRSwNP group and normal control group to identify significant genes and key genes. Finally, the support vector machine (SVM) with C-classification was utilized to evaluate the performance of the classification.Results: A total of 11, 100 genes and 273 pathways (gene count>5) were initially obtained. Then, 5 differential pathways which contained 346 genes were identified. Topological analysis conducted on the MINs revealed 20 hub genes (degree centrality ³220). In the following, 795 DEGs were identified (|log fold change (FC) |³ 2.0, P value£0.01). Furthermore, 35 significant genes and 14 key genes were detected. Finally, the results of SVM with C-classification indicated that the key genes gave the best result.Conclusions: Our research identified several key genes (such as IL6R), which might play key roles in the occurrence and development of aCRSwNP. We predicted that these genes might provide additional diagnostic and therapeutic targets for aCRSwNP.

Background: Job stress has recently been regarded as a risk factor for some diseases.Objectives: In this study, we standardized the Persian version of the HSE management standards indicator tool and studied the psychological properties of the tool.Methods: In this cross-sectional study, the Persian version of the HSE questionnaire was submitted to 429 participants who were randomly drawn from five occupational groups in Isfahan, Iran in 2014. Internal consistency, reliability, discriminative validity, and construct validity were evaluated. Predictive validity was explored with respect to the beck depression inventory (BDI). discriminant validity was explored with respect to type of occupational groups.Results: Cronbach’s alpha for the all subscales ranged between 0.53 and 0.74. In addition, the intraclass correlations for the domains ranged from 0.52 to 0.73 with a median of 0.7. The confirmatory factor analysis showed that the Persian version of the HSE questionnaire had adequate construct validity. The root mean square error of approximation, incremental fit index, and comparative fit index were 0.064, 0.9, and 0.9, respectively; moreover, other indexes were satisfactory. An analysis of variance highlighted the differences between the stress of the occupational groups (P=0.012). A lower score on the HSE questionnaire was significantly related to a higher BDI score (r=-0.46, P<0.001).Conclusions: The analysis of the reliability and validity of the Persian version of the HSE questionnaire showed that it is a useful and reliable measure to analyze work-related stress.

Background: Glucose is an essential element in the supply of body’s energy. In diseases such as diabetes, glucose increase is associated with disturbance in metabolism. Cortisol is an important hormone in the regulation of glucose metabolism, and human serum albumin (HSA) is one of the most important glucose and cortisol transmitters in blood. Interaction between albumin and these ligands could affect HSA secondary structure and its stability.Objectives: The aim of this study was to investigate HSA secondary structure in the presence of different concentrations of glucose and cortisol.Methods: This was an in vitro (analytical/descriptive) study in which, completely randomized design was used to study the interaction between human serum albumin at 37oC at different glucose concentrations of 0, 80, 180, 240, and 400 mg/dL and cortisol at concentrations of 0, 10, 20, and 40mg/dL. Intrinsic fluorescence spectroscopy and Circular dichroism (CD) were performed to obtain data.Results: HSA secondary structure underwent changes in the presence of different concentrations of cortisol and glucose. P values less than 0.01 were considered to be statistically significant. Fluorescence spectroscopy and CD results showed that at normal glucose concentrations, HSA was very flexible, beta-sheet content reduced, and the maximum increase in fluorescence and blue-shift happened. At higher concentrations of glucose, HSA became rigid. Also, HSA in presence of 10 mg/dL cortisol was very flexible; but a cortisol concentration of 40 mg/dL caused stability in HSA structure in presence of different glucose concentrations.Conclusions: Under normal glucose conditions, very low cortisol concentrations create large changes in HSA secondary structure. At normal glucose concentrations, some of the binding sites of HSA that are all occupied by glucose at higher concentrations become available to cortisol. Cortisol structure is very hydrophobic, which causes large changes in HSA secondary structure and significant increases in quenching and blue shift. In conclusion, binding of compounds such as medicines to HSA sites may be affected by competitive bindings of glucose, depending on its concentration in the blood.

Background: The increasing prevalence of overweight and obesity in children has posed some challenges in many countries. There is a relationship between parenting styles, parental feeding practices, and children’s nutritional status.Objectives: This study aimed to apply Authoritative Parenting style Model in children’s nutritional status.Methods: This research was a cross-sectional study conducted on 1000 parents selected by random cluster sampling. Parents who had primary school children aged 7 - 8 years in Bojnord, Iran, completed questionnaires related to the constructs of the model in 2016. Structural Equation Model Model (SEM) analysis was used to test the fit of the model. CMIN/DF, GFI, IFI, CFI, PGFI, PNFI, and RMSEA indices were employed to check the goodness-of-fit.Results: Correctly completed questionnaires were collected from 294 dyads of parents. The mean age was 36.26 years (SD=±5.38) in fathers and 32.96 years (SD=±4.88) in mothers.232 mothers (80.5 %) were housewives and only 99 of them (34.4%) had university education. Most fathers were employee (115, 40%) or self-employed (111, 38.5%) and 120 of them (41.7%) had university education. The values of goodness-of-fit were obtained for CMIN/DF=4.6, GFI=0.91, CFI=0.93, IFI=0.92, PGFI=0.68, PNFI=0.77, and RMSEA=0.07. Nutritional knowledge e and attitude directly affected authoritative parenting style (b=0.21, P<0.001) and parental feeding practices (b=0.33, P<0.001) and indirectly affected children’s nutritional status (b=- 0.01). The authoritative parenting style construct had a direct effect on feeding practices of parents (b=0.54, P<0.001) and an indirect effect on children’s nutritional status (b=- 0.01). The feeding practices of parents construct also affected the children’s nutritional status directly (b=- 0.02, P<0.05).Conclusions: This study indicated that the use of this model in the children’s nutritional status can result in positive outcomes, and this model can make interventions more effective in this regard.

Background: Previous studies demonstrated partial attenuation of noise induced hearing loss (NIHL) by N-acetyl-L-cysteine (NAC) or CoQ10 (ubiquinone).Objectives: The present study investigates the protection effect of coad ministration of NAC and CoQ10 against NIHL.Methods: In an experimental study in Iran in 2015, a total of 36 male Wistar rats (27525 g) were divided randomly based on the permuted block design into 6 experimental groups: (I) noise controls, (II) noise and NAC, (III) noise and CoQ10, (IV) noise and CoQ10 and NAC, (V) noise and saline (as vehicle of NAC) and (VI) noise and olive oil (as vehicle of CoQ10). Antioxidants and vehicles were intraperitoneally injected once a day for two days prior to and 1 hour before 102±0.5 dB white noise exposure 8 h/day in 10 executive days and two days after the noise exposure daily. Distortion product otoacoustic emissions were measured one day before and 1, 7 and 21 days after the exposure.Results: The temporary hearing changes that occurred 1-day post exposure were not significantly different in all groups (P>0.05). The total recovery (between 1 - 21 days after noise exposure) varied by a frequency increase between 1.08 - 19.10 in the noise group compared to 1.75 - 24.5 and 0.62 - 22.08 in animals treated with NAC and the combination of NAC and CoQ10 respectively. The less permanent hearing impairment was observed in noise exposed animals treated with either NAC or both NAC and CoQ10.Conclusions: The effect of coad ministration of NAC and CoQ10 was neither additive nor synergic in protecting against NIHL.

Background: Surgery as a stressful experience can affect the child and quality of care plan. Nurses can use non-pharmacological intervention to reduce anxiety and help children cope with this stress.Objectives: This study was designed to compare the effects of dramatic puppet and therapeutic play on anxiety of children undergoing surgery.Methods: In this randomized clinical trial, 75 children were divided into three groups (dramatic puppet, therapeutic play, and control) using a simple random allocation method. The study was conducted in Iran in 2013 - 2014. The revised children’s manifest anxiety scale (RCMAS) was used to determine the anxiety of children. The data were analyzed using paired t-test, one-way analysis of variance (ANOVA), and Tukey test.Results: The findings revealed that the changes of anxiety scores after the intervention were significantly different among the three groups (P<0.001), so that the anxiety scores decreased in both the intervention groups (puppet and play) and increased in the control group.Conclusions: Therapeutic play and dramatic puppet can be used by nurses as a care strategy and effective preoperative preparation intervention to reduce anxiety in children undergoing surgery.

Background: Preterm premature rupture of membrane (PPROM) prior to 37 weeks’ gestation is among the most common obstetrics problems, which is associated with prenatal mortality and several maternal and neonatal complications. History of PPROM is a risk factor for recurrence. Zinc has an important effect on the strength of membranes by affecting collagen [tensile] strength - a substance with immunity mechanism and antioxidant properties.Objectives: This study was conducted to investigate the effect of zinc supplement on the prevention of PPROM and improvement of some pregnancy outcomes in pregnant women with a history of PPROM during the second trimester and the early third trimester.Methods: In this randomized, double-blind, controlled clinical trial, 108 healthy pregnant women (at gestational age of 16 - 30 weeks) with a history of PPROM and singleton pregnancy were selected by convenience sampling method in the Midwifery Clinic of Shahid Akbarabadi hospital in Tehran, Iran, between 2014 and 2015. They were then divided into two groups of placebo and zinc sulfate tablet (40 mg) recipient using randomized block design. In total, 92 subjects completed the study. The frequency of PPROM was regarded as the primary outcome, and frequency of PROM, average gestational age at birth, average birth weight, and average head circumference were considered as the secondary outcomes. The statistical analysis was based on intent-to-treat principle.Results: There was no between-groups difference in terms of demographic and pregnancy specifications. Results showed no significant between-groups (zinc versus placebo recipient) difference (P>0.05) in terms of the frequency of preterm pregnancy (22% versus 33.3%), frequency of PPROM (4.9% versus 11.8%), frequency of PROM (14.6% versus 17.6%), average birth weight (3192.17 g versus 3080.52 g), average gestational age at birth (38.2 weeks versus 37.2 weeks), and average head circumference at birth (34.63 cm versus 34.81 cm).Conclusions: According to the results, daily intake of zinc sulfate (40 mg) by pregnant women with a history of PPROM does not contribute to the prevention of PPROM and PROM and improvement of average gestational age at birth and anthropometric measurements.

Background: The imbalance in the T helper (Th) 1/Th2 and Th1/T regulatory (Treg) cells-related immune responses plays a key role in pathogenesis of allergic asthma.Objectives: The aim of this study was to evaluate the effects of CPG-Oligodeoxynucleotide (CPG-ODN), Monophosphoryl Lipid A (MPLA) and Bacillus Calmette-Guerin (BCG) on the ratio of Th1/Th2 and Th1/Treg cells-related parameters in an animal model of asthma.Methods: This was an experimental study in which female BALB/c mice were divided to five groups and then immunized Subcutaneously (SC) with the allergen Dermatophagoides pteronyssinus 2 (Derp2) on days 1, 15 and 22. Three groups of mice were considered as test groups and pre-treated SC with CPG, CPG+MPLA or CPG+BCG on days 0, 14 and 21. Two groups were also considered as saline-control group and Derp2-sensitized control group that were administrated only saline or allergen Derp2, respectively. The mice (except saline-control group) were challenged intranasally with allergen Derp2 for ten days, from days 28 to 37 of post immunization. Blood samples were obtained from retro-orbital sinus, on days 0, 23 and 40. The serum Interleukin (IL) -4, Interferon (IFN)g-, Immunoglobulin (Ig) E and IgG2a levels were measured using the enzyme linked immunosorbent assay (ELISA) technique.The blood count of Th1- and Treg cells was detected using flow cytometry.Results: At sensitization phase, the serum IFN-g/IL4 ratio was significantly increased in Derp2-sensitized group pre-treated with CPG plus MPLA or CPG plus BCG as compared with Derp2-sensitized control mice (P<0.002 and P<0.003). The IFN-g/IL4 ratio was also markedly elevated in Derp2-sensitized group pre-treated with CPG as compared with Derp2-sensitized control mice (P= 0.07). In the challenge phase, the IFN-g/IL4, IgG2a/IgE and Th1/Treg ratios in Derp2-sensitized mice pre-treated with CPG plus MPLA were significantly higher than in Derp2-sensitized control mice (P<0.003, P<0.006 and P<0.003, respectively). The IFN-g/IL4 and Th1/Treg ratios were also significantly raised in Derp2-sensitized mice pre-treated with CPG plus BCG in comparison with Derp2- sensitized control mice (P<0.001 and P=0.012, respectively). In the challenge phase the Th1/Treg ratio was significantly decreased in Derp2-sensitized group pre-treated with CPG plus BCG in comparison with Derp2-sensitized mice pre-treated with CPG (P=0.011). The Th1/Treg ratio in Derp2-sensitized group pre-treated with CPG plus MPLA was significantly higher than in Derp2-sensitized mice pre-treated with CPG plus BCG (P<0.035).Conclusions: These results showed that BCG, MPLA and CPG improve the Th1/Th2- and Th1/Treg cells imbalances in a mouse model of asthma.

Background: Low serum levels of vitamin D are supposed to contribute to the incidence of diabetes; therefore, vitamin D supplementation may reduce the incidence of diabetes in individuals with prediabetes.Objectives: The aim of this current study was to examine the effect of vitamin D supplementation on the glycemic status and percentage of body fat mass in adults with prediabetes.Methods: In a 3-month randomized placebo-controlled supplementation trial, 120 eligible subjects were randomly assigned in a vitamin D or placebo group. They were stratified according to the percentage of body fat mass into four blocks to receive 1000 IU/daily vitamin D or an identical placebo tablet respectively, for 3 months. The study was conducted from January to March of 2016 in Urmia in the North West of Iran. Participants were adults aged 18 to 70 with prediabetes. The fasting blood sugar (FBS), glycated hemoglobin (HbA1c), homeostasis model assessment of insulin resistance (HOMA-IR), serum 25 (OH) D levels, and percentage of body fat mass were assessed before and after the intervention.Results: The comparison of changes from baseline between two groups showed a significant inverse association between the changes in serum 25 (OH) D and changes in FBS (-4.64 ± 11.38 compared with -2.11 ± 9.15 for placebo; P=0.03), HOMA-IR (-0.73 ± 4.2 compared with 0.44 ± 4.4 for placebo, P=0.01) and serum insulin (-1.98 ± 15.25 compared with 2.47 ± 15.85 for placebo; P= 0.007) but not in the percentage of body fat mass (-0.28±0.77 compared with -0.39±2.82 for placebo; P=0.39).Conclusions: The study demonstrated that 1000 IU vitamin D supplementation for 3 months can decrease the insulin resistance in individuals with prediabetes; however, it has no significant effect on body fat mass percentage.

Background: Nephrotoxicity is a common adverse effect of vancomycin. However, some aspects of vancomycin nephrotoxicity have not been studied well in the Iranian population. Serum creatinine as a classic marker of renal function has several limitations in clinical practice.Objectives: To determine the incidence, time onset, and possible associated factors of vancomycin nephrotoxicity, and compare the patterns and the accuracy of urine kidney injury molecule 1 (KIM-1) with that of serum and urine creatinine during vancomycin treatment.Methods: A longitudinal study was performed during 9 months from August, 2015 to April, 2016 at three hematology-oncology wards of the Namazi Hospital in Shiraz, Iran. Patients>18 years with no documented history of acute kidney injury or chronic kidney disease scheduled to receive vancomycin for at least 1 week were recruited. Required demographic and clinical data of patients were gathered. Serum, as well as urine creatinine and urine KIM-1, were determined at days 0, 3, 5, 7, 10, and 14 of vancomycin treatment.Results: Thirteen out of the 52 recruited patients (25%) developed nephrotoxicity, with a mean±standard deviation onset of 11.46 ± 7.56 days. Furosemide co-administration (odds ratio=0.126, 95% confidence interval=0.023-0.694, P=0.017) was significantly associated with vancomycin nephrotoxicity. Vancomycin nephrotoxicity resolved spontaneously in about two-fifths (38.46%) of the affected individuals. Mortality (P=1) and duration of hospitalization (P=0.175) were comparable between patients with and without nephrotoxicity. Urine KIM-1 increased during vancomycin treatment, but its mean values did not differ significantly within (P= 0.070) or between (P=0.179) patients with and without nephrotoxicity. Urine KIM-1 accuracy in detecting vancomycin nephrotoxicity was significantly lower than that of serum creatinine at days 5, 7, and 10 of treatment.Conclusions: Vancomycin nephrotoxicity is common but usually reversible and has readily manageable adverse effect. Urine KIM-1 was not more accurate than serum or urine creatinine in detecting vancomycin nephrotoxicity in our study population.

Background: The effect of kidney transplantation on improvement of survival rate and post-transplant-medical health is dramatic. Transplantation is associated with various emotions such as loss, grief and bereavement. Therefore, any psychiatric intervention that can improve the psychological aspects of these patients is valuable.Objectives: Due to the specific medical and psychiatric conditions of Kidney transplant recipients, researchers have designed expressive emotion psychotherapy as a simple, feasible and time limited brief psychotherapy for these patients. The aim was the assessment of this psychotherapy on quality of life and general health of kidney transplant recipients.Methods: This 12-week randomized double-blind clinical trial took place at the Kidney transplant department of Imam Khomeini hospital, an academic and governmental hospital affiliated with Tehran University of Medical Sciences (TUMS) from November 2015 to February 2016 (Iran). From a total of 82 patients screened for this study, 64 patients (34 in the intervention group and 30 in the control group) completed the trial. Participants were divided to two groups: the first received expressive emotion intervention and the second received fact recording education as the control group. Outcomes were assessed by the kidney transplant questionnaire (KTQ) and general health questionnaire (GHQ-28) at baseline and at weeks four and twelve.Results: Baseline demographic characters of patients in both groups were similar. The mean age of patients that participated in the study were respectively 39.26±12.98 and 40.83±14.37 for intervention and control groups. The results of this study indicated that patients in the “intervention” group had a statistically significant enhancement in total KTQ score (P=0.001) and total GHQ score (P=0.001). Regarding every domain of GHQ, this group had a better condition than the “control” group (P=0.000). The intervention had a significant effect on certain domains of KTQ such as “uncertainty/fear” and “emotion”.Conclusions: Expressive emotion brief psychotherapy that focuses on the instructions of expression about one’s living and dealing with a diagnosis of chronic medical condition is recommended for kidney transplant recipients.

Background: People with diabetes report that diabetes affects particular aspects of their marital life and leads to other problems in their lives. Moreover, the self-efficacy of diabetic patients is affected by their disease in various respects. There is a significant relationship between self-efficacy and health behaviors.Objectives: This study was conducted to determine the effect of audio-visual education on self-efficacy toward marriage in single people with type 1 diabetes.Methods: This randomized, controlled trial study was carried out on 100 unmarried patients with type 1 diabetes visiting Iran’s diabetes society in 2015 - 2016. The convenient sampling method was used in this study. Samples were divided into two groups (50 patients in each group) with a simple, randomized sampling method. The data collecting tool was a researcher-made questionnaire that patients completed before the intervention and eight weeks afterwards. The intervention was an educational CD about improving self-efficacy toward marriage in diabetics. Using descriptive statistics, inferential statistics (i.e., chi-square, t-test, paired t, Fisher, and co-variance tests), and SPSS software version 16, the self-efficacy toward marriage in both the intervention and control groups was compared. A significant level was considered less than 0.05.Results: The mean of the self-efficacy score improved significantly in the intervention group (84.14 ± 16.29 to 105.82 ± 5.49, P< 0.001). However, this score decreased in the control group (92.92±12.33 to 86.48±11.54, P<0.001). In addition, the self-efficacy in the control group was higher than in the intervention group before the study (P=0.003), although the score of the intervention group significantly increased after the study (P<0.001).Conclusions: This study showed that audio-visual training can have a significant effect on the self-efficacy of people with type 1 diabetes. Providing audio-visual equipment to referral centers of type 1 diabetics, such as hospitals, health centers, and clinics, as well as informing related officials, can be of benefit to managers.

Background: Tendency of patients toward diseases and their therapeutic responses are different based on their own temperament according to traditional Persian medicine.Objectives: The aim of this study is to investigate the difference between therapeutic responses of hot and cold temperament patients (based on traditional Persian medicine) with ulcerative colitis to pomegranate peel extract.Methods: Seventy-eight patients with moderate ulcerative colitis based on the Lichtiger colitis activity index (LCAI) criteria were randomized to receive an aqueous extract of the Punica granatum peel (6 grams per day) or placebo for four weeks. They were assessed before and after the intervention, in terms of symptoms, by the LCAI scoring system. The results were compared in two therapeutic groups based on the patients’ temperament (cold and hot), which were diagnosed based on a previous validated questionnaire.Results: Therapeutic response was significantly higher in patients with hot temperament compared to patients with cold temperament in the P. granatum group (1.916±0.492 versus -0.500±0.500, P=0.029).Conclusions: This study showed the importance of considering syndrome differentiation and temperaments in interpreting the effect of P. granatum peels extract on ulcerative colitis.

Background: Lactobacillus reuteri is a probiotic that originated from humans and have been used for eradication of the Helicobacter pylori (HP) infection.Objectives: This study was aimed to determine whether adding probiotics to a triple regimen against HP could improve the eradication rate.Methods: In a double-blind randomized clinical trial in Iran between October 2012 and January 2014, all eligible patients (Fifty HP positive children, 5 - 14 years old, mean age: 8.5+2.5 years, Male/female: 17.33) were entered into the study based on the convenience sampling method and random selection. An endoscopy was performed on all patients and the subjects received antibiotics as well as proton pomp inhibitors with or without the probiotic (Lactobacillus reuteri) in two separate groups. Four weeks after the end of treatment (discontinuation of all medicine) a urea breath test was performed in both groups in order to evaluate eradication of the HP infection.Results: Eradication rate in the group that received Lactobacillus reuteri was 88% compared to the group that was treated with standard Helicobacter pylori regimen (76%). This study showed the eradication rate of the probiotics group was 12% higher than the control group, although it was not significant (P=0.46). Furthermore, results of this study showed a reduction of symptoms before and after treatment in both groups, although the difference between two groups was not significant.Conclusions: There was no significant effect of Lactobacillus reuteri on the eradication of Helicobacter pylori compared to the standard group. More research in this regard is recommended.

Context: Dysmenorrhea is the most common gynecological complaint in Iran but the true prevalence of it is not clear yet. This study is aimed to estimate the overall prevalence of dysmenorrhea in Iran.Evidence Acquisition: International and national electronic databases including PubMed, ISI, Ovid, Scopus, Science Direct, SID, MagIran and Iran Medex were searched up to January 2016. All studies, in which the prevalence of dysmenorrhea in Iran had been reported, were included in this meta-analysis. Eligible studies were reviewed, and data was extracted onto a standard data sheet. A Meta-analysis was done by a random-effects model with a 95% confidence interval (CI).Results: Twenty-five studies were assessed involving an overall of 9, 677 participants, of which 6, 748 had primary dysmenorrhea and 280 had secondary dysmenorrhea. The overall prevalence of primary and secondary dysmenorrhea was 0.71 (95% CI: 0.65, 0.77) and 0.18 (95% CI: 0.03, 0.32), respectively.Conclusions: Primary dysmenorrhea is a common problem in Iran however, there are only a few studies regarding secondary dysmenorrhea prevalence. Moreover, there is a significant variation between the results of the studies on the primary dysmenorrhea prevalence. Therefore, further evidence-based data on national studies is needed to estimate the exact estimation of dysmenorrhea prevalence in Iran.

Background: Sleep-deprivation in children decreases the quality of life and endangers health. Increasing mother’s level of awareness can help improve the children’s sleep schedule and avoid many associated problems.Objectives: This study aimed to investigate the effect of SMS-based education on the level of sleep knowledge in mothers with 7 - 12 years old children.Methods: In this single-blind randomized controlled trial, 13 governmental primary schools in Tabriz (Iran) in 2016 (7 girls’ schools and 6 boys’ schools) were randomly selected among the primary schools, using cluster sampling approach. Then, the mothers of sleep-deprived students were randomly divided into intervention and control groups by using RAS. Both of the groups took a pretest on sleep knowledge by PSKI and then, mothers in the intervention group received education through sending SMS. Finally, all of the participants took again the posttest in two time intervals including a week and three months after the intervention. A number of 92 mothers (experiment=47, control=45) completed all of the three phases of the research and the data were analyzed using SPSS ver13.Results: The results showed that the difference between the scores obtained in the first and the second measurements of sleep knowledge in the experimental group was significantly different from that of the control group [mean between-group difference of 5.98 within 95% CI of 3.56 to 8.41 (P<0.001)]. The difference of sleep knowledge scores between the third and first measurements in the experimental group was also significantly different from that of the control group [mean between-group difference of 4.09 within 95% CI of 1.44 to 6.74 (P<0.003)].Conclusions: The use of SMS-based education is a constant and efficient educational approach for increasing mothers’ level of knowledge about children’s sleep health.

Background: Handwriting difficulties are one of the most common reasons for referral to school-based occupational therapy. Assessing handwriting performance using standardized tools is necessary for scientific research and clinical assessment.Objectives: The objective of this study was to develop and validate the Persian handwriting assessment tool to evaluate legibility and speed in near-point copying and dictation domains in primary school-aged children.Methods: This methodological study was conducted in Tehran, Iran during 2015 - 2016. Measurement items were selected by reviewing the past literature and considering the opinions of an expert panel. The scale development, the analysis of content validity, and item analysis were performed in phase one using the data from 131 students in grades two and three. Exploratory factor analysis and discriminant validity were analyzed in phase two using the data from 208 subjects. Sampling was conducted using the random cluster method. Confirmatory factor analysis was conducted on a randomly split sample of half of the data.Results: The content validity ratio of most of the criteria was greater than 0.57. Item analysis confirmed the writing assignments in the copying and dictation domains. Principal component analysis revealed that measurements in the copying and dictation domains loaded into three components separately, which accounted for 71.96% of the variance in the copying domain and 70.46% of the variance in the dictation domain. Confirmatory factor analysis also confirmed the accuracy of the three-dimensional structure designated through exploratory factor analysis. Discriminant validity showed that handwriting speed and legibility increased with maturation.Conclusions: The Persian handwriting assessment tool as a comprehensive and quickly scored tool that can help therapists identify primary school students with handwriting problems so that appropriate interventions for these students can be implemented.