Iranian Red Crescent Medical Journal
Year:2016 | Volume:18 | Issue:1|Papers Count:17

Background: Adolescence is a transition period from childhood to early adulthood. Because of the immense pressure imposed on adolescents due to the complications and ambiguities of this transition, their level of excitement increases and sometimes it appears in the form of sensitivity and intense excitement.Objectives: This study aimed at determining the effectiveness of assertiveness training on the levels of stress, anxiety, and depression of high school students.Materials and Methods: This quasi-experimental study was conducted on high school students of Isfahan in academic year 2012 - 13. A total of 126 second grade high school students were collected according to simple random sampling method and divided into two groups: experimental with 63 participants and control with the same number. Data gathering instruments included a demographic questionnaire, Gambill-Richey assertiveness scale, and depression anxiety stress scales (DASS-21). Assertiveness training was carried out on the experimental group in 8 sessions; after 8 weeks, posttest was carried out on both groups. Statistical tests such as independent t test, repeated measures ANOVA, Chi-square test, and the Mann-Whitney test were used to interpret and analyze the data.Results: The Chi-square and Mann-Whitney tests did not show significant statistical differences between the two groups in terms of demographic variables (P³0.05). Repeated measures ANOVA showed no significant difference between the mean scores for assertiveness before (100.23±7.37), immediately after (101.57±16.06), and 2 months after (100.77±12.50) the intervention in the control group. However, the same test found a significant difference between the mean score for assertiveness in the experimental group before (101.6±9.1), immediately after (96.47±10.84), and 2 months after (95.41±8.37) implementing the training program (P=0.002). The independent t test showed no significant difference in the mean score for anxiety and stress between two groups before the assertiveness training program; however, 2 months after the intervention, the mean score for anxiety in the experimental group was found significantly lower than the control group. As for the mean score for depression, the independent t test showed no significant difference between two groups before training; however, despite the decrease in the mean scores for depression in the experimental group following the intervention, the difference was not significant (P=0.09).Conclusions: The results of the current study show that conducting assertive training in high school students decreases their anxiety, stress, and depression. Given that high school years are among the most sensitive stages of one’s life plus the fact that conducting such training programs besides their safe and low cost nature are effective and practical, it is highly recommended that such programs be carried out among high school adolescents.

Introduction: Ventriculoperitoneal (V-P) shunt surgery is the most common technique used for the treatment of hydrocephalus. The migration of ventriculoperitoneal shunt to the bladder is rare. Only two cases have been previously reported in the literature.Case Presentation: We report on a 38-year-old male who had hydrocephalus and V-P shunt for 12 years. Two years ago, he found himself with recurrent urinary tract infections, haematuria and urges incontinence, and then he was diagnosed with bladder perforation and merge stones. The patient had an abdominal operation to cut off and take out the shunt catheter, as well as a transurethral holmium laser lithotripsy.Conclusions: Bladder perforation and stones are rare examples of complications in V-P surgical procedures. Controlling the effective length of the terminal V-P shunt and modifying it appropriately can effectively reduce these complications.

Background: The globally increasing epidemic of diabetes will lead to serious problems including diabetic nephropathy and kidney diseases in near future. The first clinical diagnosable stage in a diabetic kidney disease is microalbuminuria (urinary albumin excretion of 30 - 300 g/24 hours).Objectives: This prospective cohort study investigated the risk factors of microalbuminuria in patients with type 2 diabetes who had been registered in endocrine and metabolism research center in Isfahan city, Iran.Patients and Methods: This prospective cohort study was performed on 90 diabetic type 2 patients with microalbuminuria, who were selected according to the consecutive sample selection method during 6 years. Data were collected through regular and systematic measurements of serum albumin as the response variable and body mass index, systolic and diastolic blood pressure, the duration of diabetes, glycosylated hemoglobin (HbA1c), total cholesterol, triglyceride (TG), fasting blood sugar (FBS), low-density lipoprotein (LDL), and high-density lipoprotein (HDL) as the related factors. Non-normal mixed models were used to investigate the impact of effective factors on the amount of excreted serum albumin.Results: According to the deviance information criterion (DIC=56.2), the non-normal mixed effects model with the skewed t distribution had a best fit and indicated that HbA1c, HDL and total cholesterol had a significant effect on the amount of albumin in urine (P<0.05).Conclusions: Using nonnormal mixed models may lead to the best results as compared to common normality assumption.

Background: Iron supplementation is a chief component in prenatal care, with the aim of preventing anemia; however, extreme maternal iron status may adversely affect the birth outcome. Given the negative consequences of high maternal iron concentrations on pregnancy outcomes, it seems that iron supplementation in women with high hemoglobin (Hb) should be limited.Objectives: The aim of this study was to examine the effect of iron supplementation on iron status markers in pregnant women with high Hb.Patients and Methods: In a randomized, double-blind, placebo-controlled trial, 86 pregnant women with Hb>13.2 g/dL and ferritin>15 mg/l in the 16th - 20th week of pregnancy were randomized into experimental and control groups. From the 20th week until the end of pregnancy, the experimental group received one ferrous sulfate tablet containing 50 mg of elemental iron daily, while the control group received a placebo. Hb and ferritin levels at 37 - 39 weeks of pregnancy were evaluated and compared. In addition, after delivery the birth weight was measured in two groups and compared.Results: There were statistically significant differences between the two groups in Hb (p=0.03) and ferritin (p=0.04) levels at the end of pregnancy, but the incidence of anemia exhibited no difference in either group (p<0.001). In addition, the mean of birth weight in experimental group and control group were 3391.56±422, 3314.06±341, respectively and it was not significant difference (p=0.2).Conclusions: Not using iron supplementation did not cause of anemia in women with Hb concentrations greater than 13.2 g/dL during pregnancy; thus, the systematic care and control of iron status markers without iron supplementation is recommended for these women.

Background: Tumor necrosis factor receptor-associated factor 6 (TRAF6) has been reported to be highly expressed in many tumor tissues, but it is still of value to detect its expression in patients with colon cancer and to clarify its clinical significance.Objectives: To study the expression and clinical significance of TRAF6 in patients with colon cancer.Patients and Methods: A total of 135 patients with colon cancer who underwent surgery at our hospital from February 2008 to March 2013 were selected. The expression levels of TRAF6 protein in tumor and paracancerous tissues were detected with the immunohistochemical method to evaluate their clinical significance.Results: The positive expression rate of TRAF6 in tumor tissues was 66.7%, which was significantly higher than in normal paracancerous tissues (18.5%). The positive expression rate of TRAF6 was significantly correlated with Dukes’ staging, degree of differentiation, and lymphatic metastasis (P<0.05), but not gender or age (P>0.05). The expression level of TRAF6 was negatively correlated with the 5-year survival rate; patients with high TRAF6 expression levels had significantly decreased survival compared to those with low levels (P<0.05).Conclusions: TRAF6 plays an important role in the onset of colon cancer; therefore, drugs targeting it may have great clinical significance in the treatment of this disease.

Background: Kidney stones were previously rare among children, but now its prevalence and frequency among children has increased.Objectives: The aim of this study was to investigate the effect of a double-J stent on the treatment of kidney stones larger than 10 mm in children under 13 years, using extracorporeal shock wave lithotripsy.Patients and Methods: This double blind clinical trial study was conducted on 68 children younger than 13 years with renal calculi at pelvic, referred to Tohid hospital in Sanandaj during 2010 - 2014. The patients were randomly divided into two groups: the double-J stent group (34 patients) and the control group (34 patients).2000 shock waves were given during each period to all subjects. Data were analyzed using SPSS version 18, and descriptive statistics (frequency, ratio, mean, and standard deviation) were collected.Results: The stone sizes of the intervention and control groups were 13.76±2.62 mm 13.91±2.79 mm, respectively (P=0.69). In 58.8% of the children in the intervention group and 76.5% of those in the control group, the right kidney was involved (P=0.12). In terms of post-lithotripsy outcome frequency, including fever, hospitalization and steinstrasse, there were no statistically significant difference between the intervention and the control groups (P>0.05). The frequency of urinary tract infection in the intervention group and the control group was 23.5% and 5.9%, respectively, meaning there was a statistically significant difference between the intervention and the control groups (P=0.04).Conclusions: The kidney stone clearance rate in children with and without using the stent was almost equal. Considering the problems of kidney stents and additional charges, extracorporeal shock wave lithotripsy (ESWL) without stents is recommended for treatment of 8 to 15 mm kidney stones.

Background: Over the past few decades, the association between leisure activity patterns and marital conflict or satisfaction has been studied extensively. However, most studies to date have been limited to middle-class families of developed societies, and an investigation of the issue, from a developing country perspective like Iran, is non-existent.Objectives: In an observational, analytical, cross-sectional study we aimed to investigate the relationship between leisure activity patterns and marital conflict in a nationally representative sample of Iranian married males.Patients and Methods: Using the cluster sampling method, a representative sample of 400 Iranian married individuals from seven provinces of Iran was surveyed. Self-administered surveys included a checklist collecting demographic and socioeconomic characteristics of the enrolled participants, leisure time questionnaire, and marital conflict questionnaire. The main patterns of leisure activity were derived from principal component analysis. For each pattern, factor scores were calculated. The relationship between factor scores and marital conflict were assessed using multivariate linear regression models accounting for the potential confounding effects of age, education, socioeconomic status, job status, number of children, duration of marriage, and time spent for leisure.Results: Two hundred and ninety-nine respondents completed the leisure time and marital conflict questionnaires. Five major leisure patterns were identified accounting for 60.3% of the variance in data. The most dominant pattern was family-oriented activities (e.g. spending time with family outdoors and spending time with family indoors) and was negatively linked to marital conflict (standardized beta=−0.154, P=0.013). Of the four remaining patterns, three only included individual activities and one was a family-individual composite. Individual patterns exhibited discrepant behavior; while the pattern involving activities like ‘watching TV’, ‘non-purposive time spending’, and ‘napping’ was positively associated with conflict (standardized beta=0.165, P=0.009) and the other two were not. The mixed family-individual pattern was also positively associated with marital conflict (standardized beta=0.240, P<0.001).Conclusions: Among Iranian married men, family-based leisure activities are linked to a lower level of marital conflict. The associations for individual patterns are less congruent.

Background: Because of their unique magnetic properties, Fe3O4 nanoparticles (Fe3O4-NPs) have extensive applications in various biomedical aspects. Investigation of the possible adverse aspects of these particles has lagged far behind their fast growing application.Objectives: The current study aimed to evaluate the toxicity of Fe3O4-NPs in the liver of mice.Materials and Methods: In the present clinical trial, 90 BALB/c mice were randomly divided in 15 groups. Five control groups were fed by usual water and food. Five placebo groups were gavaged with physiological serum in doses of 25, 50, 75, 150, and 300 micrograms per gram of body weight (mg/gr). Five experimental groups were gavaged with Fe3O4-NPs, in doses of 25, 50, 75, 150, and 300 mg/gr. This pattern was repeated every other day, for 3 days. Then, the levels of liver enzymes [alanine transaminase (ALT), aspartate aminotransferase (AST) and alkaline phosphatase (ALP)] were compared between these groups. The histological alterations of livers were examined, as well. For statistical analysis, Kruskal-Wallis and Mann-Whitney, with type I Bonferroni correction, as post-hoc, have been used.Results: The administration of 150 and 300 mg/gr doses of Fe3O4-NPs were associated with significant elevation in liver enzymes, compared to controls (P<0.0001). Furthermore, the histopathological effects were observed in the liver tissue of these groups. However, in groups treated with lower doses of Fe3O4-NPs, no significant adverse effect was observed.Conclusions: Based on our results, the administration of Fe3O4-NPs causes dose dependent adverse effects on liver.

Background: Few studies have been conducted on role conflict in nursing faculty in the world. This research reports the first study about this subject in Iran.Objectives: The purpose of this research was to explore the experiences of role conflict in Iranian nursing faculty members.Materials and Methods: We conducted a qualitative study using a conventional content analysis approach. We used semi-structured and in-depth interviews by purposive sampling of 19 (15 instructors, three group managers and one educational assistant) participants to identify the influential factors of role conflict among nurse faculty members, working in seven nursing colleges in Iran.Results: The three following categories emerged from data analysis: "roles Interference"; "role ambiguity", and "conflicting expectations". The main theme was "working in conflict climate".Conclusions: This study highlighted the influential factors that could produce role conflict for nursing faculty members. The results can help university leaders to improve nursing faculty working conditions.

Dear Editor: In allopathic medicine, absence seizure is a kind of generalized seizure characterized by sudden, brief lapses of consciousness without loss of postural control (1, 2). Typical absence only lasts for a few seconds and consciousness returns suddenly as it was lost, without postictal confusion (3)...

Background: Insulin resistance is a measure of metabolic stress in the perioperative period. Before now, no clinical trial has determined the summative effects of glutamine, L-carnitine, and antioxidants as metabolic conditioning supplements in the perioperative period.Objectives: The purpose of this study was to determine the effects of a new conditioning supplement on perioperative metabolic stress and clinical outcomes in non-diabetic patients.Patients and Methods: In this randomized controlled trial, 89 non-diabetic patients scheduled for coronary artery bypass grafting, with ejection fractions above 30%, were selected. Using the balanced block randomization method, the patients were allocated to one of four study arms: 1) SP (supplement/placebo): supplement seven days before and placebo 30 days after the surgery; 2) PS: placebo before and supplement after the surgery; 3) SS: supplement before and after the surgery; and 4) PP: placebo before and after the surgery. The supplement was composed of glutamine, L-carnitine, vitamin C, vitamin E, and selenium, which was manufactured for the first time by this research team. Five blood samples were drawn: seven days preoperatively, at the entrance to the operating room, while leaving the operating room, seven days postoperatively, and 30 days postoperatively. Levels of glucose, insulin, and HbA1c were measured in blood samples. Insulin resistance and sensitivity were calculated using a formula. Surgical complications were assessed 30 days postoperatively. Data analysis was done using one-way ANOVA, the Chi-square test, and a general linear model repeated-measures analysis with Bonferroni adjustment.Results: Blood glucose levels were increased postoperatively in the four groups (<0.001), but a significantly higher increase occurred in the PP group compared to the SP (0.027), PS (0.026), and SS (0.004) groups. The superficial wound infection rate was significantly different between the four groups (0.021): 26.08% in PP, 9.09% in SP, 4.54% in PS, and 0% in SS.Conclusions: Our new metabolic conditioning supplement, whether given pre- or postoperatively, led to better perioperative glycemic control and decreased postsurgical wound infections in non-diabetic patients.

Background: Fever is the most common complaint in pediatric medicine and its treatment is recommended in some situations. Paracetamol is the most common antipyretic drug, which has serious side effects such as toxicity along with its positive effects. Diclofenac is one of the strongest non-steroidal anti-inflammatory (NSAID) drugs, which has received little attention as an antipyretic drug.Objectives: This study was designed to compare the antipyretic effectiveness of the rectal form of Paracetamol and Diclofenac.Patients and Methods: This double-blind controlled clinical trial was conducted on 80 children aged six months to six years old. One group was treated with rectal Paracetamol suppositories at 15 mg/kg dose and the other group received Diclofenac at 1 mg/kg by rectal administration (n=40). Rectal temperature was measured before and one hour after the intervention. Temperature changes in the two groups were compared.Results: The average rectal temperature in the Paracetamol group was 39.6±1.13oC, and 39.82±1.07oC in the Diclofenac group (P=0.37). The average rectal temperature, one hour after the intervention, in the Paracetamol and the Diclofenac group was 38.39±0.89oC and 38.95±1.09oC, respectively (P=0.02). Average temperature changes were 0.65±0.17oC in the Paracetamol group and 1.73±0.69oC in the Diclofenac group (P<0.001).Conclusions: In the first one hour, Diclofenac suppository is able to control the fever more efficient than Paracetamol suppositories.

Background: Ventilator-Associated Pneumonia (VAP) is the main cause of nosocomial infection at intensive care units (ICUs), which causes high mortality and morbidity.Objectives: The objective of the present survey was to identify the VAP risk and prognostic factors among poisoned patients, who were admitted to the toxicological ICU (TICU), especially central nervous system (CNS) depressants due to their prevalence and importance.Patients and Methods: A case-control study was conducted at the Loghman Hakim hospital between March 2013 and March 2014. Among 300 poisoned patients with mechanical ventilator³48 hours, 150 patients, who had developed microbiologically-confirmed VAP were considered as the VAP group and 150 without VAP were defined as the control group. The following data were collected; age, gender, type of poisoning, glasgow coma score, Acute physiology and chronic health evaluation (APACHE) II score, length of hospital stay, previous antibiotic use, microbial culture of the trachea, body temperature, leukocyte count, and patients’ outcome. Based on the type of poisoning, patients were divided into three groups including: opioid, CNS depressants and others. All data were expressed as means (SD) for continuous variables and frequencies for categorical variables. Logistic regression was used to determine the relationship between risk factors and VAP.Results: The mean age of the patients was 33.9±14.3 years. The probable VAP incidence and mortality were 22% and 18.6%, respectively. The rate of CNS depressant versus opioid use (odds ratio, 3.74; P<0.027), APACHE II (odds ratio, 1.28; P<0.000) and length of hospital stay (odds ratio, 2.15; P<0.000) were the independent risk factors for VAP. While, the APACHE II score (odds ratio, 1.12; P<0.044) and length of hospital stay (odds ratio, 2.15; P<0.000) were the independent predictors of VAP mortality among these patients. The most common microorganisms in VAP cases were Methicillin-Resistant Staphylococcus aureus (MRSA) and Acinetobacter sp. (56.7% and 12.7%, respectively).Conclusions: Central nervous system depressant was an important risk factor for VAP among poisoned patients. Hypoventilation due to CNS depression can lead to VAP. The APACHE II and length of hospital stay were shown as independent predictors of VAP and mortality among these patients.

Background: Most urinary tract infections (UTI) are caused by Escherichia coli. Integrons have an important role in distributing antibiotic resistance genes among bacteria.Objectives: The aim of this study was to investigate the presence of class 1, 2 and 3 integrons and their association with antibiotic resistance in E. coli isolated from patient with UTI in Yasuj, Iran.Patients and Methods: In this cross-sectional study a total of 200 E. coli were collected from 1820 patients diagnosed with UTI that had been referred to two clinical laboratories between February 2013 and November 2014 in Yasuj city, southwest of Iran. Susceptibility of isolates to 11 different antibiotics was determined by the disk agar diffusion method. multiplex-polymerase chain reaction (PCR) was used for detection of class 1, 2 and 3 integrons. The data were analyzed using the SPSS software (version 16) and the chi-square test. A P value of<0.05 was considered statistically significant.Results: The highest rate of resistance was observed toward cephalothin (99%) and amoxicillin (76%) while only two (1%) isolates showed resistance to imipenem. Overall, 79% of isolates were multi drug resistant (MDR). Class 1 and 2 integrons were detected in 104 (52%) and 5 (2.5%) isolates respectively, while none of the isolates were positive for class 3 integrons. A significant association was observed between the presence of integrons and resistance to co-trimoxazole, nalidixic acid, ciprofloxacin, amoxicillin, ceftazidime and tetracycline (P<0.05).Conclusions: High MDR isolates of E. coli were observed in this study. The significant association between class 1 integrons and resistance to ciprofloxacin, nalidixic acid, co-trimoxazole, amoxicillin, ceftazidime and tetracycline showed that class 1 integrons have an important role in resistance to these antibiotics in this region.

Background: Mothers got stressed when they are informed about the occurrence of stillbirth. Many researchers believe that the failure to provide the required care by health teams during this hard time is the main determinant of maternal mental health in the future. In other words, psychosocial support by medical care providers can significantly improve mental outcomes of mother after stillbirth.Objectives: This study aimed to explore stillborn mothers’ suggested strategies to provide maternal mental health in the experience of stillbirth.Patients and Methods: Twenty women who had experienced stillbirths participated in this qualitative content analysis study. They were selected through purposeful sampling method. Data were gathered by individual interviews recorded on audiotapes, transcripted and then analyzed. Then, transcriptions were coded and classified. Finally, 3 main categories and 9 subcategories were emerged.Results: Analysis of participants’ viewpoints and their opinions about strategies to provide maternal mental health in the experience of stillbirth lead to development of 3 main categories: "before delivery strategies" with 3 subcategories, "during labor strategies" with 3 subcategories, and "postpartum strategies" with 3 subcategories. Analyses of findings showed that, health care providers can mitigate some of the long-term negative mental outcomes of stillborn mothers by spending extra time with grieving mothers, facilitating bonding, and validating their emotional expressions.Conclusions: According to the results, revision and modification of the care plan in the experience of stillbirth seems necessary to improve mental health in these mothers. According to suggested strategies, midwives and health care providers are health professionals who can effectively and properly care for stillborn mothers.

Background: Cancer affects not only the patient but also their entire family, especially adolescents. Adolescents whose parents are ill may manifest their distress through changes in school performance, physical complaints of pain and discomfort, as well as changes in social and interpersonal relations. There has been very little research about the effects of cancer on adolescents in Iran.Objectives: The purpose of this qualitative study was to explore the Iranian adolescents’ experiences when living with a parent with cancer.Patients and Methods: In this research, the descriptive-explorative approach was used. There were a total of 27 participants. Purposeful sampling was used and data collection methods were semi-structured deep interviews. Constant comparative analysis was used to study the data.Results: The findings of this study showed that the main experiences of these adolescents were categorized into seven themes: 1- psychological problems of adolescents; 2- supportive-educative needs; 3- cancer as a two edged sword in family relationships; 4- stages of confrontation with the parent’s cancer; 5- effect of cancer on social dimensions; 6- affective and helpful supportive agents; 7- Need of support for education under special conditions.Conclusions: This research showed that Iranian adolescents had the same experiences as other adolescents in other countries in many aspects yet in some issues, such as religious strategy, they had strong religious beliefs that would help them cope with their parents’ cancer. Also it was shown that we must plan a program in which education and support should be provided to enable adolescents to cope with this detrimental situation with minimal disruption.

Background: It is estimated that about 15% (10% - 30% in most of the studies) of the total adult population has some aspects of the Chronic Venous Insufficiency (CVI). Frequency of the Peripheral Arterial Disease (PAD) in the adult population is 3% - 4%. Studies dealing with etiopathogenesis of leg ulcers show that between 10% and 18% of all ulcers are of mixed, arterial-venous origin.Objectives: The purpose of this study was to find out if there is a higher frequency of PAD among CVI patients in comparison with the control group, as well as to discover some common risk factors for CVI and PAD.Patients and Methods: This cross-sectional descriptive study was conducted at the dermatovenereological clinic, clinical center of Vojvodina, Serbia. A total of 162 examinees were included. All patients were examined for the existence of CVI and staged according to CEAP (Clinical, etiology, anatomy and patophysiology) classification. In this way, 3 groups were formed: Patients with the mild forms of CVI (stage 1 - 4 by CEAP classification), 57 patients; patients with the severe forms of CVI (stage 5 and 6 by CEAP classification), 55 patients; control group (no CVI), 50 patients. Also, the Ankle Brachial Pressure Index (ABPI) was assessed in all subjects, and its value of£0.9 was set as criteria for diagnosis of PAD. The same sample was divided according to the presence of PAD into two groups. The most important risk factors for CVI and PAD were identified for each patient through complete examination, medical record and appropriate questionnaire.Results: Our results showed that the risk factors for CVI were high Body Mass Index (BMI), hypertension, predominantly standing position during work and positive family history for CVI. In the same sample it was found that 28 (17.28%) patients had PAD. Relevant risk factors for PAD in the present study were: high BMI, hypertension, diabetes and a positive family history for PAD. Comparison of frequency of PAD among patients with severe forms of CVI and control group showed that this difference was statistically significant (P=0.0275; OR 3.375; 95% CI 1.125 - 10.12). After multivariate analyses, adjusted odds ratio OR was still statistically significant.Conclusions: The peripheral arterial disease is more frequent in patients with the severe form of CVI, than in patients without CVI. Concomitant risk factors for CVI and PAD were high BMI and hypertension. In each patient with severe CVI it is necessary to determine the ABPI, in order to exclude the presence of PAD.