Iranian Red Crescent Medical Journal
Year:2016 | Volume:18 | Issue:2|Papers Count:27

Background: α-adrenergic receptor 2A (ADRA2A) and angiotensin-converting enzyme (ACE) genes have been variably associated with obesity and its related phenotypes in different populations worldwide. Objectives: This cross-sectional study aims to investigate the association of adrenergic receptor α 2A (ADRA2A) rs553668 and angiotensin-converting enzyme (ACE) I/D single nucleotide polymorphisms (SNPs) with obesity traits (body mass index-BMI; waist-hip ratio-WHR; total body fat percentage-TBF) in a Malaysian population. Materials and Methods: Demographic and clinical variables were initially collected from 230 subjects via convenience sampling among residents and workers in Setapak, Malaysia, but in the end only 214 multi-ethnic Malaysians (99 males; 45 Malays, 116 ethnic Chinese, and 53 ethnic Indians) were available for statistical analysis. Genotyping was performed by polymerase chain reaction using DNA extracted from mouthwash samples. Results: The overall minor allele frequencies (MAFs) for ADRA2A rs553668 and ACE I/D were 0. 55 and 0. 56, respectively. Allele distribution of ACE I/D was significantly associated with ethnicity and WHR class. Logistic regression analysis showed that subjects with the ACE II genotype and I allele were, respectively, 2. 15 and 1. 55 times more likely to be centrally obese, but when adjusted for age and ethnicity, this association was abolished. Covariate analysis controlling for age, gender, and ethnicity also showed similar results, where subjects carrying the II genotype or I allele did not have significantly higher WHR. Combinatory genotype and allele analysis for ADRA2A rs553668 and ACE I/D showed that subjects with both ADRA2A rs553668 GG and ACE I/D II genotypes had significant lowest WHR compared to other genotype combinations. Conclusions: The ACE II genotype might be a protective factor against central adiposity risk among the Malaysian population when in combination with the ADRA2A rs553668 GG genotype.

Background: There is a strong relationship between physical inactivity and low-grade inflammation and its adverse health outcomes, particularly cardiovascular disease. The level of anti-inflammatory and pro-inflammatory cytokines may be changed by exercise.Objectives: The aim of the present study was to determine the response of certain inflammatory biomarkers to exercise with differences in maximal oxygen consumption (VO2max). These biomarkers were IL-1b, TNF-a, hs-CRP, IL-6, sICAM-1, IL-10, and ratios of TNF-a/IL-10 and IL-6/IL-in circulating peripheral blood (PB).Materials and Methods: In a semi-experimental study, twenty male students who performed regular football exercise at least three days a week, for two years, were selected by easy sampling at Shahid Chamran university of Iran. Subjects were then randomly assigned to two groups: the protocol of the first group was 30 minutes of running at a speed of 65% of VO2max, and the second group performed six periodic repetitions with three minutes at a speed of 85% of VO2max with a 90-second rest between the repetitions. Blood samples were taken at baseline, immediately after the exercise and at rest. Cytokine levels were quantified by the Sandwich enzyme-linked immunosorbent assay (ELISA) method.Results: The first protocol resulted in a decrease of serum IL-1b to 3.77±0.28 pg/mL at rest, from 4.33±0.28 at baseline and 4.32±0.34 immediately after exercise (P=0.008 and P=0.013, respectively). There was also a decrease in the level of sICAM-1 to 260.11±15.64 ng/mL at rest, from 329.58±20.82 at baseline and 302.7±20.49 post exercise (P=0.013 and P=0.038, respectively). On the other hand, IL-6 and ratio of IL-6/IL-10 increased to 6.55±0.84 pg/mL and 2.12±0.37 immediately after exercise from baseline (2.73±0.58 and 1.16±0.33) and rest (2.49±0.45 and 0.95±0.19) in the second protocol (P=0.001 and P=0.001, respectively for IL-6, and P=0.047 and P=0.024, respectively for IL-6/IL-10).Conclusions: The data of the present study demonstrated that a single bout of exercise with higher-intensity induces a transient increase in some proinflammatory markers, and lower-intensity can reduce these biomarkers.

Background: Basic fibroblast growth factor (bFGF) is a member of a highly conserved superfamily of proteins that are involved in cell proliferation, differentiation, and migration.Objectives: The objective of this study was to overexpress and purify the high-level active human bFGF in Escherichia coli (E. coli).Materials and Methods: This experimental study was conducted in the Islamic Republic of Iran. After codon optimization and gene synthesis, the optimized FGF-2 gene was subcloned into plasmid pET-32a. pET32-FGF-2 was transformed into E. coli BL21 for expression. The cultivation parameters were optimized to produce a high yield of FGF-2.Results: The optimal conditions were determined as follows: cultivation at 37°C in TB medium, with 1 mM isopropyl-b-D-thiogalactopyranoside (IPTG), followed by post-induction expression for 6 h. Under the abovementioned conditions, the expression volumetric productivity of FGF-2 reached 1.48 g/L.Conclusions: A fusion tag from the pET32 expression plasmid permits the recovery of the recombinant fusion FGF-2 from E. coli, without affecting its biological activity.

Background: Evidence based practice is an effective strategy to improve the quality of obstetric care. Identification of barriers to adaptation of evidence-based intrapartum care is necessary and crucial to deliver high quality care to parturient women.Objectives: The current study aimed to explore barriers to adaptation of evidence-based intrapartum care from the perspective of clinical groups that provide obstetric care in Iran.Materials and Methods: This descriptive exploratory qualitative research was conducted from 2013 to 2014 in fourteen state medical training centers in Iran. Participants were selected from midwives, specialists, and residents of obstetrics and gynecology, with a purposive sample and snowball method. Data were collected through face-to-face semi-structured in-depth interviews and analyzed according to conventional content analysis.Results: Data analysis identified twenty subcategories and four main categories. Main categories included barriers were related to laboring women, persons providing care, the organization environment and health system.Conclusions: The adoption of evidence based intrapartum care is a complex process. In this regard, identifying potential barriers is the first step to determine and apply effective strategies to encourage the compliance evidence based obstetric care and improves maternity care quality.

Context: Bowel obstruction is one of the most common causes of acute abdomen. Because of heterogeneity of patients’ population and variety of causes, therapeutic strategies are not standardized, so treatment of intestinal obstruction is a surgical challenge in many cases. A traditional medicine approach could help detect some issues that were ignored by modern medicine. One of the major schools of medicine, with a history of several thousand years, is Iranian traditional medicine. In this regard, Avicenna, who lived in the medieval period, has had a great influence on the medical knowledge of the world by writing an encyclopedia of medicine entitled "Qanun of Medicine." Evidence Acquisition: The aim of this study was to investigate Avicenna’s views on the causes of intestinal obstruction and comparing them to modern medicine views. This is a review study on an Iranian traditional textbook of medicine by Avicenna, entitled "Qanun of Medicine" (in short "Qanun"). We used Qanun in its original language (Arabic) along with its Persian translation. It consists of 5 books. Part 16 of the third book talks about intestinal anatomy and introduces some intestinal diseases such as "qoolinj" and "ilavos." Intestinal obstruction can be a kind of "qoolinj" or "ilavos" disease. All intestinal obstruction etiologies in Qanun are searched in international and Iranian databases (Scopus, ISI, SID, and Iranmedex) and similar causes in modern medicine will be discussed in this article.Results: According to Qanun, 16 causes are involved in intestinal etiologies of bowel obstruction such as "reeh, " mucoid phlegm, abdominal hot and dry distemperament, decreased bile secretion, job, and so on while modern medicine considers some of them, for instance, volvulus, intestinal herniation, worm, intestinal pseudo-obstruction, and opiate.Conclusions: Attention to the similar causes of intestinal obstruction in modern medicine and traditional medicine is the starting point for investigation of noninvasive diagnostic and therapeutic methods that have been mentioned in Qanun. In addition, etiologies which are missed in modern medicine can open new doors to the researchers and gastroenterologists for the study, diagnosis, and prevention of the disease.

Background: Epidemiological data on antibiotic susceptibility of Staphylococcus strains isolated from nasal carriers in each region can be helpful to select appropriate drugs to eradicate carriage states, control nosocomial infections and also treat patients. Objectives: The current study aimed to investigate the antibiotic resistance profile and the molecular prevalence of the ermA, ermB, ermC and msrA genes among Staphylococcus strains isolated from the anterior nares of hospital employees. Patients and Methods: In this cross-sectional study, a total of 100 Staphylococcus isolates, 51 Staphylococcus aureus, 49 coagulasenegative staphylococci (CoNS) were isolated from the anterior nares of hospital employees in Khorramabad, Iran. Susceptibility pattern to macrolide antibiotics were determined using the disk diffusion method. The polymerase chain reaction (PCR) assay was applied to determine the major erythromycin-resistant genes (ermA, ermB, ermC and msrA). Results: Fifty-three (53%) isolates were simultaneously resistant to erythromycin, azithromycin and clarithromycin (crossresistance); while 8 (8%) isolates had variable macrolide susceptibility pattern. Among the S. aureus isolates, the difference in prevalence of resistance to erythromycin between males and females was significant (P = 0. 011). The frequency of ermA, ermB, ermC, and msrA genes were 3%, 5%, 33% and 20%, respectively. It was also found that out of 53 isolates resistant to erythromycin, 44 (83%) isolates (eight S. aureus and thirty-six CoNS strains) carried at least one of the four tested genes. Eight (8%) isolates had intermediate phenotype to erythromycin, in which 4 (50%) isolates carried ermB or ermC genes. In addition, out of 39 erythromycin-susceptible isolates, 3 (7. 7%) isolates were positive for ermB or ermC genes. Conclusions: No entire association was found between genotype and phenotype methods to detect macrolides-resistant isolates. In addition, distribution of genetically erythromycin-resistant isolates is geographically different among staphylococci. It is recommend removing S. aureus from nasal carriers by proved approaches such as local or systemic administration of effective antibiotics or bacterial interference.

Background: The use of long-term care services has risen and this trend is expected to continue as the population reaches old age.Objectives: This study was performed to assess the caring conditions in nursing homes.Patients and Methods: This study was conducted with a qualitative approach using conventional qualitative content analysis. The study was conducted on 23 Iranian participants including 14 elders and 9 caregivers. Data was collected with unstructured interviews and continued to the point of data saturation. Analysis of data was performed continually and concurrently with data collection through a comparative method.Results: Three themes emerged from 595 open codes including care as unpleasant task, sustained care and insufficient resources. Ten subthemes indicated participants’ experiences and understanding of caring conditions in a nursing home.Conclusions: The prevailing given care was the routine one with a focus on physical aspects, although there was some psychological care given to the older people. The findings of this research are guidelines for managers and care planners in nursing homes who should pay attention to physical and psychological care needs of older people. In addition, it is important to pay close attention to the needs of caregivers and provision of instructions for treatment, supervision and education of caregivers and medical students to provide a better care.

Background: Health-related quality of life (HRQoL) is used as a measure to valuate healthcare interventions and guide policy making. The EuroQol EQ-5D is a widely used generic preference-based instrument to measure Health-related quality of life. Objectives: The objective of this study was to develop a value set of the EQ-5D health states for an Iranian population. Patients and Methods: This study is a cross-sectional study of Iranian populations. Our sample from Iranian populations consists out of 869 participants, who were selected for this study using a stratified probability sampling method. The sample was taken from individuals living in the city of Tehran and was stratified by age and gender from July to November 2013. Respondents valued 13 health states using the visual analogue scale (VAS) of the EQ-5D. Several fixed effects regression models were tested to predict the full set of health states. We selected the final model based on the logical consistency of the estimates, the sign and magnitude of the regression coefficients, goodness of fit, and parsimony. We also compared predicted values with a value set from similar studies in the UK and other countries. Results: Our results show that the HRQoL does not vary among socioeconomic groups. Models at the individual level resulted in an additive model with all coefficients being statistically significant, R2 = 0. 55, a value of 0. 75 for the best health state (11112), and a value of-0. 074 for the worst health state (33333). The value set obtained for the study sample remarkably differs from those elicited in developed countries. Conclusions: This study is the first estimate for the EQ-5D value set based on the VAS in Iran. Given the importance of locally adapted value set the use of this value set can be recommended for future studies in Iran and In the EMRO regions.

Background: Nursing management is the most important aspect for providing high-quality nursing care. Therefore, skillful nursing managers, such as head nurses, are required to accomplish this goal. High-quality nursing care is one of the most important principles of health organizations to ensure society’s health.Objectives: The goal of the conventional content analysis is to explain the dominant experienced-based behavior of the head nurses in clinical wards.Materials and Methods: This study was conducted by applying a quality study approach with a common content analysis model (Granheim and Lundmen). The participants were 25 head nurses who were working in the wards of various hospitals in Zahedan City. They were selected via the purposeful sampling method. The data were collected thoroughly and continued until a saturation stage was reached.Results: The result of data analysis was the theme "turbulent atmosphere-based management," which consists of five categories as follows: the work culture of the ward, job burnout, negligent evaluation, job conflict, and decision making with limited effects.Conclusions: The analysis of the findings of the present study through considering the defined categories demonstrated that, to modify and correct the turbulent atmosphere-based management, several important measures are required and need to be continually monitored.

Background: Wellbeing is one’s evaluation and judgment of one’s life. It consists of 3 dimensions: positive affectivity, negative affectivity, and life satisfaction.Objectives: This study aimed to compare the subjective wellbeing and positive future expectations between working and nonworking adolescents.Patients and Methods: The study was designed as descriptive and comparative. The study sample consisted of 420 working and 482 nonworking adolescents (n=902) aged 15 - 20 years, who were randomly recruited from two occupational education centers in Istanbul, Turkey and two high schools (formal educations) in the same district.Results: Adolescent subjective wellbeing scale (ASWS) total mean (SD) scores for working adolescents and nonworking adolescents were 48.76 (9.50) and 49.72 (8.01), respectively. In addition, positive future expectations scale (PFES) total mean (SD) scores for working adolescents and nonworking adolescents were 18.71 (4.50) and 19.06 (3.49), respectively. In this study, no significant difference was found between the general wellbeing (scale total median score) scores of the working and nonworking adolescent groups (Z=1.01, P=0.315). However, significant differences were found in the family relations satisfaction (Z=3.23, P=0.002) and relations with significant others (Z=2.85, P=0.004) subscales of the ASWS.Conclusions: A positive relationship was found between adolescent subjective wellbeing and positive future expectations. It was found that nonworking adolescents scored higher on the dimensions of "family relations" and "relations with significant others" of subjective wellbeing compared to those dimensions in working adolescents.

Dear Editor: Low back pain and sciatica have been considered as the common morbidities of human kind throughout the history. The explanation of the etiology has been changed during the centuries and still remains a dilemma. Reviewing ancient theories may lead to novel findings about the etiology and its better treatments.

Background: Complications and postoperative pain are major care problems that can affect the quality of health care plan. Objectives: According to the use of multimodal therapy the current study aimed to compare the efficacy of gabapentin and celecoxib in pain management and complications after laminectomy at Ilam University of Medical Sciences, Ilam, Iran, in 2015. Patients and Methods: In this randomized double-blind clinical trial, 114 patients scheduled for elective laminectomy with simple random sampling design received gabapentin (n = 38, 900 mg/day), celecoxib (n = 38, 600 mg/day) and placebo (n = 38, capsule contain starch). Visual analog scale (VAS) was used to determine the intensity of pain. Complications after surgery, anxiety scores before surgery and patient’ s satisfaction 24 hours after the surgery were recorded. Results: The mean pain intensity in the gabapentin group was lower compared to those of the placebo and celecoxib groups respectively at different time durations (P < 0. 001). The means of morphine consumption were 11. 9 mg, 22. 8 mg and 30. 1 mg in the gabapentin, celecoxib and placebo groups, respectively (P < 0. 001). The prevalence of shivering, nausea, vomiting and pruritus were 10. 5%, 12. 8%, 10. 3% and 18. 4% in the gabapentin group vs 31. 5%, 29. 8%, 32. 4% and 28. 9% in the celecoxib group and 42. 1%, 44. 7%, 39. 5% and 44. 7% in the placebo group (P < 0. 001). The mean anxiety score in the gabapentin group was 2. 4 vs those of the celecoxib group 3 and placebo group 3. 6 (P < 0. 001). The frequencies of drowsiness were 42. 1%, 13. 2% and 5. 3% in the gabapentin, celecoxib and placebo groups, respectively (P < 0. 001). In the gabapentin group, patient satisfaction was significantly higher compared to those of the placebo and celecoxib groups (P < 0. 05). Conclusions: According to the effect of gabapentin on pain management, complications after laminectomy and increased patients satisfaction, it can be regarded as an alter native in multimodal analgesia.

Background: Understanding sexual behavior before marriage is relatively rare in the East, especially in Islamic societies, because sexuality is a sensitive subject for many Muslims.Objectives: The purpose of this study was to identify premarital sexual intercourse-related individual factors among Iranian adolescents.Patients and Methods: This qualitative study was performed on 30 students of Payame Noor university of Shiraz city, Iran, in 2014. The study sample includes male and female university students selected using the convenience sampling method. Semistructured interviews were used to collect data. All interviews were conducted by the researcher in a comfortable atmosphere and carried out without the presence of others. Each interview lasted between 30 - 20 minutes. Interviews continued until data saturation occurred. Data were analyzed using the qualitative content analysis method. Participation in the study was voluntary by obtaining an informed consent.Results: The study included 30 participants, 56.6% (n=17) males and 43.4% (n=13) females. The age range of study, participants was from 19 to 25 years of age. Data analysis showed that three main categories extracted in shaping premarital sexual intercourse in adolescents: health beliefs, religious-spiritual beliefs, and character.Conclusions: This study can help find a culturally appropriate intervention to delay sexual initiation and prevent sexual behavior before marriage in adolescents and young adults. The results of the present study have both experimental and theoretical implications for future research. Finally, this study is a form of shared experience that can help similar studies.

Background: The amount of effective ingredient production in plants is influenced by various climatic and environmental factors such as quality of water resources, soil quality, air quality, and the level of environmental pollutants. Objectives: In this research, we seek to study and analyze the qualitative effects of heavy metals on the respiratory organ of rosemary. Further, we will compare the results to the permitted levels in various ecological regions. Materials and Methods: Rosemary leaves were collected from four regions: Isfahan, Foulad Shahr, Zoub Ahan, and Shahr-e-Kurd. Samples were placed in an atomic absorption device, after they had been dried, in order to measure the density of lead, mercury, cadmium, arsenic, zinc, and sulfur. Results: A significant difference, as much as P < 0. 01, was observed between the levels of sulfur, cadmium, lead, mercury, arsenic, and zinc in various regions. The densities of lead, arsenic, mercury, and cadmium in the respiratory organs of rosemary were much less than the permitted level. Although the density of cadmium in the region of Foulad Shahr was close to the critical level (due to the presence of the Isfahan steel company), the main problem was with the elements of zinc and sulfur. The densities of zinc in Shahr-e-Kurd, Zoub Ahan, and Isfahan were far more than the permitted levels. The densities of sulfur in Zoub Ahan, Foulad Shahr, and Isfahan were far more than the permitted level, while this density was quite within the permitted range in Shahr-e-Kurd, which is noteworthy. Conclusions: Planting rosemary in polluted areas to clean the air and using this plant in clan areas for medical products seems quite appropriate.

Background: Severe burned patients developed metabolic imbalances and systemic inflammatory response syndrome (SIRS), which can lead to malnutrition, impaired immunologic response, multiple organ failure and death. Studies have shown that providing an early and adequate nutrition support can lower hypermetabolic response and improve the outcome. Unfortunately, little emphasis has been given to the role of nutritional support, especially for demonstrating the importance of a proper nutritional support in determining the outcome of critically burned patients.Objectives: This study was designed to determine the possible protective effect of early and adequate nutrition support on sequential organ failure assessment (SOFA) score and length of stay (LOS) in hospital, in thermal burn victims.Patients and Methods: Thirty patients with severe thermal burn (More than 20% of total body surface area [TBSA] burn), on the first day in the intensive care unit, joined this double-blinded randomized controlled clinical trial. Patients were randomly divided into two groups: control group (group C, 15 patients) received hospital routine diet (liquid and chow diet, ad libitum) while intervention group (group I, 15 patients) received commercially prepared solution, with oral or tube feeding. The caloric requirement for these patients was calculated, according to the Harris-Benedict formula. The SOFA score was also measured on admission (SOFA0), day 2 (SOFA1), day 5 (SOFA2) and day 9 (SOFA3), consequently. The difference between the last measurement (SOFA3) and day 2 (SOFA1) was calculated.Results: The results showed that there was a significant change between SOFA3 and SOFA1, {-1 [(-1) – 0], P=0.013 vs. -1 [(-2) - 0], P=0.109}. Mean LOS in hospital, for patients consuming commercial standard food, also proved to be shorter than those consuming hospital routine foods (17.64±8.2 vs.23.07±11.89).Conclusions: This study shows that an adequate nutritional support, in patients with severe burn injury, can improve SOFA score. It is also more cost-effective, resulting in a shorter LOS in hospital.

Background: Maintaining proper size and rotation of components of total knee arthroplasty is mandatory for optimal longevity. Ethnical differences may affect the fitness of prostheses that were manufactured mainly based on Caucasian dimensions.Objectives: To evaluate the distal femur morphology of the Iranian population at the level of standard cuts simulated via computed tomography.Patients and Methods: During 2013, 150 consecutive patients (96 males and 54 females) from the outpatient Department of Orthopedic Surgery of Rasoul Akram Hospital with knee CT scans were studied. We entered cases with apparent normal extremity alignment and bone maturity. Exclusion criteria were history of fracture or conditions affecting knee profile. Standard cuts were simulated on the CT scan using the Marco Pacs program. For each bone, anteroposterior (AP), mediolateral (ML), and aspect ratio (ML/AP) were measured. Values were compared with the sizing of four currently available prostheses.Results: The mean age of the patients was 43 years (range: 17 to 80). All isolated parameters were higher in men significantly (P<0.001). However, the aspect ratio did not show any significant difference (1.51±0.11 vs 1.46±0.1), suggestive of a similar configuration of distal femur profiles between genders. Ultimately, close correlations were observed among simulated cuts and size-matched femoral components of the prostheses. For females, however, components were mostly overhang mediolaterally except for one gender-specific subset. Decrement in the aspect ratio for larger knees was another mismatch with current prostheses that preserve an almost constant ratio throughout all sizes.Conclusions: Our findings may be applied by manufacturers to design prostheses more compatible with Asian populations. Alterations to the shape of components should be considered to provide optimal coverage.

Background: The incidence rate of gastric cancer in western countries has shown a remarkable decline in the recent years while it is still the most common cancer among males in Iran. The proto-oncogene MYC, located at 8q24. 1, regulates almost 15% of human genes and is activated in 20% of all tumors. The amplification of MYC and overexpression of its protein product are observed in 15-30% of gastric neoplasias. Objectives: The objective of this study was to find the preferences of Chromogenic In Situ Hybridization (CISH) and Immunohistochemistry (IHC) in diagnosis and prognosis of gastric cancer. Patients and Methods: We studied 102 samples of gastric cancer in Iran and all the patients had undergone primary surgical resection at the Cancer Institute Hospital, Tehran University of Medical Sciences. The CISH and IHC techniques were applied for all our samples. All of the samples had adenocarcinoma gastric cancer and were selected randomly. Also, the type of study was cross sectional. The sample size was 100 patients. Results: Our data revealed that both diffuse and intestinal types of gastric cancer occurred significantly more in males than females. Our results showed that there was an indication of some correlation between grades and CISH, although the difference was not significant. Our data also showed that CISH positive patients (43%) were more frequent compared to IHC positive patients (14. 7%). There was a correlation between CISH and IHC. These results revealed that there was a significant difference between grades and IHC. There was also no statistical difference between CISH amplification in diffuse and intestinal types. Conclusions: From the results, it could be concluded that for administration of the treatment of stomach cancer, and progress and prognosis of tumor, which is important for patients and clinicians, the CISH is a better and more feasible test than IHC, in regards to sensitivity and specificity.

Background: Lead has been widely used in different industries for ages. It is one of the heavy metals, highly poisonous even at low doses, and has biochemical, physiological and behavioral side effects on human and animals. It has been shown that lead has toxic effects on different tissues such as neural and genitourinary tissues, cardiovascular systems and blood. Therefore, high attention has been paid to its environmental pollutions.Objectives: Although many histological and biochemical studies have reported about the effects of lead on the renal tissue, there are a few studies about the ultrastructure and morphometric effects of lead on the kidney. Hence, the aim of this study was the evaluation of morphology and morphometrics of rabbit renal urinary barrier ultrastructure following long-term exposure to lead acetate.Materials and Methods: In this experimental study, 20 male New Zealand rabbits were divided into control and test groups (10 in each). The test group was injected intraperitoneally with chronic dose (8.5 mg/kg of body weight) of lead acetate and for the control group the same volume of normal saline was used, every other day for 10 weeks. After anesthetizing, the biopsies of renal tissues were taken for light and electron microscopic morphometric and morphologic analyses.Results: Long-term exposure to lead acetate caused histopathology effects including dilatation, congestion, nuclei heterochromatic effects, increase in diameter of renal tubules and urinary barrier thickness in rabbit renal tissue.Conclusions: Quantitative and qualitative results of long-term lead acetate exposure showed many histopathology side-effects, especially in the urinary barrier.

Background: There are increasing change and development of information in healthcare systems. Given the increase in aging population, managers are in need of true and timely information when making decision.Objectives: The aim of this study was to investigate the current status of the health information management system for the elderly health sector in Iran.Materials and Methods: This qualitative study was conducted in two steps. In the first step, required documents for administrative managers were collected using the data gathering form and observed and reviewed by the researcher. In the second step, using an interview guide, the required information was gathered through interviewing experts and faculty members. The convenience, purposeful and snowball sampling methods were applied to select interviewees and the sampling continued until reaching the data saturation point. Finally, notes and interviews were transcribed and content analysis was used to analyze them.Results: The results of the study showed that there was a health information management system for the elderly health sector in Iran. However, in all primary health care centers the documentation of data was done manually; the data flow was not automated; and the analysis and reporting of data are also manually. Eventually, decision makers are provided with delayed information.Conclusions: It is suggested that the steward of health in Iran, the ministry of health, develops an appropriate infrastructure and finally puts a high priority on the implementation of the health information management system for elderly health sector in Iran.

Introduction: Phenylketonuria (PKU) is an autosomal recessive inborn error of phenylalanine metabolism, which is caused by mutation in phenylalanine hydroxylase (PAH) gene. Most of the PAH mutations are missense mutations (67%), which are followed by small or large deletions (13%).Case Presentation: We reported a patient with classic PKU and his parents harboring a large deletion in exon 3 (EX3del4765) of PAH gene. This is the first case report of EX3del4765 in Asian patients with PKU.Conclusions: This finding may help improve early detection, differential diagnosis, genetic counseling, and even treatment of patients with PKU.

Introduction: Idiopathic systemic capillary leak syndrome (ISCLS) is rarely seen, and presents with recurrent episodes of hypotension, shock, hemoconcentration, and hypoproteinemia. The main pathology is the dysfunction of the vascular endothelium, and it is characterized by an increase of capillary permeability that is accompanied by the loss of intravascular fluid and protein. Case Presentation: We present a 58-year-old female who presented with peripheral edema, leg pain, and syncope at the emergency department. Interestingly demyemilising neuropathy, which is a rare finding, ensued on day 4. She is still being treated using intravenous immunoglobulin therapy. Conclusions: The early signs and symptoms of ISCLS may be subtle; therefore the diagnosis can easily be missed and prompt treatment of the syndrome may be postponed. Thus, the clinician must consider ISCLS in differential diagnosis in cases of hypotension, hemoconcentration, and hypoalbuminemia.

Context: Insects can be the cause of major ecological problems; they can transmit microbes and parasites that affect humans, and damage food crops, trees, and homes. The total economic cost of insect-related damage and disease is immeasurable. In traditional Iranian medicine (TIM), several medicinal plants have been identified as insecticides or insect repellents, but many of them are still unknown. Therefore, the aim of this study was to review the insecticidal or insect repellent activity of certain medicinal plants described in TIM.Evidence Acquisition: Information about medicinal plants proposed as insecticides and insect repellents in the TIM was collected from the TIM literature, and searched in modern medical databases to find studies that confirmed their efficacy.Results: Modern investigations have supported the claims of the insecticidal activity of several plants, including Allium sativum, Artemisia absinthium, Citrullus colocynthis, Laurus nobilis, Mentha pulegium, Myrtus communis, Nerium oleander, Ocimum basilicum, and Origanum majorana. However, in the cases of plants like Iris florentina and Malva sylvestris, there is not enough evidence in modern medicine to prove their effectiveness with regard to their insecticidal and insect repellent activities.Conclusions: This study confirmed the Iranian traditional medicine claims of the insecticidal and insect repellent activity of certain plants. Further pharmacological and clinical studies are recommended to evaluate the overall efficacy and possible mechanisms underlying these herbs.

Background: Discovery of new risk factors poses new challenges on how to quantify their added value and importance in risk prediction improvement. Objectives: The aim of this study was to apply different statistics and to quantify the importance of some risk factors in acute myocardial infarction (AMI). Patients and Methods: In a retrospective cohort study, 607 patients with AMI, aged more than 25 years were studied. They were admitted to the CCU of Imam Reza hospital in Mashhad, Iran from 2007 to 2012. Health information and death registration systems were used to identify patients and to assess their outcome. At first a model containing all variables was fitted (full model). Importance of variables was compared in terms of standardized regression coefficient and inclusion frequency in bootstrap samples. Then, a series of reduced models were fitted, where in each of them only one of the independent variables was excluded. Models were compared in terms of goodness of fit, accuracy (Cindex, R square), separation of patients into risk groups (SEP), and net reclassification improvement (NRI). Results: Age was selected as the important factor based on all 7 statistics. Exclusion of age variable decreased C index from 0. 75 to 0. 68 and R square from 0. 25 to 0. 15. Duration of hospitalization was important based on 4 statistics. Exclusion of this variable decreased R square from 0. 25 to 0. 21. While gender was a useful variable in separation of patients into risk groups, its omission did not reduce model likelihood. The opposite was true in the case of using streptokinase during hospitalization. Conclusions: Our results revealed that a variable with high separation ability might not necessarily be useful in terms of goodness of fit. Therefore, importance should be defined carefully based on clinical objectives of the study.

Context: Recurrent aphthous ulcer (RAU) is an oral disease and the most common oral lesion, with 2% to 66% of the world’ s population infected annually. Its prevalence is about 25% in Tehran and 27. 6% in Mashhad. The etiology of RAU is multifactorial. Aphthous risk factors include: immunological factors, psychological factors, stress, trauma, sensitivity, family history, blood disorders, malnutrition, and use of certain medications, It should be noted that the best treatment for RAU is the topical application of drugs. The use of topical treatments is recommended not only because the drug can directly impact the source of the disease, but also systemic side effects of the drug are reduced. Treatment of RAU has been considered in Iranian traditional medicine (ITM), and is covered in therapeutic books. The use of herbs in RAU has a centuries-old history; accordingly, extensive research should be conducted for this treatment of the disease. Evidence Acquisition: Iranian medical sources were reviewed and effective plants used in the traditional treatment of RAU were found and compared with new findings. Finally, we have created a table listing the plants that are part of the therapeutic protocol for RAU. Results: Based on this article we can explain some of traditional pharmacological effects of plants and how these plants can be a source for a cure. Conclusions: The plants listed can be used as a prediction of RAU management. Of course, there are is no evidence for curing RAU by some of these plants in allopathic medicine, and the further investigations in this area could lead to the discovery of a new drug.

Background: Findings of recent studies have demonstrated a rapid increase of the incidence of papillary thyroid carcinoma (PTC), which accounts for nearly 80% of thyroid cancers.Objectives: The aim of this study was to explore the association between AXIN2 gene polymorphism and papillary thyroid carcinoma (PTC).Patients and Methods: 106 blood samples (56 PTC patients and 50 healthy controls) were drawn from China-Japan Union Hospital in Jilin province, China, during October 2010 to March 2011. A case-control study was designed to examine the association between AXIN2 and PTC. Seven tag single nucleotide polymorphisms (tag SNPs) in AXIN2 were selected and genotyped. Frequencies of different genotypes and alleles were analyzed between the patients and the controls, using the R × C column contingency table c2 test. The possible association of haplotypes constructed by the combined effects of two or more loci with PTC was analyzed through the UNPHASED 3.1.4 program.Results: Rs11655966, rs3923086 and rs7591 of AXIN2 showed significant associations with PTC (P<0.05). The result of haplotypes analysis showed that rs11655966-rs3923086-rs4791169 had statistically significant differences between the two groups (P<0.05).Conclusions: Together with the functions of the target genes, we further elucidated that AXIN2 is associated with papillary thyroid carcinoma in the Chinese Han population.

Background: On the basis of the literature, vitamin D is known as an important medium in bodily immune function, and it therefore may play a role in the pathogenesis of sepsis. Objectives: In this study, we aimed to evaluate the relationship between vitamin D serum levels and sepsis severity. Patients and Methods: This study was a case-control study that evaluated adult patients admitted to the emergency department of Imam Reza hospital with suspected sepsis. These patients were enrolled in the study as the case group. In addition, healthy individuals without the sepsis diagnostic criteria were included in the control group. For all of the study participants, vitamin D levels were evaluated. The acute physiology age chronic health evaluation (APACHE) was used to evaluate disease severity in the case group. A difference of P < 0. 05 was regarded as statistically significant. Results: A total of 112 patients were assessed: 56 in the control group and 56 in the case group. In the case group, 18 patients had sepsis, 25 patients had severe sepsis, and 13 patients were in septic shock. The mean ages of the patients in the case and control groups were 57. 7 ± 15. 15 and 58. 6 ± 15. 05 years, respectively (P = 0. 741). Vitamin D levels in the case group were lower than in the control group (16. 3 ± 10. 7 versus 27. 9 ± 11. 46 ng/mL), and the difference between the groups was significant (P < 0. 001). Mean vitamin D levels in the severe sepsis and septic shock groups were lower than in the sepsis group, and the mean level in the septic shock group was lower than in the severe sepsis group (P = 0. 001). In the case group, there was a significant reverse correlation between APACHE II criteria and vitamin D levels (P < 0. 001, r =-0. 586). Conclusions: The results of this study indicated that patients with sepsis had lower serum vitamin D levels than healthy controls. Also, patients with more severe disease had lower serum vitamin D levels, but to evaluate causation and determine whether vitamin D supplementation could be effective in reducing the risk or severity of sepsis, randomized controlled trials should be conducted.

Background: In recent years, the caregiving responsibilities of cancer patients’ family members have increased dramatically. Reducing caregiver strain and burden supports the mission of professional nursing.Objectives: The aim of this study was to determine and compare the caregiver strain index scores of breast cancer informal caregivers, before and after a patient-caregiver educational and telephone follow-up program.Patients and Methods: This is an experimental two-group design study. Participants were recruited from an outpatient chemotherapy unit of the largest hematology and oncology research center in Northwest Iran. Thirty patient-caregiver pairs were randomly allocated to intervention and control groups. The intervention group received 2 face-to-face education sessions at bedside and 4 subsequent telephone follow-up sessions. The control group received routine care. Pre and post tests were administered in both groups pre and post intervention. To analyze the data, SPSS (13th version) software was used.Results: The caregiver strain index decreased significantly in the intervention group after the patient-caregiver education and follow-up (P<0.001), while the control group’s scores did not change (P=0.04).Conclusions: It appears that the patient-caregiver education and follow-up program had a beneficial effect on the caregiver strain index compared to the usual care.