Iranian Red Crescent Medical Journal
Year:2016 | Volume:18 | Issue:12|Papers Count:33

Background: Self-rated health (SRH) and life satisfaction (LS) are of increasing interest to medical researchers, because of their close relationship with different aspects of health.Objectives: This paper describes the patterns of LS and SRH among Iranian children and adolescents, analyzed by sex and residence area, at the national and provincial levels.Methods: In this nationwide study 14880 students, aged 6-18 years, were selected by multistage random cluster sampling from urban and rural areas of 30 provinces in Iran, as part of the fourth survey of a national surveillance program conducted in 2011-2012. LS and SRH were assessed through a questionnaire following the World Health Organization-Global School-based Student Health Survey (WHO-GSHS) protocols.Results: 13486 out of 14880 invited students completed the study (participation rate: 90.6%). Their average age was 12.47±3.36 years. The prevalence of good SRH at national level was 80.13 (95% CI: 79.25, 80.99); the prevalence of LS among Iranian students at the national level was 80.17 (95% CI: 79.18, 81.13). At the provincial level, the highest and the lowest LS scores were 85.42 (80.01, 89.55) and 74.78 (68.74, 79.99), respectively. Likewise, the highest and the lowest prevalence of good SRH was 88.36 (83.99, 91.66) and 74.22 (69.06, 78.78), respectively.Conclusions: Our findings show that, at provincial levels, a complex set of known/unknown influencing factors affect individuals’ assessments of their own health quality. Understanding these patterns of SRH and LS could be useful for better health policy and more targeted studies in this field.

Background: Inborn factor X deficiency (FXD) is a very rare (1: 500, 000) hereditary coagulation disorder, which is characterized by clinical manifestations including hematoma, epistaxis, menorrhagia, ecchymosis, and central nervous system (CNS) or gastrointestinal (GI) bleeding (depending on the zygosity). In homozygote patients, the risk of spontaneous intracranial hemorrhage (ICH) is high. Objectives: The aim of this investigation was to study and long-term follow-up of the patients with FXD and ICH. In addition, we investigated their frequent bleeding symptoms throughout their life and the results were compared with results of other studies. Patients and Methods: This study investigated 2 cases with spontaneous intracranial hemorrhage in patients with severe congenital (factor X) FX deficiency including a 3-year-old boy and a 1-month-old female neonate. The world literature was explored through the PubMed Medline and Scopus using appropriate and pertinent key words. Results: The Patients referred to the hematology department due to the neurological complications such as vomiting, unconsciousness, prolonged nasal bleeding for recent 12 hours. They had no familial history of spontaneous CNS bleeding. The blood coagulation test analysis indicated a prolonged activated partial thromboplastin time (APTT) and also revealed a prolonged prothrombin time (PT) and the low levels of coagulation factor X implicating severe congenital FX deficiency. They followed up by our hematologists to prevent intracranial hemorrhage. Discussions: AsoneICHpatientwhosePTandaPTT suggest a coagulation disorder secondary to vitaminKdeficiency or coagulation factor deficiency, unresponsiveness to vitamin K therapy should be useful to take FX deficiency into consideration.

Context: The aim of this review was to address the recent data regarding the role of IL-17A in the pathogenesis of depression and its complications, such as cancer.Evidence Acquisition: This review article summarizes the recent data on the role of IL-17A in depression, using the PubMed and Google Scholar databases.Results: It has been documented that depression may alter the immune response via unknown mechanism/s. It is possible that immune responses and depression are linked via several molecules, including cytokines. IL-17A, a pro-inflammatory cytokine, participates in the pathogenesis of several inflammatory-based diseases, such as autoimmunity.Conclusions: Due to the comorbidity of depression and chronic inflammatory processes, and depression’s effect on the immune system, it may be hypothesized that the IL-17A cytokine plays a key role in the pathogenesis of depression.

Background: Identification of homogenous subgroups of patients with low back pain (LBP) and classification-based treatment have been recommended by some researchers and primary care clinicians. However, evidence regarding the effectiveness of this approach is not conclusive; one reason for this controversy appears to be the heterogeneity of trials in this context.Methods: The aim of this study was to determine the effectiveness of classification-specific physical therapy in patients with LBP. The included trials were investigated in more homogeneous categories with respect to their classification scheme. Electronic databases including Medline, Cochrane, Ovid, Scopus, and PEDro were searched systematically for English-language randomized controlled trials (RCTs), published from 1980 to October 3, 2015. We included studies on LBP cases, which aimed to compare classification specific physical therapies with non-specific treatments lacking patient classification. PEDro scoring was used to check the quality of the included trials, and the GRADE approach was used to evaluate the overall quality of evidence. Data on participants’ characteristics, sample size, and inclusion/exclusion criteria were extracted to obtain an overview of the included RCTs.Results: A total of 12 RCTs were identified and categorized into four classification schemes. Some evidence supporting classification specific treatment was found in each of the schemes. However, the reported evidence was conflicting predominantly due to differences in the study design. Also, GRADE quality assessment indicated the low quality of evidence for both approaches.Conclusions: Categorization of trials based on their classification scheme to investigate the efficacy of classification-based physical therapy could reduce the heterogeneity of trials and allow researchers to understand the contradictory results in this context.

Introduction: Salivary gland tumors are rare head and neck lesions. The majority are benign, with only 20% of cases malignant. An epithelial-myoepithelial carcinoma is a rare low-grade malignant salivary and lacrimal gland tumor, which accounts for less than 1% of salivary gland tumors. It mostly involves the parotid gland and affects adults in their sixth and seventh decades. It is usually painless, unless the minor salivary glands are affected. Case Presentation: We describe a rare case of a 35-year-old woman who presented with a 1-year-old unilateral painful parotid swelling in December 2014. Conclusions: Acomplete immunohistochemical study should be considered in cases of malignant salivary gland tumors. Toreduce the recurrence rate of these tumors, the optimum therapies are radiotherapy and chemotherapy.

Background: Polycystic ovarian syndrome (PCOS) is the most common hormonal disorder in reproductive-age women. This syndrome is associated with many complications, so treatment of the disorder is usually warranted. Objectives: To evaluate the effects of a combined low-dose oral contraceptive (LD) and Vitex agnus on the improvement of clinical and paraclinical parameters of PCOS. Methods: This triple-blind, controlled trial was performed in 2015 in 70 women aged 18-45 years with PCOS in the clinics of the Alzahra and Taleghani hospitals and at other health centers in Tabriz, Iran, using a purposive sampling method. The women were randomized to either the LD or Vitex agnus groups. Regulation of menstrual cycle length, free testostrone, DHEA-S (Dehydroepiandrosterone sulfate), prolactin levels were assessed both before and after three cycles. Results: The socio-demographic characteristics of the two groups were homogeneous before the intervention began. Nosignificant statistical differences were identified between the LD and Vitex agnus groups three months after the intervention in terms of normalization of the menstrual cycle duration, means of free testostrone levels, DHEA-S, prolactin serum levels, and side effects. Three months after the intervention, the menstrual cycle duration in about 68. 6% of the LD group members and 60% of the Vitex agnus group members became normal. The average levels of serum free testosterone and prolactin in both the LD and Vitex agnus groups had no differences three months after the intervention compared to prior to the intervention. The mean of the serum DHEA-S level in both the LD (Mean Difference (MD) =-0. 52; [95% CI:-0. 85 to-0. 18]) and the Vitex agnus groups (MD =-0. 60; [95% CI:-0. 79 to-0. 40]) decreased significantly three months after the intervention when compared with before the intervention. Conclusions: This study showed that LD and Vitex agnus were both effective in normalizing the menstrual cycle and reducing DHEAS, but they had no impact on the serum free testosterone or prolactin levels. The effects of LD and Vitex agnus on the normalization of the menstrual cycle and the means of serum prolactin, free testosterone, and DHEA-S levels in the women with PCOS were similar. Therefore, Vitex agnus can be used in place of LD.

Background: Accidents in the construction industry are a significant problem in many countries around the world. Occupational accidents result in reduced working hours, loss of life, and other related costs. These accidents result in socio-economic losses such as disability support costs, loss of working time, and increased medical care needs. They also create a lot of waste for communities and labor organizations.Objectives: Despite extensive studies calculating the cost of accidents, our understanding of these costs is still not clear or practically applicable; consequently, the ultimate aim of the present study is to provide a new framework for the calculation of the (direct and indirect) costs of construction accidents.Methods: In this paper, using a new and structured seven-step approach, the costs of construction accidents were calculated. In order to calculate the total cost of construction accidents in the city of Tehran for 2013 - 2014, the severity of accident results were first classified into five groups: 1, short-term absences from work; 2, long term absences; 3, partial disability; 4, total disability; and 5, death. The types of costs resulting from accidents were also categorized: 1, production disturbance costs; 2, human capital costs; 3, medical costs; 4, administrative costs; 5, transfer costs; and 6, other costs. These costs were classified according to the direct or indirect costs resulting from the incident and the imposition of costs on workers, employers and society. Finally, the calculated amount of investment in HSE-MS was analyzed using statistical tests.Results: The present study indicates that before and after the establishment of HSE-MS that the maximum calculated cost was related to the production disturbance cost (before: $568, 000; after: $80, 500) and the lowest cost was related to transfer costs (before: $15, 000; after: $3, 000) and other costs (before: $98, 000; after: $28, 500). Statistical analyses indicates that there is a significant difference (P=0.007) between the direct and indirect costs of accidents for before and after the establishment of HSE-MS. In other words, the direct and indirect costs had multiple, significant differences. The present study indicates that the indirect cost is four times greater than the direct costs.Conclusions: Accidents resulting in death, total disability and partial disability impose huge costs that are borne by society, and employers bear relatively low costs due to the health, treatment and welfare systems provided by society for the treatment and rehabilitation of injured workers and their families. Also, the results of this study show that investment in the HSE-MS is effective and associated with reduced accidents.

Introduction: Gossypiboma is a raretumorcaused by gauze fibers retained during surgery. This medico-legal problem is associated with an increase in patients’ morbidity and mortality. The aim of this study is to report two cases of gossypiboma mimicking the imaging of a malignant tumor. Case Presentation: We report two patients (the first patient was 50 years old, with a history of an appendectomy three years ago in another city; the second patient was 52 years old, with a history of a cesarean section 25 years ago in another hospital) who were admitted to the oncology department of GhaemHospital, MashhadUniversity of Medical Sciences in 2014. The initial manifestations were signs and symptoms of malignant ovarian tumors, and abdominal ultrasounds and CT scans also indicated malignant tumors. Both patients had a history of a previous laparotomy. Surgical evaluation confirmed gossypiboma as a definite diagnosis. Conclusions: In patients with abdominal or pelvic masses and a history of previous abdominal surgery, the possibility of gossypiboma should be kept in mind.

Background: Nitrate is a polyatomic ion with the molecular formula NO3-. Nitrate poisoning occurs through metabolism in the liver and conversion of nitrate to nitrite, which acts as an intermediary. Laminins are high-molecular weight proteins in extracellular matrix, regarded as one of the major components of the basement membrane. Objectives: The current study aimed to evaluate the effects of nitrate on laminin  5 expression in rat renal glomeruli. Methods: The current interventional study was conducted on 24 male Wistar rats in Iran during 2014-2016. Samples were randomly divided into four groups as follows: 1) Normal drinking water, 2) Distilled water containing 45 mg/L of nitrate, 3) Distilled water containing 100 mg/L of nitrate and 4) Distilled water (control). Sample size consisted of 48 kidneys randomly collected from rats. Laminin  5 content in renal glomeruli was determined using the immunohistochemistry (IHC) protocol. Data analysis was performed using the Kruskal-Wallis test and the Spearman correlation coefficient; P value below 0. 05 was considered statistically significant. Results: In the study, intensity of reaction to anti-laminin was not the same in renal glomeruli. While there was no significant difference between the groups one and two (P > 0. 05), a significant difference was observed between the groups three and four (P < 0. 05) in this regard. Conclusions: According to the results of the study, standard amount of nitrate in drinking water had no significant impact on laminin content. On the other hand, exceeded nitrate concentrations limited the distribution of laminin, leading to potential adverse effects on glomerular basement membrane.

Background: Some medicinal plants with their antioxidant properties have protective effects on sperm parameters and neutralize the harmful effects of lead exposure.Objectives: The present study aimed to determine the effects of Melissa on sperm parameters and spermatogenesis quality in adult rats exposed to lead.Methods: This animal experimental study was conducted on 45 male Wistar rats weighing 180±20 g, which were allocated randomly into five groups (n=9): distilled water gavages (control) (0.5 ml); intraperitoneal distilled water (i.p. control) (0.5 ml); Melissa (100 mg/kg/bw); lead acetate (10 mg/kg/bw); and lead acetate (10 mg/kg/bw) plus Melissa (100 mg/kg/bw). After a 30-day treatment, the animals were sacrificed. Sperm parameters (count, motility, morphology, and chromatins assay) and weighing of the epididymis and testis were performed.Results: The results showed that in the lead acetate plus Melissa group, epididymis weight (0.37gr vs.0.32gr), testis weight (1.40 vs.1.28g), sperm motility (4.44% vs.33.2 % (, and viable sperm (90 vs.50) were higher than the lead group. However, testicular weight, normal morphology, and DNA percentage showed insignificant differences among the study groups (P>0.05).Conclusions: The results of the present study indicate the protective effects of Melissa officinalis on some sperm parameters and spermatogenesis quality in rats exposed to lead.

Dear Editor, We read with great interest the article by Gerayli et al. (1) in your esteemed journal recently. The authors assessed the H63D and C282Y polymorphisms of the HFE gene in Iranian patients from north east Iran with hepatitis C as well as healthy individuals. They found the distribution of C282Y CC, CY and YY genotypes in hepatitis C patients as follow: 84. 61%, 10. 76% and 4. 61%, respectively. Moreover, the frequency of C282Y CC, CYandYY genotypes in healthy individuals was found to be 64. 61%, 0% and 35. 38%, respectively...

Background: Advantages and limitations of build-operate-transfer (BOT) contracts in various forms of public-private partnership (PPP) arrangements have not been studied. Objectives: This study is the first of its kind to determine the framework, advantages, and limitations of BOT contracts for health care projects in selected countries. Methods: A comparative design was employed to identify factors affecting the development of medical facilities through the adoption of PPPs and the implementation of BOT contracts. England, Spain, Australia, Turkey, and Canada were selected, and data were gathered through well-known databases for the relevant studies. Electronic databases were searched using the keyword terms, “ build-operate-transfer, ” “ public-private partnerships, ” “ health sector/health system, ” “ health care facilities, ” “ Spain, ” “ Canada, ” “ England or United Kingdom, ” “ Turkey, ” and “ Australia. ” Results: The findings revealed that while there was insufficient information transparency for adoption of the BOT contract model in developing medical facilities and building new hospitals, some similarities were observed in its adoption in public fields. Adoption of the BOT contract model has been proven feasible in the selected countries for the health sector, in particular, for the development of new hospitals. These contracts are usually long-term in nature to provide the private sector with the chance to appropriately exploit the field. Different countries utilize this model to meet public regional and long-term health care needs, where the goal is not just a matter of seeking the private sector’ s contribution. Conclusions: This study suggests that more information transparency is required for these types of contracts. Factors such as the term of the contract, the maintenance of the facilities built andtheir post-completion ownership status, facilities and credits offered to the private sector during the construction and operation phases, and the provision of financial and non-financial incentives to the private sector require deeper examination and should also be adjusted to the local contexts of the developing country.

Craniosynostoses is defined as a condition of premature fusion in one or more cranial sutures leading to a number of significant complications, mainly raised intracranial pressure which can itself cause other neurodevelopmental complications. Copper beaten skull appearance is a well-known presentation of craniosynostoses made by the strong impression of the brain’s gyri on the inner layer of the skull. It may also represent an increase in ICP. We report a 1-month-old infant with the diagnosis of craniosynostoses, confirmed by conventional radiologic studies and a three dimensional CT scan, presenting as copper beaten skull appearance. After diagnosis, the patient underwent a successful neurosurgical intervention.

Background: Cancer is one of the most significant causes of death around the world, and oral squamous cell carcinoma (OSCC) represents 90% of oral malignancies. Ferula persica has been used for treatment of different diseases in Iranian traditional medicine. Previous studies reveal some evidence relating to the value of preventing malignancies through F. persica.Objectives: The aim of the present study was to evaluate the protective effect of methanolic extract of Ferula persica in rat tongue neoplasm induced by 4-Nitroquinoline-1-Oxide (4-NQO).Materials and Methods: This experimental study was carried out in the pharmaceutical research center in Tabriz, Iran. According to ethical considerations, the results of the pilot study (five rats in each group) and pathologic changes in 30% of cases with considering =5%, P=80%, and d=5%, 15 samples for each group were determined. In this study, the OSCC was induced by 4-NQO in 60 SD rats (in four groups). At the same time, three groups of rats received Ferula persica methanolic extract (FPME) intraperitoneally (IP) in the doses 50, 250, and 500 mg per kilogram of body weight twice each week for 14 weeks.Results: The obtained weight differences between groups were not significant (P=0.18). Pathological changes in the treated and non-treated groups were significantly different (P<0.001). After treatment, pathologic changes were seen in groups A, B, C, and D (the cancer control group) respectively as follows: mild dysplasia - 13.3%, 26.7%, 20%, and 0.0%; moderate dysplasia - 33.3%, 13.3%, 40%, and 0.0%; severe dysplasia - 33.3%, 40%, 26.7%, and 0.0%; carcinoma in situ - 6.7%, 13.3%, 6.7%, and 20%; and squamous cell carcinoma - 13.3%, 6.7%, 6.7%, and 80%.Conclusions: The results showed that the FPME prevented the progress of the malignancy in the OSCC model in rats. However, further investigations are necessary to clarify effective fractions, mode of action of the FPME, and its potential therapeutic application in different types of cancer.

Dear Editor, Scorpion stings are a major public health problem in many countries. The southern areas of Iran are characterized by a warm and dry climate. Many species of scorpion are found in Iran, some of which are dangerous. Among the different species found in this area, yellow colored scorpions are more prevalent, with the two main species being Mesobuthus eupeus and Hemiscorpius lepturus. Both of these species are prevalent; they are both yellow and they are approximately the same size. Distinguishing between the two species is very important because it helps to determine the appropriate treatment and prognosis following a sting. A Mesobuthus eupeus bite is not dangerous and it does not usually cause any complications, while Hemiscorpius lepturus venom is dangerous and may cause acute renal failure and even death if it is not properly managed...

Background: Pneumonia is an important and commonly occurring disease, with significant morbidity and mortality. Community acquired pneumonia (CAP) is associated with a very rapid rise in procalcitonin (PCT), which has been considered a primary marker of bacterial infection.Objectives: The aim of this study was to compare the serum levels of PCT in patients with CAP and in patients with acute exacerbation of chronic obstructive pulmonary disease (COPD).Methods: This cross-sectional prospective descriptive study was performed in the emergency department (ED) on patients with CAP and acute exacerbation of COPD. A total of 53 patients were included in this study and their serum levels of PCT and C-reactive protein (CRP) were measured.Results: The patients included 31 males and 22 females with a mean age of 76.52±9.93 years and a mean BMI of 25.98±3.04. The mean PCT level was 0.93±1.56 in patients with CAP and 0.29±0.27 in patients with acute exacerbation of COPD; the PCT level was significantly higher in the patients with CAP (P=0.049). The mean CRP level was 34.00±12.37 in patients with CAP and 31.66±11.73 in patients with acute exacerbation of COPD; this difference was not statistically significant (P=0.483).Conclusions: We found statistical differences in PCT levels that would differentiate CAP from acute exacerbation of COPD in the ED setting. Further studies are required to verify this finding.

Background: Preconception health behaviors (PCHBs) include couples’ planning for pregnancy and changing their lifestyle to have a greater chance of fertility and desirable pregnancy outcomes. Although starting preconception care has been considered in Iran for nearly a decade, it has not received enough attention. For this reason, there is a dearth of studies in this area.Objectives: The aim of this study was to investigate the patterns and determinants of PCHBs in women referred to healthcare centers in Mashhad, Iran.Methods: In this cross-sectional study, 480 married women who had decided to become pregnant were selected from five different health centers in Mashhad through a multistage cluster sampling method. The data collection tool was a self-structured, valid, reliable questionnaire consisting of the three following parts: women’s demographic data, questions about knowledge and attitudes about PCHBs, and a checklist of PCHBs that were being performed. Data analysis was carried out using SPSS v16.5 with descriptive and inferential statistics, including the Pearson correlation, Chi square, and Kruskal-Wallis tests. A P value<0.05 was considered statistically significant.Results: It was found that 77.7% of women had attended preconception care (PCC) programs. About 31.7% and 68.3% of women carried out preconception and interconception care, respectively. About 39.8% of women used a folic acid supplement in the correct way. Only 6.9% of women engaged in regular physical activities. Approximately 33.1% of women had dental care; 9.8% received genetic counseling; and 33.3% carried out blood testing. There were significant relationships between attending PCC programs and using a folic acid supplement, engaging in physical activities, having blood tests, and receiving dental care and genetic counseling (P<0.0001). There were positive correlations between knowledge score and acid folic consumption (r=-0.181, P=0.001), physical activity (r=0.184, P=0.001), and fruit consumption (r=0.126, P=0.001), respectively.Conclusions: Although the majority of women had PCC records and received advice from healthcare professionals to carry out PCHBs, most of them did not adhere to the PCHB guideline recommendations. It is therefore suggested that strategies should be adopted to establish PCC services in the healthcare system and encourage clients to adhere to the PCHB guideline recommended by the ministry of health.

Background: Given the high prevalence of rheumatoid arthritis (RA) in females of reproductive ages, it seems that hormonal factors might be important in RA pathogenesis.Objectives: The current study aimed to investigate the association between females’ reproductive factors occurring prior to the onset of rheumatoid arthritis and the risk of RA development.Methods: This case-control study was conducted on 231 patients with RA and 238 controls among females aged 26 - 64 years old from the North-West of Iran. The adjusted risk of RA was assessed using multivariate logistic regression models.Results: Females³14 years old at menarche, were more likely to be at risk of RA (OR=1.69; 95%CI: 1.08 - 2.64). Advanced maternal age at first delivery (OR=1.91; 95%CI: 1.21 - 3.26) and having abortion (OR=1.97; 95%CI: 1.23 - 2.99) significantly increased the risk of RA. Post-menopausal status increased the risk of developing RA (OR=2.97; 95%CI: 1.98 - 4.46). Longer duration of breast-feeding was determined as significant protective variable for RA (P<0.05). Subjects with oral contraceptives (OCs) use (OR=0.36; 95% CI: 0.20 - 0.64), parity (OR=0.20; 95%CI: 0.06 - 0.70) or large number of children tended to show rather more reduced risk of RA.Conclusions: The risk of RA increased with delayed menarche, advanced maternal age at first delivery and early age at menopause. However, longer duration of breast-feeding, parity, large number of children and consumption of OCs were found as protective independent variables against RA.

Background: Anxiety after myocardial infarction is a very common problem leading to an increase in complications and hospitalization length.Objectives: This study was conducted to evaluate a 12-month follow-up of the effect of eye movement desensitization and reprocessing (EMDR) on anxiety levels in myocardial patients.Materials and Methods: This study was a clinical trial study. Sixty myocardial patients were selected using convenience random sampling and divided into two experimental and control groups. The experimental group (n=30) received EMDR in two 45 - 90 sessions. No treatment was given to the control group (n=30). The instrument for collecting data in this study was the Beck anxiety inventory which was completed in both groups in three steps: before and after intervention, and at the end of a 12-month follow-up period.Results: The findings collected during the 12-month follow-up indicated that EMDR was effective for treating anxiety in myocardial patients.Conclusions: EMDR is an effective tool for curing or decreasing the level of anxiety in myocardial patients.

Context: The introduction of new drugs that specifically antagonize tumor necrosis factor alpha (anti-TNF-a) has provided an effective treatment in a wide variety of autoimmune diseases. Nevertheless, the possibility of the reactivation of latent TB (Tuberculosis) infection (LTBI) among these patients is a considerable challenge. The aim of this paper is to evaluate LTBI diagnostic tools in patients who are candidates for anti-TNF-a therapy emphasizing how to manage these patients.Evidence Acquisition: A systematic web-based search was conducted in MEDLINE, Cochrane Library Database, and UpToDateÒ resources using the key words “anti-TNF-a” and “latent tuberculosis” up to March 2015. Two reviewers extracted and summarized the data and suggested protocols for the diagnosis and management of LTBI in patients receiving TNF-a inhibitors.Results: There were somewhat different approaches proposed by various researchers regarding the subject. While no recommendation was found to be unique to include all patients in all situations, the data emphasize the importance of ruling out TB infection before deciding to start an anti- TNF-a drug.Conclusions: Special high-risk groups, including patients with LTBI, should be treated before receiving TNF-a inhibitors. The tuberculin skin test (TST) is a somewhat cost-effective test for the diagnosis of LTBI. However, its usefulness with respect to false results should be re-evaluated in this situation.

Background: Inflammatory events following brain death (BD) decrease the quality of donor organs which can affect the outcome of the transplantation. It experimentally and clinically is verified that the level of inflammatory cytokines is increased in the BD of the donor results. In experiments, the in vitro use of vitamin C can successfully decrease the levels of inflammatory cytokines. Objectives: The aim of this study was to investigate the influence of vitamin C administration on the inflammatory status of the graft in BD liver donors. Methods: This study was conducted at Nemazee Hospital’ s transplant center (Shiraz, Iran). In this interventional study, the BD liver donors (n = 40) were randomly divided into two groups. The control group received only the routine intensive care unit (ICU) considerations, and the intervention group was treated with Vitamin C before harvesting organ (100 mg/kg, initially followed by 100 mg/kg/6h until organ removal). Blood samples were taken from BD patients in the intervention and control groups 3 times: 6 hours before operation, immediately after laparotomy, and immediately prior to clamping the aorta to assess the gene expression ratio of Interleukin 1 beta (IL1B) and Interleukin 10 (IL10) cytokines using real time polymerase chain reaction (PCR) (n = 40). Soluble serum cytokines were measured by enzyme-linked immunosorbent assay (ELISA) (n = 24). Results: No significant differences were observed in mRNA expression ratio of IL1B and IL10 between two groups. Despite an acceptable decrease in serum concentration of the inflammatory markers IL1B and IL10 at time point 2 minus time point 1 (T2-1), no significant differences were observed in vitamin C-treated BD donors compared with the control donors. There was a significant difference among aspartate aminotransferase (AST) and alanine aminotransferase (ALT) changes on the 3rd to 1st days after operation between the control and intervention recipients (P < 0. 05). Conclusions: The present study suggests a beneficial effect of vitamin C adsministration on post-transplant function of the liver from BD liver donors.

Background: Adolescence is a critical period in the life of human beings characterized by risk-taking behavior as one of its prominent features that affects the adolescent’s health. There is a direct relationship between spirituality and health-risk behaviors, indicating the need for promoting preventive interventions.Objectives: The present study aims to explain the concept of hope as a component of spiritual health from the perspective of adolescents.Methods: This qualitative study was conducted using the content analysis approach. Data were collected through in-depth, semi-structured interviews with high school students in Tehran (the capital city of Iran) who were selected through purposive sampling and with maximum diversity.Results: Analysis of the data led to the identification of three categories: “connection with the source of hope,” “belief in finding solutions through efforts,” and “having an optimistic view”; the categories together formed the common theme “hope, the foundation of inner peace.” Conclusions: Through effective interventions, health care providers are able to foster hope in adolescents and thus improve their spiritual heath.

Background: Garlic and Zataria multiflora boiss (ZMB) are herbal medicines used traditionally in the treatment of infections, including candidal vaginitis.Objectives: This study aimed to examine the effect of garlic and ZMB vaginal cream 2%, in the treatment and recurrence of candidal vaginitis.Methods: This randomized, double-blinded clinical trial was conducted on240 married women with candidal vaginitis. The patients used 5 gr garlic, ZMB or clotrimazole vaginal cream 2% daily, for 7 days. Complaints of the patients, clinical observations and laboratory parameters were recorded before treatment, on days 7 and 30, after treatment. The data were analyzed by SPSS v.21 through chi-square, Fisher, ANOVA with repeated measures, McNemar and Kruskal-Wallis tests. A P<0.05 was considered significant.Results: Before treatment, all patients had positive candidiasis fungi culture, in both groups (100%). The positive culture was 14.1%, 15.2%, 10.3%, respectively, on day 7 after treatment and 2.6%, 0%, 0% on day 30, after treatment with garlic, ZMB and clotrimazole, respectively (P<0.001). No significant differences were observed between groups on days 7 (P=0.69) and 30 (P=0.21) after treatment, in culture results. There were no significant differences between groups, in terms of patient complaints and clinical observations before intervention, at days 7 and 30 after treatment (P>0.05). Mean scores of candidal symptoms reduced significantly in all groups at on 7 and 30, after treatment (P<0.001).Conclusions: Garlic and ZMB vaginal cream 2% can be used as an effective treatment option in cases of drug resistance and, also, by the people who are interested in treating with herbal medicines.

environmental and occupational factors. Shift work is currently a commonly used program at workplaces.Objectives: The purpose of this study was to determine the impact of shift work on blood pressure changes.Patients and Methods: The data used in this retrospective cohort study was collected using annual observations conducted in the Diseases Follow-up Unit, Industrial Medicine Unit of the Occupational Health Center of the Mobarakeh Steel company from 2007 to 2010. In this study, the effect of shift work on systolic and diastolic blood pressure changes were analyzed by controlling for the body mass index (BMI), age, and educational levels using multilevel models.Results: This study included 5, 351 people (45.2% on the day shift, 6% on the weekly rotation shift, and 48.8% on a normal rotation shift). By controlling the confounding factors, shift work showed a significant relationship with systolic blood pressure (P=0.01) but failed to show any significant relationships with diastolic blood pressure (P=0.08).Conclusions: According to the results of this study, it seems that shift work can be considered a risk factor for high blood pressure changes. It is recommended that workers who are working in shifts are more at risk and need more supervision.

Context: Constipation is one of the most prevalent gastrointestinal disorders and is characterized by stiffness of waste and difficult defecation. In modern medicine, different laxative drugs are used for the treatment of constipation, but they are not without side effects. Nonetheless, the appropriate use of herbal medicines can be beneficial for treating this disorder. Therefore, this study attempted to draw together some pharmacological and medical insights into the management of constipation through the use of Iranian traditional medicine (ITM).Evidence Acquisition: In this review article, we initially researched constipation and laxative herbs using some of the most famous ancient medical and pharmacological textbooks pertaining to Iranian medicine written from the 10th to 18th century AD. This includes The canon of medicine by Avicenna (10th and 11th centuries, Beirut publication), Makhzan-ol-advie by Aghili (18th century, Tehran University of Medical Science Press), and Al-shamel by Gharashi (13th century, Caltural foundation Publication). Then we extracted the names and laxative mechanisms of some herbs prescribed for constipation through ITM. Finally, a search of scientific databases such as PubMed and Google Scholar was performed to find related works concerning laxative mechanisms.Results: In ITM doctrine, laxatives are weak purgatives that lead to the defecation of waste from the gastrointestinal tract. From this perspective, laxative herbs can be classified into two groups based on their nature: laxative herbs with a hot nature cause the dilution and flowing of humors, but herbs with a cold nature function as laxatives due to their mucilage properties. Each of the laxatives was used in accordance with the primary reason for constipation.Conclusions: This study presents medical and pharmacological approaches in ITM for dealing with complications arising from constipation. Considering the optimistic results, these herbs can be used as a means of constipation management and further investigation into this area can potentially lead to the formulation of new drugs.

Background: Hospitals as the most common health care centers should be changed into high reliability organizations to achieve the best performance and also improve patient safety. High reliability organizations can manage adverse events better, and create a safe environment for patients and staff. This requires accurate planning, training, and high responsibility and commitment hospitals leaders to implement this model. Objectives: The current study aimed to determine the knowledge of Farabi eye hospital’ s managers and supervisors of the departments, and the success of this hospital to implement high reliability model before and after the training course. Methods: Study was a semi-experimental research. Data were collected through a questionnaire and a checklist in two phases, before and after the training course of high reliability model; 80 clinical and non-clinical managers and supervisors of Farabi eye Hospital in Tehran, Iran, participated in the study by census method. Results: After holding high reliability model training course, 52. 2% of respondents expressed obtaining a keen knowledge of high reliability organizations model. Compared to knowledge of the managers and supervisors of the departments before the training course (18. 8%), it was indicated that high reliability organizations model training course had a significant effect (P < 0. 001) on the knowledge development. Also, the results of this research showed that implementation of high reliability organizations model after the training course increased (P < 0. 001). Conclusions: Although, successful implementation of high reliability organizations is based on knowledge of managers and supervisors, the effectiveness of this model is still in the maturity and readiness phase.

Background: At present, women tend to have a longer life-expectancy after a diagnosis of breast cancer has been established, primarily due to earlier diagnoses and advances in the treatment of cancer. Unfortunately, because of the complications of medical treatments, women saved from breast cancer experience a considerable level of disability. One of the complications of such treatments is the avoidance of physical activity.Objectives: The purpose of this study was to conduct a training intervention based on the constructs of self-efficacy and outcome expectations in order to enhance the physical activity levels of women suffering from breast cancer.Patients and Methods: The present research was a quasi-experimental study with a randomized control group conducted on 70 women with a final diagnosis of breast cancer in Isfahan, Iran (35 patients in each group). The data collection instruments included: (1) Underlying factors questionnaire, (2) self-efficacy in physical activity and outcome expectations measurement, and (3) the International Physical Activity Questionnaire (IPAQ). After collection, the data were entered into SPSS version 19 software. To analyze the data, statistical tests such as the independent t-test, paired t-test, chi-square, and analysis of covariance were used.Results: A significant increase in the self-efficacy and outcome expectations in the experimental group was observed one month after the training intervention, and the amount of physical activity showed a significant increase three months after the intervention (P<0.05, t=4.1), while the same figures in the control group did not indicate any significant change (P>0.05, t=0.2). In addition, changes in mean scores of self-efficacy (58.4±2.3), outcome expectations (11.3±1.3), and physical activity (418±183.5) before and after intervention were significant in the intervention group (P<0.000).Conclusions: It seems that health education programs based on the assessment of the needs of the patients can positively affect their behavioral motivation and performance in physical activities.

Background: Recently herbs considered as biological and safe agents to treat, control and prevent of many health problems such as obesity and its complications. Objectives: This study investigated protective effects of extracts from saffron stigma, petal, and their mixture on dyslipidemia, atherosclerosis, and insulin resistance in high-fat-fed obese rats. Methods: This experimental study was performed in animal house of Birjand University of Medical Sciences, Birjand, Iran. We used systematic random sampling to divide 56 adult male rats into 8 groups with 7 rats in each group that were fed a high-fat or standard diet for 10 weeks. Then, doses of saffron stigma, petal (40 and 80 mg/kg body weight, respectively), and their mixture (80 mg/kg body weight of both) were administered orally on a daily basis for three weeks. At the end of treatment priods, we examined all biochemical parameters. Data were analyzed by valid statistical analysis. Results: Saffron extracts markedly (P < 0. 05) decreased the serum total cholesterol (TC, 90 9. 3), triglyceride (TG, 99 10. 5), and low-density lipoprotein cholesterol (LDL-C, 27  1. 1) in obese rats, while they increased the serum high-density lipoprotein cholesterol (HDL-C, 68 2. 2). The atherosclerosis-index (LDL/HDL, 0. 39 0. 5), atherogenic index (TC/HDL, 1. 32 4. 2), and the liver enzymes (ALT, AST, and ALP) were also reduced drastically (P < 0. 05) after herbal treatments. Treatment with saffron extract significantly (P < 0. 05) decreased the levels of leptin (0. 26  0. 04), insulin (4. 11  0. 1), resistin (11. 1  0. 5) and homeostasis model assessmentestimated insulin resistance index (HOMA-IR, 20. 0 1. 4) and enhanced the levels of circulating adiponectin (108  3), potentially indicating a cardio-protective influence. Antioxidant capacity (511. 63 19) increased after treatment with saffron extracts, but malondialdehyde levels (1. 94 0. 1) decreased. Conclusions: This in vivo study demonstrated that saffron extracts, particularly the mixture of extracts from stigma and petal, ameliorated dyslipidemia in obese rats, leading to decreased atherosclerosis and insulin resistance. Our data suggested a potential therapeutic strategy against obesity and its related complications.

Background: Unwanted pregnancy is the kind of pregnancy which is undesirable for at least one of the parents, and is accompanied by unfavorable consequences for the family and society.Objectives: In this study, three classification models have been used to predict the occurrence of unwanted pregnancies in the urban population in Khorramabad, Iran, and the performance of these models was compared.Methods: In this cross-sectional study, 467 multi parous mothers referred to the health centers of Khorramabadin 2012wereselected using a combination of cluster and stratified sampling, and the relevant variables were measured. The logistic regression, decision tree, and a neural network were implemented using SPSS version 21 and MATLAB version R2013a. To compare these models, the indices of sensitivity and specificity, the area under the ROC curve, and the correct percentage of the predictions were used.Results: Overall, the prevalence of unwanted pregnancies was 32.3%. The performance of the models based on the area under the ROC curve as the indicator was as follows: artificial neural networks (0.741), decision tree (0.731), and logistic regression (0.712).The highest sensitivity level belonged to the decision tree (73.5%), and the highest specificity level belonged to the artificial neural network (62.3%).Conclusions: Given the high prevalence of unwanted pregnancies in Khorramabad, Iran, it is necessary to revise and improve the family planning projects. In selecting the best classification method, if the researcher is interested in the better interpretability of the results, the use of the decision tree and logistic regression is recommended; however, if the researcher is interested in a higher prediction power of the model, the neural network is recommended.

Background: Abnormal cholesterol homeostasis is associated with the pathogenesis of neurodegenerative disease and cognitive impairment. Objectives: Our objective was to evaluate changes in the expression of proteins related to cognition and cholesterol homeostasis in the hippocampi of rats as well as behavioral modifications following the administration of a cholesterol-rich diet. Methods: In this experimental study, lasting 16 weeks, 20 male Wistar rats (aged 8 weeks) were randomly divided into two groups. One group was fed with a normal diet (ND; n = 10) and the second with a high cholesterol diet (HD; n = 10). The expression of the cognition-related proteins N-methyl-D-aspartate receptor (NMDAR) and beta-secretase 1 (BACE1) and cholesterol 24-hydroxylase (CYP46A1), the key cholesterol hemostasis protein, were determined by an immunoblotting assay in the hippocampus homogenate. The Morris water maze (MWM) test was used to examine cognitive performance. Plasma lipidic parameters, including total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), and triglycerides (TG), as well as brain TC were measured by colorimetric assay. Results: After a high cholesterol diet had been administered for a period of 16 weeks, a significant increase in TC, LDL-C and TG was observed in the HD group in comparison with the ND group (P < 0. 05). Neither the mean of brain wet weight nor brain TC showed significant change in the HD versus the ND group (P = 0. 114, P = 0. 84, respectively). Despite this fixity, differences in the expression of BACE1 and CYP46A1 were significant (P < 0. 05) between the two groups, with high levels of BACE1 and CYP46A1 in the HD group compared with the ND group. These biochemical changes were associated with a significant decrease in the time traveled on a platform quadrant in the HD versus the ND group (P < 0. 05) during a spatial memory probe test administered at the same time. Conclusions: The findings show that irregularities in cognitive performance as a result of a high cholesterol diet can be partially mediated by distortion in brain cholesterol homeostasis and processing of the amyloid precursor protein (APP).

Introduction: Folliculotropic mycosis fungoides (FMF) is a variant of mycosis fungoides characterized by the presence of folliculotropic atypical Tcells infiltrates, often with sparing of the epidermis and preferential involvement of the head and neck. Since the original designation of folliculotropic mycosisfungoides (FMF) is a distinct entity, there has been an increasing appreciation of the broad clinical and histopathology spectrum, which can present in this disease. Case Presentation: In July 2013, a 37-year-old male from Tehran (Iran) who had complained of 9 months of progressive erythematous follicular patches and plaques on the trunk and comedones and acne like lesions on his forehead has been referred to us. The histopathology studyshowedperifollicularandintrafollicular lymphoid cells infiltration predominantly. There wasnohistopathology evidence of dermal mucin deposit (PAS negative) and alopeciaor syringotropism T cell infiltration. The immunohistochemical analysis was positive for CD3 and D4. The patients received different treatments based on the stage of their disease. Conclusions: FMF should be considered in patients who present with alopecia, acne like lesions, cysts and comedones in older ages with a spectrum of histologic changes. We emphasize for any time it should be under-recognized.

Background: An increased amount of menstrual bleeding in women causes anemia and decreased quality of life.Objectives: The present study aimed to determine the effects of lemon balm alone and in combination with Nepeta menthoides on menstrual bleeding in students with premenstrual syndrome.Patients and Methods: This triple-blind randomized controlled trial included 93 female students with aged 18 years and older. The intervention groups received 500 mg capsules of lemon balm alone or lemon balm in combination with N. menthoides. The control group received 500 mg capsules of placebo twice daily in the luteal phase for two consecutive menstrual cycles. A Pictorial Blood Loss Assessment Chart (Higham) was completed at baseline and 1 and 2 months after the intervention. Data were analyzed using the chi-square, one-way analysis of variance (ANOVA), analysis of covariance (ANCOVA), and repeated measures tests.Results: The differences in baseline characteristics and Higham scores of the three groups were not statistically significant (P> 0.05). General linear model analysis with adjustment for the preintervention menstrual bleeding level showed that there was no statistically significant difference in terms of menstrual bleeding mean in the first (P=0.602) and second menstrual periods after intervention (P=0.148) among the three intervention groups.Conclusions: Based on the results of this study, treatment with lemon balm and lemon balm N. menthoides herbs did not decrease menstrual bleeding in students with premenstrual syndrome. However, further clinical studies should be performed to assess the efficacy of lemonbalm and N. menthoides in reproductive women to determine whether this medication is appropriate for treatment in the clinical setting.

Background: The emergence of Pseudomonas aeruginosa as a multiple drug resistant bacteria has renewed efforts to identify alternative antibacterial materials, such as medicinal plants.Objectives: The aims of this study were to investigate the antibacterial effects of a Rumex dentatus methanol extract against drug resistant P. aeruginosa isolates and to analyze the chemical composition of this extract.Materials and Methods: Sixty strains of P. aeruginosa were isolated from urine and wound samples and identified using conventional tests, as well as 16S rDNA gene sequencing.Results: The isolates were completely resistant to the tested antibiotics, with minimum inhibitory concentration (MIC) values for ceftazidime, imipenem, and gentamicin between 256 to>256 mg/mL, 8 to>256 mg/mL, and 64 to>256 mg/mL, respectively. The R.dentatus extract had a broad spectrum activity against all tested isolates and maximum growth inhibition against isolates from burn wound and urinary tract infections occurred at 200 mg/mL (22.43mm and 22.86mm, respectively). The means of the MIC and minimum bactericidal concentration (MBC) values were 25 and 50 mg/mL, respectively. The effects of a combination of the methanol extract and ceftazidime, imipenem, and gentamicin antibiotics were antagonistic. The GC-MS analysis of the methanol extract revealed a high probable presence percentage of alpha-pinene, sabinene, and eucalyptol (1, 8-cineole) that have confirmed antimicrobial activity.Conclusions: The R. dentatus methanol extract with broad spectrum activity can be viewed as an alternative to antibiotics for treatment of P. aeruginosa infection.