Iranian Red Crescent Medical Journal
Year:2017 | Volume:19 | Issue:5|Papers Count:18

Background: Over the past few years, other methods have been replaced by endoscopic forehead rejuvenation. In many cases, it is the treatment of choice and it is widely used for the rejuvenation of the upper third of the face, especially to raise eyebrows.Objectives: Due to the growing number of cosmetic surgeries and particularly endoscopic surgeries, awareness of the effectivity and longevity of endoscopic surgery appears necessary due to relatively high costs and complications that the patient imposes. There is still ambiguity about changes which appear during aging in the forehead area, however, almost all forehead rejuvenation surgeries are based upon the fact that forehead aging causes eyebrow dropping.Methods: All patients, who had endoscopic brow lift surgery at Amir Aalam hospital in 2013, were considered in this study. The surgeries were performed at Amir Aalam hospital of Tehran, Iran, by a plastic surgeon and usually on an outpatient basis (day-care basis) and by means of the standard procedures during 1 year. All patients had sub-periosteal endoscopic brow lift surgery, which was performed by 5 separate incisions. Standard photography was performed for all patients with standard views before and after surgery. Complications and surgical techniques were described for the patients in an understandable (simplified) manner. To evaluate the position of the brows before and after surgery, photography was performed before and after the surgery.Results: Twenty-five patients had an endoscopic brow lift surgery at Amir Aalam hospital, during year 2013. The information and the photography of 20 patients were evaluated. The average age of the patients was 54 years old. Eighteen patients were female and 2 were male. All patients were Iranian. The photographic comparison before and after surgery clearly showed elevation of the brows.On the medial side, the average elevation was 5.25mmand on the lateral side that was 4.5 mm. In all cases, there were statistically significant differences (P=0.001).Conclusions: Based on the results of this study, we could conclude that endoscopic forehead rejuvenation surgery, which is used for the rejuvenation of the upper third of the face, has had a clear brow elevation with complete satisfaction in Iranian patients.Most patients (95.2%) were satisfied and only encountered slight side effects.

Background: The effectiveness of cervical cerclage (CC) in mothers suffering cervical incompetence (CI) for preventing preterm birth (PTB) in twin gestations remains controversial. Some studies show that it plays a preventive role in the occurrence of PTB, while others suggest it is ineffective.Objectives: Our aim was to evaluate the effectiveness of CC in preventing PTB and negative neonatal outcome (e.g., respiratory distress syndrome (RDS) and birth weight) based on a new statistical framework: multilevel analysis and propensity score matching (PSM) in twin pregnancies.Methods: A cross-sectional study was conducted in the maternity wards of three general and teaching hospitals in Tehran, Iran, during January 2014 to February 2015. Using stratified random sampling with the proportional allocation method, twin pregnancies were randomly selected from the medical files list. Of 431 eligible individuals, 31 patients underwent CC as a result of CI, and the others had healthy cervixes and no CC. Next, variables that confound the relationships between CC and PTB (e.g., assisted reproductive technology (ART), preterm rupture of membrane (PROM), nulliparous, history of abortion, and mother’s age) by applying 1: 2 PSM were matched in both groups. The CC group was considered the case group and, based on PSM, 61 patients, whose characteristics were similar to the CC group, were selected from 400 healthy mothers as a control group. For considering twins dependencies, multilevel modeling was used, and prevalence of PTB, LBW, and RDS, as well as mean gestational age in the two groups, were compared.Results: The standardized mean difference (SMD) shows that the distribution of confounding variables in the propensity-matched data is the same in both groups. Results revealed that, although gestational age in the case group was significantly less than the control group, the prevalence of PTB in case and control was not significantly different (P=0.190). The prevalence of neonatal outcome of RDS and LBW in the case and control groups was not significant (P>0.05).Conclusions: It appears that CC has an effective role in prevention of PTB, LBW, and RDS, because their prevalence in both groups was the same. However, drawing a clear conclusion regarding its role requires more research with a random clinical trial (RCT) design.

Background: Women with previous gestational diabetes mellitus (GDM) are at elevated risk for developing Type 2 diabetes. Despite the recommendation for postpartum diabetes screening for these women, the rate of screening is low.Objectives: The present study aimed at conducting an in-depth exploration of the experiences of Iranian women with recent GDM in the process of diabetes screening.Methods: This grounded theory qualitative study was conducted in Tehran, Iran, from 2013 to 2016. In this study, 22 women with recent GDM, who gave birth at least 6 months before the interview, were selected by purposeful sampling method; then, to achieve saturation, the participants were followed using theoretical sampling method. The participants were asked about their postpartum experiences, specially about the process of attendance/not attendance in diabetes screening at 6weeks to 6 months after child birth, using semi-structured interviews. Data were analyzed using Corbin and Strauss method (2008).Results: Three main categories were extracted as postpartum diabetes screening process in women with a recent GDM: to be aware, to be sensitive, and to perceive severity of the threat. Also, the outcomes have been classified into 4 levels: selective screening, accidental screening, primary lack of screening, and secondary lack of screening. In our study, the participants had a range of procrastination in screening, from no procrastination in selective screening to high procrastination in secondary lack of screening. Sometimes, the participants had the intention to be screened but they took no action, did not do the screening due to self-deception, or perceived screening as lacking immediate reward (3 main features of procrastination). Thus, due to procrastination, they did not do the screening. Screening in the range of procrastination, as the core category, was the most obvious concept that implicitly existed in all the data.Conclusions: Even when sensitivity and perceiving a threat about diabetes were activated in women with recent GDM, they did not undertake screening due to procrastination. Procrastination is an important and missed factor in screening. Conducting further studies is recommended to develop evidence-based strategies to decrease women’s procrastination in screening.

Background: Flavonoids are recently being recognized for their important biological effects. Quercetin is a flavonoid that has several pharmacological properties including anti-inflammatory, neuroprotective, and anticonvulsant effects.Objectives: This study was designed to elucidate the role of quercetin in the gene expression of ionotropic glutamate receptor subunits in kainic acid (KA) -induced seizure in mice.Methods: This experimental study was conducted on 56 male BALB/c mice. Quercetin (50 and 100 mg/kg, intraperitoneally) was administered 7 days before administration of KA. The hippocampi of the animals were removed and used for molecular analysis 2 hours and 7 days after KA administration.Results: Pretreatment of mice with quercetin (100 mg/kg) significantly enhanced the gene expression of GluR1 subunit of AMPA and NR2A and NR2B subunits of NMDA only 7 days after KA administration compared to the control and KA groups in the mice hippocampus (P<0.001, P<0.001, and P<0.05, respectively).Conclusions: Increment of gene expression of subunits of AMPA and NMDA receptors by quercetin might explain its protective effect on synaptic plasticity and memory.

Background: Transcranial light therapy (TCLT) is a new noninvasive interventional method, which applies red to near infrared spectrum laser or light emitting diode (LED) source on the head, transcranially. This spectrum can penetrate the skull and could improve the brain pathological conditions and cognitive functions. Despite relative advantages of the LED upon laser sources, TCLT research has been limited on the beneficial effects of LED source on human cognitive performances.Objectives: This study aimed at investigating the effectiveness of the TCLT with LED source on brain attentional performance as an important cognitive ability.Methods: This experimental intervention study was conducted in Tabriz, Iran, from September to October 2016. The study samples were selected by the convenience sampling method. Thirty-four healthy individuals (age: 18 to 24; 17 males and 17 females) were randomly assigned to sham (n=17) or real intervention (n=17) groups. We applied 850 nm LED with irradiation energy density 60 J/cm2 upon the frontal cortex, the brain region involved in attentional activities. Before and after TCLT, participants completed a cognitive task (Level-1 of parametric Go/No-task), which measures attentional performance.Results: Our results revealed improvement of efficiency score as the main parameter of attentional performance in the real intervention group versus sham-TCLT group. The interaction of grouptime was significant (P=0.004). Mean change of the efficiency score was higher in the real intervention group (mean=4.6±3) than the sham group (mean=0.8±3) after TCLT (P=0.001).Conclusions: Applying the TCLT by LED source over the PFC, promotes attentional performance as an important cognitive function.

Background: Evidence shows the effectiveness of complementary medicine and its use in the treatment of chronic diseases are increasing.Objectives: This study aimed to determine the relationship between knowledge and attitude toward complementary medicine in patients with chronic disease and referred to a hospital in an urban area of Iran.Methods: This cross-sectional correlation study was conducted with 400 patients with chronic diseases referred to a hospital in an urban area of Iran. The samples were chosen using convenience sampling. The patients’ knowledge and attitudes were assessed using a researcher-made questionnaire and the holistic complementary and complementary medicine questionnaire, respectively.Results: The patients’ knowledge was the highest and lowest in the subscales of herbal medicine and energy therapy, respectively. Also, their attitudes mean regarding holistic health was better than attitude regarding scientific validity of complementary medicine (21.37 versus 15.88). There were statistically significant relationships between knowledge and attitude (r=0.28, P<0.001). While the relationship between knowledge regarding complementary medicine and attitude toward holistic health (r=0.52, P<0.001), its relationship with attitude toward the scientific validity of complementary medicine was reverse and negative (r=-.23, P<0.001). Moreover, demographic variables such as the level of education, marital status, disease type, exercise habits, and information about the methods of complementary medicine had statistically significant relationships with the patients’ knowledge about complementary medicine. The frequency of consumption of vegetables per week (r=-0.18, P<0.001) and the duration of disease (r =-0.16, P=0.002) had a statistically significant reverse relationship with knowledge regarding complementary medicine.Conclusions: Knowledge regarding herbal medicine was high in patients with chronic diseases. Given a lack of sufficient knowledge and poor attitudes about other aspects of complementary medicine, patients need more education about the significance of complementary medicine and its positive effects on their health.

Background: Cystic echinococcosis of soft tissue is rare even in endemic areas. Intermuscular and intramuscular cystic echinococcoses have been occasionally reported in the literature.Case Presentation: A 40-year-old male was referred to the surgery clinic of Alzahra Hospital, Isfahan, Iran, with a swelling over the right side of his chest in September 2015. In physical examination, a nontender soft bulging in depth of the right pectoralis major muscle with no skin manifestation was noticeable. The axial and coronal contrast-enhanced CT scan showed a multicystic mass lesion between the right pectoralis major and minor muscles with extension beneath the pectoralis minor muscle. The patient underwent a surgery for resection of the mass. After dissection of the pectoralis major fascia, a large cystic mass was visualized just beneath the muscle with some adhesion to the chest wall. Histopatholgic study of the surgical specimen also revealed cystic echinococcosis.Conclusions: This case reveals that cystic echinococcosis should be considered in differential diagnoses of any chest wall swelling.

Background: The functional status questionnaire is aimed as a self-administered functional assessment of the mothers’ performance in the postpartum period based on five different areas, including baby care, personal care, household, social and community, and occupational activities.Objectives: The aim of this study was to evaluate the psychometric properties of the functional status questionnaire for assessing Iranian women in the postpartum period.Methods: In this cross-sectional, methodological study, 200 Iranian women were selected randomly via a two-stage cluster sampling method at the end of the postpartum 6th week from healthcare centers in six areas of Tehran (the capital of Iran). The translation validity of the questionnaire was confirmed by forward and backward translation. Content-related validity was determined in two qualitative and quantitative sections, respectively, by evaluating the experts’ opinions and calculating of content validity ratio (CVR) and content validity index (CVI), while the face validity was evaluated by a sample of 30 mothers in the postpartum period.To determine the construct validity, exploratory factor analysis was used. The reliability was determined in terms of reproducibility via the intra-class correlation coefficient (ICC) by test-retest and internal consistency (Cronbach’s alpha).Results: The CVI and CVR as the indices for content validity were 0.88 and 0.82, respectively. Further, the reliability was good, both in terms of reproducibility (ICC=0.96) andinternal consistency (a=0.73). The construct validity wasalso supported by the exploratory factor analysis for all four areas of functional status. The Kaiser-Meyer-Olkin (KMO) index of household, social and community, baby care, and personal care activities subscales was calculated as 0.85, 0.85, 0.56, and 0.50, respectively. The total variance (%) for household activities, social and community, baby care, and personal care was 56.86, 53.94, 38.07, and 43.39. All items with a minimum and maximum factor loading of 0.2 and 0.96 are placed at the right factor.Conclusions: The findings support the instrument’s validity and reliability. Therefore, it is recommended to be used for both clinical and research purposes.

Background: Bullying is considered a serious health problem in primary schools, high schools, and universities. It can have negative effects on both the bully and who is bullied. The negative consequences of it include depression, anxiety, drug abuse, etc. These consequences can be devastating in many areas of the person’s future life like his/her relations with other people. The current study aims at investigating the factors that students and teachers believe can affect bullying.Methods: A qualitative design based on content analysis approach was used to collect the data and analyze the perspective of 72 Iranian students, 12 teachers, and 9 parents chosen by a purposeful sampling strategy in Gonabad. Semi-structured interviews were held in order to collect the data. Sampling was continued until the data saturation. The data were analyzed using a qualitative content analysis approach by MAXQUDA 2010 software.Results: In this study, five factors associated with bullying were identified. The factors include ‘psychological factors’, ‘family factors’, ‘school factors’, ‘socioeconomic factors’, and ‘the influence of the media’. The first factor includes four sub-factors of psychiatric disorder, pride and arrogance, jealousy, and imposing will and opinions on others. The second factor includes four sub-factors of family violence, wrong parenting, siblings’ bullying behavior, and parental employment. The third factor includes four sub-factors of not paying attention to the students’ inappropriate behaviors, discrimination against the students, teachers’ behaviors, and peer influence. The fourth factor includes three sub-factors of the lack of patience, neighbors’ influence on our behaviors, and poverty.And the fifth factor includes two sub-factors of the influence of social media and the Internet, and violent video games.Conclusions: Bullying has different aspects and, therefore, we should pay attention to its psychological causes, family problems, school problems, and social and economic factors, etc. we should pay more attention to the lack of patience as a religious-mental variable which seems to be closely linked with a behavioral issue.

Background: Increasing of childhood allergic diseases throughout the world and its heavy socioeconomic burden have posed an important health concern. Therefore, providing the updated relevant epidemiological information is robustly recommended.Objectives: The study aimed to determine the prevalence of asthma, allergic rhinitis (AR), and eczema symptoms in primary school children aged 6 - 7 years and ascertain the association of acetaminophen use, antibiotic consumption, and hospitalization for respiratory infection in early life with allergic symptoms.Methods: In this cross-sectional study conducted on primary school children aged 6 - 7 years from May to July 2012 in Tehran (Iran), a total of 4993 individuals took part. Cluster sampling was used for random selection of primary schools. Data were gathered by using a modified questionnaire of international study of asthma and allergies in childhood (ISAAC). Then, the questionnaires were completed by parents of the children.Results: The prevalence rates of current wheeze, wheeze ever, current itching rash, itchy rash ever, and rhinitis ever were found to be 19.64%, 27.49%, 8.95%, 8.28%, and 21.87%, respectively. Physician-diagnosed asthma, eczema, and AR were reported in 4.32%, 7.29%, and 9.61% of children, respectively. Univariate logistic regression analysis showed that antibiotic use was significantly associated with symptoms of allergic rhinitis (P=0.001). Also, the strongest association was found between asthma and atopic dermatitis symptoms and hospitalization due to respiratory infection in early life by multivariate analysis (P=0.002 and P=0.009, respectively).Conclusions: This study determined the rising pattern of allergic symptoms in 6 - 7 year old children in Tehran. Moreover, acetaminophen/ antibiotic use and hospitalization due to respiratory infection in early life were detected as significant risk factors for the appearance of childhood allergic symptoms.

Background: Hearing impairment (HI), resulting from noise exposure, can be incapacitating and irreversible.Objectives: The present study aimed to determine the relationship between noise exposure and HI among workers and employees in a spinning industry.Methods: This cross sectional study was conducted on 489 workers in a spinning industry in Iran during 2015. The census method was applied for the purpose of sampling. The hearing threshold of each ear was determined during work shifts, using Madsen audiometric device. HI was calculated, based on the guidelines by the American Medical Association (AMA). The effects of different variables on HI were assessed via regression analysis.Results: The mean noise level at workplace was 88.87± 13.6 dB. The highest noise level in the sampled worksites was observed in the ring spinning section (94.1±3.2 dB). Based on the results, maximum HI in both ears was 41%. The findings showed a significant relationship between HI and noise level, age, educational level, and work shift. Also, a linear equation was proposed in which each dB increase in noise level resulted in an approximately 0.5% decline in HI.Conclusions: By introducing an equation, this study demonstrated that spinning workers, who are exposed to relatively high noise levels, are at risk of major HI. In addition, a number of potential contributing factors, including age, work experience, occupation, and work shift, were correlated with HI.

Introduction: Ovarian borderline serous papillary epithelioma is a rare epithelial ovarian tumor between adenoma and carcinoma.This study was carried out to compare six cases of ovarian borderline serous papillary epithelioma.Case Presentation: This retrospective study was conducted on 6 patients with ovarian borderline serous papillary epithelioma regarding clinical symptoms, auxiliary examination, treatment process, and prognosis. These six patients were diagnosed with the disease from January 2010 to June 2013 in the People’s hospital of three Gorges university, Yichang, Hubei, China. Two patients were diagnosed with ovarian surface serous papillary epithelioma. One patient was diagnosed with ovarian surface serous papillary epithelioma transferred to bilateral fallopian tubes. One patient was diagnosed with ovarian borderline serous papillary epithelioma while parts of tissues had become cancerous. One patient was diagnosed with ovarian borderline serous papillary epithelioma with pelvic lymph node metastasis, which had transferred to bilateral fallopian tubes, omentum majus, and epityphlon. One patient was diagnosed with ovarian surface serous papillary epithelioma with epithelial hyperplasia. All the six patients received surgical resection.Conclusions: Were commend ovarian borderline serous papillary epithelioma evaluation for patients as preoperative observations, intraoperative careful exploration, and pathological diagnosis in order to find and timely treat ovarian borderline serous papillary epithelioma patients.

Background: Body mass index (BMI) is the most applicable measure to screen overweight and obesity. However, individual and demographic factors affect the BMI cutoff values.Objectives: The current study aimed to determine the cutoff points for waist circumference (WC), waist-to-hip ratio (WHpR), waist-to-height ratio (WHtR) and neck circumference (NC) as indicators of overweight and obesity in Iranian females.Methods: This cross-sectional survey was conducted on 2466 females, aged 30-59 years, recruited from five ethnic groups; Arab, Kurd, Sistani and Baluchi, Turk and Turkmen in Iran, from Nov 2015 to Feb 2016. The subjects were selected by cluster multistage random sampling through five provinces. Receiver operating characteristics (ROC) analyses and Youden index were used to estimate the optimal anthropometric cutoff points.Results: Overall, 38.1% of females were overweight and 38.0% were obese. Significant differences of nutritional status were observed among different ethnic groups (P<0.001). The higher rates of overweight were observed in Kurd and Turk subject. Furthermore, the obesity was more common among Arab and Kurd subjects. Sistani and Baluchi showed the lowest rate of obesity and highest underweight. ROC analysis showed the highest area under curve (AUC) for WHtR and WC, followed by NC and WHpR was in the lowest area. The optimal cutoff points to diagnose overweight and obesity were WC, 90.25 and 95 cm, WHtR, 0.57 and 0.62, NC, 33 and 34 cm, and WHpR, 0.90 and 0.93 in total population, respectively.Conclusions: Higher cutoff values were proposed for anthropometric parameters in different ethnic groups of Iranian females compared to international cutoff points to predict overweight and obesity.

Background: Mapping from non-performance-based measures onto generic performance-based measures provides an appropriate solution to derive utilities to be used in economic evaluations.Objectives: This study aimed to create a model through which EQ-5D utilities for cataracts can be obtained from scores on the disease-specific Catquest measure.Patients and Methods: One hundred ninety-nine observations from 103 patients who self-administered the EQ-5D, the Catquest and questions on demographic and clinical characteristics were included in the analysis. Data was divided into estimation and validation datasets. To predict EQ-5D utilities, multiple regression analysis, using the Ordinary Least Square (OLS) and the censored least absolute deviation (CLAD), was performed. Catquest scores, age, gender, and performing surgery were included as explanatory variables. An estimation dataset was used to derive the coefficients, and these coefficients were then validated using a validation dataset. Based on the explanatory power, the consistency, the simplicity, theme an absolute error (MAE) and the correlations between observed and fitted utilities, the most appropriate model was selected.Results: The mean EQ-5D and Catquest scores of the total sample were 0.631 and 15.8, respectively. Age and surgery showed no significant effect for either method. Removing age and surgery, model II was built and given an R2 of 0.697, an MAE of 0.1176 for the OLS and an R2 of 0.614, and an MAE of 0.1153 for the CLAD method. In the validation stage, the CLAD revealed better prediction ability, with an MAE of 0.198 versus an MAE of 0.209 for the OLS. ICC and Bland-Altman analysis put the CLAD as a preferred method with the following equation: Utilities (EQ-5D) =0.988 - 0.0281Catquest (PD) +0.102gender (male=1).Conclusions: Based on these results, a mapping function was obtained which appears to be valuable in predicting EQ-5D utilities from Catquest scores. This function gives an appropriate solution to estimate utilities when primary EQ-5D data is not available.Although the model represents good consistency and predictive ability, further examination of obtained function is required with large samples.

Background: Emergence of multidrug-resistant (MDR) Acinetobacter baumannii infections is becoming a worldwide threat to hospitalized patients, particularly in intensive care units.Objectives: The aim of this study was to investigate the antimicrobial susceptibility patterns and prevalence of blaOXA-type carbapenemases of A. baumannii isolates in a teaching hospital in Iran.Patients and Methods: The study included a total of 40 isolates of carbapenem-resistant A. baumannii, obtained from 103 tracheal tubes in hospitalized ICU patients.Antimicrobial susceptibility testing was performed according to CLSI guidelines. Thebla OXA-51, bla OXA-23, bla OXA-24, bla OXA-58, and IS Aba1 genes were detected by PCR.Results: All of the A. baumannii isolates were resistant to imipenem and meropenem, and 100% of the isolates were MDR. The bla OXA-51 and IS Aba1 genes were detected in 100% of the isolates.bla OXA-23 and bla OXA-24 were detected in 90% and 40% of the isolates, respectively, but bla OXA-58 was absent in the A. baumannii isolates. In addition, 32.5% of carbapenem-resistant strains contained at least three genes encodingbla OXA-type carbapenemase. Colistin and polymyxin B were the most effective antibiotics.The sole risk factor for infection of hospitalized patients with carbapenem-resistant Acinetobacter strains was age over 40 years (P=0.042). The mortality rate was 27.5%.Conclusions: These findings signify the alarming spread of OXAgenes in A. baumannii strains in our intensive care unit. The spread of carbapenem-resistant Acinetobacter strains has serious health implications and requires the application of strict infection-control measures.

Background: Tissue engineering is an available treatment for large bone defects. The therapeutic effects of mesenchymal stem cell (MSC) are mostly attributed to secretion of many cytokines and growth factors. Many factors of MSC secretions accumulate in a conditioned medium and these factors recruit native cells into a defect site to generate new bone tissues.Objectives: The aim of this study was to evaluate the influence of adipose tissue derived MSCs-conditioned medium (ADMSC-CM) on bone repair of rats with critical - size calvarial defect.Methods: This experimental study was performed at Shahid Beheshti University of Medical Sciences, Tehran, Iran, from 2016 to 2017.Conditioned medium was collected from healthy rat adipose tissue derived MSC (ADMSC) at passage four. Calvarial bone defect was created in hypothyroid rats using a dental bur. Sampling was taken by the linear-mono-gram method to determine sample size (n =6 per group). The rats were divided randomly into four groups based on graft material as follows: empty defect, scaffold (Bio-Oss / type I collagen gel), scaffold / ADMSCs, scaffold /ADMSC- CM. Evaluations were made at 4 and 8 weeks after surgery using stereological analysis.Results: Histological analysis at 8 weeks indicated that the newly regenerated tissue almost covered the defect in the ADMSC-CM group. Stereological analysis showed that ADMSC-CM increased regenerated bone and numbers of osteocytes and osteoblasts compared with the defect and scaffold groups (P<0.05). Also, bone regeneration was more effective in animals treated with ADMSC-CM than in those received ADMSC.Conclusions: These results suggest an important role for ADMSC-CM in bone regeneration, through trophic impact of its cytokines and growth factors that induce native cell prolife ration and migration into the defect. Thus, ADMSC-CM seems to have good potential for application in bone tissue regeneration, in the cases of hypothyroidism.

Background: Sustained virologic response (SVR) to pegylated-interferon (PegIFN) and ribavirin (RBV) in hepatitis C virus (HCV) -infected patients could be predicted by detection of serum HCV RNA whereas detection of HCV RNA in other reservoirs such as peripheral blood mononuclear cells (PBMCs) for prediction of treatment response is still a mystery.Objectives: This study aimed at assessing the prediction of SVR by detection of HCV RNA in PBMCs or serum in patients during treatment.Methods: In a cohort study (2011 to 2014), 100 chronic HCV patients at Tehran Hepatitis Center were treated with PegIFN and RBV. Serum HCV RNA level was measured at baseline, 4, 12, and 24 weeks during treatment and at 24 weeks after termination of treatment.Meanwhile, HCV RNA was evaluated in PBMCs at weeks 4, 12, and 24 during the treatment.Results: Out of 100 patients treated in this study, 91 completed the course of treatment. Most patients were young males infected with HCV genotype 1. Cirrhosis and previous history of treatment was found in 16.5% and 26.5% of patients. Sustained virologic response was achieved in 65 (71.4%) patients. Among baseline parameters, only female gender was significantly associated with SVR.Undetectable serum HCV RNA at week 4 (OR=4.74) and week 12 (OR=11.63) of treatment predicted SVR rate while the same was not true for detection of serum HCV RNA at week 24 of treatment. Moreover, detection of HCV RNA in PBMCs at weeks 4 and 12 of treatment was not associated with the rate of SVR, while absence of HCV RNA in PBMCs at week 24 of treatment was associated with SVR (OR=4.55).Conclusions: Detection of HCV RNA in PBMCs, especially at week 24 of treatment with PegIFN and RBV, could be considered as an additional marker for prediction of treatment response. It is recommended to assess HCV on-treatment kinetic in PBMCs of patients treated with direct-acting antiviral agents for prediction of treatment response.

Background: Clinical judgment (CJ) is a complex process and is one of the most important concepts in the domain of education of the nursing students. Despite the special importance of its concept in nursing, this term still has not created an equal perception in the minds of many experts in the nursing education and no study has been done in order to define and explain this concept by concept analysis of the “CJ” in the educational domain.Objectives: The current study was done with the purpose of determining dimensions and features of this concept in the domain of clinical education of nursing students in Iran.Methods: The design of this study is qualitative with concept analysis method and hybrid model approach. It was done in three phases that were described by Walker and Avant. In the theoretical stage, reviews on the related and valid articles were accomplished.The articles were assessed and analyzed in order to present the working definition. In the stage of field work, the interview was done with 17 participants including 7 nursing students, 6 teachers, and 4 clinical instructors. In the final stage, the general analysis was done and the antecedents, attributes, and the consequences of the concept were extracted.Results: According to the final analysis, CJ for the nursing students is a cognitive and reasoning process, in order to achieve which, the nursing students by guidance of teachers in a secure clinical environment, assess the patients’ needs, interpret, and evaluate the patients’ response to the clinical practice and then reflect and perform the critical evaluation of the patients’ conditions. In the meanwhile, making effective clinical decisions, increasing the trust of patient and quality of care, the necessary conditions for the promotion of their professional competence will be provided.Conclusions: In the concept analysis of CJ, some of the needed conditions for CJ in the nursing students have not been reported in the studies.