Iranian Red Crescent Medical Journal
Year:2017 | Volume:19 | Issue:11|Papers Count:18

Background: Contrary to popular belief, no study to date has provided evidence regarding the effect of low cholesterol level onextended overall survival. Objectives: The aim of the current study was to examine the possible relationship between low serum cholesterol (< 160 mg/dL)and mortality from cardiovascular diseases (CVDs) and non-CVDs in males and females. Methods: This observational, prospective, cohort study included 19 different large-scale dynamic cohort studies in Italian populations, followed-up for 9 years. The Cox proportional hazard ratio (HR) was measured to analyze the data. The associations werepresented as HRs with 95% confidence intervals. Results: The results showed that 1906 deaths (males, 1439 and females, 467; total non-CVD, 1214 and total CVD, 692) occurred duringthe 9-year follow-up. Total mortality for non-CVD was almost twice (1. 76) higher than that of CVD. There was a significant inverseassociation between low serum cholesterol and non-CVD mortality in males, unlike females. The association of low cholesterol levelwith non-CVD mortality was more significant than CVD mortality among males (non-CVD: HR, 2. 06; 95% CI, 1. 54-2. 74 vs. CVD: HR, 0. 81; 95% CI, 0. 54-1. 22). However, an insignificant association was found between both non-CVD and CVD mortalities and low serumcholesterol among females (non-CVD: HR, 1. 52; 95% CI, 0. 91-2. 50 vs. CVD: HR, 1. 56; 95% CI, 0. 72-3. 38). Conclusions: The findings indicated an inverse association between low serum cholesterol and high non-CVD mortality versus CVDmortality. Therefore, non-CVD mortality rate was higher than CVD mortality in males and lower in females at minimum cholesterollevel.

Background: Chronic low-grade inflammation has been confirmed to be a major etiological factor in polycystic ovarian syndrome(PCOS). The anti-inflammatory effects of quercetin, a major flavonol in onion, have been suggested by experimental studies. However, lack of data exists to investigate the effects of onion on inflammatory markers in PCOS. Objectives: This study aimed at assessing the effects of raw red onion consumption on inflammatory markers in PCOS. Methods: Fifty-four overweight/obese patients with PCOS were randomly assigned to either High-Onion (HO; raw red onions: 2 (40-50 g/day) for overweight and 2 (50-60 g/day) for obese patients) or Low-Onion (LO; raw red onions: 2 (10-15 g/day)) group over 8weeks in this randomized controlled trial (RCT). Serum adiponectin, leptin, and high-sensitivity C-reactive protein (hs-CRP) levelsand their correlations with metabolic and anthropometric parameters were assessed at baseline and endpoint. Results: The 2-month treatment with onion could not significantly effect mean serum levels of adiponectin, leptin, or hs-CRP. However, the percentage change of serum adiponectin was significantly different between the two groups after 8 weeks (-11. 9% in LO vs. 48. 32% in HO; P = 0. 026). Percentage change of serum leptin and hs-CRP showed no significant differences between the 2 groups. Leptin had significant correlations with most anthropometric and metabolic variables of insulin resistance (P < 0. 05). Adiponectinconcentration correlated significantly with fasting glucose (r =-0. 35; P < 0. 05), while log hs-CRP had significant correlations withmost of the anthropometric markers (P < 0. 05). Conclusions: The 8-week intervention with red onion could increase percentage changes of serum adiponectin level in overweight/obese females with PCOS. However, no such effect was observed for serum leptin as well as hs-CRP levels.

Breakdowns of the 7-year war in Syria, especially in the health care infrastructures, such as water networks, and in the basic healthrequirements, such as public hospitals, emergency equipment from one side and emigration of the skilled resources from the countryfrom the other side, has led to a disaster not only for the residents and neighboring countries but also for all other countries, which accept asylum seekers. Deficiency of national immunization programs and safe water has increased the risk of newepidemicsof enterally transmitted virus infections like Hepatitis A virus (HAV) infection. Ringing alarms of a public health emergency mustconcern all authorized policy makers around the world. Vaccination againstHAV, both for residents and asylum seekers, controllingthe immune system of all other nations involved in Syria, fixing the water networks, and investing on infrastructures of the primaryhygiene requirements would eliminate the risk of communicable infections in all the region.

Background: Numerous studies have shown that long-term treatment with anticonvulsants may be an important risk factor forthe onset of atherosclerosis, or worsening of its symptoms. Context: The present study aimed at investigating the relationship between carbamazepine (CBZ) monotherapy and plasma homocysteine(Hcy) levels in patients with epilepsy. Evidence Acquisition: Studies concerning homocysteine levels in carbamazepine monotherapy patients with epilepsy, which werepublished in VIP, Wanfang, CNKI, Cochrance Library, PubMed, Web of Science, and EMBASE, were included in March 2016. The qualityof the controlled clinical trials (CCT) selected for this study was assessed using the Newcastle-Ottawa scale (NOS), and the relevantdata of the included studies were extracted through RevMan5. 2 software. Results: In this meta-analysis, 22 eligible studies were enrolled including 9 Chinese and 13 English studies. The study included atotal of 1604 cases including 575 cases of patient group and 1029 control group cases. Results of the meta-analysis showed thatplasma homocysteine level in patients with epilepsy with long-term treatment of CBZ was significantly higher than that in thehealthy control group [SMD = 1. 55, 95% CI: [1. 09, 2. 01], P < 0. 00001]. Moreover, there was significant heterogeneity in the estimatesaccording to I2 test (P < 0. 00001; I2 = 93%). Further subgroup analysis showed that no significant difference was present when thestudy participants were grouped by region and age, however, the risk of heterogeneity in the West Asian group (I2 = 58%, P = 0. 07)was diminished when compared with overall groups (I2 = 93%, P < 0. 00001). The results of sensitivity analysis by Stata12. 0 showedgood stability. The funnel plotmethod and Beggmethodwere used to detect publication bias, and the results showed a substantiallysymmetrical funnel plot, Pr > |Z|= 0. 091 > 0. 05 (no statistical significance), suggesting no significant publication bias in the study. Loss factor of safety (Nfs) 0. 05 equaled 7269. 16 (P = 0. 05), meaning that addition of about 7269 negative results were required tooverthrow the conclusion of this study. Conclusions: The seizures significantly increased plasma homocysteine levels in the patients, thus it is appropriate to add folicacid, vitamin B12, and vitamin B6 to reduce the seizures. Moreover, homocysteine may be beneficial for those patients with epilepsywho take carbamazepine.

Background: Human beings firmly obtain a better understanding of the creator, its aims and destination, natural phenomenaas well as the surrounding concepts with the help of thoughts. Invitation towards contemplation is one of the principles of HolyQuran’ s teachings. Thought is one of the best activities of the human being’ s brain from the neuroscience point of view, whichoccurs in specific parts of the cerebral cortex. These areas consist of parts of the cerebral cortex, which either does not exist in othercreatures or is not highly developed. Objectives: The purpose of this study was to investigate the importance of thought from the Holy Quran’ s point of view and theFoundations of Neuroscience. Methods: This research was carried out during year 2015 in the city of Tehran (the capital city of Iran). In this qualitative study, datawere collected based on the Holy Quran and the interpretation of authentic books of the Quran and matching interpretation ofthese verses with neuroscience articles and books in the field of thought. Results: Careful consideration of the data led to the identification of 18 verses of the Holy Quran that pointed directly to thinking, which were consistent with accepted principles in neuroscience. Conclusions: Scientific secrets of the Holy Quran can be easily revealed by making a connection between a medical sciences, basicsciences, and Quranic sciences. There is hope of greater connection between the community of researchers in different fieldswith Quranic scientists, which might lead to the discovery of the secrets of this scripture and deep realization of the mystery ofpermanence.

Background: Identifying the best marker for appropriate screening of risk factors of chronic diseases seems necessary in any society. Objectives: This study aimed at performing a comparative evaluation of anthropometric indices to determine a better marker forprediction of high blood pressure in adolescents. Methods: This cross-sectional study was done during 2013 on 1046 students, aged 11 to 19 year old in Kashan, who were chosen bycluster and class sampling method. Height, waist circumference (WC), waist-to-hip ratio (WHR), waist-to-high ratio (WHtR), systolicblood pressure (SBP), and diastolic blood pressure (DBP) of the subjects were measured. Blood pressure of all subjects, whohad theirblood pressuresmeasuredduring the first visit, wasmeasuredduring the secondandthird visit again, andthe threemeasuredbloodpressure averages was considered as subjects’ blood pressure. Results: This study showed a significant positive correlation between BP and body mass index (BMI), WC, WHR, and WHtR indices(P < 0. 001). Receiver operating characteristic curve (ROC) analysis was performed. Area under the curve (AUC) was obtained for BMI(0. 62 to 0. 73), WC(0. 67 to 0. 76), WHR(0. 57 to 0. 67), andWHtR(0. 63 to 0. 77) in diastolic blood pressureandBMI(0. 66 to 0. 76), WC(0. 68to 0. 78), WHR (0. 57 to 0. 67) and WHtR (0. 67 to 0. 77) in systolic blood pressure. The WHtR in adolescents had better distinguishingpower than other anthropometric indices. Conclusions: TheWHtR, as a relatively simple, inexpensive, andconvenient measurementmethodis the best anthropometric indexfor determination of blood pressure in these subjects.

Background: Noninvasive positive-pressure ventilation (NIPPV) has been safely used in selected patient populations. The purposeof this study was to determine the safety and efficacy of NIPPV outside the intensive care unit (ICU) in a tertiary hospital. This descriptive, cross sectional study was performed at Masih Daneshvari Hospital, Tehran, Iran during 2011-2015. Methods: Between March 2011 and June 2015, patients requiring NIPPV were enrolled in the study. The study population included alleligible patients. Census sampling was applied in this study. The patients’ medical history (including comorbidities), age, sex, andhospital ward in which NIPPV was delivered were assessed retrospectively. Moreover, venous pH, partial pressure of carbon dioxide(PCO2), and bicarbonate (HCO3-) were analyzed before and after the intervention (NIPPV application). Results: A total of 946 patients, including 598 (63. 2%) men and 348 (36. 8%) women, received NIPPV for inpatient hospital care. Themean age of the patients was 61. 92 15. 5 years (range, 3-102 years). Indications for NIPPV included exacerbation of chronic obstructivepulmonary disease (COPD; 55. 4%), obstructive sleep apnea (OSA; 6%), bronchiectasis (7. 8%), concurrence of COPD and OSA (4. 8%), neuromuscular disorders (1. 7%), congestive heart failure (4%), postthoracotomy pain (0. 6%), thoracic malignancy (2. 1%), pulmonarythromboembolism (1. 1%), pneumonia (7. 3%), asthma (1. 5%), interstitial lung disease (2. 5%), tuberculosis (4%), and cystic fibrosis (1. 3%). We found significant improvements in venous pH and PCO2 with no significant changes in HCO3-(P > 0. 05). Conclusions: NIPPV could be safely used under the supervision of trained pulmonologists in non-ICU settings. This method waseffective in treating acute abnormalities in venous blood gas, including pH and PCO2.

Background: Diabetes could be especially difficult for females. The burden of diabetes on females is unique because the diseasecould affect both mothers and their unborn children. Objectives: The aim of this study was to determine the effect of developing a communication network among physicians on thelevel of HbA1C and Fasting Blood Sugar (FBS) in patients with diabetes in Iran. Methods: This study was a randomized clinical trial performed with 100 patients, who were randomly divided to experimentaland control groups. The study was conducted from 20/11/2015 to 15/1/2016. A communication network was established among thephysicians at health centers, to which patients in the intervention group were referred. The data were collected using a checklistof demographic information of patients. Laboratory results regarding the level of Glycated Hemoglobin (HbA1C) and Fasting BloodSugar (FBS) of patients were gathered at baseline and 4 months after the establishment of the communication network. Results: After the development of the communication network, HbA1C levels had reduced from 8. 14  2. 08 to 7. 90  2. 01 in theintervention group (P < 0. 001), while in the control group HbA1C levels had increased from 8. 98 2. 20 to 9. 09 2. 21 (P < 0. 001). Conclusions: The results showed that for successful control of diabetes, physicians need to communicate with each other and shareinformation and experiences. Furthermore, establishing a communication network among physicians could be effective to controldiabetes.

Background: There are different tools for assessing evidence-based practice in nursing in Iran, however, there are some limitationsin each of them, and they do not examine EBP comprehensively. Objectives: The purpose of this study was to evaluate the validity and reliability of the Persian version of EBPQ. Methods: This study was a methodological research on 300 nurses working in Guilan province (Iran). A cluster sampling was done. After a forward-backward translation, the questionnaire was translated into Persian and its psychometric evaluation was done. Results: CVIs for all items were 0. 8 and CVRs were 0. 63. All of the impact scores were > 1. 5. Cronbach’ s alpha of the scale was0. 92. The ICC test was 0. 96 and significant (P < 0. 001). In exploratory factor analysis, KMOwas 0. 84 and Bartlett’ s test was significant(P < 0. 001). Confirmatory factor analysis showed an acceptable fit model. Conclusions: This study introduces the evidence-based practice questionnaire (EBPQ) as a valid and reliable tool to assess the statusof evidence-based practice among nurses in Iran.

Background: The goal of healthcare professionals is to provide safe care, prevent injury, and promote the health of patients. Differentfactors and conditions, in particular, medication errors, may threaten patient safety. Objectives: This study was conducted to explore and to describe the role of interactions among healthcare professionals regardingmedication errors in intensive care units. Methods: The study was conducted using a descriptive qualitative method in 2016. The participants were purposively chosen. Datawere collected by semi-structured interviews and used qualitative content analysis for the analysis. The setting of the study included16 internal, surgical, poisoning, and cardiac intensive care units of 7 educational hospitals affiliated to Isfahan University of MedicalSciences located in central Iran with a total of 190 beds. Participants included 19 members of the healthcare team (physician, nurseand clinical pharmacist) with at least 1 year of work experience in intensive care units. Results: Themaincategoryand3 sub-categories were extracted from interviews. The 3 sub-categories were: “ weak interprofessionalinteraction (physician and nurse)” , “ weak intraprofessional interaction (among physicians)” , and “ weak interaction of physician aswell as nurse with the patient and family” . Conclusions: The findings suggest that medication errors may occur due to lack of interprofessional collaboration and weak communicationof the healthcare team with the patient and his family. The collaboration between healthcare providers and communicationwith patients directlyhadanimpactonpatient outcomes. Toimprove the qualityandsafety of care delivery, healthcare centermanagers need to promote interprofessional collaboration, the participation of patient and family in care plan, interprofessionaldevelopment, and implementation of programs to prevent as well as reduce medication errors in intensive care units.

Context: Population aging is one of the most important health concerns worldwide, leading to an increase in the prevalence ofchronic diseases such as dementia and Alzheimer disease (AD). Disease registries have great potential to determine the effect ofclinical care, healthcare costs, and healthcare improvement for patients. Although there are several registries for dementia andAD worldwide, no systematic review is so far performed in this area. Therefore, the current study aimed at identifying the basicinformation in dementia and AD registries and comparing their characteristics. Evidence Acquisition: The current systematic review studied the dementia and AD registries in English literature based on keywordsin the title with no time limitations, using the following databases: Institute of Electrical and Electronics Engineers (IEEE), ProQuest, PubMed, Science Direct, Web of Science, Scopus, Ovid Medline, Scientific Information Database (SID), and IranMedex (earliestentry to 07 February, 2017). In the current research, only the studies related to disease registries were evaluated. Results: A total of 28 articles meeting the inclusion criteria were evaluated in the current study. Based on the findings, 22 dementiaand AD registries were identified. The majority of the registries (13 registries) were from North America. In half of the registries, patient recruitment was performed among outpatients and inpatients referred to healthcare centers. The comparison of the structuralinformation in these registry systems showed that they differed in terms of objectives, data sources, minimum data sets, anddata quality. Conclusions: The current study was the 1st systematic review of dementia and AD registries. Since there are no international standardsto develop dementia and AD registries, comprehensive analysis can be effective to promote disease registry systems.

Dear Editor, Current medicine is the last ring of a long chain ofprogress of medical sciences in various civilizations duringhistory. Among them, Persia was one of the oldest civilizationsin history, and dates back to about 10000 yearsago. Medicine and allied sciences were well-developedin this civilization. In this regard, nutrition was alwaysconsidered as one of the main issues in Persian medicine(PM) and had a deep history in antiquity. There is extensiveevidence in this regard, in the literature, databasessuch as PubMed and Scopus, as well as search engines includingGoogle Scholar and also in historical documentsand manuscripts. In the Achaemenids era (550 to 330BC), eating and drinking manners were taught to childrenand they were encouraged to avoid overeating. Kidsand youth meals included hunting meat or bread, andvegetables, twice a day.

Background: Hypertension is a major health problem in all communities that is closely associated with lifestyle. Different educationalmodels have been used to improve the lifestyle in these patients. However, inconsistent results have been reported. Objectives: This study aimed to investigate the effect of education based on the BASNEF model on lifestyle in patients with essentialhypertension. Methods: This single-blind randomized controlled clinical trial was conducted in 2015 on 80 patients with essential hypertension. The intervention group received five sessions of training based on the BASNEF model, while the control group received routine care. A two-part instrument was used in this study. The first part included a demographic questionnaire and the second part comprisedthe life style questionnaire (LSQ). The LSQ was responded in two times, i. e. before and one month after the intervention. Descriptivestatistics, independent sample t-test, and analysis of covariance were used to analyze the data. Results: The mean score of lifestyle in the intervention group was 121. 80 at the start of the study that changed to 149. 60 (with anincrease of 27. 8) after the intervention (P < 0/001). However, the mean score of lifestyle did not significantly change in the controlgroup (126. 55 vs. 122. 78). The greatest improvements were observed in the areas of nutrition and weight management, sports andfitness, physical health, disease prevention, and mental health, in sequence. Conclusions: Using a training program based on the BASNEF model was effective in improving the lifestyle in patients with hypertension. Thus, this model of behavior modification can be used as an inexpensive and applicable method in modification of lifestyleand behavior change in patients with hypertension.

Introduction: Crimean-Congo hemorrhagic fever (CCHF) is a fatal tick-borne viral zoonosis. CCHF virus (CCHFV) has 7 distinctgenotypes with a determined geographical distribution pattern. However, similar genotypes have been reported from distant geographicalareas. Case Presentation: On 4 June 2016, a CCHF suspected case from Sanandaj city, Kurdistan province of Iran, was confirmed withCCHFV infection by RT-PCR test. The phylogenetic analyses showed a strain belonging to Europe-1 genotype. Conclusions: Considering the similarity of Iranian strain of Europe-1 genotype to the strains from Turkey and Russia, it could beclaimed that Europe-1 genotype has introduced to Iran from European countries. However, to have a better understanding aboutthe circulation of CCHFV Europe-1 genotype in Iran, further investigations should be performed.

Background: An increase in disasters around the world like bioterrorism attacks emphasizes the need to assess healthcare workers’ preparedness to respond to bioterrorism. Nurses form the majority of first responders in disasters and emergencies, thus it isimportant to guarantee that their knowledge and skills are adequate to respond to such events. Objectives: This study aimed at assessing the level of nurse’ s knowledge and attitude of Sari city of Mazandaran province aboutbioterrorism, in 2015. Methods: Overall, 240 nurses participated in this cross-sectional study that was conducted at the University of Mazandaran MedicalSciences. The units were selected through the accessible sampling method. Data were collected by a questionnaire in 3 sections, demographic data, knowledge, and attitude, respectively. Results and Conclusions: The results showed that 91. 7% of samples had low knowledge about bioterrorism and 93. 3% had noopinion in regarding attitude of bioterrorism. Little knowledge of nurses regarding bioterrorism attacks indicates inefficienciesin hospitals units. Therefore, bioterrorism preparedness should be proposed through continuing education for under graduateand post-graduate nursing curriculum.

Background: Attention towomen’ shealth is considered a health priority in every country. Oneof the factors that promotewomen’ sgeneral health is self-efficacy. Objectives: The present study was conducted to determine the effect of counseling on the self-efficacy of middle-aged women. Methods: The present randomized controlled clinical trial was conducted on 102 middle-aged women (51 women in each group)and was covered by health centers in Tabriz in 2015-16. Participants were randomly assigned into two groups (one group receivedcounseling and another did not) using the block randomization stratified based on age (40 to 50 and 50 to 60) in block sizes of 4 and6. The intervention group received counseling on health promotion over three 45-minute sessions. Sherer et al’ s general self-efficacyscale was completed in both groups before the intervention, and four and eight weeks after the intervention. Data were analyzedusing independent t-test and repeated measures ANOVA. Results: Before the intervention, no significant difference was observed between the two groups in terms of self-efficacy. Four andeight weeks after intervention, mean(SD) of self-efficacy scores were 69. 0 (11. 4) and 71. 7 (11. 1) respectively in the counseling group and65. 7 (13. 2) and 64. 9 (11. 3) respectively in the control group. After the intervention, and with adjusting the baseline values, repeatedmeasures ANOVA test showed a significantly higher mean self-efficacy score in the counseling group compared to the control group(Adjusted mean difference = 5. 3; 95% confidence interval = 2. 1 to 8. 5; P < 0. 001). Conclusions: Counseling in middle-aged women can lead to improved self-efficacy, resulting in improved health in this age group.

Background: Overweight/obesity is increasing in both developing and developed countries. Its socioeconomic determinants have been well studied in developed countries. It has been reported that the family socioeconomic status is associated with overweight/obesity in childhood and adolescence. However, socioeconomic inequalityhas not been studied sufficiently in developing countries. Objectives: This study aimed to determine the status of socioeconomic inequality in overweight/obese high school students and its related factors in Kermanshah, Iran. Methods: Within a cross-sectional study and using stratified cluster random sampling, 1440 students in the academic year of 2015-16 were selected from all high schoolsin Kermanshah, Iran. To collect data, we used a demographic, socioeconomic status, and nutritional status questionnaire. Height and weight of the participants weremeasured and the status of obesity was determined by calculating body mass index (BMI). The concentration index and a concentration curve were used for the measurementof inequality. We used multinomial logistic regression to investigate the factors associated with obesity. The collected data were analyzed using Stata 11 software. Results: The mean age of 1445 students participating in the study was 16. 35 0. 84 years. Of all, 51. 63% (746 students) were female and the rest were male. The medianof BMI was 20. 54 kg/m2 (IQR = 4. 32) in female participants, 21. 20 (IQR = 4. 42) in male participants, and 20. 76 kg/m2 (IQR = 4. 49) in all the participants. Concerning assetindex, Concentration Index for overweight/obesity was 0. 09 in girls (95% CI:-0. 14-0. 33),-0. 02 in boys (95% CI:-0. 14-0. 09), and 0. 01 in the entire participants (95% CI:-0. 13-0. 17). The odds of overweight/obesity in males was 1. 81 times higher than that in females; the odds of overweight/obesity in those consuming high-fat food was 1. 61 timeshigher than that of people not consuming high-fat diet. Conclusions: Overweight/obesity is more prevalent in adolescents with low socioeconomic level; this indicates the shift of the problem to the poorer groups of thecommunity. Predominance of boys and the use of high-fat foods are affecting obesity/overweight; therefore, it must be considered in all health policy interventions.

Context: Disasters are increasing worldwide, with more devastating effects than ever before. Hospitals must maintain their normalfunctions or have an evacuation plan due to the rate of damages at the time of a sudden disaster. The present study was conductedto determine the effective determinants and components in hospital evacuation decision-making. Evidence Acquisition: In this systematic review study, which was conducted in 2016, bibliographies, citation databases, and otheravailable records such as international guidelines, documents and reports of organizations and academic dissertations were usedto find an answer to the following question: What are the effective components in hospital evacuation decision-making? Finally, 34articles were included in this systematic review. This systematic review article was checked with PRISMA checklist. Results: The common factors affecting hospital emergency evacuation decision-making were classified into 4 general categoriesand 40 subcategories, which have been explored during thematic analysis. These 4 categories included hospital infrastructure consequences, threat, internal factors, and external factors. Level of risk was the most important component of threat category and itwas mentioned in most of the reviewed literature. Loss of electricity and water, communication and transportation, resources suchas staff, and removing patient devices were the most mentioned factors in hospital infrastructure consequences, external factors, and internal factors, respectively. Conclusions: Different variables affect the process of hospital emergency evacuation decision-making. Thus, further studies areneeded to develop a decision-making tool for hospital emergency evacuations in Iran.