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1.  Estimating the Annual Incidence of Abortions in Iran Applying a Network Scale-up Approach 
Background:
Abortions are of major public health concern in developing countries. In settings in which abortion is highly prohibited, the direct interview is not a reliable method to estimate the abortion rate. The indirect estimation methods to measure the rate of abortion might overcome this dilemma; They are practical methods to estimate the size of the hidden group who do not agree to participate in a direct interview.
Objectives:
The aim of this study was to explore the practicality of an indirect method for estimating the abortion rate , Known as Network Scale-up, and to provide an estimate about the episode of abortion with and without medical indications (AWMI+ and AWMI-) in Iran.
Materials and Methods:
This cross-sectional study was conducted in 31 provinces of Iran in 2012. A random sample between 200 and 1000 was selected in each province by the multistage sampling method that 75% of the data were collected from the capital and 25% from one main city. We selected samples from urban people more than 18 years old (12960) and we asked them about the number of abortion in women they knew who had experienced the medical and non-medical abortions in the past year. A range for the transparency factor was estimated based on the expert opinion.
Results:
The range of the transparency factors for AWMI+ and AWOMI- were 0.43-0.75 and 0.2-0.34, respectively. Regarding the AWMI+, our minimum and maximum estimations (per 1000 pregnancies) were 70.54 and 116.9, respectively. The corresponding figures for AWMI- were 93.18, and 148.7.
Conclusions:
The frequency rates for AWMI+ and AWMI- were relatively high. Therefore, the system has to address to this hidden problem using the appropriate preventive policies.
doi:10.5812/ircmj.15765
PMCID: PMC4270634  PMID: 25558379
Abortion; Iran; Size Estimation; Network Scale-Up
2.  Occupational Asthma in a Cable Manufacturing Company 
Background:
During the past decade, incidence of asthma has increased, which might have been due to environmental exposures.
Objectives:
Considering the expansion of cable manufacturing industry in Iran, the present study was conducted to evaluate the prevalence of occupational asthma in a cable manufacturing company in Iran as well as its related factors.
Patients and Methods:
This study was conducted on employees of a cable manufacturing company in Yazd, Iran, in 2012. The workers were divided into two groups of exposure (to toluene diisocyanate, polyvinyl chloride, polyethylene or polypropylene) and without exposure. Diagnosis of occupational asthma was made based on the subjects’ medical history, spirometry and peak flowmetry, and its frequency was compared between the two groups.
Results:
The overall prevalence of occupational asthma was 9.7%. This rate was 13.8% in the exposed group. Logistic regression analysis showed that even after adjustment for confounding factors, a significant correlation existed between the frequency of occupational asthma and exposure to the produced dust particles (P < 0.05). In addition, age, work experience, body mass index, cigarette smoking and shift work had significant correlations with the prevalence of occupational asthma (P < 0.05).
Conclusions:
Considering the high prevalence of occupational asthma among cable manufacturing company workers in Iran, this issue needs to be addressed immediately in addition to reduction of exposure among subjects. Reduction in work shift duration, implementation of tobacco control and cessation programs for the personnel, and performing spirometry tests and respiratory examinations in shorter periods may be among effective measures for reducing the incidence of occupational asthma in this industry.
doi:10.5812/ircmj.9105
PMCID: PMC4270639  PMID: 25558389
Asthma; Occupational Asthma; Occupational Exposure
3.  Effects of SP6 Acupuncture Point Stimulation on Labor Pain and Duration of Labor 
Background:
Acupressure has been used frequently to improve labor, manage labor pain, and shorten delivery time. However, there has been little research-based evidence to support the positive effects of acupressure in the obstetric area and obstetric nursing.
Objectives:
The aim of this study was to evaluate the effects of SP6 acupressure on labor pain and delivery time in primigravida women in labor.
Patients and Methods:
The study was conducted at the Trabzon Maternity Hospital in Turkey. Its design was a randomized controlled clinical trial study using a single-blinded method. One hundred (100) primigravida women in labor were randomly assigned to either the SP6 acupressure (n = 50) or control group (n = 50). Acupressure was practiced 35 times in total on the SP6 point of both legs in the SP6 acupressure group; 15 times (during contraction) when cervical dilation was 2-3 cm, 10 times when cervical dilation was 5-6 cm and 10 times at 9-10 cm dilation, while the women in the control group received standard care. Labor pain was measured five times using a structured questionnaire of a subjective labor pain scale (visual analogue scale-VAS) when dilation was 2-3 cm (VAS 2), 5-6 cm (VAS 3) and 8-9 cm (VAS 4) before and after acupressure was applied to the SP6 point (VAS 1), and finally at the early postpartum period (VAS 5). The duration of labor in both groups was measured with a partograph and the length of delivery time was calculated in two stages: from 3 cm cervical dilation to full cervical dilation, and from full cervical dilation to delivery.
Results:
There were significant differences between the groups in subjective labor pain scores (except VAS 4) (P < 0.001). The duration of the Phase one (3 cm dilatation to full dilatation) and Phase two (full dilatation to birth) in the acupressure group was shorter than the control group (Phase one, 225 min and 320 min, respectively; Phase two, 15 min and 20 min, respectively; both P < 0.001).
Conclusions:
It was determined that SP6 acupressure was effective in decreasing pain and duration of labor.
doi:10.5812/ircmj.16461
PMCID: PMC4270652  PMID: 25558386
Acupressure; Acupuncture point; Labor; Labor Pain; Randomized Clinical Trial
4.  A Qualitative Content Analysis of Knowledge Storage in Nursing Education System 
Background:
The need for effective management of intellectual and academic assets is constantly growing. The nursing educational system should be considered as a storage of knowledge since it is deposited in the nursing educational system in the form of intellectual investment.
Objectives:
The purpose of the present study was to explore nursing knowledge storage in the nursing educational system.
Materials and Methods:
The participants of this study consisted of eight nursing educators and five students. The inductive content analysis method was used in this research. Participants were interviewed through the semi-structured method. Data analysis was done by five stage framework approaches. The trustworthiness of the study was ensured through validity and acceptability criteria.
Results:
Data analysis showed that nursing educators and students were involve in teaching and learning activities by storing knowledge in subjective and objective forms. Knowledge was gained through the different educational activities of the nursing educators and through contact with their peers. Moreover, the nursing students gained knowledge for better learning and a more knowledgeable and advanced performance with the help of the educators.
Conclusions:
This study revealed the main components of knowledge storage. An enhanced preservation of explicit knowledge is recommended in the nursing educational system so that in the future, students and educators can easily access the same knowledge from storage sources and not from individuals who might be carrying only a single experience of the subject.
doi:10.5812/ircmj.21835
PMCID: PMC4270655  PMID: 25558388
Education; Knowledge; Knowledge Management; Nursing; Qualitative Research
5.  Psychometric Evaluation of the Role Strain Scale: The Persian Version 
Background:
Nursing teachers have difficulties fulfilling multiple roles expectations and balancing the various dimensions of their roles that may lead to role strain. In order to lack of culturally and academically proper scale in Iran to measure role strain in nursing teachers, localizing a foreign scale in this field is necessary.
Objectives:
The objective of this study was psychometric evaluation of the Role Strain Scale (RSS) and confirming its structural model in an Iranian population.
Materials and Methods:
The present cross- sectional study was conducted in 2012, comprising 302 nursing teachers from around the country who were selected using stratified- cluster sampling. Psychometric evaluation process of the RSS was carried out by Face, content and constructs validity (confirmatory and exploratory factor analysis). Reliability was examined using test-retest and Cronbach’s alpha for internal consistency reliability.
Results:
In the primary results, in spite of being approved by face and content validity, in Construct validity, fitness indices of original Role Strain Scale showed no satisfactory findings in Iranian data. Therefore, some items from the structural model of original version were extracted by exploratory factor analysis and a five–factor model with 33 items was obtained. These factors were role conflict, role ambiguity, role overload, role incompetence, and role incongruity. New model as Persian version of RSS was confirmed by calculating fitness indices such as GFI = 0.93, AGFI = 0.94, NFI = 0.91, RMSEA = 0.093. Internal consistency reliability for the total scale and subscales were respectively 0.92, and 0.71-0.84. Results from Pearson correlation test indicate a high degree of test-retest reliability (r = 0. 89). ICC was also 0.91.
Conclusions:
This reliable and valid scale is academically appropriate for nursing teachers to measure role strain and helps detect and predict a multiplicity of role problems and consequently make educational managers aware of nursing teachers’ difficulties while facing with multiple roles and possible future challenges.
doi:10.5812/ircmj.15469
PMCID: PMC4270659  PMID: 25558378
Strain; Psychometrics; Evaluation; Nursing
6.  Comparing the Healing Effects of Arnebia euchroma Ointment With Petrolatum on the Ulcers Caused by Fractional CO2 Laser: A Single-Blinded Clinical Trial 
Background:
Arnebia euchroma ointment (AEO) has been used in Iranian traditional medicine for burn wound healing.
Objectives:
The aim of this study is to evaluate wound healing efficacy of AEO in burn wounds after fractional Co2 laser.
Patients and Methods:
This split-face, single-blinded, single-center clinical study was performed in Shohada-e-Tajrish Hospital, Tehran, Iran. A total of 26 subjects with facial acne scar, who were to receive fractional CO2 laser resurfacing were recruited. After laser procedure, AEO was applied to one side of the face and petrolatum on the other side for wound healing. Digital photographs were taken from acne scar area before resurfacing and on each of the assessment sessions. Three researchers, who were unaware of the applied medications, assessed these digital photographs for erythema, edema, epithelial confluence, crusting/scabbing, and general wound appearance. Subject’s irritations such as dryness and itching were evaluated on the second, fifth, and seventh days.
Results:
Our study indicated higher epithelial confluence and general wound appearance scores (P = 0.045 for both) and less erythema and edema on fifth day in petrolatum (P = 0.009 and P = 0.034, respectively). The results showed less crusting and erythema (P = 0.016 and P = 0.035, respectively) and higher general wound appearance scores in petrolatum on the second day (P = 0.035 and P = 0.001, respectively). Dryness was the most common subjective complaint in both groups; however, it was more severe in AEO, especially on the second day (P = 0.023).
Conclusions:
Despite the healing effects of AEO in burn wounds, petrolatum was more effective than AEO in post-laser wound.
doi:10.5812/ircmj.16239
PMCID: PMC4270663  PMID: 25558382
Acne; Arnebia; Traditional Medicine; Laser; Wound Healing
7.  Efficacy of Myrtus communis L. and Descurainia sophia L. Versus Salicylic Acid for Wart Treatment 
Background:
Wart is a skin disease with circular appendages, which is called “suloul” in Iranian traditional medicine (ITM). According to ITM literature, warts have different types and causes. The most important mechanism is excretion of materials (Khelt) from body to skin and mucus; its causative material is often phlegm, black bile or a combination of them. To treat warts, it is necessary to consider the patient’s life style, modify his dietary intake and moisturize his temperament.
Objectives:
This study aimed to compare Myrtus communis L. and Descurainia sophia L. as a method of ITM, versus salicylic acid in treatment of wart.
Patients and Methods:
In this study, conducted in Yazd, Iran, 100 patients were selected and randomly divided into four groups. Group 1) salicylic acid, group 2) salicylic acid and D. sophia L. group 3) M. communis L. group 4) M. communis L. and D. sophia L. Numbers, sizes of lesions and symptoms, on days 0, 20, 40 and 90 were examined and analyzed. The relapse rate was investigated three months after. Changes of sizes and numbers of warts in each period of time in each group, compared to baseline, were assessed by Wilcoxon Signed Rank test. To compare these changes between the groups, Kruskal Wallis test was used.
Results:
In this study 100 patients participated, 69% of which were female. Compared to baseline, mean ± SD of changes for the number of warts in day 40 were 1.12 ± 4.2, 0.96 ± 2.5, 1.32 ± 5.1 and 0.04 ± 0.2 respectively in the four groups (P = 0.02). Mean ± SD of changes for the number of warts in day 90 were 1.84 ± 4.5, 1.56 ± 2.8, 1.24 ± 5.1 and 0.04 ± 0.6 respectively in the four groups (P = 0.03). In addition mean ± SD of changes for the size of warts in day 40 were 0.96 ± 1.8, 1.03 ± 2.4, 2.47 ± 3.0 and 0.45 ± 1.7 respectively in the four groups (P < 0.001). Mean ± SD of changes for the size of warts in day 90 were 1.24 ± 2.1, 1.3 ± 2.3, 2.45 ± 3.1 and 0.45 ± 1.7 respectively in the four groups (P < 0.001). Relapse was not seen in any groups after three months. The frequency of side effects was similar after three months.
Conclusions:
M. communis L. can be used as a topical treatment for warts. It not only shows more rapid response than salicylic acid, but also has fewer side effects. It seems that D. sophia L. can modify the digestion process and patients can excrete large amounts of the substance that causes warts. Therefore, it is better to use it more than 40 days. According to our investigation, in ITM, considering the cause and mechanism of disease generation and the causing materials of the disease, different treatments should be applied for each patient. Although applying an appropriate treatment is necessary, a unique treatment for all the patients cannot be available.
doi:10.5812/ircmj.16386
PMCID: PMC4270664  PMID: 25558385
Suloul; Wart; Iranian Traditional Medicine; Classical Medicine; Myrtus communis L.; Descurainia sophia L.; Salicylic Acid
8.  Family and the Risky Behaviors of High School Students 
Background:
Family plays an important role in helping adolescent acquiring skills or strengthening their characters.
Objectives:
We aimed to evaluate the influences of family factors, risky and protective, on adolescent health-risk behavior (HRB).
Patients and Methods:
In this cross-sectional study, students of high schools in Kerman, Iran at all levels participated, during November 2011 till December 2011. The research sample included 1024 students (588 females and 436 males) aged 15 to 19 years. A CTC (Communities That Care Youth Survey) questionnaire was designed in order to collect the profile of the students’ risky behaviors. Stratified cluster sampling method was used to collect the data.
Results:
Using logistic regression, 7 variables enrolled; 4 of them were risk factors and 3 were protective factors. The risk factors were age, (linear effect, ORa = 1.20, P = 0.001), boys versus girls (ORa = 2.33, P = 0.001), family history of antisocial behavior (ORa = 2.29, P = 0.001), and parental attitudes favorable toward antisocial behavior (ORa = 1.72, P = 0.03). And, protective factors were family religiosity (ORa = 0.65, P = 0.001), father education (linear effect, ORa = 0.48, P = 0.001), and family attachment (ORa = 0.78, P = 0.001).
Conclusions:
Our findings showed that family has a very significant role in protecting students against risky behaviors. The education level of the father, family religiosity, and attachment were the most important factors.
doi:10.5812/ircmj.15931
PMCID: PMC4270667  PMID: 25558380
Parents; Risk; Health; Behaviors; Adolescent
9.  The Occupational Safety of Health Professionals Working at Community and Family Health Centers 
Background:
Healthcare professionals encounter many medical risks while providing healthcare services to individuals and the community. Thus, occupational safety studies are very important in health care organizations. They involve studies performed to establish legal, technical, and medical measures that must be taken to prevent employees from sustaining physical or mental damage because of work hazards.
Objectives:
This study was conducted to determine if the occupational safety of health personnel at community and family health centers (CHC and FHC) has been achieved.
Martials and Methods:
The population of this cross-sectional study comprised 507 nurses, 199 physicians, and 237 other medical personnel working at a total of 18 family health centers (FHC) and community health centers (CHC) in Trabzon, Turkey. The sample consisted of a total of 418 nurses, 156 physicians, and 123 other medical personnel. Sampling method was not used, and the researchers tried to reach the whole population. Data were gathered with the Occupational Safety Scale (OSS) and a questionnaire regarding demographic characteristics and occupational safety.
Results:
According to the evaluations of all the medical personnel, the mean ± SD of total score of the OSS was 3.57 ± 0.98; of the OSS’s subscales, the mean ± SD of the health screening and registry systems was 2.76 ± 1.44, of occupational diseases and problems was 3.04 ± 1.3 and critical fields control was 3.12 ± 1.62. In addition, occupational safety was found more insufficient by nurses (F = 14.18; P < 0.001).
Conclusions:
All healthcare personnel, particularly nurses working in CHCs and FHCs found occupational safety to be insufficient as related to protective and supportive activities.
doi:10.5812/ircmj.16319
PMCID: PMC4270669  PMID: 25558383
Occupational Safety; Community Health; Family Health; Health Personnel
10.  Staphylococcal Enterotoxin C in Synovial Fluid of Patients With Rheumatoid Arthritis 
Background:
In the previous studies using the commercial ELISA kit, the existence of staphylococcal superantigens has been reported in synovial fluid of patients with rheumatoid arthritis (RA).
Objectives:
This study aimed to design molecular methods to detect staphylococcal enterotoxin C in synovial fluid of patients with rheumatoid arthritis.
Materials and Methods:
In this experimental study, Staphylococcus aureus strain producing enterotoxin C was used as the reference strain. The polymerase chain reaction (PCR) was set up by design a specific pair of primers. Besides bacterial culture, 50 synovial fluid samples of patients with rheumatoid arthritis were subjected to DNA extraction, and then PCR amplification was carried out according to the protocol. All samples were examined by ELISA method for enterotoxin C. The data were descriptively analyzed.
Results:
The results of bacterial culture were negative for all samples. The results showed that 66% (33 cases) of samples contained entC gene and only 46% (23 cases) have also enterotoxin C. The interesting finding was that the results of ELISA and PCR were the same and have shown only 22 positive cases (44%samples) for staphylococcal enterotoxin C.
Conclusions:
Based on the findings of this study, S. aureus enterotoxin C (SEC) has been detected in synovial fluid of patients with rheumatoid arthritis by PCR and ELISA methods. These valuable findings may describe the exact etiology of the RA and as well as change the methods of its diagnosis and treatment. This is the first research, which has shown the staphylococcal entC gene in synovial fluid of RA patients. However, S. aureus strains can produce more than 20 types of enterotoxins. Therefore, its involvement on rheumatoid arthritis pathogenesis makes an important challenge in the future. In this regard, further investigation on the other enterotoxins is necessary.
doi:10.5812/ircmj.16075
PMCID: PMC4270673  PMID: 25558381
Staphylococcal Enterotoxin C; Synovial Fluid; PCR, ELISA; Rheumatoid Arthritis
11.  Efficacy and Safety of Different Dosages of Praziquantel for the Treatment of Schistosoma Japonicum: A Systematic Review and Meta-Analysis 
Background:
Praziquantel, an antischistosomal compound, is used as first-line drug for chemotherapy of Schistosoma japonicum since 1984. In this article, we conducted a systematic review and mete-analysis to evaluate the efficacy and safety of different dosages of praziquantel (PZQ) for treatment of Schistosoma japonicum.
Evidence Acquisition:
A number of six articles published in peer-reviewed journals before December 2012 were selected for analysis after searching the following literature databases: PubMed/Medline, the Chinese WanFang Literature Database, China National Knowledge Infrastructure (1994-2012.12), and the Chinese Biomedical Literature (1978-2012.12).
Results:
The meta-analyses showed that there is no statistically significant difference of the negative rate on the egg using 40 mg/kg compared to 60 mg/kg PZQ for S. japonicum treatment (RR 0.79, 95% CI 0.46 1.35; P < 0.39). The meta-analysis showed that there is no statistically significant difference of the side effects using 30 mg/kg compared with 40 mg/kg (RR 0.97, 95% CI 0.68 1.38; P = 0.87), 40 mg/kg compared with 60 mg/kg (RR 0.79, 95% CI 0.46 1.35; P = 0.39) and 50 mg/kg compared with 60 mg/kg (RR 0.89, 95% CI 0.56 1.42; P = 0.63).
Conclusions:
According to the results, there is no statistically significant difference in different doses of PZQ for treating S. japonicum.
doi:10.5812/ircmj.9600
PMCID: PMC4270676  PMID: 25558390
Schistosomiasis Japonicum; Praziquantel; Meta-Analysis
12.  The Effects of Insulin-Like Growth Factor-1 Gene Therapy and Cell Transplantation on Rat Acute Wound Model 
Background:
Wound healing is a complex process. Different types of skin cells, extracellular matrix and variety of growth factors are involved in wound healing. The use of recombinant growth factors in researches and production of skin substitutes are still a challenge.
Objectives:
Much research has been done on the effects of gene therapy and cell therapy on wound healing. In this experimental study, the effect of insulin-like growth factor (IGF-1) gene transfer in fibroblast cells was assessed on acute dermal wound healing.
Materials and Methods:
Fibroblasts were cultured and transfected with IGF-1. Lipofectamine 2000 was used as a reagent of transfection. Transgene expression levels were measured by the enzyme linked immunosorbent assay (ELISA). To study in vivo, rats (weighing 170-200 g) were randomly divided into three groups (five/group) and full-thickness wounds were created on the dorsum region. Suspensions of transfected fibroblast cells were injected into the wound and were compared with wounds treated with native fibroblast cells and normal saline. For the microscopic examination, biopsy was performed on day seven.
Results:
In vitro, the maximum expression of IGF1 (96.95 pg/mL) in transfected fibroblast cells was 24 hours after gene transfer. In vivo, it was clear that IGF-1 gene therapy caused an increase in the number of keratinocyte cells during the wound healing process (mean of group A vs. group B with P value = 0.01, mean of group A vs. group C with P value = 0.000). Granulation of tissue formation in the transfected fibroblast group was more organized when compared with the normal saline group and native fibroblast cells.
Conclusions:
This study indicated that the optimization of gene transfer increases the expression of IGF-1. High concentrations of IGF-1, in combination with cell therapy, have a significant effect on wound healing.
doi:10.5812/ircmj.16323
PMCID: PMC4270678  PMID: 25558384
IGF-1; Gene Therapy; Cell Transplantation; Fibroblast; Wound Healing
13.  Moral Distress in Physicians Practicing in Hospitals Affiliated to Medical Sciences Universities 
Background:
Researchers have regarded moral distress as a major concern in the health care system. Symptoms associated with moral distress may manifest as frustration, dissatisfaction, and anxiety and may lead to burnout, job leaving, and finally, failure to provide safe and competent care to patients. Proper management of this phenomenon can be fulfilled through study of its causes at different levels of health services and taking necessary measures to solve them.
Objectives:
This study aimed to determine the status of moral distress in physicians practicing in hospitals affiliated to Medical Sciences Universities in Tehran.
Materials and Methods:
This cross-sectional study was carried out using the Standard Hamric Scale to collect data after modification and evaluation of its reliability and validity. A total of 399 physicians responded to the scale. Data analysis was performed using descriptive and correlation statistics with respect to the variables.
Results:
Results showed that the frequency of moral distress of physicians was 1.24 ± 0.63 and the intensity of moral distress and composite score of moral distress were 2.14 ± 0.80 and 2.94 ± 2.38, respectively. A significant negative correlation existed between age and frequency and composite score (r = -0.15, P < 0.01 and r = -0.16, P < 0.01, respectively) as well as years of experience and composite score (r = -0.11, P = 0.04). Moral distress composite score in adults specialists was higher than pediatricians (P = 0.002), but lower in physicians participated in medical ethics training courses compared to those not participated.
Conclusions:
Physicians may encounter moral distress during their practice; therefore, the common causes of distress should be identified in order to prevent its occurrence.
doi:10.5812/ircmj.18797
PMCID: PMC4270679  PMID: 25558387
Physicians; Hospitals; Medical Ethics
14.  Effect of Biochanin A on Serum Visfatin Level of Streptozocin-Induced Diabetic Rats 
Background:
Bioflavonoids are well known for their multi directional biologic activity including antidiabetic effect. It has been demonstrated that flavonoids can act as insulin secretagogue or insulin mimetic agents.
Objectives:
This experimental study was designed in Arak University of Medical Sciences, Arak, Iran, to investigate the effects of biochanin A (a bioflavonoid) on fasting blood glucose (FBG), body weight, glycosylated hemoglobin (HbA1c), lipid profile, serum enzymes, and visfatin of streptozocin-induced diabetic rats.
Patients and Methods:
We used 24 male Wistar rats and randomly allocated them to four groups of six rats. One group was randomly assigned as control and diabetes was induced in three other groups by administration of streptozocin (35 mg/kg of body weight) intraperitoneally. The groups received the following treatments: group 1 (control), 5% DMSO; group 2 (diabetic control), 0.5% DMSO; and group 3 and 4, respectively 10 and 15 mg/kg biochanin A for 30 days. Body weight and biochemical parameters including FBG, HbA1c, lipid profile, aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), and visfatin were measured in all rats.
Results:
FBG level was significantly reduced in treated diabetic rats (139.8 ± 9.3 and 206 ± 11 mg/dL in groups 3 and 4, respectively) in comparison to the diabetic control (295.1 ± 14 mg/dL) (P < 0.05). Administration of biochanin A significantly decreased HbA1c in group 3 (6.66 ± 0.33) and group 4 (7.11 ± 0.31) in comparison to the diabetic control group (8.26 ± 0.44) (P < 0.05). Levels of serum visfatin were improved to near normal levels in the treated rats (249 ± 35.5 and 161.33 ± 13.07 in groups 3 and 4, respectively) in comparison to the diabetic control (302.17 ± 19.4) (P < 0.05). Furthermore, biochanin A showed a protective effect against weight loss in diabetic rats (P < 0.05). In treated rats, serum total cholesterol, triglyceride, and low-density lipoprotein cholesterol (LDL-c) were significantly decreased and high-density lipoprotein (HDL-c) was increased in comparison with the diabetic control group. In addition, biochanin A restored the altered plasma enzymes (AST, ALT, and ALP) activities to near normal. Histopathologic examination of the pancreas also indicated that biochanin A had protective effects on β-cells in streptozocin-induced diabetic rats.
Conclusions:
This study demonstrated that biochanin A possessed hypoglycemic and antilipemic activities and could increase visfatin expression, which suggests its beneficial effect in the treatment of diabetes.
doi:10.5812/ircmj.15424
PMCID: PMC4270635  PMID: 25593725
Visfatin; Biochanin A; Diabetic Rats
15.  In Vitro Ovine Embryo Production: the Study of Seasonal and Oocyte Recovery Method Effects 
Background:
To current knowledge, different oocyte's recovery method and various seasons have profound impact on in vitro embryo production (IVEP).
Objectives:
The aim of this study was to define an efficient recovery method for oocytes harvesting from slaughterhouse material in different seasons, and their effects on IVEP yield.
Materials and Methods:
Ovaries from slaughtered ewes in breeding season (BS) and non-breeding season (NBS) were collected from a local abattoir. The oocytes were recovered through aspiration, centrifugation (ORC), puncture and slicing, and categorized into three classes (I, oocytes with more than three layers of cumulus cells; II, less than three layers with damaged cumulus cells; III, denuded oocytes). After cultivation in TCM 199 for 24 hours, matured oocytes were subjected to in vitro fertilization (IVF) and in vitro culture (IVC). The oocyte recovery using ORC in BS and NBS was significantly higher (P < 0.05) compared with other recovery methods.
Results:
No significant dissimilarities in the proportion of oocytes reaching M-II stage were recorded when using different oocyte recovery methods in different seasons. Aspiration resulted in lower (P < 0.05) proportion of class I (BS, 60.0 ± 2.1; NBS, 51.1 ± 2.1) compared to ORC (BS, 82.0 ± 1.2; NBS, 70.0 ± 1.2), slicing (BS, 80.0 ± 2.1; NBS, 71.0 ± 1.4) and puncture (BS, 80.0 ± 1.5; NBS, 72.0 ± 2.0). Monospermy and blastocyst development rates were significantly higher using ORC than other recovery techniques in both BS and NBS. More oocytes with high quality, greater blastocyst development and oocyte recovery rates were achieved in BS.
Conclusions:
The results revealed that oocytes harvesting technique and season are effective in the rate of cleavage and blastocysts’ development, and suggest that despite same meiotic resumption rate in all treatments, it would be better to use ORC.
doi:10.5812/ircmj.20749
PMCID: PMC4270640  PMID: 25593733
In Vitro Oocyte Maturation Techniques; Fertilization in Vitro; Embryo Production; Sheep; Oocytes
16.  Iatrogenic Submandibular Duct Rupture Complicating Sialography: A Case Report 
Introduction:
Sialolithiasis is the most common disease of salivary glands. Sialography is particularly important for the assessment of the outflow tract and in diagnosing obstructive salivary gland lesions including calculi.
Case Presentation:
We report on a 38-year-old female with sialolithiasis whom had Wharton’s duct perforation, complicating the sialography. She was treated conservatively with a course of co-amoxiclav, oral prednisolone for three days and pain-killers. The patient was clinically well on follow-up reassessments at the end of the first week and three weeks post procedure.
Conclusions:
Perforation of salivary duct complicating the sialography is rare. Awareness of this potential complication and utilizing a good sialography technique need to be advocated amongst radiologists. Response to treatment by conservative management is preferred as illustrated in this case.
doi:10.5812/ircmj.7882
PMCID: PMC4270643  PMID: 25593739
Salivary Gland Calculi; Sialography; Salivary Ducts; Rupture
17.  A Glance at Methods for Cleft Palate Repair 
Context:
Cleft palate is the second most common birth defect and is considered as a challenge for pediatric plastic surgeons. There is still a general lack of a standard protocol and patients often require multiple surgical interventions during their lifetime along with disappointing results.
Evidence Acquisition:
PubMed search was undertaken using search terms including 'cleft palate repair', 'palatal cleft closure', 'cleft palate + stem cells', 'cleft palate + plasma rich platelet', 'cleft palate + scaffold', 'palatal tissue engineering', and 'bone tissue engineering'. The found articles were included if they defined a therapeutic strategy and/or assessed a new technique.
Results:
We reported a summary of the key-points concerning cleft palate development, the genes involving this defect, current therapeutic strategies, recently novel aspects, and future advances in treatments for easy and fast understanding of the concepts, rather than a systematic review. In addition, the results were integrated with our recent experience.
Conclusions:
Tissue engineering may open a new window in cleft palate reconstruction. Stem cells and growth factors play key roles in this field.
doi:10.5812/ircmj.15393
PMCID: PMC4270645  PMID: 25593724
Cleft Palate; Cleft Lip; Platelet-Derived Growth Factor; Transforming Growth Factor; Mesenchymal Stem Cells; Embryonic Stem Cells; Platelet-Rich Plasma
18.  Gastrointestinal Basidiobolomycosis Accompanied by Liver Involvement: A Case Report 
Introduction:
Basidiobolomycosis is a rare disease that, unlike other fungal infections, affects immunocompetent individuals. It is caused by an environmental saprophyte named the fungus Basidiobolus ranarum. Basidiobolomycosis usually appears as a subcutaneous infection. GI basidiobolomycosis is an emerging disease, and the colon is the most frequent involved part of the GI tract.
Case Presentation:
The present study presents a middle-aged lady suffered from basidiobolomycosis with concomitant lesions in the cecum and liver involvement. This disease is extremely rare in adults and only a few cases have been reported so far.
Conclusions:
GI basidiobolomycosis is a very rare disease which resembles as an infiltrative, infectious, or inflammatory process. Concomitant liver and bowel involvement is extremely rare too. It is an aggressive disease which has a high mortality rate despite treatments like surgical resection and prolonged antifungal therapy.
doi:10.5812/ircmj.14109
PMCID: PMC4270646  PMID: 25593711
Fungal Infections; Basidiobolomycosis; Granuloma
19.  The Reasons for Using Acupuncture for Pain Relief 
Background:
Acupuncture has recently received considerable attention around the world due to its cost-effectiveness, few side effects, and well-established analgesic properties.
Objectives:
The present study aimed to identify the factors that might lead to using acupuncture for pain relief.
Patients and Methods:
This qualitative study was conducted using conventional content analysis method. The study population included eight patients and six highly experienced acupuncturists, who were able to express their opinion and were willing to take part in the study. The inclusion criteria for patients were being under treatment with acupuncture for pain relief or a history of treatment during the last year and age > 18 years. All highly trained acupuncturists with minimum of one-year active experience were included. The data were collected via semi-structured in-depth interviews. Categories were extracted through inductive analysis and codes and eventually, themes emerged. Data rigor was assured by data collection triangulation, participants’ variety, and external and members’ check.
Results:
Initially, 1311 primary codes were extracted, then the related codes were divided into 127 subcategories according to their similarities, and after reduction and integration process, 16 categories were developed from subcategories and eventually five themes were determined, including conventional medicine limitation, efficacy of acupuncture, external promoters, internal promoters, and acupuncture inhibitors.
Conclusions:
The important factors that affect choosing acupuncture for pain relief included conventional medicine limitations, external promoters, internal promoters, acupuncture efficacy, and acupuncture inhibitors. More interest can be drawn to this technique by basic planning to enhance some of the underlying factors and eliminate obstacles to its further applicability.
doi:10.5812/ircmj.15435
PMCID: PMC4270647  PMID: 25593727
Acupuncture; Analysis; Pain Relief
20.  Hepatotoxicity of Halogenated Inhalational Anesthetics 
Context:
Halogenated inhalational anesthetics are currently the most common drugs used for the induction and maintenance of general anesthesia. Postoperative hepatic injury has been reported after exposure to these agents. Based on much evidence, mechanism of liver toxicity is more likely to be immunoallergic. The objective of this review study was to assess available studies on hepatotoxicity of these anesthetics.
Evidence Acquisition:
We searched PubMed, Google Scholar, Scopus, Index Copernicus, EBSCO and the Cochrane Database using the following keywords: “inhalational Anesthetics” and “liver injury”; “inhalational anesthetics” and “hepatotoxicity”; “volatile anesthetics” and “liver injury”; “volatile anesthetics” and hepatotoxicity for the period of 1966 to 2013. Fifty two studies were included in this work.
Results:
All halogenated inhalational anesthetics are associated with liver injury. Halothane, enflurane, isoflurane and desflurane are metabolized through the metabolic pathway involving cytochrome P-450 2E1 (CYP2E1) and produce trifluoroacetylated components; some of which may be immunogenic. The severity of hepatotoxicity is associated with the degree by which they undergo hepatic metabolism by this cytochrome. However, liver toxicity is highly unlikely from sevoflurane as is not metabolized to trifluoroacetyl compounds.
Conclusions:
Hepatotoxicity of halogenated inhalational anesthetics has been well documented in available literature. Halothane-induced liver injury was extensively acknowledged; however, the next generation halogenated anesthetics have different molecular structures and associated with less hepatotoxicity. Although anesthesia-induced hepatitis is not a common occurrence, we must consider the association between this disorder and the use of halogenated anesthetics.
doi:10.5812/ircmj.20153
PMCID: PMC4270648  PMID: 25593732
Anesthesiology; Liver Injury Drug-Induced; Inhalation Anesthesia; Halothane; Sevoflurane
21.  Effect of Therapeutic Dose of Vitamin D on Serum Adiponectin and Glycemia in Vitamin D-Insufficient or Deficient Type 2 Diabetic Patients 
Background:
Lower vitamin D status has been reported in diabetic patients. Serum 25-hydroxyvitamin D and adiponectin were inversely associated with type 2 diabetes and insulin resistance. Vitamin D may involve in regulation of the adiponectin levels, which is directly related to insulin sensitivity.
Objectives:
The aim of this study was to investigate the effect of therapeutic dose of vitamin D on serum adiponectin and insulin resistance in vitamin D-insufficient or deficient type 2 diabetic patients.
Materials and Methods:
This double-blind, randomized, clinical trial was conducted on 81 type 2 diabetic patients with vitamin D level of 10-30 ng/mL. Intervention was 50000 IU vitamin D or placebo once a week for 8 weeks. At the beginning and end of the study, blood samples were collected after 12 hours of fasting and serum glucose, insulin, 25-hydroxyvitamin D, and adiponectin were measured. Insulin resistance was calculated by homeostasis model assessment (HOMA-IR).
Results:
After 8-week intervention, serum 25-hydroxyvitamin D significantly increased and reached the normal levels in patients receiving vitamin D (P < 0.001) and the levels of fasting serum glucose, insulin, and HOMA-IR were significantly decreased (P = 0.04, 0.02 and 0.007, respectively). No significant changes were observed in these levels in the placebo group. Significant differences were observed in mean changes in the above-mentioned variables between the two groups (P = 0.01, 0.04 and 0.006, respectively). No significant changes were found in serum adiponectin in the vitamin D and placebo groups (P = 0.83).
Conclusions:
Therapeutic dose of vitamin D can improve vitamin D status and glycemic indicators. But it seems that an 8-week intervention period was not sufficient to reveal the possible effects of vitamin D on serum adiponectin levels.
doi:10.5812/ircmj.21458
PMCID: PMC4270651  PMID: 25593737
Diabetes Mellitus; Vitamin D; Insulin Resistance; Adiponectin
22.  Comparing the Effects of Aromatherapy With Rose Oils and Warm Foot Bath on Anxiety in the First Stage of Labor in Nulliparous Women 
Background:
Anxiety is the most common emotional response in women during delivery, which can be accompanied with adverse effects on fetus and mother.
Objectives:
This study was conducted to compare the effects of aromatherapy with rose oil and warm foot bath on anxiety in the active phase of labor in nulliparous women in Tehran, Iran.
Patients and Methods:
This clinical trial study was performed after obtaining informed written consent on 120 primigravida women randomly assigned into three groups. The experimental group 1 received a 10-minute inhalation and footbath with oil rose. The experimental group 2 received a 10-minute warm water footbath. Both interventions were applied at the onset of active and transitional phases. Control group, received routine care in labor. Anxiety was assessed using visual analogous scale (VASA) at onset of active and transitional phases before and after the intervention. Statistical comparison was performed using SPSS software version 16 and P < 0.05 was considered significant.
Results:
Anxiety scores in the intervention groups in active phase after intervention were significantly lower than the control group (P < 0.001). Anxiety scores before and after intervention in intervention groups in transitional phase was significantly lower than the control group (P < 0.001).
Conclusions:
Using aromatherapy and footbath reduces anxiety in active phase in nulliparous women.
doi:10.5812/ircmj.14455
PMCID: PMC4270653  PMID: 25593713
Aromatherapy; Warm Foot Bath; Anxiety; Active Phase; Nulliparous
23.  Estimating the Annual Risk of Tuberculosis Infection and Disease in Southeast of Iran Using the Bayesian Mixture Method 
Background:
Tuberculosis is still a public health concern in Iran. The main challenge in monitoring epidemiological status of tuberculosis is to estimate its incidence accurately.
Objectives:
We used a newly developed approach to estimate the incidence of tuberculosis in Sistan, an endemic area in southeast of Iran in 2012-13.
Patients and Methods:
This cross-sectional study was conducted on school children aged 6-9 years. We estimated a required sample size of 6350. Study participants were selected using stratified two-stage cluster sampling method and recruited in a tuberculin skin test survey. Indurations were assessed after 72 hours of the injection and their distributions were plotted. Prevalence and annual risk of tuberculosis infection (ARTI) were estimated using the Bayesian mixture model and some traditional methods. The incidence of active disease was calculated using the Markov Chain Monte Carlo technique.
Results:
We assumed weibull, normal and normal as the best distributions for indurations due to atypical reactions, BCG (Bacillus Calmette–Guérin) reactions and Mycobacterium tuberculosis infection, respectively. The estimated infection prevalence and ARTI were 3.6% (95%CI: 3.1, 4.1) and 0.48%, respectively. These estimates were lower than those obtained from the traditional methods. The incidence of active tuberculosis was estimated as 107 (87-149) per 100000 population with a CDR of 54% (40%-68%).
Conclusions:
Although the mixture model showed slightly lower estimates than the traditional methods, it seems that this method might generate more accurate results for deep exploration of tuberculosis endemicity. Besides, we found that Sistan is a high endemic area for tuberculosis in Iran with a low case detection rate.
doi:10.5812/ircmj.15308
PMCID: PMC4270654  PMID: 25593722
Tuberculosis; Infection; Survey
24.  Prolonged Survival of a Patient With Pelvic Recurrence of Ovarian Malignant Mixed Mullerian Tumor After Chemoradiotherapy 
Introduction:
Malignant Mixed Mullerian Tumor (MMMT) is a very rare tumor, accounting for less than 1% of all ovarian cancers.
Case Presentation:
We present a 64-year-old woman with stage III MMMT of ovary that was treated with platinum-based chemotherapy after optimal cytoreductive surgery. After 25 months of being disease free, she had a pelvic recurrence and a good response to chemoradiotherapy.
Conclusions:
Optimal cytoreductive surgery and chemotherapy may be the best treatment in MMMT but more discussion and experiences are needed regarding the effectiveness of radiotherapy.
doi:10.5812/ircmj.14919
PMCID: PMC4270657  PMID: 25593719
Mixed Tumor, Mullerian; Cytoreductive Surgery; Chemoradiotherapy; Chemotherapy; Ovary
25.  Heart Hydatid Cyst Close to the Left Descending Artery in a Thirteen-Year-Old Boy 
Introduction:
Hydatid cyst is a significant health problem in underdeveloped and developing countries, particularly among sheep breeders. Although cardiac involvement is seen only in 0.2% to 3% of the cases, early diagnosis and treatment are important.
Case Presentation:
A 13-year-old boy with dyspnea and atypical pericardial type chest pain for three months was referred to us. Chest X-ray revealed linear calcification in the left side of the heart. Computed tomography demonstrated a cyst with peripheral calcification and without internal septation in the lateral left ventricle (LV) myocardium. Serologic IgG test was positive for Echinococcosis. No other cyst was seen in the other organs such as the lungs and liver. By midline sternotomy on pump, an incision was made 2-cm lateral to the left ascending artery through the LV myocardium and without entering any cardiac chamber. After injecting hypertonic (5%) saline, the cyst was punctured and its fluid contents were aspirated, the cyst was enucleated, and the cavity marsupialization was done for protection of the myocardium. LV ejection fraction before operation was 40% but after operation and repairing LV myocardium, ejection fraction increased to 50% in. Histopathologic examination confirmed a hydatid cyst.
Conclusions:
In myocardial hydatid cysts, we recommend a direct approach without entering the cardiac chambers to avoid dissemination of the infection. We recommend excision of the germinative membrane without capitonnage to avoid impairment of myocardial contraction.
doi:10.5812/ircmj.15164
PMCID: PMC4270658  PMID: 25593721
Echinococcosis; Myocardium; Heart; Cysts

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