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BACKGROUND: The birth of a premature infant, hospitalization, and separation from the family cause disruption on maternal role adaption. This study was conducted with the aim of investigating the effect of participation education on maternal role adaption in mothers of premature infants hospitalized in the neonatal intensive care unit. MATERIALS AND METHODS: This semiexperimental study was conducted with the participation of 129 eligible mothers with premature infants into three groups of 43 (face-to-face education, virtual education, and control). Data collection was done using a checklist measuring adaptation to the maternal role. Data were analyzed by descriptive statistical and multiple linear regression tests at a significance level of P < 0.05. RESULTS: The mean age of mothers was 30.8 years, the mean gestational age of infants was 31.7 weeks, the mean birth weight was 1781.4 g, and the most common (84.5%) reason for hospitalization of infants was respiratory distress. Multiple linear regression analysis showed that the total score of maternal role adaptation at the time of discharge was significantly different in the two groups of virtual education (134.362 ± 0.925) (P < 0.001) and face-to-face education (132.421 ± 0.928) (P = 0.005) with the control group (128.286 ± 0.924). CONCLUSION: The implementation of educational programs is a suitable solution to improve maternal role adaption. Therefore, it is recommended that managers and healthcare planners consider codified and regular educational programs in order to increase the ability of mothers, in order to adapt to the maternal role.

Background: No instrument specifically designed to investigate the caring self-efficacy of nurses in pediatric wards was found. The aim of the present study was therefore to develop a scale to evaluate pediatric wards nurse's caring self-efficacy. Materials and Methods: In this study, an exploratory, sequential, mixed method was used in 2015 in Iran. Data collected from 27 semi-structured interviews with nurses in pediatric wards were analyzed using conventional content analysis. The initial version of the scale was obtained with 65 items. Face validity was determined using impact score and content validity using the Content Validity Index (CVI) and Content Validity Ratio (CVR). The construct validity of the scale was investigated using exploratory factor analysis with 305 nurses in pediatric wards. The concurrent validity of the scale was acquired using the General Self-Efficacy Scale. Internal consistency and test–retest reliability were also examined. Results: The scale-CVI (S-CVI) (average) was 0.85. The 14 items with a CVR and CVI of less than 0.51 and 0.70, respectively, were deleted and the final 51-item scale was approved. All 51 items had good impact score (>1.50). In the final scale, four subscales were extracted using construct validity. The concurrent validity of the scale was also obtained (r = 0.77, p < 0.001). The total Cronbach's α correlation coefficient of the scale was 0.96 and test–retest reliability was 0.98. Conclusions: The Pediatric Ward Nurses' Caring Self-Efficacy (PWNCSE) scale developed in this study is a practical, reliable, and valid scale to evaluate pediatric ward nurses' caring self-efficacy.

Objective: Given the need for further studies on health-promoting behaviors, the present study aimed to investigate the antecedents of controlling risk factors for cardiovascular diseases (CVDs) according to the affective and emotional composite temperament (AFECT) model and the mediating role of self-regulation. Materials and Methods: The samples of this cross-sectional study included 776 people resident in Kermanshah in Western Iran in 2019. The participants were selected using a cluster sampling method. Data were collected using the controlling the risk factors for cardiovascular disease questionnaire (CRC), the short form self-regulation questionnaire, and the AFECT scale. The structural equation modeling was used to analyze the data. Results: The analysis results indicated that there was a significant correlation between dimensions of AFECT and self-regulation with the control of risk factors for CVDs. The results also indicated that the dimensions of AFECT did not directly affect the control of risk factors for CVDs, but the mediating role of self-regulation was confirmed in this regard. Conclusion: According to the results, the dimensions of AFECT could affect the control of risk factors for CVDs through self-regulation; hence, the role of self-regulation in controlling CVDs should be taken into account.

Introduction: Most fatal presentation of coronary artery disease (CAD) has been related to acute coronary syndrome (ACS), and we as a referral center in the country decide to launch a registry of patients with ACS to monitor the way they are managed and the way they are treated. Materials and Methods: Rajaie Cardiovascular, Medical and Research Center ACS registry (RHC-ACS registry) launched on December 2015 with enrolling all ACS patients referred or presented to the center. All patients' demographic variables, presenting symptoms, known risk factors, past medical history, past CAD records, serial ischemic electrocardiogram (ECG) changes, presenting echocardiographic data (such as left ventricular ejection fraction [LVEF], valvular abnormality, and mechanical complication of myocardial infarction [MI]), laboratory assessment (biochemistry, complete blood count, cardiac markers, and inflammatory indicators), and their angiographic and angioplasty data were recorded. Results: Recordings showed in the RHC-ACS registry, most patients were men (73.2%), with mean age of 59.16 ± 11.64 years, hypertension were the most known cardiac risk factor. Most patients were non-ST elevation MI patients (43.2%), 32.8% were in premature CAD group, and typical retrosternal chest pain were complained in 83.5% of our registry population. Most patients had no new ECG changes (51.7%) and from whom with new ECG changes, anterior territory ECG changes were the most common pattern (28.2%). LVEF was reported 30% or less in 171 (16.6%) of patients. Angiographic findings revealed femoral access was most common access (63.9%), most involved vessel was left anterior descending with 49.3% of the patients, percutaneous coronary intervention was performed in 48% of patients with drug-eluting stent implantation in 99.3% of these patients, dissection was the most angiographic-related complication in our registry (1%), and in-hospital death was reported in six patients (0.5%). Conclusion: RHC-ACS registry as a real-world middle-east running ACS registry would help cardiologists justify their revascularization strategy in ACS patients and would have a promising impact in future multi-center studies.

Chronic massive gastric distention is a rare condition that can occur due to an underlying obstruction or dysmotility. Gastric outlet obstruction (GOO) is often the culprit that can manifest as the result of the luminal, mural, or extrinsic compression. Gastric adenocarcinoma can rarely manifest as massive gastric distention due to partially obstructing mass or peptic stricture. Severe and fatal sequelae may develop, if early detection and appropriate intervention are delayed, such as gastric decompression, endoscopic evaluation and/or surgical resection. Herein, we present a case of a 60-year-old male who presented with progressive worsening of nonspecific symptoms over the 8-month period. He was found to have remarkable massive gastric distention on imaging which was chronic in etiology secondary to GOO due to metastatic signet-ring cell gastric adenocarcinoma.

Introduction: Clinical registries are a targeted way of data collection aimed at finding a solution to a specific clinical inquiry. The present report introduces the Rajaie Cardiovascular, Medical and Research Center percutaneous coronary intervention (RHC-PCI) Registry. The primary objectives of the RHC-PCI Registry consist of monitoring different complex PCI procedures and their mutual impact on interventional cardiology programs. Methods: RHC is a large and well-known cardiovascular tertiary center in Iran. The RHC-PCI Registry was first launched in 2015, since which time it has collected >5000 parameters regarding the baseline, clinical, and procedural characteristics of various PCI procedures. Noncomplex coronary interventions, bifurcation stenting, left main interventions, chronic total occlusion (CTO) PCI, and bypass graft interventions comprise the major categories gathered by the RHC-PCI Registry. The main registry outcomes are comprised in-hospital mortality, major adverse cardiovascular events, vascular access site complications, and 6-month all-cause mortality. Results: In this primary report, we elaborate on the principal infrastructure of the RHC-PCI Registry and present a synopsis of the registry scope. During the first 40 months of the registry, 11,005 patients underwent PCI. The acute coronary syndrome was reported in 5043 (45.8%) patients. Bifurcation stenting, left main interventions, CTO PCI, and bypass graft interventions were performed in 1679 (15.2%), 236 (2.1%), 946 (8.5%), and 764 (6.9%) patients, respectively. The preferred access site was the femoral artery (n = 6614, 60%), and drug-eluting stents were deployed in 9230 (83.8%) patients. In-hospital mortality in the total registry data was reported in 104 (0.9%) patients. Conclusions: This report introduces the RHC-PCI Registry, its primary objectives, infrastructure, and preliminary results (the 3-year outcome).

Background: One of the most prominent global health threats is antibiotic resistance, leading to infection treatment failure. The first Iranian antibiotic awareness week campaign was initiated to improve the prudent use and wise prescription of antibiotics. Materials and Methods: The Isfahan antibiotic awareness campaign was held from November 30 to December 6, 2019, among two targeted populations; the general population and health-care workers by Isfahan University of Medical Sciences. In this campaign held in the main squares, streets, and a city's referral hospital, various educational methods were used to aware and sensitize the general population and medical staff about antibiotics and microbial resistance. These methods include face-to-face training, brochures, advertisement posters and billboards around the city, educational videos, social media messages, retraining for medical doctors and medical specialists, and interviewing in the Islamic Republic of Iran Broadcast. Results: Two hundred and twenty general practitioners, medical specialists, and residents participated in two retraining educational conferences in Al-Zahra Hospital, Isfahan, Iran. The mean score satisfaction of the two conferences was three from four. Nearly 2000 of the general population were under face-to-face educational programs whom after that, 83.6% had the correct answer to the questions around antimicrobial awareness. Conclusions: This campaign was an excellent experience as a pilot study with appealing issues. Further, activities are required to improve engagement with the target population and determine the impact of this campaign on antibiotic consumption and prescription behavior among the public and health-care professionals.

Background: Health-care workers (HCWs) are in the frontline for fighting the coronavirus disease 2019 (COVID-19) pandemic and are at higher risk of acquiring the infection. Therefore, the defining immunity status among HCWs helps mitigate the exposure risk. In this study, we investigated the anti-SARS-CoV-2 immunoglobulin G (IgG) and immunoglobulin M (IgM) and also the associated risk factors in the HCWs working in Isfahan University of Medical Sciences COVID-19 referral hospitals. Materials and Methods: In a cross-sectional study, demographics, COVID-19 symptoms during the past 2 weeks, and health-care details were collected from 200 consenting health workers of COVID-center-hospitals of Isfahan University of Medical Sciences from 23 October to 21 December 2020. The recombinant SARS-CoV2 nucleocapsid protein enzyme-linked immunosorbent assay-based IgM, and IgG antibody tests were evaluated. Data were analyzed using Chi-square and independent-t-student tests, and P < 0.05 was considered significant. Results: One hundred and forty-one women and 59 men with a mean age of 36.4 ± 7.77 years participated in the study. IgG Ab and IgM Ab were positive in 77 (38.5%) and 12 (6%) of samples, respectively, and both antibodies were detected in 9 (4.5%). Higher ages, direct contact with the patients with COVID-19, muscle pain, loss of taste and smell, fever, and cough were the factors associated with antibody seropositivity against SARS-CoV2. Conclusion: This study demonstrated that the prevalence of HCWs with antibodies against SARS-CoV-2 is relatively high in Isfahan University referral hospitals. The development of safety protocols and screening and vaccination strategies in the frontline HCWs must be implemented to reduce the burden of infection.

Background: Vulvovaginal candidiasis (VVC) is the second most common infection of the lower female genital among women passing through their productive age. Furthermore, Candida albicans is the most common VVC agents followed by, non-albicans Candida species. Nowadays, extensive studies are being conducted on alternative therapies and the use of herbal medicines. Objectives: The present study was conducted to compare the effect of curcumin and clotrimazole vaginal cream in the treatment of VVC. Methods: The present randomized controlled trial study was performed on 94 women passing through their productive age after their being diagnosed with VVC. The subjects were randomly divided into two groups, with one receiving curcumin-based vaginal 10% cream and the other receiving clotrimazole vaginal 1% cream. The treatment period was 1 week and a full 5 g applicator was used every night. Required follow-up was implemented 4–7 days after the end of treatment. Results: The results showed no significant differences between the two groups in terms of vaginal discharge, itching, vulvovaginal irritation, and vulvovaginal erythema (P > 0.05); however, the number of negative cultures in the group receiving curcumin was significantly lower in comparison with the other group, which received clotrimazole (P = 0.002). Conclusion: It seems that although curcumin could be effective in the treatment of clinical symptoms of VVC, it, quite similar to clotrimazole vaginal cream, did not affect vaginal culture.

Background: Studying personality traits and patterns is of significant importance in adopting healthy behaviors. Therefore, the current study investigates the relationship between Enneagram personality types and perceived risk of heart disease and readiness to lifestyle modification. Methods: In this cross-sectional study, 190 noncardiac patients (82.3% female) in an outpatient clinic in western Iran were selected using a simple random sampling method to fill out standard questionnaires. The obtained data were analyzed using Pearson's correlation coefficient and linear regression analysis. Results: The findings show that the performer personality (Type 3) can directly predict increasing readiness to lifestyle modification (P < 0.001). In contrast, there is a reverse significant relationship between the challenger personality (Type 8) and readiness to lifestyle modification (P = 0.019). Moreover, the helper personality (Type 6) is able to directly predict increasing the perceived risk of heart disease (P = 0.012). Conclusions: In the Enneagram system, unique personality types possess a unique risk perception and readiness to adopt healthy behaviors. The results of the current study can provide valuable information for healthy lifestyle programs professionals with regard to preventing cardiovascular diseases.

BACKGROUND: In the coronavirus disease 2019 pandemic era, clinical programs and mandatory hands-on activities have been supplanted by remote teaching to maintain the fundamental capabilities of medical training and to furnish medical students with quality education. Nonetheless, the satisfaction of faculty members with this training method in the current pandemic has yet to be assessed. The aim of this study was to design a Persian questionnaire with appropriate validity and reliability on cardiology professors' satisfaction level with virtual education. MATERIALS AND METHODS: In this cross-sectional study, a questionnaire was devised drawing upon scientific sources and Iranian medical educators' expertise. Seventeen faculty members in various specialties evaluated the questionnaire concerning face and content validity. Content validity was assessed through the calculation of the content validity ratio (CVR) (values >0.62 were considered acceptable) and the content validity index (CVI) (values >0.79 were considered acceptable), construct validity was evaluated through principal component factor analysis by the Kaiser–Meyer–Olkin (KMO) statistic and Bartlett's sphericity test, internal reliability was measured through the calculation of Cronbach's alpha coefficient, and consistency was appraised through the use of test-retest reliability at two different time points. RESULTS: The questionnaire had a reliability rate of 95%, indicating high internal validity. Concerning test-retest reliability, the intraclass correlation coefficient was 0.96 (P < 0.001), demonstrating relatively good stability. The CVI was 0.81, and the CVR was 0.85. The KMO measure of sampling adequacy was 0.954, indicating the acceptability of the degree of common variance among the all items. CONCLUSIONS: This Persian questionnaire on virtual education aimed at cardiology faculty members in the current pandemic with its low question count and appropriate domains had high reliability and validity. By knowing the level of professors' satisfaction with the new method of education, it is possible to take steps to better provide specialized medical education to cardiology residents.

Background: This study aimed to assess the relationship between the osteoporotic condition and periodontitis in postmenopausal women. Materials and Methods: Ninety-four women aged 50–80 years were studied in this cross-sectional study. Bone mineral density (BMD) of lumbar vertebra BMD (LBMD), total hip BMD (HBMD), and neck of femur BMD (NBMD) was assessed using standardized dual-energy X-ray absorptiometry (DXA) (normal: T-score ≥−1, osteopenic: −2.5 ≤ t-score 0.05). Conclusion: Although osteoporosis is not the main cause of periodontitis, it can indirectly affect periodontal status by increasing CEJ-AC. Early diagnosis of osteoporosis followed by early referral to a dentist for the treatment of potential existing periodontal diseases is important to avoid complications among postmenopausal women

BACKGROUND: Professional identity includes the values and beliefs of a nurse that guide her thinking, action, and interaction with patients. The stressful conditions of the COVID-19 pandemic may have affected nursing students' resilience and attitudes toward their profession. Therefore, the aim of this study was to investigate the professional identity and resilience in nursing students during the COVID-19 pandemic. MATERIALS AND METHODS: This cross-sectional descriptive study was performed in November and December 2020 with the participation of all nursing students of Babol University of Medical Sciences who spent at least one semester of internship in a hospital during the COVID-19 pandemic. Data were collected using demographic questionnaire, Connor-Davidson resilience scale, and nursing students' professional identity scale. Data analysis was performed using independent t-test, ANOVA, and correlation tests at a significance level of 0.05. RESULTS: Nursing students in the 3rd, 5th, and 7th semesters have spent a minimum of 13 and a maximum of 151 days of internship during the pandemic period. The mean score of professional identity of nursing students was 61.86 ± 9.34 and their mean resilience score was 32.08 ± 13.54. The resilience score of 92% of students was below 50. Professional identity was significantly stronger, and resilience was considerably higher in students who were satisfied with their profession and lived with their families (P < 0.05). In other words, students with higher professional identity scores had higher resilience (r = 0.39, P = 0.000). CONCLUSION: Despite a good professional identity score, the resilience of nursing students during the COVID-19 pandemic is low. Therefore, professors and the clinical education system should provide more support for students in such stressful times as the COVID-19 pandemic period.

Background: The assessment of a dream and its mechanisms and functions may help us to percept cognitions, emotions, and complex behaviors of patients. Hence, the present study aimed to assess (i) the rate of perceived dream and its emotional load and content and (ii) the relationship between functions of dream with anxiety and depression. Methods: In this cross-sectional study, 167 cardiac patients who had undergone rehabilitation in the western part of Iran were assessed during May–October 2016. Research instrument included Beck depression inventory, Beck anxiety inventory, Schredl's dream emotions manual, and content analysis of dreams manual. The findings were analyzed through Pearson's correlative coefficient and multiple regression analysis. Results: The mean age of participants (66.5% men) was 59.1 ± 9 years. The results indicated that the emotional content of patients' dreams included happiness (49.1%), distress (43.1%), sad (13.8%), fear (13.2%), and anger (3%). Although women report more sad dreams than men (P = 0.026), there was no difference between them in terms of other components of dreams, anxiety, and depression. Regression models showed that anxiety and depression were significantly able to predict perceived dream rates (P = 0.030) and emotionally negative dreams (P = 0.019). Conclusion: The increased rates of depression, especially anxiety, are related to increasing perceived dreams with negative and harmful emotional load. Regarding severity and negative content of dreams are reflexes of stressful emotional daily experiences, the management of experienced psychological symptoms such as depression and anxiety is concerned as an undeniable necessity.

Background: Mineral trioxide aggregate (MTA) has a high biocompatibility and its physical properties could be improved by adding the containing silica fume an amorphous silicon dioxide (condensed silica fume [CSF]). The aim of this study was to evaluate the cytotoxicity of MTA mixed with CSF on the viability of L929 mouse fibroblast cell using 3-(4,5-dimethylthiazol-2-Yl)-2,5-diphenyltetrazolium bromide reduction assay (MTT assay). Materials and Methods: In this in vitro study white MTA was mixed with distilled water according to the manufacturer's instructions. Mixtures of White MTA with 10%, 15%, and 20% CSF by weight were prepared and mixed with distilled water. Cytotoxicity of mixtures was compared with MTT assay on L929 mouse fibroblast cell line after 24, 48, and 72 h. Differences in cytotoxicity were assessed by one-way analysis of variance (ANOVA). Results: Mean ± SD of vital cell counts cultured in MTA, MTA + 10% CSF, MTA + 15% CSF, and MTA + 20% CSF were 98% ± 6%, 97% ± 6%, 94% ± 4%, and 98% ± 4%, respectively. One-way ANOVA did not reveal any statistically significant difference between the groups (P > 0.05). Conclusion: It may be concluded that addition of CSF to MTA may not influence its cytotoxicity.

Introduction: Older people are at risk for polypharmacy due to multiple chronic diseases. Considering the lack of information in this regard, the aim of this study was to investigate the state of polypharmacy among the elderly in the city of Amirkola in northern part of Iran. Materials and Methods: This descriptive/analytical cross-sectional study is a part of Amirkola Health and Aging Project that was conducted on 1616 individuals aged 60 years and over. The data about medications were gathered through interviews and observation of prescriptions and medications consumed by patients. The data were analyzed by SPSS software version 18, and P ≤ 0.05 was regarded significant. Results: In this study, 1616 individuals including 883 men (54.6%) and 733 women (45.3%) were investigated. The average age of individuals was 69.37 ± 7.42. Among the investigated individuals, 526 including 368 men (41.7%) and 158 women (21.6%) consumed no medications. The prevalence of polypharmacy in this study was 23.1%, which was 32.7% in women and 15.2% in men (odds ratio = 1.51, 95% confidence interval: 1.10–1.93). The most prevalent group of medications used in both genders was cardiovascular drugs. Conclusions: Regarding the considerable prevalence of polypharmacy among the elderly, especially in aged women, serious efforts are required to manage polypharmacy. Provision of educational programs for physicians, personnel of pharmacies, and the staff of health-care centers in order for appropriate and safe consumption of medications in aged people is absolutely necessary.

Objectives: The aim is to achieve the standard tools for heart health, the present study aimed to design, develop, and standardize the two questionnaires of perceived heart risk scale (PHRS) and heart health literacy scale (HHLS). Methods: The present study was a methodological research conducted on the residents of Kermanshah Province, Iran, using the multi-stage cluster sampling. Further, considering the scientific methods in the psychometric field, the design of the research questionnaires was conducted. In addition, the viewpoints of experts in different domains were qualitatively and quantitatively included to assess the validity of the questionnaires. To assess the reliability of the questionnaires, a sample including 31 subjects was first selected and studied within a fortnight's interval. Then, the reliability and validity of the scales were assessed using factor analysis and Cronbach's alpha in a sample of 771 subjects. Results: After reviewing the viewpoints of experts, the items were adjusted and implemented in the first sample at two stages. The results were indicative of the stability and acceptability of the Cronbach's alpha. In addition, the validity and reliability of the questionnaires were confirmed in the second sample too. Conclusion: According to the results of the present study, it can be concluded that the two questionnaires of PHRS and HHLS had acceptable reliability and validity.

Background: Radial artery occlusion (RAO) is one of the few postprocedural complications of transradial approach (TRA) which may be symptomatic in some cases. The aim of this study was to investigate the safety and efficacy of enoxaparin compared with unfractionated heparin (UFH) for preventing RAO among patients who underwent elective diagnostic coronary artery angiography (CAG) via TRA. Patients and Methods: This randomized clinical trial study was conducted on patients who underwent TRA for elective diagnostic CAG. Then, the patients included were randomly divided into 2 groups. A group received 0.75 mg enoxaparin intravenously and the second group received 70–100 IU/Kg UFH single-bolus dose intravenously. During 24 h after the procedure and 3 months later, all the participants were monitored for the occurrence of RAO, access hematoma, periprocedural myocardial infarction, stroke, and death. Results: From 189 patients with mean age of 52.52 ± 6.23 years old, 95 patients received UFH (70–100 IU/kg), and the other group (n = 94) received enoxaparin after radial sheath insertion. After 24 h, decrease in radial pulse was observed in 17.6% patient (14.9% in UFH group and 20.2% in enoxaparin group) and only one patient had absent radial pulse in UFH group. There were no significant differences between UFH group compared with enoxaparin group in the reduction of the radial pulse that examined with reverse Allen test (P = 0.359). Furthermore, other complications did not differ significantly between the two groups. Conclusion: This study demonstrates that intravenous enoxaparin administration compared with intravenous UFH during diagnostic CAG via TRA is a safe and effective strategy for preventing RAO at 24 h after the procedure.

Background: One of the most important roles of nurses in the war was the application of management interventions, which led to provide better services for the wounded soldiers. The purpose of this study was to explore the Management behaviors of civilian nurses in the Iran-Iraq war. Materials and Methods: The historical research methodology and thematic analysis using in-depth interviews were applied to gather data. This study was conducted in 2010-2012 in five big cities of Iran, and involved 18 male nurses who were selected by purposeful sampling method. Results: The interviews of the nurses revealed a main category as the management behaviors of the nurses in the war. Six subcategories were obtained, namely call up for the war, establishing emergency teams, managing the therapeutic units, managerial innovation during war operations, teamwork and variety of roles of nurses in the war. Conclusions: This study demonstrated how the nurses adapted to the harsh a situation without any previous experience on management in crises such as wars and increased medical treatment facilities outcome using management principles.

Background: Preinfarction angina has been recognized as a surrogate for preconditioning episodes. This study was designed to evaluate the cardiovascular effects of preinfarction anginal episodes among acute myocardial infarction (AMI) patients undergoing primary percutaneous coronary intervention (PCI). Materials and Methods: Of 520 patients who had undergone primary PCI, 393 patients were finally included in a prospective cohort study. Standard primary PCI procedure according to the latest guidelines was performed. The patients were divided into three groups based on previous symptoms as follows: asymptomatic (Group A), chronic stable angina (Group B) and unstable angina (Group C). Results: A total of 393 patients were evaluated. 185 (47.1%) patients were described as asymptomatic, 48 (12.2%) had stable angina and 160 (40.7%) were categorized as unstable angina. There was no significant difference among the study groups regarding pre- and post-PCI thrombolysis in myocardial infarction flow grade (P = 0.81). Median of peak post-PCI creatine-kinase-muscle/brain level of Group A (asymptomatic) was 250.5 (115.5–389), and it was significantly higher than Group C (176 [60.00–313.50]) (P = 0.03). Q wave formation was observed in 142 (88.75%), 31 (64.5%), and 96 (52.0%) patients of Group A, B, and C patients, respectively, which was significantly higher in asymptomatic patients (P = 0.002). There was no significant difference among the three groups regarding in-hospital and 6-month mortality (P = 0.36, 0.06, respectively). The composite endpoint of 6-month mortality, acute coronary events, cerebrovascular accidents, and target vessel revascularization was not significantly different between the three groups (P = 0.11). Conclusion: Preinfarction angina among AMI patients undergoing primary PCI seems to have a limited beneficial effect on infarct size, and this benefit was not translated to any clinical benefit.

Background: The first step in health education is awareness of the people and their acceptance to change their behavior. Therefore, the aim of this study was to investigate the effects of empowerment program towards the concept of self-care and prevention of sexually transmitted diseases (STDs) in women at risk of STDs. Materials and Methods: The present study was conducted as a qualitative approach (step of action and observation of an action) by using conventional content analysis method. An empowerment program regarding STDs (Action) was performed among 32 (with convenient sample) drug user women with addicted husbands referring to the counseling center for vulnerable women (drop in enter) in Isfahan in 2015. The knowledge of quiddity, transmission, and prevention of STDs, as well as some items of life skills such as self-awareness, interpersonal communication, and assertive behavior were taught in an educational program. Teaching methods were lectures, group, and individual training and role play. The impact of the program on modified belief and behavior change regarding STDs was evaluated with structured interviews. Results: Analysis of the obtained results yielded three categories. The categories were awareness of STD, believing in being at risk, and decision and change. Conclusions: Promoting self-care and prevention through education programs based on action research can make a significant reduction in the incidence of problems and cause a behavior change in women with the disease or those at risk for STDs.

Background: Untreated procedural pain leads to long-term and short-term complications in neonates. Preventing pain in sick infants and neonates, whose conditions are getting worse, not only is a professional and legal duty but also a prevention measure to decrease future psychological and even neurological complications. Therefore, nurses should prevent newborns' pain. The aim of this study was to compare the effects of massage and breastfeeding on the pain of the neonates. Materials and Methods: This was a clinical trial conducted among 75 full-term and near-term infants who underwent venipuncture. The newborns were randomly allocated to the following groups (n = 25 for each): group 1, breastfeeding; group 2, massage; and group 3, control. In the first group, venipuncture was done 2 minutes after breastfeeding. In the second group, massage was done with effleurage technique for 3 minutes and venipuncture was done 2 minutes after massage. The Neonatal Infant Pain Scale (NIPS) was used for pain measurement in the first 30 seconds of venipuncture. Data were analyzed by t-test and one-way analysis of variance (ANOVA). Results: The lowest mean pain score recorded in the massage group (0.92) whereas it was 4.84 in the breastfeeding group and 6.16 in the control group. ANOVA test and post-hoc statistics revealed that both interventions resulted in a significant reduction of the pain scores. Conclusions: According to the findings of this study, the lowest pain score was in massage group, then in breastfeeding group and control group accordingly. Considering the fact that massage and breastfeeding are natural, useful, and cost free interventions and do not need any special facility, these methods are suggested in pain management and pain control during painful procedures administrated for infants.

Pseudomelanosis of the gastrointestinal (GI) tract is a rare condition used to describe the accumulation of pigment deposits in the intestinal mucosa. Its underlying cause is not well understood. It has been described in association with gastrointestinal hemorrhage, chronic kidney disease, hypertension, diabetes mellitus, and medications such as hydralazine, ferrous sulfate, and furosemide. Melanosis coli is a well-known condition associated with the use of anthranoid laxatives; however, pseudomelanosis of the small intestine is extremely rare and most commonly described in the duodenum, with few cases in the gastric mucosa and even more rare in the jejunum. Herein, we report a case of pseudomelanosis intestini involving the pylorus, duodenum, and proximal jejunum in a patient presented with GI bleeding. The clinical significance of this condition is unknown; however, gastroenterologists should be aware of its existence.

Acute coronary syndrome (ACS) is a term used to describe a spectrum of diseases associated with sudden reduced blood flow to the heart. Coronary artery thromboembolism is recognized as an important nonatherosclerotic cause of acute myocardial infarctions in 2.9% of ACS cases, with a long-term outcome indicating that coronary embolism patients represent a high-risk subpopulation. There are various risk factors for developing a coronary thromboembolism, with atrial fibrillation being the most frequently reported cause. Herein, we are presenting a case of a 65-year-old female patient who presented to the emergency department with sudden-onset pressure-like chest pain diagnosed as ACS due to nonatherosclerotic thromboembolism secondary to atrial flutter.

Introduction: Identifying factors that delay diagnosis of tuberculosis (TB) are important for the health system when timely patient treatment and reducing TB transmission are desirable goals. Aim of this study was to investigate the prognostic factors that delay TB diagnosis. Material and methods: This retrospective cohort study used National TB Program (NTP) data from 1056 TB patients during 2006–2014 in Hamadan province, western Iran. The Cox regression model was performed to determine associations between baseline explanatory variables and survival outcome with Hazard Ratio HRs (95% CIs). Results: N (%) of delay in TB diagnosis more than 90 days was significantly higher in male patients, new case patients and pulmonary positive cases. After adjustment for covariates, HR (95% CI) in relapsed TB compared to new cases was 0.67 (0.53, 0.85) and these figures for positive pulmonary cases and extra pulmonary cases in compared to negative pulmonary cases were 0.80 (0.68, 0.94) and 0.84 (0.73, 0.98) respectively. Conclusion: A high proportion of patients had delays in diagnosis exceeding three months. Our findings suggest that male gender, new cases, positive and extra pulmonary cases might increase the risk for delayeddiagnosis among TB patients.

Objectives: Treatment outcome of Tuberculosis (TB), as a key determinant to evaluate the effectiveness of TB control program, remains a public health challenge in many developed and developing countries. This study aimed to assess treatment outcomes of new smear-positive pulmonary tuberculosis (PTB). Methods: This retrospective cross-sectional study was conducted on 510 registered new PTB patients in Hamadan province, Iran during 2005–13. The data were extracted from the National TB Program (NTP). The main outcome was treatment success. The results of evaluation of the associated factors with successful treatment were presented as Odds Ratios (OR), and bootstrap method was used to obtain 95% Confidence Interval (95% CI). All statistical analysis was performed at 0.05 significant levels using the Stata 12 (Stata Corp, College Station, TX, USA). Results: Overall, successful treatment outcome was 83.1%, and 9.4% of the patients died during the study period. In univariate logistic regression, only hospitalization history was associated with successful treatment (OR = 2.02, 95% CI: 1.25, 3.24). After adjustment for age, weight, and delayed diagnosis, the factors associated with successful treatment were gender and having HIV risk factors and hospitalization history. Conclusion: Treatment success rate in our study was 83.1%, which is slightly lower than the success target set by World Health Organization (WHO). Key determinants of poor treatment success rate, such as male gender, and not having hospitalization history during the treatment period, should be considered in efforts aimed to improve the treatment outcome in the management of TB.

Background: The purpose of this study was to investigate of radiographic pattern and relative frequency of idiopathic osteosclerosis (IO) and condensing osteitis (CO) in panoramic radiographs. Materials and Methods: Totally 411 panoramic radiographies were randomly selected from patients referred to Radiology Department of Faculty of Dentistry, Tabriz University of Medical Sciences. Descriptive characteristics of radiopacities, including shape, border, localization, and dental relationship, were recorded. The Chi-squared test was used. Results: IO was detected in 31 (7.5%) patients and 22 (68.8%) lesions had exact border while their shape was mostly irregular. About 17 (53.1%) lesions were apical, and 13 (40.6%) lesions had no relation to the teeth. The most involved teeth were the second premolar (28.1%) and first molar (25%). Moreover, CO was detected in 32 (7.8%) patients. 17 (53.1%) lesions had an ill-defined border, and their shape was mostly irregular (65.6%) with ill-defined border. Around 18 (56.3%) lesions were apical, and 11 (34.4) lesions were apical and interradicular. The most involved teeth were the second premolar (59.4%) and the first molar (21.9%). Conclusion: The results demonstrated that relative frequency of IO in the selected population was 7.5% and for CO, it was 7.8%.

Background: Nurses′ clinical competency plays an important role in the care of preterm infants. On the other hand, burnout is one of the most important factors in reducing the nurses′ efficiency. With regard to the importance of the role of nurses, and the vulnerability of the infants, the purpose of this study was to investigate the relationship between nurses′ burnout and clinical competency in NICUs. Materials and Methods: The descriptive cross-sectional study was conducted with the participation of 86 nurses working in the NICUs of hospitals in Isfahan, Iran. Census sampling method was used in the NICUs of educational hospitals in 2014. Data were collected by a questionnaire including demographic characteristics, Patricia clinical competency, and Maslach burnout scales. Data were analyzed by the statistical tests of independent t-test and Pearson correlations test with the significance level of α < 0.05. Results: Six dimensions of clinical competency and three dimensions of nurses′ burnout were assessed at three levels (weak, moderate, and strong levels). Statistical tests showed that clinical competency was at a moderate level in all fields. Of the dimensions of nurses′ burnout, emotional exhaustion was moderate, depersonalization was weak, and personal performance was strong. The results showed that nurses` burnout and clinical competency in the NICUs were at a moderate level and had a significant negative relationship (r = −0.322, P = 0.003). Conclusions: Results showed that burnout had a negative relationship with competency. Therefore, managers are suggested to improve nurses′ competency and diminish their job burnout through better and more applicable planning.

Background: Parent–infant attachment is an important factor in accepting parenting role, accelerating infant survival, and adjusting to the environment outside the uterus. Since family supportive interventions can strengthen the parent–infant caring relationship, this study sought to investigate the relationship between mother–infant attachment and satisfaction of the mothers with the supportive nursing care received in the neonatal intensive care unit (NICU). Materials and Methods: In this descriptive–correlational study, 210 mothers with premature infants who were hospitalized in the NICUs affiliated to Isfahan Medical University hospitals took part. The data were collected via Maternal Postnatal Attachment Scale and researcher's self-tailored questionnaire based on Nurse Parent Support Tool. Pearson correlation coefficient and multiple linear regressions were used to analyze the collected data. Results: The results showed that the overall score of mother–infant attachment and the overall score of maternal satisfaction correlated with a correlation coefficient of r = 0.195. Also, the overall score of mother–infant attachment and mothers' satisfaction scores in the emotional, communicative-informative, and self-confidence domains correlated with correlation coefficients of r = 0.182, r = 0.0.189, and r = 0.0.304, respectively. The results of multiple regression analysis revealed that about 15% of changes in the dependent variable (mother–infant attachment) could be explained by different dimensions of mothers' satisfaction. Conclusions: The results of the study showed that mother–infant attachment improved by increasing mothers' satisfaction of supportive nursing care. Therefore, it seems necessary to increase maternal satisfaction through given nursing care support, in order to promote mother–infant attachment.

BACKGROUND: International research collaboration (IRC) is known as one of the important indicators of productivity, efficiency, and validity of universities in the world. In other words, IRC is necessary for the scientific trade-off between researchers in international scientific societies. The study aimed to address the experiences of an academic researcher about factors related to IRC. MATERIALS AND METHODS: The present study was conducted using a qualitative approach and conventional content analysis method. The participants consisted of 19 experienced faculty members and researchers from Isfahan University of Medical Sciences, who were selected based on the purposive and snowball sampling techniques. Data were collected through semi-structured interviews and were analyzed using the content analysis technique. Guba and Lincoln's evaluative criteria, including credibility, confirmability, dependability, and transferability, were applied to evaluate the trustworthiness of the study. RESULTS: According to the research findings, factors of “personal skills,” “personality,” “professional position,” and “scientific activities” under the category of personal factors; “rules and regulations” and “equipment and facilities” under the organizational factors; and “domestic policies” and “foreign policies” were identified under the government factors category. CONCLUSION: Research collaborations are influenced by individual, intra-academic, and extra-academic factors; thus, research policymakers can help further to enhance the quantity and quality of scientific output and promote the university's placing in international rankings through providing conditions that enable international interactions.

Clinical education requires creating a supportive atmosphere for learners and nursing students, who need support to be prepared for their future profession. The purpose of this study is to investigate the challenges of supporting the nursing students in clinical education. This article reviewed studies conducted between 2009 and 2019 with the keywords including support, challenge, students, education, and nursing using SID, Magiran, IranMedex, Google Scholar, Elsevier, and PubMed as databases. Among the 926 articles obtained during the two review stages, which were based on the inclusion and exclusion criteria and the first one analyzed the title and the abstract and the second one analyzed the whole article, ultimately 32 articles were selected for the study. The types of articles used in this study are as follows: qualitative (16 articles), descriptive analytical and cross-sectional (12 articles), review (3 articles), and mixed-methods (1 article). The focus of all studies was on the students' clinical education environment. The participants of the studies were undergraduate nursing students (in 22 articles), graduate students (in 2 articles), nursing instructors and students (in 4 articles), and nursing instructors and managers (in 1 article). Most of the challenges of supporting the students included violence, fear, and anxiety; socio-cultural challenges, environmental-organizational stresses; and ineffective clinical education. The findings of this study showed that nursing students face many challenges in the clinical setting. Therefore, the managers of educational and health-care centers should give a high priority to their students' support programs.

Background: The improved physical action following administration of supplements to bodybuilders was supported by changes in laboratory parameters. Despite the fact that these supplements are sometimes associated both advantage and side effects, this study were conducted for the purpose of evaluating the possible effects of some commonly used supplements in bodybuilders on the hematological and biochemical parameters. Materials and Methods: In this study, we included 40 male bodybuilders as cases and 40 controls in the age group of 20-40 years. They used different kinds of supplements for 1 year. In general, all the supplements used were classified into two groups: hormonal and non-hormonal. Laboratory tests were requested for evaluation of hematological and biochemical parameters. Results: In an equation model, we found that weight (P = 0.024), duration of bodybuilding (P < 0.001), and duration of hormone supplement consumption (P < 0.001) were loaded significantly on the latent variables, demographic and dietary supplement, respectively. The relationship between dietary supplement and biochemical and hematological parameters was significant (P = 0.01) and some of these parameters including creatinine (P = 0.023), blood aspartate aminotransferase (AST) (P < 0.001), alanine aminotransferase (ALT) (P < 0.001), and red blood cell distribution (RDW) (P = 0.046) had a significant role than others. In a multivariate regression model, we found that WBC (P < 0.001), platelets (P < 0.001), blood urea nitrogen (BUN; P < 0.001), creatinine (P < 0.001), AST (P = 0.005), and ALT (P = 0.001) were higher in athletes than in controls. Conclusions: It is strongly advised that there should be some concerns about possible supplement-induced changes in the laboratory exams for bodybuilders. The available supplements are unchecked and not approved by the US Food and Drug Administration (FDA). More studies should be designed for a better and precise administration of each supplement in athletes.

Background: Qualitative research focuses on social world and provides the tools to study health phenomena from the perspective of those experiencing them. Identifying the problem, forming the question, and selecting an appropriate methodology and design are some of the initial challenges that researchers encounter in the early stages of any research project. These problems are particularly common for novices. Materials and Methods: This article describes the practical challenges of using qualitative inquiry in the field of health and the challenges of performing an interpretive research based on professional experience as a qualitative researcher and on available literature. Results: One of the main topics discussed is the nature of qualitative research, its inherent challenges, and how to overcome them. Some of those highlighted here include: identification of the research problem, formation of the research question/aim, and selecting an appropriate methodology and research design, which are the main concerns of qualitative researchers and need to be handled properly. Insights from real-life experiences in conducting qualitative research in health reveal these issues. Conclusions: The paper provides personal comments on the experiences of a researcher in conducting pure qualitative research in the field of health. It offers insights into the practical difficulties encountered when performing qualitative studies and offers solutions and alternatives applied by these authors, which may be of use to others.

Background: Identification of the main needs of infertile patients is essential to provision of appropriate supportive services and care based on their needs. Thus, the present study aims to explore infertile couples' counseling needs. Materials and Methods: This study was carried out with an inductive qualitative content analysis approach during 2012–2013. The participants of this study included 26 Iranian infertile couples and 7 medical personnel (3 gynecologists and 4 midwives). The infertile couples were selected through purposive sampling and considering maximal variation from patients attending state-run and private infertility treatment centers as well as infertility specialists, offices in Isfahan and Rasht, Iran. Unstructured in-depth interviews and field notes were utilized for data gathering and replying to this research main question, "What are the counseling needs of infertile couples?" The data from medical personnel was collected through semi-structured interviews. Data analysis was carried out through conventional content analysis. Results: Data analysis revealed two main themes. The first theme was "a need for psychological counseling," which included four subthemes: Emotional distress management, sexual counseling, marital counseling, and family counseling. The second theme was "a need for guidance and information throughout treatment process," which included three subthemes: Treatment counseling, financial counseling, and legal counseling. Conclusions: The counseling needs of infertile couples are varied, and they require various psychosocial support and counseling interventions. The participants of this study identified clearly the significance of psychological counseling and information throughout the long and onerous journey of infertility and its treatment.

Background: Identifying and using the strengths of patients, in practice, is a new territory. Today, the need to educate nurses and psychiatric patients about positive psychology in practice and the importance of understanding and focusing on strengths is clear. However, little is known about the strengths the psychiatric patients use and experience. Thus, this study has been designed and conducted in order to understand how people with psychiatric disorders demonstrate their strengths. Materials and Methods: In the present study, 13 semi-structured, qualitative interviews with patients and 2 focus groups with nurses were carried out. In addition, a qualitative content analysis was used to identify significant strengths. Results: Based on the results, the four main strengths consisted of: Finding a meaning in daily living, work as enduring strength, entertaining activities, and positive relationship. Patients also reported that health care providers rarely focused on patients′ strengths, and experts confirmed these findings. Our findings indicate that patients′ own strengths are a pivotal factor in getting through their illness from their perspective. Conclusions: Despite the enduring legacy of pessimism regarding psychiatric patients, these people have a repertoire of strengths. Nurses should, therefore, have a greater focus on eliciting and nourishing psychiatric patients′ strengths in their care. It is suggested that the theoretical and practical aspects of patients′ strengths be incorporated in nursing school curricula.

Background: Clinical guidelines are important instruments for increasing the quality of clinical practice in the treatment team. Compilation of clinical guidelines is important due to special condition of the neonates and the nurses facing critical conditions in the neonatal intensive care unit (NICU). With 98% of neonatal deaths occurring in NICUs in the hospitals, it is important to pay attention to this issue. This study aimed at compilation of the neonatal palliative care clinical guidelines in NICU. Materials and Methods: This study was conducted with multistage comparative strategies with localization in Isfahan in 2013. In the first step, the components of the neonatal palliative care clinical guidelines were determined by searching in different databases. In the second stage, the level of expert group′s consensus with each component of neonatal palliative care in the nominal group and focus group was investigated, and the clinical guideline was written based on that. In the third stage, the quality and applicability were determined with the positive viewpoints of medical experts, nurses, and members of the science board of five cities in Iran. Data were analyzed by descriptive statistics through SPSS. Results: In the first stage, the draft of neonatal palliative care was designed based on neonates′, their parents′, and the related staff′s requirements. In the second stage, its rank and applicability were determined and after analyzing the responses, with agreement of the focus group, the clinical guideline was written. In the third stage, the means of indication scores obtained were 75%, 69%, 72%, 72%, and 68% by Appraisal of Guidelines for Research and Evaluation (AGREE) instrument. Conclusions: The compilation of the guideline can play an effective role in provision of neonatal care in nursing.

Saffron is the most expensive spice in the world and consists of the dried stigmas of Crocus sativus L. It is used as food coloring and flavoring in food industry and traditional cooking and also in folk medicine as antispasmodic, carminative, stomachic, expectorant, aphrodisiac and cardiotonic. The present study has evaluated the diuretic activity of aqueous extract of dried saffron (stigma of Crocussativus) in rat. Aqueous extracts of saffron were administered to experimental rats orally as doses of 60, 120 and 240 mg/kg body weight (BW) and compared with hydrochlorothiazide (10 mg/kg B.W., intraperitoneally), a potent diuretic as positive control and normal saline solution as placebo for control group. The measured parameters for diuretic activity were total urine volume, urine electrolytes concentration such as sodium and potassium, creatinine and urea concentration. The treated rats with aqueous extract of saffron as doses of 120 and 240 mg/kg BW showed higher urine output when compared to the control group. Also, it has shown a significant dose-dependent increase in the excretion of electrolytes when compared to the control group. Our findings proved the diuretic activity of saffron which is used in traditional medicine, it can be an effective and safe strategy for related dysfunction. Also further studies are needed to identify the mechanisms of action, probably other effects and interactions with other medicines.

BACKGROUND: Adolescence is considered an important stage in the onset of high-risk behaviors. Identity styles have significant pathological effects in various aspects of high-risk behaviors. The present study was conducted aiming at investigating the association between high-risk behaviors and identity styles in adolescents. MATERIALS AND METHODS: The present cross-sectional research studied 384 girls and boys studying in the second grade of High School in Babol in 2018. Data collection was done through a demographic questionnaire, Mohammadkhani's Risky Behaviour Questionnaire, and Berzonsky's Identity Style Inventory. Data analysis was performed using Chi-square test, Pearson's correlation coefficient, and linear regression analysis. P ≤ 0.05 was considered statistically significant. RESULTS: The mean age of adolescents was 17.21 ± 48.4 years (aged 16–19 years). Aggression (23.4%), relationship with the opposite gender (14.5%), smoking cigarettes and hookah (10.9%), consuming alcohol (9.3%), suicidal thoughts and attempts (5.7%), running away from home (3.9%), and consuming psychotropic substances (1.8%) were among the most common high-risk behaviors observed in the adolescents. The scores of high-risk behaviors were negatively correlated with the identity scores of informational style (4.56 ± 3.107), normative style (4.45 ± 2.581), and identity commitment style (4.15 ± 2.245) and positively correlated with the scores of diffuse-avoidant style (4.15 ± 3.089). Regression analysis showed that only the informational style had a negative and significant correlation with high-risk behaviors. CONCLUSIONS: The present study showed significant prevalence of high-risk behaviors and its relationship with identity styles in adolescents, which requires regular and planned health education intervention at schools.

Background: Inflammatory bowel disease (IBD) as a chronic and debilitating disease is affected by sleep disturbance which increases the risk of malignancy. Sleep disturbance is more common in irritable bowel syndrome (IBS) and few reported studies have assessed its role in IBD. We evaluated the effect of IBS on sleep quality and quality of life (QOL) of IBD patients in clinical remission. Methods: In a cross-sectional study, 115 IBD patients in clinical remission aged from 14 to 70 years referred to gastroenterology outpatient departments and private gastroenterology offices from 2007 to 2016. Patients considered in four groups (with/without IBS). The Revised “Rome III criteria” used for diagnosing IBS. Pittsburgh Sleep Quality Index questionnaire and the health-related QOL questionnaire used for evaluating sleep quality and QOL. Results: About 85 (73.9%) cases had ulcerative colitis (UC) and 30 (26.1%) cases had Crohn's disease (CD). Forty (34.8%) cases had IBD + IBS. Poor sleep quality in UC + IBS (OR: 0.018, P = 0.003) and UC (OR: 0.016, P = 0.002) was less than CD. Diseases extent in left side colitis (OR: 0.064, P = 0.016) were less than with pancolitis. Sleep quality affected by quality of life (IBDQ) (P = 0.048). Mean quality of life (IBDQ) in patients who had poor sleep was 11% less than those with good sleep. Conclusions: The syndrome of IBS affects the sleep quality of IBD in clinical remission, especially in CD. Its additive effect with IBD may worsen symptoms that correlated with sleep disturbance, such as pain, psychological and physical condition, and QOL.

Background: TIMI Frame Count (TFC) is one of the methods to estimate the coronary blood flow velocity. This is a simple, inexpensive, quantitative, reproducible, and continuous variable method. Many studies have been conducted on TFC assessment in ST elevation myocardial infarction (STEMI) patients. Objectives: The present study is aimed to measure the TFC in the coronary arteries of UA/NSTEMI patients to find abnormalities in diseased or patent vessels and compare with the normal values. Patients and Methods: The participants were 105 consecutive UA/NSTEMI patients who underwent coronary angiography in Shahid Rajaie Cardiovascular Medical and Research Center, Tehran, Iran in 2009. Exclusion criteria were history of CABG, PCI, or STEMI or presence of occluded arteries in angiography. We measured the coronary TFC in these patients. We examined also 55 stable patients without coronary lesions and with TIMI 3 flow to have an estimation of normal TFCs. Results: From a total of 105 patients, 25 (23.8%) had no significant coronary lesion (> 60%); 35 (33.3%) were diagnosed with single vessel disease; 22 (21%) were 2VD; and 23 (21.9%) were 3 VD.). In overall, mean TFC in UA/NSTEMI group was 28.7 (± 14) frames compared to 23.8 (± 7.8) frames in the normal group (P < 0.05). In the vessels with significant lesions, TFC was significantly higher than normal (30.84 vs. 23.8; P < 0.001) and also significantly higher than patent vessels of the same patients (30.84 vs. 26.10; P = 0.029). In these patients, patent vessels had higher TFC values compared to normal coronaries (26.10 vs. 23.8), but the difference was not significant (P = 0.12). In the patients with significant lesions, mean TFC was higher than the same value in acute coronary patients without significant lesions (29.3 vs. 27.2), but the difference was not significant (P = 0.114). In the patients who underwent PCI and stenting, TFC changed significantly after PCI toward the normal value (P = 0.001). In the patients with elevated cardiac enzymes, TFC was higher but the difference was not significant (P = 0.35). Conclusions: Patent coronaries of UA/NSTEMI patients have a trend to higher TFCs compared to normal values. Presence of significant coronary lesions in these patients significantly increases TFC.

Objectives: Health care providers in the rural centers offer the primary health services in the form of proficiencies and professions to the most required target population in the health system. These services are provided in certain condition and population with a verity of limitations. This study aimed to describe and interpret the experiences of the employees from their own working condition in the rural health centers. Methods: The present study conducted in a qualitative research approach and content analysis method through individual and group interviews with 26 employed primary health care providers (including 7 family physicians, 7 midwives, and 12 health workers) in the rural health centers in Isfahan in 2009. Sampling was done using purposive sampling method. The data were analyzed using qualitative content analysis as constant comparative basis. Results: During the content analysis process, six themes were obtained; "instability and frequent changes", "involved in laws and regulations", "pressure and stress due to unbalanced workload and manpower", "helplessness in performing the tasks and duties", "sense of identity threat and low self-concept", and "deprivation of professional development". The mentioned themes indicate a main and more important theme called "burnout". Conclusions: Health services providers in the rural health centers are working in stressful and challenging work conditions and are suffered from deprivation of something for which are responsible to the community.

Background/Aim: Chronic diarrhea is defined as a decrease in fecal consistency lasting for four or more weeks. Prevalence of this complication in the general population is 5%. Mast cells that play an important role in the regulation of gastrointestinal visceral sensitivity and vascular permeability may be involved in functional chronic diarrhea. In this study we tried to evaluate mast cells density in colonic mucosa of patients with chronic diarrhea. Patients and Methods: 50 patients with chronic diarrhea and 50 persons as control group were investigated. All specimens were immunohistochemically stained for mast cell tryptase (MCT) with monoclonal mouse anti-human MCT as well as toluidine blue. Mean number of mucosal mast cells were counted in 10 high power microscopic fields of patients and control groups. Results: In patients group (age range, 15-78 years; 26 females), the number of mast cells per high power field in the immunohistochemistry staining was 21.3 ± 4.8 compared to 14.2 ± 3.4 in the control group (age range, 18-78 years; 24 females) [P < 0.001]. Also number of mast cells in toluidine blue staining was 10.3 ± 3.6 per high power field in cases and 7.1 ± 2.4 in the control group (P < 0.001). Conclusion: Elevated number of colonic mast cells exist in patients with chronic diarrhea. Further research should be considered on application of these findings for new therapeutic opportunities.

Background: Angiogenesis contributes to different physiological and pathological conditions. The aim of this study was to investigate for the first time the antiangiogenic effects of amygdalin on the cultured endothelial cells of diabetic rats. Materials and Methods: A total of 20 streptozotocin-induced diabetic rats were divided into two equal groups of control and amygdalin-treated animals. Eight weeks after the induction of diabetes, amygdalin was injected intraperitoneally (3 mg/kg) to the rats of the treatment group. One day later, rats were sacrificed; the aortic arteries were excised and cut as 2 mm rings. Each aortic ring was incubated in a cell-culture well for 7 days. The process of angiogenesis was monitored by counting the number of microvessels and primary microtubules in each well. Results: Optic microscopy showed proliferation and migration of new endothelial cells to the fibrin gels. The endothelial cells produced primary microtubules which gradually made several branches and finally made a vascular matrix. The number of the primary microtubules and microvessels were significantly lower in the amygdalin-treated vs. control group (P < 0.01). Conclusion: Therefore, amygdalin exerts inhibitory effects on angiogenesis in aortic rings of diabetic rats and may pave a new way for treatment of unfavorable angiogenic conditions.

The incidence of difficulty in tracheal intubation has been reported to range from 0.5 to 18% in patients undergoing surgery. We aimed to elucidate the role of upper lip bite test (ULBT) with other prevailing tests, hyomental/thyrosternal distances (HMD/TSD), and the mandible length (ML) and their possible correlation in predicting difficulty in intubation. After institutional approval and informed consent were obtained, 300 consecutive patients aged 20-60 years of ASA physical status I and II, scheduled for elective surgical procedures requiring tracheal intubation and meeting the inclusion criteria, were enrolled in this study. Each patient was evaluated regarding ULBT, HMD, TSD and ML. Laryngoscopy was assessed by an attending anaesthesiologist blinded to the measurements. The laryngoscopic result was graded according to Cormack and Lehane′s Grading system. The negative predictive value (NPV) and positive predictive value (PPV) of ULBT were found to be 94 and 100%, respectively. These corresponding figures for TSD were 88.5 and 0%, respectively. Specificities for ULBT, HMD, ML and TSD were 100, 98.9, 98.9 and 98.1%, respectively. ULBT class and laryngoscopic grading showed the greatest agreement (kappa = 0.61, P < 0.001). An agreement between laryngoscopic grading and HMD and ML also existed (0.003 and 9 cm and HMD > 3.5 cm were good predictors of negative difficult intubation.

Background: Dextromethorphan (DM) is an N-methyl-D-aspartate (NMDA) receptor antagonist that may be useful during opiate addiction process, especially in reducing methadone consumption in methadone maintenance therapy (MMT). The goal of the current study was to evaluate the effects of oral administration of DM on reducing methadone dose in MMT used to treat illicit opioid drug abuse. Methods: A double-blinded randomized clinical trial was designed. Seventy two opiate abusers undergoing MMT were randomly divided into two groups. Participants in the intervention group were medicated by DM while those in the control group received placebo. After a 6-week follow-up, methadone consumption dosage, quality of life (QOL) and withdrawal symptoms were assessed and compared between the two groups by repeated measure ANOVA statistical test. Results: The mean of methadone consumption in the DM and control groups were 62.7 mg/day (52.7-72.7) and 70.4 mg/day (60.4-80.4), respectively. No statistically significant difference was found between the two groups among the four evaluations made (F = 1.192, P = 0.279). There were not any significant differences in withdrawal symptoms between the two groups (P > 0.05). Total mean scores of QOL in the intervention and control groups were 84.8 (78.7-90.8) and 77.8 (71.8-83.7) (P > 0.05), respectively. Conclusions: Although DM might be useful for opioid dependence treatment, results of the current study did not reveal any statistically significant differences. Therefore, further studies exploring this possibility are needed.

Endobronchial spillage of fungal material into normal lung can infect it and the spillage of fungal material should be prevented during surgery. We report our experience of a patient who presented for right upper lobectomy with bronchiectasis, tubercular destruction and subsequent aspergilloma. A 4F Fogarty catheter was introduced through the tracheal lumen of the left sided endobronchial double lumen tube (DLT) to occlude the bronchus intermedius to prevent spillage of aspergilloma into the non-infected lower and middle lobes of the right lung. The Fogarty catheter was pulled into the trachea just before stapling the bronchus; thereafter, right upper lobectomy was completed successfully. The patient was extubated uneventfully and transferred to post-operative recovery ward. The endobronchial blockage of the intermediate bronchus of the operative lung by the Fogarty catheter and isolation of the left lung by the DLT prevented spillage of aspergilloma in both the operative right lung and the left lung.

Background: Child abuse and violence toward children has become a complex phenomenon in nowadays societies leaving hurt children with numerous complications such as lowered self-efficacy. Hence, this study was conducted to assess the effect of trauma-focused cognitive behavioral therapy (TF-CBT) in physically abused children self-efficacy. Materials and Methods: This study was a randomized clinical trial. From this statistical population of all abused children aged 9–12 in Kermanshah in 2016–2017, 40 were divided into intervention and control groups randomly. Tools used in this study were Maurice self-efficacy questionnaire and child abuse questionnaire. Data analysis was done using Chi-square test, paired t-test, and independent t-test. Results: It was revealed that the mean difference between two groups was not meaningful before intervention. After TF-CBT in intervention group, self-efficacy mean scores of social (17.95 vs. 24.20) and emotional (15.05 vs. 19.05) domains showed meaningful differences, whereas academic self-efficacy mean score did not change significantly (14.10 vs. 14.65) (P < 0.086). In control group, social (16.20 vs. 15.55), emotional (13.90 vs. 14.35), and academic (13.40 vs. 13.90) mean self-efficacy scores were not of significant difference (P > 0.001). Conclusions: TF-CBT can be used as an appropriate therapy intervention to improve social and emotional self-efficacy in abused children.