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BackgroundGlycemic variability is a novel predictor for diabetic complications. Different studies have demonstrated contradictory results for the association between HbA1c variability and diabetic retinopathy. We aimed to assess the relationship between visit-to-visit variability in glycemic profile (HbA1c, 2hPP, and FBS) and diabetic retinopathy.MethodsPatients with type 2 diabetes were monitored for the development of retinopathy for 10 years. The association between the incidence of retinopathy and glycemic variability was assessed via Cox regression analysis, and coefficient of variation for glycemic indices was compared using independent sample t-test.ResultsPatients with diabetic retinopathy had significantly higher glycemic profile variability. The incidence of retinopathy was positively correlated with cv-FBS10% (10% of coefficient of variance), cv-FBS20%, cv-2hpp10%, and cv-HbA1c5%. Our analysis revealed that the higher variability of FBS increased the incidence and progression of retinopathy (HR: 12.29, p-value = 0.003).ConclusionOur findings demonstrated glycemic profile variability as an independent risk factor for diabetic retinopathy in patients with type 2 diabetes and support glycemic profile variability measurement in addition to common glycemic parameters to improve risk stratification in patients with type 2 diabetes. Further investigation is required to demonstrate the long-term effects of alleviating glycemic variability on the prognosis of patients with type 2 diabetes.

Abstract Background The etiology of LARS has not been elaborated on clearly. Studies have reported neoadjuvant therapy, low-lying rectal cancers, adjuvant therapy and anastomotic leakage as risk factors for the development of LARS. Anastomotic level has also been proposed as a possible risk factor; However, there have been conflicting results. This study aims to evaluate the role of the level of anastomosis as a potential risk factor for the development of LARS. Method A systematic literature search was conducted on Pubmed, Scopus, Embase, and Web of Science databases using Mesh terms and non-Mesh terms from 2012 to 2023. Original English studies conducted on rectal cancer patients reporting of anastomotic level and LARS status were included in this study. Eligible studies were assessed regarding quality control with Joanna-Briggs Institute (JBI) questionnaires. Results A total of 396 articles were found using the research queries, and after applying selection criteria 4 articles were selected. A sample population of 808 patients were included in this study with a mean age of 61.51 years with male patients consisting 59.28% of the cases. The Mean assessment time was 15.6 months which revealed a mean prevalence of 48.89% for LAR syndrome. Regression analysis revealed significantly increased risk of LAR syndrome development due to low anastomosis level in all 4 studies with odds ratios of 5.336 (95% CI:3.197–8.907), 3.76 (95% CI: 1.34–10.61), 1.145 (95% CI: 1.141–2.149) and 2.11 (95% CI: 1.05–4.27) for low anastomoses and 4.34 (95% CI: 1.05–18.04) for ultralow anastomoses. Conclusions LARS is a long-term complication following surgery, leading to reduced quality of life. Low anastomosis level has been reported as a possible risk factor. All of the studies in this systematic review were associated with an increased risk of LARS development among patients with low anastomosis.

Abstract Background Considering the importance of intention to receive COVID-19 vaccine among healthcare workers and its role in maintaining their health and inhibiting the epidemic spread of Covid-19, the present study was done to identify the changes in intention to receive COVID-19 vaccine rate in two different time points and it’s determinants based on the dimensions of the health belief model among healthcare workers in Iran. Methods Two cross-sectional surveys performed to investigate COVID-19 vaccination intent and associated factors based on the health belief model. The first conducted on 1244 participants from August 18 to 23, 2020, and the second on 1514 participants from February 5 to April 29, 2021, both using a questionnaire of intent to accept COVID-19 vaccination. The questionnaire distribution platform in both surveys was similarly, WhatsApp and Telegram social and working virtual groups of HCWs. Data were analyzed with SPSS-16 software for descriptive and analytical statistics. Results In the first survey, 58.4% (95% CI: 0.55-0.61%) of healthcare workers intended to receive the COVID-19 vaccine, the rate dropped to 45.7% (95% CI: 0.43-0.48%) in the second survey (P

BackgroundThe prevalence of dyslipidemia in patients with type 2 diabetes (T2D) has been reported to be relatively high. The current study aimed to investigate the trend of serum lipid levels and the prevalence of dyslipidemia in patients with T2D.MethodsData were extracted from a cohort of patients with T2D who had regular follow-ups every year for three years. TG, TC, LDL-C, HDL-C, and non-HDL-C were analyzed. The atherogenic index of plasma (AIP) was calculated using log (TG/HDL-C).ResultsA total of 747 patients with T2D were included in this study, consisting of 469 (62.8%) women and 278 (37.2%) men. There was a significant downward trend in mean TG, TC, LDL-C, non-HDL-C, and AIP levels. The trend of mean HDL-C levels showed no significant change. The prevalence of high TG, high TC, high LDL-C, and high non-HDL-C significantly decreased from the first to the last visit. There was no significant change in the trend of prevalence of low HDL-C. The prevalence of high AIP significantly decreased in women and showed no significant changes in men.ConclusionsA decreasing trend was observed in the mean levels and prevalence of TG, TC, LDL-C, non-HDL-C, and AIP. HDL-C did not change significantly. The success rate in achieving a complete normal lipid profile during follow-up years was not promising and continues to be challenging.

Background: Theoretically, smoking status should be associated with metabolic syndrome. This relationship has not been studied in Iranian population so far. This study aimed to explore the association among cigarette smoking, metabolic syndrome (MetS) and its domains in a nationally representative sample of Iranians aged 25-64. Methods: Information of participants regarding demographic data and smoking habits gathered through WHO STEPS questionnaires in the frame of fourth national surveillance of the risk factors of non-communicable diseases in 2011 across the country. The fasting plasma glucose, triglyceride level, high-density lipoprotein cholesterol (HDL-C) level, blood pressure, and anthropometric indices in each patient were measured. Data of 4000 subjects were analyzed with complex sample survey method. The prevalence of metabolic syndrome was assessed according to two definitions: International Diabetes Federation (IDF) and Iranian definition. Results: Herein, 38.4% of smoker participants and 36.6% of non-smokers met the IDF criteria for MetS (P=0.67). Similarly, 31.1% of smokers and 34.1% of non-smokers had MetS according to Iranian-IDF (P=0.427). Only in univariate analysis, using IDF criteria female smokers had lower prevalence of MetS than non-smokers (13.9% vs. 36.5%, P=0.01). Multivariate analysis determined the following odds ratios for the association of smoking with MetS defined by IDF and Iranian-IDF criteria, respectively: OR= 0.89 (0.53-1.47), P=0.638 and OR= 0.97 (0.59-1.58), P=0.901. Conclusion: There was no significant association between smoking and MetS overall and among men. However, smoking was associated with lower prevalence of MetS among women.

Background: There is debate on the necessity of booster doses of COVID-19 vaccination, especially in countries with limited resources. Methods: This cross-sectional study was conducted in a referral laboratory in Tehran, Iran. The level of COVID-19 antibodies was measured and compared between individuals regarding the number of COVID-19 vaccine shots. Results: In this study, 176 individuals with a mean age of 36.3 (±11.7) years participated. A total of 112 individuals received two doses of the COVID-19 vaccine, and 64 individuals received three doses. Level of all antibodies was higher in those who received three doses than in those who received two doses of the COVID-19 vaccine. Considering the SARS-CoV-2 Spike IgG, the difference was not statistically significant but for the SARS-CoV-2 RBD IgG and SARS-CoV-2 NAB the difference was statistically significant. Regarding to the background variables, receiving influenza vaccine in the past year, history of autoimmune diseases and past medical history of chicken pox showed a significant association with the number of vaccine doses received. Their effects on the outcome variables assessed with multivariate logistic regression analysis. Conclusion: The results of our study show that a booster dose of the COVID-19 vaccine enhances the antibody response.

COVID-19 vaccines are supposed to be critical measure for ending the pandemic. Governments had to decide on the type of vaccine to provide for their population. In this decision-making process, cost-effectiveness analysis is considered a helpful tool. This study is a cost-effectiveness analysis utilized to calculate the incremental cost per averted disability-adjusted life year (DALY) by vaccination compared to no vaccination for different COVID-19 vaccines. The incremental cost-effectiveness ratio (ICER) for a vaccination with COVID-19 vaccines was estimated at 6.2 to 121.2 USD to avert one DALY and 566.8 to 10,957.7 USD per one death. The lowest and highest ICERs belong to Ad26.COV2.S and CoronaVac, respectively. Considering the scenario of Iran, vaccines that are recommended include ad26.cov2.s, chadox1-S, rAd26-S + rAd5-S, and BNT162b2 in the order of recommendation.

Background: Cupping is one of the most common traditional medical procedures in Iran, which is widely used and prescribed from long time ago. Putting a cup on the skin with induction of negative pressure, causes an artificial inflammation with collection of some body fluids under the skin which can be extracted by scarification. Different mechanisms and effects are attributable to cupping based on several assumptions and theories. Regarding to the vast use of this traditional therapeutic method and relatively different point of views about the effects of cupping, this study was performed to systematically assess published studies in this field and also to find probable indications of cupping. Methods: In this systematic review, according to search via Google Scholar, PubMed, Scopus databases and Iranian databases (IranMedex and SID), 99 different scientific articles about cupping and it`s positive and negative effects were assessed. Different diseases categorized in 19 groups according to the pathophysiology and organ similarities for better presentation Results: More than 50 different disorders have been studied in randomized or nonrandomized clinical trials. 84.9% of reviewed papers have reported significant positive effects of cupping. The most common disorders studied in the reviewed papers were musculoskeletal, pain and skin disorders, especially low back pain has been studied more with positive results of cupping. Conclusion: In Iran the prevalence of cupping performance is really high. The reported positive effects and also complications especially infection were also dramatic. It seems performing systematic studies on cupping effects in different disorders and designing and implementing an active surveillance system for cupping in our country is essential. According to the type of studies, authors concluded that cupping have been reported as an effective intervention for some diseases such as musculoskeletal and skin disorders, but further methodologically elaborated studies with larger sample sizes should be considered for recommending this intervention scientifically.

Background: Thyroid carcinoma is the most common malignancy of the endocrine system. Papillary thyroid carcinoma (PTC) is the most common type of thyroid cancer, accounting for 70–90% of well-differentiated thyroid malignancies. Thyroid papillary microcarcinoma is a subtype of papillary carcinoma that included tumors with less than 10mm diameter. As a result of diagnostic methods improvement, prevalence of this tumor is increasing. In this study we reviewed different characteristics of tumor. Methods: We searched various factors about this tumor in different databases (PubMed, Ovid, Google scholar, Iran medex and SID databases,July 2012 till August 2013), after that the articles were classified. Data of each article were extracted and sorted in tables.Data of each factor in different articles were summarized. Results:Etiology, clinical presentation, prognosis, histopathology, follow-up, diagnosis and also age, gender, tumor size and treatment were factors about this tumor described in details here. Conclusion: Awareness and better understanding of the characteristics of this tumor and manage it as an individual and valuable tumor can take an effective step in promoting public health practice.

Memory regulatory T cells (Tregs) has been demonstrated to produce IL-17 in Psoriasis. Forkhead box P3 (Foxp3) has been demonstrated not to be reliable marker to evaluate Treg cells. Effector CD4+T cells also express Foxp3 after activation. Human T helper-17 cells (Th-17) express high level of surface CD26, while regulatory T cells are CD26 negative or low and this phenotype is stable even after activation of Treg cells. In this study, we aimed to analyze IL-17 producing Treg cells using CD26. Memory T cells were isolated from 10 patients with psoriasis and 10 controls. Ex vivo stimulated IL-17 producing regulatory (Forkhead Box P3 (Foxp3)+CD25+CD26-/low) and effector (Foxp3+CD25+CD26hi) memory T cells were analyzed by flow cytometry. IL-23, IL-6, TNFα, TGFβ and IL-17 cytokine levels were also evaluated. No significant difference in IL-17+memory regulatory T cells was seen between patients and controls (p=0.19). A significant decrease in the percentage of IL-17 producing CD26hi effector memory T cells was observed in patients (p=0.04). However, the percentage of these cells was not different between patients with mild or severe form of psoriasis compared to controls (p=0.13). We could not find any significant difference regarding IL-23, IL-6, TNFα, TGFβ and IL-17 cytokine levels in plasma and cell culture supernatant samples between patients and controls. Taken together, our results showed a reduced IL-17 producing effector memory CD26hi T cells in patients with psoriasis compared to controls. However, IL-17 producing memory regulatory CD4+T cells of patients showed no significant difference from that of controls.

Background: Smoking is known as the most important preventable risk factor for morbidity and premature death. It is the fourth risk factor attributable to burden of disease globally. Because of the misconception that waterpipe is less harmless than cigarette and also less socially prohibited, people smoke waterpipe more. Studies showed that tobacco consumption rate is increasing among adolescents and it`s initiation age has been declined. The aim of current study was the assessment of the prevalence of different types of tobacco use among students aged between 14 to 18 year old in Tehran. Also we had a comparison with similar studies. Methods: In this cross-sectional study 2877 students between May and July 2014 have been assessed. Samples were collected from language institutes and “Farhangsara”s according to stratified cluster sampling based on the educational zones in Tehran. A structured questionnaire was used for different types of tobacco use habit assessment. Because of sampling method, data analysis was done with complex sample survey analysis in SPSS, ver. 20 (Chicago, IL, USA) and Stata, ver. 12 (College Station, TX, USA) software. P-values less than 0.05 considered as statistically significance. Results: Among participants 11.5% (10.8%-13.3%) had cigarette smoking experience. The prevalence of current cigarette smoking was 4.4% (3.7%-5.3%). 1.4% (0.9%-2.2%) of girls and 7% (5.7%-8.5%) of boys were current cigarette smokers (P< 0.001). Waterpipe smoking experience prevalence was 41.5% (39.7%-43.4%) in total, 41.7% (39.2%-44.2%) in girls and 41.4% (39.2%-44.2%) in boys. Current waterpipe smoking was reported in 25.7% (24.1%-27.4%) of students with no statistically significant difference between boys and girls. Pipe smoking experience prevalence was 3.9% (3.2%-4.7%) and it was more frequent in boys. Conclusion: Cigarette smoking was significantly higher among boys than girls, while waterpipe smoking prevalence showed no difference. In addition, smoking prevalence was higher among students who had smoker parents or smoker friends and also had a bad economic status. It seems that specific interventions should be considered to reduce tobacco burden in adolescents specially in regard to cigarette and waterpipe smoking.

Background & Aim: There are some ambiguities in assessment of associations between continuous risk factors and different health outcomes usually from different cut points. Data loss, near to the cut point values different categorization, and no real definition of risk are important limitations for usual odds ratios (ORs). Fuzzy method considers a specific membership function for all numbers in range of the variable and can provide a similar OR. In this study, we used a large data set for these different measures calculation and making a comparison between them according to their privileges. Methods & Materials: The study was conducted on noncommunicable diseases risk factors surveillance data set (National Surveillance of Risk Factors of Non-Communicable Diseases-2007) with regard to obesity and abdominal (central) obesity as risk factors for hypertension according to a “fuzzy risk factor” approach and usual approach based on regular cut points in different literature. OR of chances to have hypertension calculated by both methods and compared with each other. Results: ORs with usual and fuzzy methods of calculations had similarities and some differences in amount, confidence interval and confidence length. With different cut points (for waist circumference), variation between different calculations was high. Fuzzy OR was more sensitive and resistant to minor change in individual data than the others. Conclusion: OR{Fuzzy} measures the association of exposure to risk factors with different outcomes in a closer form of clinical reality with no dependency to any cut point selection, less variability and more resistance to data variation and can be suggested as a good estimator.

The present study aimed to evaluate the distributions of High-Sensitivity C-reactive protein, TC-HDL ratio and 10-year risk of cardiovascular diseases among Iranian adult population. We conducted a cross-sectional study on a total of 2125 adults aged 25 to 65. Data of the Third National Surveillance of Risk Factors of Non-Communicable Diseases (SuRFNCD-2007) was used. Anthropometric indices, blood pressure and biochemical measurements had been obtained. Ten-year risk of cardiovascular events was also calculated using different models. Median (interquartile range) and geometric means (95% CI) of hs-CRP were 5.1(3.9) and 4.1(4.38-4.85), respectively. Mean TC-HDL ratio±(SD) was 5.94±2.84 in men and 5.37±1.97 in women (P

Background: Health literacy is an important issue in public health and defined as the cognitive and social skills of an individual that determine his/her ability to obtain, access, understand, and apply health information. As the area of social determinant of health and structure content of the questionnaires, such as the perception of health and the health status of people, were neglected in the previous reviews, the present study was conducted to review and compare Health literacy questionnaires, which have domains in these areas, in English and Persian languages. Methods: We reviewed the most famous health literacy questionnaires designed and validated in English and Persian languages published in PubMed, Google Scholar, Ovid, Scientific Information Database, and Barakat Knowledge Network System. After removing repetitive articles, the remaining articles were studied and the questionnaires were qualitatively analyzed. Results: More than 31 well-known English and Persian questionnaires and articles were included in the present review. Among these tools, 17 questionnaires had a section on understanding and comprehension and 14 had calculation and analysis in addition to comprehension. Among the 31 questionnaires, three questionnaires had some items about social determinants of health and 12 had some items about perception of health. According to our study, the questionnaire that covers all areas of health literacy as well as social determinants of health is the HLS-EU-Q, which has been translated into different languages. Conclusion: Since health literacy levels are related to many social determinants of health, the HLS-EU-Q can be used for health literacy evaluation as a strong predictor of a person’s health status.

Background: Tobacco smoking has been a major health concern for many years. People's awareness of the potential health hazards and government policies might change its pattern and prevalence of use. In order to monitor its conversion, determining the overall pattern of tobacco use and trend analyses would be crucial, which were aimed in the present study. Methods: Patterns of smoking in four national surveys conducted in years 2000, 2005, 2007, and 2011 with 33300, 89337, 5287, and 8837 participants, respectively, were assessed. Current status of cigarette, pipe and water-pipe smoking, the number of cigarettes used per day, and the age of smoking initiation were major parameters. After weighting based on province, residential area, gender, and age group, trend analysis was done through complex samples general linear model using IBM SPSS Statistics for Windows, Version 20.0. The values in the first survey (2000) were considered as reference points and categories. Results: While current cigarette smoking prevalence has been decreased (13.5% in 2000 to 11.3% in 2011) P

Objective(s):Pantoprazole, is a proton pump inhibitor (PPI) prescribed for the treatment of upper gastrointestinal disorders, which in high doses has been suggested to decrease calcium absorption leading to hypocalcaemia and therefore osteoporosis. The aim of this study was to assess whether pantoprazol, could alter the rate of orthodontic tooth movement (OTM) in rats. Materials and Methods: A time course study was established using 72 rats which were divided into six groups of 12 samples each (four: vehicle; eight: pantoprazole + vehicle). Pantoprazole at a dose of 200 mg/kg suspended in carboxymethyl cellulose (0.25 percent) was administered by a gastric tube. The upper incisors and first molars were ligated by a 5 mm nickel-titanium closed-coil spring to deliver an initial force of 60 g. Animals were euthanized two weeks after orthodontic treatment followed by assessment of tooth movement and histomorphometric evaluation of the detached maxillae. Lateral skull radiographs were obtained once a week, starting from the first day to the 6th week of the study. OTM and bone density data were analyzed using independent sample t-test and repeated measures ANOVA. Results: No significant changes in OTM measurements and optical density were observed in vehicle-receiving animals during the study (P=0.994). OTM was significantly increased after six weeks pantoprazole therapy which continued until the 7th week of the experiment (P=0.007). Optical density significantly increased in the pantoprazole-treated rats after six weeks. Conclusion: Long term PPI therapy at high doses could lead to osteoporosis and enhanced OTM.

Background and aim: Health Care Associated Infection (HCAI), especially nosocomial infection (NCI) in intensive care units (ICUs), has remained a major cause of mortality and morbidity. In this study, the rate of HCAI and the factors associated with both NCIs and deaths in ICUs were assessed in a large teaching hospital complex in Tehran, IR Iran. Materials and methods: In this cross sectional study, 300 patients hospitalized in six different ICUs of a large teaching hospital located in Tehran were assessed from January to March 2013. Nosocomial infection was defined as the presence of clinical signs and symptoms of infection in patients at least 48 h after their hospitalization, confirmed by positive cultures of specimens taken from the patients’ blood, urine, wounds, respiratory secretions and other body fluids. The risk factors of NCIs were assessed by a researcher – produced checklist consisting of 109 questions. Results: According to the findings, NCIs were observed in 59 (19.7%) (CI 95% = 15.2–24.2%) patients and the overall mortality rate was 23 (7.7%) (CI 95% = 4.7–10.7%), and the highest infection rate belonged to general ICU-1. The factors associated with the higher rate of NCI and/or mortality were as follows: lower education levels, increased length of stay in ICU, increased duration of antibiotic use, combined antibiotic therapy, long time inserted catheters, anemia, and immunosuppression or chronic diseases. Multivariate analysis showed an independent statistically significant association between prolonged urinary catheterization and both NCIs and deaths. Conclusion: It seems that patients with prolonged catheterization are prone to NCIs and deaths, so they should be treated intensively.

Background: The mortality due to Coronary Artery Bypass Graft (CABG) in patients with chronic renal failure is more common than normal population. This study evalu-ates the impacts of prophylactic dialysis on decreasing mortality and morbidity of non- dialysis-dependent patients with renal failure after CABG surgery. Methods: In this study, fifty non-dialysis-dependent patients who were suffering from renal failure and needed to CABG, were selected by convenience sampling method. Se-quentially, they were allocated to prophylactic dialysis (n=20) and no prophylactic dialysis (n=30) groups, using a randomized block design. Exclusion criteria were under 18 year old patients and doing CABG for second time. Mortality rate and some complications such as acute renal failure, brain accident and atrial arrhythmias were compared between two groups after CABG. All cardiac surgeries were performed in a single centre and through a median sternotomy. P value less than 0.05 was considered as significant. Results: The mean age of patients was (65.3±9.9). The patients included %16 (n.8) of women and %84 (n.42) of men. There were 20 patients in intervention and 30 patients in control groups. Baseline characteristics were similar in two groups. Comparison be-tween intervention and control groups after surgery did not show any difference in mortality (P=0.14), acute renal failure (P=0.4), cerebrovascular accidents (P=1) and atrial arrhythmias (P=0.3), need to second surgery due to bleeding (P=1), need to dialysis (P=0.14), need to rehospitalization (P=1), duration of ventilator use (P=0.4), duration of need to hospitalization (P=0.11), duration of a patients stay in the Intensive Care Unit (P=0.4) and deep sternal infection (P=0.7) rates. Conclusion: According the results of this study, prophylactic dialysis, before conduct-ing CABG, does not have any significant effect on mortality and other complications. The only exception is lung complications in non-dialysis-dependent patients with renal failure.

Background: Colorectal carcinoma is considering as a curable disease. Treatment of recurrent cases is hard and sometimes impossible. Evaluation of the rate and affecting factors of recurrence in each hospital would help to decreasing recurrent cases. The aim of this study is evaluation of the rate, clinical and pathologic features, and outcome of recurrent colorectal carcinoma in a referral teaching hospital in Tehran. Methods: Clinical data of 166 curative resections of colorectal carcinoma who were operated between Mehr 1384 and Mehr 1388 (between 23 September 2005 and 23 September 2009) in Imam Khomeini Hospital and were accessible for follow up was collected. Follow up data was collected prospectively up to Farvardin 1391 (19 April 2012). Forty nine recurrences were happened in this period. We compared recurrent and non-recurrent cases for different variables Results: Average age of the patients was 53.5 years, and 47% of them were female. The median time to the diagnosis of recurrent disease was 12 months (range 1 months to 54 months). There were no significant differences between recurrent and non-recurrent patients about age, sex, sub-site of the tumor and sub-type of primary operation. Rate of overall recurrence, local recurrence and distant metastasis were 29.5%, 15.7% and 12.1% respectively. Local recurrence rate was higher in colon cancer (16.44% vs. 15.05%) but distant metastasis rate was higher in rectal cancer (12.9% vs. 10/96%). Rate of curative re-resection was about 25%. Overall survival of the recurrent patients who underwent surgery was better than who underwent chemo or radiotherapy (66.7% vs. 56.8%). Median survival time of recurrent patients after primary surgery was 28 months, and after diagnosis was 12 months (9.28- 14.72,95% CI). Conclusion: In this study the rate of overall recurrence was 29.5%. Local recurrence rate was higher in colon cancer (16.44% vs. 15.05%) but distant metastasis rate was higher in rectal cancer (12.9% vs. 10/96%).

Objective:Childhood aggression may lead to severe social disorders in adolescence and adulthood. Different psychiatric approaches are focused on preschool aged aggressive children. The aim of this study was to estimate the prevalence and associated factors of childhood direct and indirect aggression Methods:In this cross sectional study a total of 1403 children attending 43 kindergartens were assessed. Data were collected through a structured 46-item questionnaire investigating symptoms of physical, verbal and relational aggression which was completed by parents and teachers of day-care centers. Complex sample survey analysis and multivariate logistic regression method were used for data analysis. Results:According to parents’rating, the prevalence of physical ,verbal and relational aggression, was 9.9% (95% CI=7.4%-12.4%) , 6.3% (95% CI=5.0% -7.6%) and 1.6% (95%CI=1.0%-2.2%), respectively; while based on teachers’ rating the prevalence of physical ,verbal and relational aggression were 10.9% (95% CI=8.9% -12.9%), 4.9%(95% CI=3.8% - 6.0%) and 6% (95% CI=4.4% -7.6%), respectively. A wide range of family environment factors including living with a single parent, having a working mother, death of someone close to the child, and having less educated mother were significantly associated with different types of aggression; additionally, there was some evidence of a relationship between sex of the children and physical aggression, after controlling for other variables (p

Objective: Pharmacists have a remarkable role in rational use of drugs by dissemination of drug information to guide patients, physicians, and policy makers. The present study was undertaken to evaluate the pharmacists′ view point about the main factors affecting current drug use pattern regarding rational drug use and the most effective strategies for improving and promoting rational drug use among pharmacists. Methods: In a cross-sectional survey, pre-designed questionnaires were filled in convenient sampling by pharmacists who had attended the congress of rational drug use in Tehran, Iran. Findings: A total of 144 pharmacists with the average age of 40.78 years old were enrolled to the study. Data indicated that the most priorities in irrational use of drugs from pharmacists′ view point were lack of appropriate cooperation and communication between physicians and pharmacists (39%), pharmacists′ low tariff and economic issues (34%), lack of public knowledge about drug usage (45%), and lack of supervisory regulations on pharmacy practice (15.8%). Conclusion: In this study, lack of public knowledge and awareness about appropriate use of medicines was the most important element from pharmacists′ viewpoint in occurrence of irrational drug use. Dissemination of information and compiling of diverse strategies in education, management, regulation, and finance can be very efficient due to a strong relationship between drug policies and performance of regulations and supervisions as well as drug services.

Background: We aimed to create a shortened form of the Champion Health Belief Model instrument which is a widely used questionnaire about breast cancer screening behaviors with acceptable validity and reliability. Methods: The Persian version of the Champion Health Belief Model (CHBM) instrument consists of 57 items in 8 concepts. The subjects of the study were 40 female faculty members and 34 nurses of Tehran University of Medical Sciences in 2014. Based on the results, the most influential questions in each concept were chosen and then analyzed for internal consistency and the mean scores of the concepts were compared to the original questionnaire. Next, the original form was delivered to a different population. The mean scores of each concept were compared between original and short forms. At last, the same second population was asked to fill in the shortened form in a two-week interval and a test re-test comparison was done. Results: In the first step, out of 57 items in the original questionnaire, 28 items were selected based on their influence on the mean score of each concept. In 40 female faculty members who were all above 40, all of the Cronbach’s alphas for all subscales were above 0.6 (ranging from 0.624 to 0.830) in the shortened form questionnaire; although they were lower than the original form. There were no significant differences between short and original questionnaires in terms of mean subscale scores. In the second step, in the second population including 34 female nurses aged over forty years in a university medical center, there was again no significant statistical difference between the 28-item and 57-item instruments. In the third step, two weeks later, the completed shortened questionnaire among 20 subjects of the same population of the nurses showed similar results, indicating the reliability of the newly design shortened form of the questionnaire. Conclusions: The shortened 28-item form of the CHBM instrument seems to be both valid and reliable, and less time-consuming. Its results can be comparable to other studies that used the standard form.

Background: Insulin-like growth factor-1 can act in both an autocrine and paracrine manner to promote normal growth and malignant cellular proliferation. The importance of this factor as a major regulatory peptide has been established for cells, in vitro and in vivo. However, the role of serum insulin-like growth factor-1 levels in the etiology of benign prostatic hyperplasia and prostate cancer has not received sufficient attention. The aim of this study was to determine the relationship between benign prostatic hyperplasia, prostate cancer, and serum insulin-like growth factor-1 levels.Methods: We collected blood samples from 68 individuals with prostate cancer (cases) and 68 individuals with benign prostatic hyperplasia (controls) who were patients at Imam Khomeini Hospital in Tehran, Iran. Those with benign prostatic hyperplasia had normal prostatic specific antigen levels 0.05). Mean serum insulin-like growth factor-1 levels were 219 ng/ml for the case group and 133 ng/ml for the control group, which was significant (P=0.0009). We did not observe any correlation between age and insulin-like growth factor-1 in the case group (P=0.83, r= -0.47), however there was a significant correlation in the control group (P=0.007, r=0.549). Although correlation between prostate volume and serum insulin-like growth factor-1 levels was not statistically significant in the case group (P=0.38, r=0.213), therewas a positive correlation observed in the control group (P

PURPOSE: To measure the level of inter/intra-observer reproducibility among pathologists as far as Gleason scoring of adenocarcinoma of the prostate is concerned. MATERIALS AND METHODS: A total of 101 prostate biopsy slides, diagnosed with adenocarcinoma of the prostate by five pathologists from different education centers, were exposed to Gleason scoring. Two months later, the slides were re-examined by three of the same pathologists. Thereafter, the kappa was calculated for the data provided in the first and second reports of each pathologist and compared between pathologists. RESULTS: Inter-observer reproducibility was inappropriate, but intra-observer diagnostic reproducibility was almost perfect with a corresponding percentage of agreement of 85.2%. CONCLUSION: The inter-observer reproducibility was poor.

Introduction: We evaluated the safety of sterile water as an irrigation solution for percutaneous nephrolithotomy (PCNL). Materials and Methods: Forty-four patients with kidney calculi were enrolled in this study and randomly divided into two groups for PCNL. Approaches to the calculi were through a single subcostal access with an Amplatz sheath, and either sterile water or isotonic saline solution was used as the irrigation fluid. Serum hemoglobin, haptoglobin, sodium, potassium, and creatinine were measured before and 12 hours after the procedure. The patients were evaluated for signs of transurethral resection of the prostate syndrome during the operation for 24 hours afterwards. Results: The mean calculus size, irrigation volume, irrigation time, and age were not significantly different between the two groups. Hemolysis occurred in 10 and 9 patients in sterile water and saline groups, respectively. The mean change in haptoglobin level was -1.7 ± 59 mg/dL in the sterile water and 11 ± 55 mg/dL in the saline group. Also, the mean change in plasma sodium level was -2.2 ± 4.7 and -0.4 ± 3.8 in sterile water and saline groups, respectively. None of these values were significantly different between the two groups, nor were other laboratory values. None of the patients developed transurethral resection of the prostate syndrome or needed transfusion. Conclusion: Sterile water is an inexpensive alternative to isotonic saline for irrigation during PCNL. We did not find any difference between the two irrigation solutions regarding the safety; however, this should be confirmed further, especially for larger calculi.

Introduction: The aim of this study was to evaluate the frequency of sexual dysfunction among epileptic patients. Materials and Methods: Eighty married men between 22 and 50 years with a confirmed diagnosis of epilepsy were enrolled in this study. Patients with other neurological diseases, hypertension, cardiovascular diseases, diabetes mellitus, underlying urogenital diseases, and impaired general health status were excluded. Furthermore, those with mental health problems were identified by the standardized General Health Questionnaire-28 and were excluded. Demographic and clinical characteristics of the disease were evaluated, and sexual function was assessed by the self-administered questionnaire of the International Index of Erectile Function-15 (IIEF-15). Results: Of 80 patients, 34 (42.5%) had erectile dysfunction. There were no differences between the patients in the 3 age groups in the IIEF scores. Type of seizure had a significant correlation with erectile function score (P = .008). None of the IIEF domains scores were different between the patients with controlled epilepsy and those with uncontrolled epilepsy during the previous 6 months. However, frequency of epileptic seizures (before treatment) correlated with the scores for erectile function (r = 0.31; P = .005), orgasmic function (r = 0.23; P = .04), and sexual desire (r = 0.24; P = .03). Conclusion: It seems that the main aspects of sexual activity such as erectile function, orgasmic function, and sexual desire are frequently impaired in epileptic patients. Our findings were also indicative of a higher risk of sexual dysfunction in patients with partial seizures.

This study was aimed at determining intra and inter-observer concordance rates in the Gleason scoring of prostatic adenocarcinoma, before and after a web-based educational course. In this self-controlled study, 150 tissue samples of prostatic adenocarcinoma are re-examined to be scored according to the Gleason scoring system. Then all pathologists attend a free web-based course. Afterwards, the same 150 samples [with different codes compared to the previous ones] are distributed differently among the pathologists to be assigned Gleason scores. After gathering the data, the concordance rate in the first and second reports of pathologists is determined. In the pre web-education, the mean kappa value of Interobserver agreement was 0.25 [fair agreement]. Post web-education significantly improved with the mean kappa value of 0.52 [moderate agreement]. Using weighted kappa values, significant improvement was observed in inter-observer agreement in higher scores of Gleason grade; Score 10 was achieved for the mean kappa value in post web-education was 0.68 [substantial agreement] compared to 0.25 (fair agreement) in pre web-education. Web-based training courses are attractive to pathologists as they do not need to spend much time and money. Therefore, such training courses are strongly recommended for significant pathological issues including the grading of the prostate adenocarcinoma. Through web-based education, pathologists can exchange views and contribute to the rise in the level of reproducibility. Such programs need to be included in post-graduation programs.

One of the identified risk factors for anxiety disorders in adolescence and adulthood is inhibited behaviors in childhood. The present study sought to examine the relationship between behavioral inhibition with some of the internal (personal) and external (family environment) factors in a sample of preschool children in kindergartens. In a cross sectional study in 2009, data was collected trough a structured questionnaire completed by parents and teachers in day-care centers. A total of 1403 children were assessed. Analysis was performed through complex sample analysis. The results showed that 7.4% (CI95%= 6.1%-9.1%) of children according to parents' and 8.1% (CI95%= 6%- 10.7%) according to teachers' evaluation classified as behaviorally inhibited. The higher levels of behavioral inhibition were shown by girls, first children, single parent families and older children. Birth year before 2004, birth rank, living in a single parent family and maternal level of education were independent predictors for behavioral inhibition in logistic regression modeling. There is relatively high prevalence of inhibited behaviors among Iranian children. Further examination of diagnosed children with behavioral inhibition by experienced psychiatrists is needed. Also establishing consultation centers for behaviorally inhibited children and instructing their parents and teachers are recommended.

Buerger's disease or thromboangiitis obliterans (TAO) seems to be common in IR Iran, The present study aimed to evaluate an Iranian population with Buerger's disease in order to suggest a diagnostic criterion for Buerger's disease based on the most frequent findings and to compare it with Papa diagnostic criteria. In a cross-sectional study, all patients with resting limb pain, limb ischemic ulcers, intermittent claudication and limb ischemia who referred to the Vascular Clinic of Sina Hospital during 2009-2011 were evaluated. The patients were allocated to Buerger's and non-Buerger's groups; Evaluating 122 patients (61 in each group), according to the model each clinical manifestations and risk factors in the patients with Buerger's disease obtained a score. Absent pulsation, abnormal distal Doppler sonography and ischemic ulcer were respectively present in 58 (95.1%), 58 (95.1%) and 49 (80.3%) individuals with Buerger's disease. Multivariate linear regression analysis and multivariate logistic regression analysis were used for modeling. Considering the model finding findings, diagnostic criteria including age, sex, smoking, Raynaud's phenomenon, abnormal proximal Doppler, diabetes mellitus and hyperlipidemia were suggested (R2=0.582); the sensitivity and specificity of the criteria was respectively 95.1% and 78.7%. Compared with Papa criteria, Kappa coefficient was measured at 0.66 with a P-value

The purpose of the current study was to determine whetherinfiltration of bupivacaine in the incision site of midline laparotomyreduces postoperative pain and opioid consumption.Fifty-six, 30-60 year-old patients who were undergoing midlinelaparotomy were enrolled in the present study. The patientswere randomly assigned into two groups of control(group C, n = 28) or bupivacaine (group B, n= 28). Just beforesuturing, the incision sites were infiltrated by 20 ml epineprinatedbupivacaine 0.25% (group B) or 20 ml normal saline asplacebo (group C). The patients were asked to score their painat 6, 24, and 48 hours after surgery. Demographic characteristicsof the patients were similar in the two groups. There wasno significant difference in the mean of visual analogue scalepain scores measured over time between the two groups.There was a significant difference in post operativemeperidine consumption between the two groups, and in thebupivacaine group, meperidine request was less (90.53±13.36mg in bupivacaine group v127.5±23.14 mg in the controlgroup, P

Various questionnaires are used in patients who undergo rhinologic surgeries but a unique comprehensive questionnaire is needed to evaluate quality of life (QOL) in rhinologic surgeries. The purpose of this study was to prepare a comprehensive questionnaire and compare QOL among four common rhinologic surgeries including functional endoscopic sinus surgery, septoplasty, septorhinoplasty, and septoplasty with turbinoplasty preoperatively and 6 months postoperatively. This was a prospective interventional before-and-after study. Preoperative and 6 months postoperative evaluations were performed with a Modified Health-Related Quality of Life (HRQL) questionnaire designed to cover all needed QOL aspects and the 22-item Sino-nasal Outcome Test questionnaire to cover all needed QOL aspects. The Modified HRQL included 33 items in six subgroups (nasal symptoms, sleep problems, headache, nonnasal symptoms, and practical and emotional problems) and general feeling. From 202 patients who completed the questionnaire before the procedures, 146 (72% of all patients) who were interviewed 6 months postoperatively were included in this study. Comparing preoperative data between followed up patients and missed patients showed no statistical difference among surgeries (p = 0.90). Comparison of patient's pre- and postoperative QOL showed a significant improvement in global QOL and in all questionnaire items (p < 0.0001 in all comparisons). Comparison of QOL changes before and after surgery among different surgeries revealed no statistical difference (p = 0.282). Our data showed a significant improvement in each surgery but the amount of improvement in different surgeries was almost constant.