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Background and aims: Injection drug use is considered as an international public health threat that can lead to serious health-related outcomes. The aim of this study was to obtain a profile of injection drug users (IDUs) in Kermanshah, Iran, in 2017. Methods: This cross-sectional study was carried out on 606 male IDUs who were recruited from 2 drop-in centers in Kermanshah using a snowball sampling method. Continuous and categorical variables are expressed as the mean and standard deviation, as well as frequency and percentage, respectively. Results: The mean age of participants in this study was 36.7±8.51 years and at first drug injection was 29.35±8.04 years. In addition, the highest frequency of injection drugs belonged to heroin (99.00%), methamphetamine (86.00%), and opium (85.00%), respectively. However, the lowest injection drugs were opium syrup (0.50%), ecstasy (0.50%), and amphorphine (0.20%). Conclusion: Based on the findings of this study, heroin, methamphetamine, and opium had the highest frequency injection among male IDUs in Kermanshah, and the age of the first drug injection was low among these individuals. Accordingly, wider coverage prevention programs are highly recommended, including harm reduction programs, counseling centers with improved quality of services, treatment programs, and greater attention to human resource development-based counseling and education.

Background Managing the amount of use of sedatives due to their high side effects in the intensive care unit is essential. Sedation-agitation protocols may play an important role in this regard. However, they have not been practically applied in Iran. Aims This study aimed to evaluate the effect of using the Richmond agitation and sedation scale on hospital stay duration and dependency rate on the intensive care unit ventilator system in Ahwaz City, Iran, in 2016–2017. Methods This randomised clinical trial was conducted on 74 patients. The subjects were selected by a stratified sampling method and divided into the experimental ( n = 32) and control ( n = 32) groups. Sedation and agitation levels were managed by the Richmond agitation and sedation scale as soon as the samples were anxious and agitated, and every 6 hours in the intervention group. However, the control group received routine care. The data obtained were analysed by the Statistical Package for the Social Sciences (SPSS). Results There was no significant difference between the two groups in terms of demographic variables, such as age, gender, admission diagnosis and Glasgow coma scale scores on admission. However, they differed in terms of hospital stay duration and ventilator connection ( P Conclusions Based on the results of this study, as well as the approval of validation and reliability of the Richmond agitation and sedation scale in different studies, this protocol can be very effective in optimising the use of sedatives in the intensive care unit.

Background: Globally, the prevalence of HIV infection among People Who Inject Drugs (PWIDs) is higher than the general population due to high-risk behaviors. The aim of this study was to determine ...

Background: Sharing of injecting paraphernalia is known to contribute to hepatitis C virus (HCV) transmission amongst people who inject drugs.Objectives: In this paper, we identify the variables co...

Background End-of-life care education is required for nurses to acquire the clinical competence necessary for the improvement of the quality of end-of-life nursing care. The aim of this study was to determine the effect of nursing care education based on End-of-Life Nursing Education Consortium (ELNEC) on the knowledge and performance of nurses working in the intensive care unit (ICU). Materials and Methods This quasi-experimental, randomized, controlled trial was conducted with a pretest-posttest design. From among nurses working in the ICU of Golestan and Imam Khomeini hospitals in Ahvaz, Iran, 80 nurses were selected bsed on the inclusion criteria. They were randomly assigned to the intervention and control groups (40 people in each group) using a table of random numbers. Data were collected using a demographic characteristics form, the ELNEC Knowledge Assessment Test (ELNEC-KAT), ‎and the Program in Palliative Care Education and Practice Questionnaire (German Revised Version; PCEP-GR‎). Results A significant difference was observed between the study groups in terms of the average knowledge score in all 9 modules including nursing care, pain management and control, disease symptom management, ethical/legal issues, culture, communication with the patient and his/her family, loss and grief, death, and quality of life (QOL) (P < 0.001). Moreover, the average performance score of nurses in the fields of preparation for providing palliative care, self-assessment of ability to communicate with dying patients and their relatives, self-assessment of knowledge and skills in palliative care increased significantly in the intervention group compared to the control group (P < 0.001). Conclusions End-of-life nursing education is recommended as an effective method for promoting knowledge, attitude, performance, and clinical competence among all nurses involved in end-of-life care.

Background Non-alcoholic fatty liver disease (NAFLD) is a prevalent chronic liver diseases. The aim of this study was to evaluate the effect of combined weight loss diet and cranberry supplementation on inflammatory, antioxidant and apoptosis biomarkers in patients with NAFLD. Methods In this randomized, double-blinded, controlled clinical trial, 41 NAFLD patients were supplemented with either a 288-mg cranberry tablet or a placebo tablet for 12 weeks. Both groups followed a diet of 500–1000 calories less than the estimated energy requirements. Serum levels of Total antioxidant capacity (TAC), Malondialdehyde (MDA), Cytokeratin 18-M30 (CK-18 M30), Chemokine C-C motif ligand 2 (CCL2) and Tumour necrosis factor alpha (TNF-α) were measured at both baseline and the end of the study. Results Significant improvements in TAC were observed in the cranberry group and between the two groups (p = 0.006 and p = 0.011 respectively), but the changes in the placebo group were not significant (p = 0.325). There were no statistically significant differences in the serum levels of MDA, CK-18 M30, CCL2 and TNF-α between the cranberry and the placebo groups (p > 0.05). Conclusions It seems that daily consumption of cranberry supplement would be beneficial in increasing serum levels of TAC. Further studies are needed to investigate the effects of anti-inflammatory and antioxidant properties of cranberry on NAFLD. Trial registration : Iranian Registry of Clinical Trial. http://www.irct.ir: IRCT20150124020765N2, January 2019.

Background: Urinary tract infection is one of the most common bacterial infections in children. Zinc is the second most abundant mineral in the body involved in the growth, cell division, and regulation of immune system activity. In studies, zinc administration has been effective in improving pneumonia and gastroenteritis in children, and today, zinc is used to treat acute gastroenteritis in children. Due to the increasing use of various supplements in children and the importance of urinary tract infection and its complications in children. Objectives: This study was performed to compare serum zinc levels between children with febrile urinary tract infection and healthy children. Methods: In this case-control study, serum zinc was measured in 60 healthy children and 60 children with febrile urinary tract infection, without any underlying disease, by an Auto analyzer. Data were analyzed by SPSS version 22 software. Results: The difference in serum zinc levels between the two groups was not statistically significant. There was no statistically significant difference in zinc deficiency between the groups. Serum zinc levels were not associated with sex, age, frequency of urinary tract infection, the severity of leukocytosis, the severity of ESR increase, CRP, and length of hospitalization. In the age group of 24 - 72 months, a significant linear relationship was observed between serum zinc levels and weight. The incidence of urinary tract infections was higher in girls, and this difference was statistically significant in all groups, except in age groups 6 - 12 months and above 72 months. Conclusions: This study showed that low serum zinc levels did not increase the risk of febrile urinary tract infection in children. Therefore, prescribing zinc supplements to treat or prevent urinary tract infections requires further studies.

Background: Hepatitis C virus (HCV) infection is global health problem with an estimated 415,000 deaths in 2015. The objective of this study was to explore the direct and indirect effects o...

Background: Blood exchange transfusion (ECT) therapy is an essential part of the modern health care for high-risk icteric neonates. Objectives: Therefore, this study sought to examine the effectiveness of monitoring sodium disorders and the required interventions indicating the overall state of health of hospitalized jaundiced neonates. Methods: This prospective analytic study was performed on 49 neonates diagnosed with severe jaundice undergoing screened exchange blood transfusion from November 2018 to May 2019. Serum sodium ion concentrations testing was performed before the exchange, then 1 - 3 hours later, and again 24 hours after receiving ECT, using a sensitive ELISA kit in a laboratory. Using the newest version of SPSS 24 software program, the association between different numerical variables was calculated by a repeated-measure ANOVA test. P < 0.05 criterion was set as the threshold of significance. Results: Out of the total 49 neonates, 24 (48.5%) were girls and 25 (51.5%) were boys, of which 93.9% and 6.1% were term and preterm-born neonates, respectively. The average birth weight was 2843 ± 267/510 g and the mean period of hospital stay was 4.55 ± 2.399 days. The various causes of severe neonatal jaundice of all the hospitalized cases were 45% unknown, 43% combined ABO and Rh incompatibility, 10% breastfeeding pattern, and 2% G6PD deficiency. A continual fall in serum sodium was observed following banked blood exchange (P < 0.05). However, these reversible changes were outside the expected normal range. Despite a diminished sodium concentration, the mean sodium levels were within the laboratory reference range of serum (137 - 142 mEq/L) in all the three measured duration times. Moreover, variation in the amount of serum sodium was associated with an unknown underlying cause that led to neonatal jaundice (P = 0.04) and this difference did not reach statistical significance in terms of birth weight, gestational age, and other causes accounting for high bilirubin (P > 0.05). Conclusions: Given these facts, it was concluded that neonatal jaundice was significantly associated with post-exchange serum sodium changes within the laboratory reference range of serum.

Objective: Although comorbidity of psychotic disorders and substance use can lead to increase in mortality, less is known about the outbreak and predictors. Psychotic patients tend to be overlooked during assessment; hence, the possibility of an undertreated or missed condition such as increasing substance use. This investigation aimed to measure the prevalence of substance use in psychotic patients and to survey the powerful predictors. Method: In a 1-year cross-sectional study, 311 psychotic patients were assessed using the Structured Interview Based on DSM-5 for diagnostic confirmation as well as questions surveying prevalence and possible predictors of substance use. Results: Prevalence of substance use among psychotic patients was 37.9%. Several variables were identified as factors associated with drug abuse among the psychotic patients. These included male gender, younger age, being currently homeless, a history of imprisonment, and having family history of drug use. The strongest predictors of substance use, however, were family history of drug use, male gender, and being currently homelessness. Conclusion: Policymakers should note the importance of substance use among psychotic patients. Developing active screening strategies and comprehensive preventive plans, especially in the high-risk population, is suggested.

A double-blind placebo-controlled randomised clinical trial was conducted on 41 patients with non-alcoholic fatty liver disease (NAFLD). Participants were randomly allocated to receive either a cranberry supplement or a placebo for 12 weeks. Both groups were assigned to follow a weight loss diet. At the end of the study, alanine aminotransferase and insulin decreased significantly in both groups (

Background. Infection with intestinal parasites is widespread worldwide, especially in developing countries. Intestinal parasites are known as one of the leading causes of diarrhea in both immunocompetent and immunocompromised subjects, but cancer patients are highly susceptible to contamination, and it can be deadly for them. This study aimed to estimate the prevalence of intestinal parasites in immunocompromised patients in Ahvaz. Material and Methods. In this descriptive cross-sectional pilot case-control study, fecal samples were collected from 52 children with malignancies hospitalized in Baqaei2 hospital in Ahvaz. A questionnaire including demographic information, type of cancer, type of gastrointestinal symptoms, and laboratory diagnosis was completed for each patient. The collected specimens were examined by direct smear, Logul staining, and concentration. Result. The 52 stool samples were collected, 46% were female and 54% male. The age range of children enrolled in the study was from 4 months to 16 years. Of these stool samples, 38.38% were infected with a variety of parasitic intestinal infections (helminths and protozoa). In this study, protozoan parasites, Blastocystis (23%), Chilomastix mesnili (1.92%), Endolimax nana (7.7%), and Entamoeba coli (1.92%), and helminth infection, Strongyloides stercoralis (3.84%), were observed and statistical analysis showed that there was a significant relationship between gastrointestinal symptoms and parasitic infection in children with cancer. Conclusion. Blastocystis and Endolimax nana are the most prevalent gastrointestinal parasitic protozoans that infect individuals admitted to Baqaei2 Hospital of Ahvaz, Iran. Since parasitic intestinal infections in immunocompromised patients lead to fatal diarrhea, children with parasitic infections must be carefully identified and treated.

In this study, the therapeutic efficacy of quercetin in combination with remdesivir and favipiravir, were evaluated in severe hospitalized COVID-19 patients. Our main objective was to assess the ability of quercetin for preventing the progression of the disease into critical phase, and reducing the levels of inflammatory markers related to SARS-Cov-2 pathogenesis. Through an open-label clinical trial, 60 severe cases were randomly divided into control and intervention groups. During a 7-day period, patients in the control group received antivirals, i.e., remdesivir or favipiravir, while the intervention group was treated with 1000 mg of quercetin daily in addition to the antiviral drugs. According to the results, taking quercetin was significantly associated with partial earlier discharge and reduced serum levels of ALP, q-CRP, and LDH in the intervention group. Furthermore, although the values were in normal range, the statistical outputs showed significant increase in hemoglobin level and respiratory rate in patients who were taking quercetin. Based on our observations, quercetin is safe and effective in lowering the serum levels of ALP, q-CRP, and LDH as critical markers involved in COVID-19 severity. However, according to the non-significant borderline results in comparing the mortality, the ICU-admission rate, and the duration of ICU-admission, further studies can be helpful to compensate the limitations of our study and clarify the therapeutic potential of quercetin in COVID-19 treatments.

Background: In Iran there are limited data regarding HIV risk perceptions among people who inject drugs (PWID). The objective of this study was to explore HIV risk perception and to examine factors...

Understanding and increasing awareness on individual risk for HIV infection as well as HIV risk perception’s effects on different behavioral outcomes for people who inject drugs (PWID) is important for policymaking and planning purposes. The objectives of the present study were to determine whether HIV risk perception was associated with greater injection and sexual risk-taking behaviors among PWIDs. We surveyed 460 PWID in Kermanshah regarding their demographic characteristics, sexual risk behaviors, HIV risk perception, and drug-related risk behaviors in the month prior to the study. Three classes of HIV risk perception were identified using ordinal regression to determine factors associated with HIV risk perception. Study participants were categorized as follows: “low” (n = 100, 22%), “moderate” (n = 150, 32%), and “high” (n = 210, 46%) risk perception for becoming infected with HIV. The odds of categorizing as “high” risk for HIV was significantly greater in PWID that reported unprotected sex (adjusted odds ratio (AOR) 2.4, p value 0.02), receptive syringe sharing (AOR 1.8, p value 0.01), and multiple sex partners (AOR 1.4, p value 0.03). PWID who reported unprotected sex had 2.7 times the odds of “high” risk perception when compared to PWID with “low” risk perception. Findings show that PWID could rate their HIV risk with acceptable accuracy. Additionally, perceived HIV risk was associated with many risk factors for transmission of HIV, emphasizing the importance of developing targeted prevention and harm reduction programs for all domains of risk behaviors, both sexual and drug-related use.

Introduction: Due to the complexity of the situation and rapid changes in patients' clinical status in intensive care units, it is necessary to teach decision-making skills to nurses, alongside critical thinking. The aim of this study was to evaluate critical thinking training by using critical thinking cards on clinical decision-making of nurses in cardiac care units (CCU). Methods: In this quasi-experimental study, 74 CCU nurses from the selected hospitals affiliated to Ahvaz and Dezful Universities of Medical Sciences were selected based on the inclusion criteria and were assigned to either the intervention or the control group by using permuted block randomization. The data were entered into SPSS V22 and analyzed. Results: There was no statistically significant difference between the demographic characteristics of the two groups (P < 0.05). The mean total score of nurses' clinical decision-making before training sessions in the intervention group was calculated to be 141.59 ± 10.76, which was lower compared to a score of 148.56 ± 10.95 in the control group (P = 0.011). Therefore, covariance analysis was used to modify the results. The mean total score of nurses' clinical decision-making after the training in the intervention group was calculated as 163.82 ± 8.83, indicating a significant increase compared to a score of 154.50 ± 11.25 in the control group (P < 0.001). Conclusion: The findings of the present study show that the education of critical thinking by using the critical card tool leads to improved clinical decision-making in CCU nurses.

Background The transition from non-injection to injection drug use dramatically increases the risk of transmitting HIV and other blood borne infections including hepatitis B virus (HBV) and hepatitis C virus (HCV). The aim of this study was to explore factors associated with the transition from first illicit drug use to first injection among drug users. Methods Using snowball sampling and convenience sampling through needle and syringe programmes (NSPs), we recruited 500 people who inject drugs (PWID) in Kermanshah, between September and December 2014. Trained interviewers collected data on socio-demographic characteristics, HIV testing and drug-related risk behaviors over the last month prior to interview using a structured questionnaire. Our main outcome variable was first illicit drug use to first injection (TIJ). TIJ was calculated by subtracting age at first drug injection from age of first illicit drug use. Results Overall, the average age at first drug use and injection were 21.4 [standard deviation (SD 5.6)] and 22.8 (SD 8.9), respectively. The average duration of injection was 6.0 (SD 4.6) years. Overall, the mean of TIJ for participants was 1.4 (IQR = 2, 4) years. Age of first injecting drug use negatively correlated with TIJ (R 2 = 0.219, p = 0.001). Education level and socioeconomic status (SES), and negatively correlated with TIJ. Conclusion Some demographic factors and drug use characteristics including educational level, SES, knowledge of HIV status, age of initiating drug use, being a poly drug user and using methamphetamine were predictors of the time to transition.

Background: Infection with hepatitis C virus (HCV) is increasingly recognized as a major global health problem. Objectives: The aim of this study was to measure the prevalence of HCV infection and determine the risk factors associated with HCV among male people who inject drugs (PWID) in Kermanshah, Iran. Methods: In this cross sectional study, the samples were recruited from 2 drop-in centers and related community outreach sites, using snowball sampling. The questionnaire consisted of 3 sections, including demographics, drug use patterns, and risky behaviors. HCV infection was tested in venous blood samples, collected from the participants, using the ABON rapid test kit. Logistic regression analysis was used to determine the association between HCV status and the associated factors, reported as odds ratio (OR) and 95% confidence interval (CI). Results: The mean age of the participants was 36.7 ± 8.5 years (range, 18 - 65 years). Over half of the participants (54.8%) tested positive for HCV antibodies; in other words, they had been exposed to the virus. Adjusted OR for people reporting shared equipments within the past month was 3.36 times higher than the OR of people who reported no shared equipments (P = 0.000). The adjusted OR of positive HCV among those who injected twice or more per day was 4.33 (P = 0.000), compared to those who injected only once a day (or less). With over half the participants having evidence of HCV exposure, there is a need to increase the coverage of harm-reduction programs, especially sterile injection equipment programs. Moreover, increasing access to harm-reduction programs and HCV treatment can ultimately reduce the opportunities for HCV transmission.

Burn is the most common pediatric injuries all over the world. The aim of this study was to study the epidemiology of burn in under 15-year-old Iranian children by applying a systematic review. The related articles published before 2016 have been gathered from international databases by using the keywords in term of pediatric burns such as ScienceDirect, PubMed, Iranmedex, Google Scholar, Embase, Magiran, and SID. The checklists of STROBE have been applied to evaluate the quality of the reviewed data. A total of 35 relevant studies were extracted and evaluated. In most studies, the incidence of pediatric burns in male patients was more than female patients by 9.5 to 50 cases in 100,000 per children. Mortality rate of pediatric burn was between 1.7 and 18.5%. The most common cause of pediatric burn was hot water or other hot liquids. Pediatric burn in urban areas was higher and the highest number of pediatric burns occurred at home. Burn is considered as one of the major incidents related to children's health that required planning to reduce its incidence, especially in the lower age groups as well as male patients who are more active and susceptible to burn.

Radiation therapy in breast cancer patients has been shown to reduce local recurrence and improve survival rates. Nevertheless, recent concerns have been raised regarding an increase in cardiac mortality, especially in patients who had been treated with radiation for left-sided breast tumors. Hence, the aim of this study is to estimate doses of irradiation to the heart, LAD coronary artery, and lungs in 2D (SAD) and 3D conformal radio therapy techniques, and to compare the two. Out of 32, 18 to 75 years old females with a diagnosis of non-metastatic breast cancer, who referred from surgery department, went through irradiation in the conventional 2D (SAD) and then 3DCRT using multi-slice CT scans to contour vital organ. Nearly all of the dosimetrical indexes were higher in 3DCRT method. This shows that 2D technique lacks a decent scale to measure cardiac toxicity since its mid-plane CT slice did not give a reliable assessment of cardiac irradiation.