Search

Abstract Background Oocyte donation is a complex and multifaceted behavior in women. Due to the acute deficiency of donated oocytes, it is necessary to identify the factors affecting the desire to donate. Planned behavior theory is a suitable model for explaining and predicting behavior in many behavioral domains. The aim of this study was to predict oocyte donation intention using the theory of planned behavior. Methods This cross-sectional study was performed on 556 women who were covered by the comprehensive health service centers in Gonabad and Neyshabour cities in 2020. Sampling was performed by the two-step method in Gonabad city and by the convenience sampling method in Neyshabour city. Data were collected online using researcher-made questionnaires included oocyte donation awareness questionnaire and oocyte donation intention questionnaire (based on the TPB constructs). The validity of the questionnaires was confirmed by face and content validity and its reliability was confirmed by Cronbach's alpha coefficient. Data were analyzed in SPSS software (version 16) using hierarchical linear regression. The statistical significance was considered as P

Abstract Background Delay in episiotomy wound healing can lead to infection. The application of natural antimicrobial agents isolated from herbal essences can be a good strategy to prevent the growth of bacteria and promote the wound healing process. Therefore, this study aimed to determine the effect of rosemary cream on episiotomy wound healing in primiparous women. Methods This triple-blind randomized clinical trial was conducted on 80 primiparous pregnant women who were referred to the maternity ward of Shahid Motahari Hospital in Marvdasht, Iran, from September 2019 to March 2020. These women were randomly assigned into two groups of intervention (rosemary cream) and control (placebo), using variable quadruple blocks. Both groups applied the prescribed cream (in a dose of 2 cm) uniformly on the sutured area to cover it with the cream. The cream was applied twice a day for 10 consecutive days postpartum, and the rate of wound healing was evaluated by the researcher in the first 12 h and at days 4 and 10 postpartum using the REEDA scale. The data were analyzed using SPSS software (Version 19) through the Chi-square test, Mann-Whitney U test, student’s t-test, and Fisher’s test. A p-value less than 0.05 (P

Introduction: Polycystic ovary syndrome (PCOS) is the most common cause of ovulation disorder in women of childbearing age, with a prevalence of 20% worldwide. Due to the increasing tendency to use herbal medicines, this study was performed aimed to investigate the effect of Vitex Agnus-Castus pill on the number and size of follicles in infertile women with polycystic ovary syndrome. Methods: This triple-blind clinical trial study was performed in 2020-2021 on 60 infertile women with polycystic ovary syndrome. Subjects were randomly assigned to the intervention (Vitex Agnus-Castus) and control (placebo) groups. The intervention group used two Vitex Agnus-Castus tablets and one Folic Acid daily and the control group used two placebo tablets and one Folic Acid tablet for two months. In the second month, in addition to the mentioned drugs, all participants from the third to the seventh day of menstruation used 2.5 mg Letrozole for five days and on the 13 day of the cycle, they referred for ultrasound. Data were analyzed using SPSS software (version 16) and Chi-square and Mann-Whitney tests. P

Background: Adherence to social distancing recommendations provided by health authorities plays an important role in the prevention and control of COVID-19 transmission, regarding the lack of effective drug therapies. Therefore, this study aimed to identify the relationship between socio-demographic factors and adherence to social distancing recommendations during COVID-19 pandemic in Gonabad, Iran. Methods: In this cross-sectional study, 587 subjects aged 15 and older were selected using the convenience sampling method from urban and rural areas in Gonabad, Iran, from July to September 2020. Data were collected online using a socio-demographic characteristics form, the adherence to social distancing recommendations scale, and a coronavirus disease awareness survey. Subsequently, the obtained data were analyzed in SPSS software (version 16) using hierarchical linear regression. The statistical significance was considered as p

Background & aim: Anxiety in pregnant women can have negative perinatal consequences. The aim of this study was to determine the effect of shared decision making on anxiety and satisfaction of decision about mode of delivery in pregnant women with a history of previous cesarean section.Methods: In this clinical trial, 78 pregnant women with previous cesarean section referred to the community health centers in Torbat-e Jam, Iran were selected and randomly assigned to the intervention and control groups. The Spielberger Anxiety Inventory was completed by the pregnant women at 24-30 weeks of pregnancy. In the experimental group, in addition to routine care, a counseling session based on three-stage shared decision making was held by a midwife and a supplementary counseling session by a gynecologist. The Anxiety Inventory was completed at 35-37 weeks of gestation and the Decision Satisfaction Questionnaire was completed 8 weeks after delivery for mothers in both groups in the community health centers and questions were asked about mode of delivery. Data were analyzed using Mann-Whitney, Chi-square, student t-test and paired t-test.Results: After the intervention, the total anxiety score of pregnant women in the intervention group was lower than the control group and the difference between the two groups was significant (70.35±11.90 vs. 75.51±6.64; P=0.02). The score of decision satisfaction two months after delivery was higher in the intervention group than the control group and there was a statistically significant difference between the two groups (21.87±3.18 vs. 19.94±3.13; P=0.008).Conclusions: Shared decision making as a practical and effective approach can reduce the anxiety score and increase the score of decision satisfaction in pregnant women with a history of previous cesarean section.

Abstract Background Uterine afterpains are among the most prevalent complaints after natural vaginal delivery. Non-pharmacological treatment modalities to relieve afterpains are an important care priority. This study was conducted to investigate the effect of foot reflexology in the fourth stage of labor on afterpains in multiparous women. Methods This single-blind, randomized, clinical trial recruited 80 eligible pregnant women presenting to Allameh Bohlool Hospital in Gonabad and 17-Shahrivar Hospital in Mashhad, Iran, in 2019. In the first and second hours postpartum, the reflexology group received 10 min of general massage and specific reflexology massage on each foot on the uterine, pituitary, and solar plexus points. The control group received 10 min of general massage, and then rotational massage on a neutral point on the lateral side of the heel. The pain was measured every hour up to 4 h postpartum using a visual analogue scale. The collected data were analyzed in SPSS-16 software at a significance level of P

Objective: Perfectaionism is a common personality trait that can affect various aspects of life, especially sexual relationships. The purpose of this systematic review was to summarize the existing evidence for the relationship between perfectionism and sexual function in studies conducted in Iran and the world. Method: A comprehensive search of databases such as Scopus, PubMed, Cochrane, Science Direct, ProQuest, PsychINFO, IranPsych, Irandoc, SID, and Google Scholar search engine was performed until December 2021 without a time limit. To find studies, we searched for the keywords perfectionism and sexual function in both Persian and English and combined these words with the AND operator. Studies that scored above 15 according to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) criteria were included. Data analysis was performed qualitatively. Results: From the total of 878 articles found in databases, six articles met the inclusion criteria and had moderate quality. Reviewing studies corroborated that, notwithstanding the positive association between general/sexual perfectionism and sexual desire, specific dimensions such as socially prescribed perfectionism, partner-prescribed, and socially prescribed sexual perfectionism, have the utmost unfavorable effect on female sexual function, which means that a higher level of perfectionism ultimately decreases the rate of sexual function in women. In addition, studies suggested that by increasing sexual anxiety and distress levels, perfectionism deteriorates sexual function. Conclusion: Perfectionism may cause a variety of problems regarding sexual function. However, to clarify the precise role of each dimension of perfectionism on different areas of sexual function, more research must be conducted in this area in various communities and on age groups other than females of reproductive ages.

Gaucher disease (GD) is a rare autosomal recessive disorder arising from bi-allelic variants in the GBA1 gene, encoding glucocerebrosidase. Deficiency of this enzyme leads to progressive accumulation of the sphingolipid glucosylsphingosine (lyso-Gb1). The international, multicenter, observational “Lyso-Gb1 as a Long-term Prognostic Biomarker in Gaucher Disease”—LYSO-PROOF study succeeded in enrolling a cohort of 160 treatment-naïve GD patients from diverse geographic regions and evaluated the potential of lyso-Gb1 as a specific biomarker for GD. Using genotypes based on established classifications for clinical presentation, patients were stratified into type 1 GD (n = 114) and further subdivided into mild (n = 66) and severe type 1 GD (n = 48). Due to having previously unreported genotypes, 46 patients could not be classified. Though lyso-Gb1 values at enrollment were widely distributed, they displayed a moderate and statistically highly significant correlation with disease severity measured by the GD-DS3 scoring system in all GD patients (r = 0.602, p < 0.0001). These findings support the utility of lyso-Gb1 as a sensitive biomarker for GD and indicate that it could help to predict the clinical course of patients with undescribed genotypes to improve personalized care in the future.

Eosinophils play important roles in the release of cytokine mediators in response to inflammation. Many associations between common genetic variants and eosinophils have already been reported, using single nucleotide polymorphism (SNP) array data. Here, we have analyzed 200,000 whole-exome sequences (WES) from the UK Biobank cohort and performed gene-based analyses of eosinophil count. We defined five different variant weighting schemes to incorporate information on both deleteriousness and frequency. A total of 220 genes in 55 distinct (>10 Mb apart) genomic regions were found to be associated with eosinophil count, of which seven genes (ALOX15, CSF2RB, IL17RA, IL33, JAK2, S1PR4, and SH2B3) are driven by rare variants, independent of common variants identified in genome-wide association studies. Two additional genes, NPAT and RMI1, have not been associated with eosinophil count before and are considered novel eosinophil loci. These results increase our knowledge about the effect of rare variants on eosinophil count, which can be of great value for further identification of therapeutic targets.

Introduction Isfahan functional disorders (ISFUN) cohort study aims to describe the interplay of genetic and environmental factors in shaping the characteristics of functional somatic syndromes (FSS). This study is primarily intended to investigate the epidemiology, risk factors, course and prognosis of FSSs in a sample of adult Iranian population. The other aim is to develop a new delimitation of FSSs based on an integrated multidisciplinary approach comprising of phenotypic and multiomics data.Methods and analysis ISFUN is a population-based prospective cohort study designed to follow a population of randomly selected seemingly healthy adults (18–65 years) through annual visits during a 4-year observation period. Structured questionnaires are used for data collection and clinical assessment of the participants. Questionnaire-based diagnosis of FSSs are validated in a medical interview. Human DNA genotyping, microbial amplicon sequencing and urine analysis is under progress for genomics, microbiota and metabolomics profiling, respectively. Enrolment began in September 2017, and study completion is expected in 2022. A total number of 1943 participants were initially recruited.Ethics and dissemination Ethical approval for data collection was granted by the National Research Ethics Committee of the Iranian Ministry of Health and Medical Education and the Research Ethics Committee of Isfahan University of Medical Sciences (IR.MUI.REC.1395.1.149). Following the description of the study procedure, we obtained written informed consent from all study participants. Study findings will be disseminated through peer-reviewed publications and presentations at scientific meetings.

Abstract Background The promotion of vaginal birth after cesarean section (VBAC) is the best method for the reduction of repeated cesarean sections. Nonetheless, the decisional conflict which often results from inadequate patient involvement in decision making, may lead to delayed decision making and regret about the choices that were made. The present study aimed to determine the effect of shared decision making on the mode of delivery and decisional conflict and regret in pregnant women with previous cesarean section. Methods This randomized clinical trial was conducted on 78 pregnant women with a previous cesarean section referring to community health centers in Torbat-e Jam, Iran, in 2019. They were randomly assigned to two groups of intervention and control. During weeks 24-30 of pregnancy, the Decisional Conflict Scale (DCS) was completed by pregnant mothers. Apart from the routine care, the experimental group received a counseling session which was held based on the three-talk model of shared decision making. This session was moderated by a midwife; moreover, a complementary counseling session was administered by a gynecologist. During weeks 35–37 of pregnancy, DCS was completed, and the Decision Regret Scale (DRS) was filled out for both groups at the 8th weeks postpartum and they were asked about the mode of delivery. Data were analyzed in SPSS software (version 19) using the Mann-Whitney, Chi-squared and Fisher’s exact tests. p-value less than 0.05 was considered statistically significant. Results After the intervention, the decisional conflict score was significantly lower in the shared decision making (SDM) group, compared to that in the control group (14.90 ± 9.65 vs. 25.41 ± 13.38; P

Background and purpose: Volvovaginal atrophy is a common and progressive complication in menopausal women, affecting their daily life activities, sexual health, and quality of life. Hormone therapy is associated with some problems and many women prefer herbal medicine to reduce the symptoms. This systematic review aimed to explore the effect of medicinal plants on treatment of vaginal atrophy in postmenopausal women Materials and methods: Electronic databases, including Scopus, Pubmed, Web of Science, Science Direct, SID, Magiran and Google Scholar search engine were searched by two researchers independently. The following keywords were used in English and Persian: Herbal Medicine, Medicinal Plants, vagina, Atrophy, Postmenopausal Period, Clinical Trial, and relevant articles published until December 2020 were selected. The CONSORT 2010 checklist was used to assess the quality of studies and those with score 18 or higher entered this systematic review. Results: Out of 747 articles, 12 clinical trials were investigated in current review. These articles studied seven medicinal plants (chamomile, licorice, fennel, Pueraria mirifica, flaxseed, black cohosh, and red clover). Herbal products can have beneficial effects on reducing the symptoms of vaginal atrophy in postmenopausal women. Conclusion: Medicinal plants containing phytoestrogens can be considered as a treatment of choice for improving vaginal atrophy and a suitable alternative to chemical drugs following further studies that prove their efficacy.

مقدمه: با توجه به اهمیت سلامت روانی پس از زايمان، این مطالعه با هدف بررسی تأثیر نوشتن افکار و احساسات بر اختلال استرس پس از سانحه و افسردگی پس از زایمان به روش مرور نظام‌مند انجام شد. روش‌ها: در این مطالعه‌ی مروری نظام‌مند پایگاه‌های فارسی و پایگاه‌های انگلیسی مورد جستجو قرار گرفتند. واژگان کلیدی بر اساس Medical subject heading (MeSH) و شامل «افسردگی پس از زایمان»، «نوشتن احساسات» و «اختلال استرس پس از سانحه» و نیز «Postpartum depression»، «Writing»، «Postpartum period» و «Post-Traumatic stress disorder» بودند که جستجوی ترکیبی واژگان کلیدی با استفاده از عملگرهای «and»، «or» و «not» بدون محدودیت زمانی تا شهریور ماه ۱۳۹۹ انجام شد. ارزیابی کیفیت مقالات وارد شده به مطالعه با استفاده از آخرین ویرایش چک لیست CONSORT 2017 انجام شد. یافته‌ها: در جستجوی اولیه از پایگاه‌های اطلاعاتی در مجموع 275 مقاله یافت شد که 110 مقاله به دلیل تکراری بودن مقالات و 142 مقاله به علت عدم داشتن شرایط ورود، از مطالعه خارج شدند. پس از بررسی متن کامل 23 مقاله، در نهایت 6 مقاله وارد مطالعه شدند. یافته‌های پژوهش نشان داد که مداخلات نوشتن احساسات با کاهش مؤثر افسردگی، استرس و علایم اختلال استرس پس از سانحه همراه است. نتیجه‌گیری: نوشتن احساسات یک انتخاب مناسب برای زنان است که باعث کاهش علایم استرس پس از سانحه می‌شود و کارایی آن برای افسردگی، قابل توجه بوده است. بنابراین، پیشنهاد می‌شود که در آینده، مطالعات کارآزمایی‌های بالینی بیشتری باید اثربخشی مداخلات نوشتاری طولانی‌تر، مکرر و هدفمندتر را بررسی کند.

Introduction: Demand for egg donors is growing worldwide. Due to the acute shortage of egg donors worldwide and since donors' satisfaction affect their willingness to re-donate, therefore, this study was conducted with aim of a systematic review of studies on donors' satisfaction with egg donation and willingness to re-donate in Iran and the world. Methods: Comprehensive searches were performed in databases of Magiran, SID, Irandoc, Scopus, Pubmed, ISI as well as Google Scholar search engine from 1990 to 2020. To search the studies, Persian and English keywords including: egg, ovum, oocyte, satisfaction, donor, Re-donation and combining these words with AND and OR operators were used. According to STROBE criteria, the studies which scored above 15 were included in the study. Data analysis was performed qualitatively. Results: Out of 63 articles found in the databases, 7 articles which met the inclusion criteria were reviewed. All of these articles were of good or average quality.The results of the studies showed that egg donors evaluated the donation experience positively, so that the level of satisfaction was high and many of them were willing to donate eggs again. Conclusion: Despite the high satisfaction of donors, determining and implementing the methods to improve donor satisfaction leads to better selection and retention of donors.

Background and purpose: Shoulder dystocia is an obstetrics emergency which could be prevented by identifying its predictors and taking effective measures. The aim of this study was to determine the relationship between maternal factors and interventions for shoulder dystocia. Materials and methods: In this descriptive correlational study, we studied 6520 delivery files in a hospital in Sabzevar, Iran 2017-2018. All vaginal deliveries at 37-42 weeks with cephalic presentation were investigated and data of deliveries with shoulder dystocia (n=212) and without this condition (n=6308) were extracted using a researcher-made checklist. Mann-Whitney, Chi-square and logistic regression were applied for data analysis. Results: Findings showed significant differences between the two groups in mean age (P

Background: Despite significant advances in reproductive technology, using donor assisted reproductive technologyis a double-edged sword that has numerous challenges. One of the most challenging issues for couples is whether ornot to disclose this information to donor offspring. This study, therefore, explored infertile couples’ decision to disclosedonor conception to their future child.Materials and Methods: This qualitative study was conducted using content analysis approach in 2012 in the MiladInfertility Centre, Mashhad, Iran. Data were collected through semi-structured interviews with 32 infertile personsincluding nine couples and 14 women who were selected by purposive sampling. Data were analysed by conventionalqualitative content analysis adopted by Graneheim and Lundman using MAXQDA 2010 software.Results: Two categories were emerged: ‘not to disclose information to the child’ and ‘to disclose information tothe child’. The first category consisted of three subcategories: 1. child support from probable harms; 2.to maintainhealthy family relationships; and 3. lack of a compelling reason to disclose this information. The second categoryembraced four subcategories: 1. awareness of the others; 2. emergence of new living conditions; 3. appreciation forthe donor; and 4. honesty among family members. The main reason for not disclosing information was to protect thechild from probable harm.Conclusion: Although protecting children from possible harms was a major reason for infertile couples' secrecy,keeping this secret would not be always easy. Therefore, increasing public awareness about the donation process inorder to change the beliefs of community and eliminate the infertile couples’ concerns would help them to overcomethis problem. Additionally, long-term psychological counselling during and after the donation process is highly recommended.

Introduction: Delay in episiotomy wound healing is associated with an increased risk of infection; prevention of perineal wound infection is a major component of daily care for mothers. For more quickly healing of episiotomy wounds, low cost, effective, convenient, accessible and acceptable methods are considered by women; medicinal plants are of these methods. Therefore, this systematic review was performed with aim to investigate the effects of medicinal plants on the episiotomy wound healing in Iran. Methods: Electronic search was done in databases of Iranmedex, Magiran, SID, Web of Science, Science Direct, Scopus, Pubmed, as well as Google Scholar search engine with Persian and English keywords including: Episiotomy, Wound healing, Perineum, Herbal Medicine, and Medicinal Plants. Combined searches of the keywords was performed using OR and boolean AND operators. The search period was from observation to December 2019. According to the CONSORT 2010 checklist, the studies with a score of ≥18 were included in the study. Data analysis was performed qualitatively. Results: In this study, 28 clinical trials including 19 types of medicinal plants were studied. According to the results of the studies, most plants were effective in episiotomy wound healing. Conclusion: Plants such as as Aloe Vera, Turmeric and Lavender that have anti-inflammatory, antibacterial and antioxidant properties are desirable options for wound healing. Due to insufficient number of articles in some cases and inconsistency in the results of some other articles, we can't definitively comment about these plants. Therefore, for definitive effectiveness of these interventions, further studies with larger sample size are recommended.

Introduction: Having a child is a basic need in humans. Infertility can lead to unpleasant outcomes such as depression which is required to identification and appropriate interventions. Acupressure is one of the methods used in the treatment of depression. This study was performed with aim to determine the effect of auriculotherapy on depression in infertile women. Methods: This randomized clinical trial was performed on 70 infertile women referred to Milad Infertility Centre at Mashhad in 2017. The subjects were randomly assigned to two groups of intervention and control. Before the intervention, depression in both groups was measured by Beck questionnaire. Then, in the intervention group, the ear glue was attached in one of the ears at the points of shenmen, anti- depressant and heart, and the patient was asked to press each of the points twice a day and 60 times for a period of one month. No intervention was performed in the control group. Depression was again measured immediately after the intervention and two months later in both groups. Data were analyzed by SPSS software (version 19) and independent t-test, Chi-square and ANOVA with repeated measurement. P 0.05). However, depression scores immediately and two month after the intervention were less in the intervention group than the control group and there was a significant statistical difference between two groups (p

Background Despite the fact that many infertile couples have to decide about whether or not to choose donor con- ception, there is no predictive scale for evaluating the process of decision-making on donor conception and its deter- minants in such couples. The present study was conducted to develop a decision-making questionnaire for selecting donor conception and assess its psychometric properties in Iranian infertile couples. Materials and Methods This cross-sectional validation study was conducted based on the method developed by DeVellis (2012) in four steps at Milad Infertility Clinic, Mashhad, Iran. The dimensions of the concept of decision- making were determined in the first step based on the qualitative results obtained from 38 semi-structured in-depth interviews. Items that were appropriate for the questionnaire were developed in the second step using the qualitative data and a review of the literature. In the third step, the research team reviewed and eliminated some of the items. The fourth step evaluated the face, content and construct validity of the questionnaire through exploratory factor analysis on a sample of 220 infertile couples using convenience sampling and investigated its initial and final reliability. Results Based on the results of the qualitative study, a pool of 170 items was developed, 101 of which were elimi- nated after revision due to ambiguity, repetition or their poor face and content validity and initial reliability. The questionnaire was evaluated for its construct validity with 69 items. After the exploratory factor analysis, the decision- making donor conception questionnaire (DMDCQ) having 51 items and seven factors, was finalized. All the factors had Cronbach’s alpha values of 0.75-0.87 and intra-class correlation coefficients (ICC) greater than 0.7. Conclusion This study led to development of a valid and reliable scale for examining infertile couples’ decision- making about whether or not to use donor conception as well as the determinants of this decision.

Objective: Major birth defects are inborn structural or functional anomalies with long-term disability and adverse impacts on individuals, families, health-care systems, and societies. Approximately 20% of birth defects are due to chromosomal and genetic conditions. Inspired by the fact that neonatal deaths are caused by birth defects in about 20 and 10% of cases in Iran and worldwide respectively, we conducted the present study to unravel the role of chromosome abnormalities, including microdeletion/microduplication(s), in multiple congenital abnormalities in a number of Iranian patients. Materials and Methods: In this descriptive cross-sectional study, 50 sporadic patients with Multiple Congenital Anomalies (MCA) were selected. The techniques employed included conventional karyotyping, fluorescence in situ hybridization (FISH), multiplex ligation-dependent probe amplification (MLPA), and array comparative genomic hybridisation (array-CGH), according to the clinical diagnosis for each patient. Results: Chromosomal abnormalities and microdeletion/microduplication(s) were observed in eight out of fifty patients (16%). The abnormalities proved to result from the imbalances in chromosomes 1, 3, 12, and 18 in four of the patients. However, the other four patients were diagnosed to suffer from the known microdeletions of 22q11.21, 16p13.3, 5q35.3, and 7q11.23. Conclusion: In the present study, we report a patient with 46,XY, der(18)[12]/46,XY, der(18), +mar[8] dn presented with MCA associated with hypogammaglobulinemia. Given the patient’s seemingly rare and highly complex chromosomal abnormality and the lack of any concise mechanism presented in the literature to justify the case, we hereby propose a novel mechanism for the formation of both derivative and ring chromosome 18. In addition, we introduce a new 12q abnormality and a novel association of an Xp22.33 duplication with 1q43q44 deletion syndrome. The phenotype analysis of the patients with chromosome abnormality would be beneficial for further phenotype-genotype correlation studies.

Abstract Background Family genetic testing of patients newly diagnosed with a rare genetic disease can improve early diagnosis of family members, allowing patients to receive disease‐specific therapies when available. Fabry disease, an X‐linked lysosomal storage disorder caused by pathogenic variants in GLA, can lead to end‐stage renal disease, cardiac arrhythmias, and stroke. Diagnostic delays are common due to the rarity of the disease and non‐specificity of early symptoms. Newborn screening and screening of at‐risk populations, (e.g., patients with hypertrophic cardiomyopathy or undiagnosed nephropathies) can identify individuals with Fabry disease. Subsequent cascade genotyping of family members may disclose a greater number of affected individuals, often at younger age than they would have been diagnosed otherwise. Methods We conducted a literature search to identify all published data on family genetic testing for Fabry disease, and discussed these data, experts’ own experiences with family genetic testing, and the barriers to this type of screening that are present in their respective countries. Results There are potential barriers that make implementation of family genetic testing challenging in some countries. These include associated costs and low awareness of its importance, and cultural and societal issues. Regionally, there are barriers associated with population educational levels, national geography and infrastructures, and a lack of medical geneticists. Conclusion In this review, the worldwide experience of an international group of experts of Fabry disease highlights the issues faced in the family genetic testing of patients affected with rare genetic diseases.

Net primary production (NPP) is one of the most important factors in ecosystem's function, which is affected by biological and climatic factors. The main objective of the current research was to investigate the potential of the CASA (carnegie-ames-stanford approach) model in determining the spatial and temporal distribution of NPP in rangland types of arid regions of Isfahan province using MODIS and Landsat. For this purpose, satellite and climatic data such as rainfall, temperature, monthly and sunny hours, were used. The NPP was modeled on two Landsat and MODIS scales and correlations between field measurements and CASA model were investigated based on rangeland conditions and vegetation types. Results showed that the highest plant production in the region was during the March-May months. Crrelation between CASA model with field data occurred in MODIS was higher than Landsat data. Based on the relations, the values of NPP and LUE (light use efficiency) were investigated in the region. The NPP spatial distribution and LUE values indicated that the amount of annual production and photosynthesis efficiency were decreased in degraded rangelands (poor and very poor conditions) compared to fair rangeland condition. The highest and lowest amount of NPP observed in Artemisia sieberi – Zygophyllum Spp (9.35 g C/m2 y-1) and Annual grasses - Annual forbs (0.2 g C/m2 y-1), respectively. The amount of NPP and LUE in shrublands and annual plant types were higher than bushlands.Results of this research probes the importance of biological classification, climate and scale of study in NPP modeling. Moreover, the stratification of rangelands based on life forms and range conditions has principal role in accuracy of the NPP estimation.

Introduction: Postpartum morbidities are among the most important health problems across the world. However, the frequency and types of these morbidities remain unclear. The present study aimed to evaluate postpartum morbidities and the influential factors in the women in Gonabad city, Iran. Methods: This cross-sectional study was conducted in Gonabad city, located in the northeast of Iran, during 2015-2016. Subjects included 158 pregnant women referring to the community health center in Gonabad for prenatal care. Data on the pregnancy period were collected using the general health questionnaire (GHQ-28) and demographic questionnaires, and the scale of postpartum morbidities was used two months after delivery. Data analysis was performed in SPSS version 16 using the Kolmogorov-Smirnov test and Chi-square at the significance level of P

Background: There are several types of radiotherapy devices available for the treatment of cancer tumors. The present study aimed to evaluate the effectiveness of selected radiosurgery devices on the treatment of cancer tumors and Arteriovenous Malformations (AVM). Methods: The evaluation was performed in two steps; First, evaluating the effectiveness of CyberKnife, Gamma knife and Linear Accelerator (Linac) on various biological systems. Then, we compered the effectiveness of devices with each other. A systematic review was conducted in MEDLINE, EMBASE, CRD, NHSEED and Cochrane library databases. The search strategy was limited to clinical trials with less than 5 treatment sessions. All searches were conducted on December 21, 2014. Results: In total, 81 studies have been included to the review. Based on the obtained results of comparison between the reported percentages of local control rate, the safety and accuracy of CyberKnife and linac are higher than Gamma Knife. Conclusion: Our findings suggested that CyberKnife is not only more effective to cover various types of tumors in the whole body, but also is safer and easier to use for various tumors, as well as AVM treatment.

BACKGROUND: Coronary angiography is the gold standard method for diagnosis of coronary heart disease and usually performed by femoral approach that has several complications. To reduce these complications, upper extremity approach is increasingly used and is becoming preferred access site by many interventionists. Although radial approach is relatively well studied, safety, feasibility and risk of applying ulnar approach in not clearly known yet. METHODS: We followed 97 patients (man = 56%, mean ± standard deviation of age = 57 ± 18) who had undergone coronary angiography or angioplasty via ulnar approach for 6-10 months and recorded their outcomes. RESULTS: In 97 patients out of 105 ones (92.38%), procedure through ulnar access were successfully done. Unsuccessful puncture (3 patients), wiring (2 patients), passing of sheet (2 patients), and anatomically unsuitable ulnar artery (1 patient) were the reasons of failure. In 94 patients (89.52%), the angiography and angioplasty was done without any complications. Five patients (5.1%) hematoma and 11 patients (11%) experienced low-grade pain that resolved with painkiller. No infection, amputation or need for surgery was reported. CONCLUSION: This study demonstrated that ulnar access in our patients was a safe and practical approach for coronary angiography or angioplasty, without any major complication. Bearing in mind its high success rate, it can be utilized when a radial artery is not useful for the catheterization and in cases such as prior harvesting of the radial artery (in prior coronary artery bypass grafting).

Introduction: In several countries, students’ open day is a permanent part of formal university programs. The purpose of this program which is run annually is to provide an opportunity for K12 students to meet university teachers and students and discuss about atmosphere (mainly educational atmosphere) of that university. This article is a report of the first education and research open day of Isfahan University of Medical Sciences which was held for high school students. Methods: In this study, performed in academic years of 2007-2008 in Isfahan, 120 students of 12 high schools having highest admission rate in university entrance exams were invited. The program included lectures about critical thinking, clinical and basic research, a video clip on university students' prevalent problems associated with research, a video show of noble winners of 2002, a panel to introduce research perspective of different disciplines in university to the students, and finally visit of exhibition of university students' research outputs. Moreover, each participant received a package containing booklets of university overview as well as its majors. Then a questionnaire for determination of students' research and education needs and interests as well as their opinions about the open day was delivered to them. Frequency measures were used for descriptive analysis. Inferential analysis was performed using chi2 and T test. Results: 68 students from 6 high schools (56.6% of invitees) participated in students’ open day and 58 students (85%) filled the questionnaire. According to questionnaires, 37 participants (67%) selected medicine as their first choice. Among major selection motivating factors, only there was a significance differences between two sexes considering the aspect of making money (P=0.031). Thirty two students (55%) were satisfied with their information about university major selection. The first choice of 60% of participants (35 students) was Isfahan University of Medical Sciences and 88% of attendees (46 students) were satisfied with taking part in this program. Conclusion: Holding such a program implies feasibility and necessity of performing similar programs to make students more familiar with universities' research and education capacities and facilities. The results also show that there is a need to give more information about major selection to high school students and also to increase their research abilities through well designed courses and workshops during high school and early university years.

Background: Stem cells are undifferentiated cells that can turn into any number of differentiated and specific cell types. For years, stem cell assisted therapy has been accepted as a standard treatment method for the management of some diseases. Scientists hope that this method can be expanded and used for the treatment of other diseases. One of the main concerns in the field of stem cell therapy research is the safety of these cells. This article assessed the safety of using mesenchymal fibroblasts, keratinocytes, melanocytes and skeletal myoblasts in clinical trials. Methods: A systematic search of reliable electronic databases was performed in order to find all articles related to safety of the mentioned cells. After studying all the articles critically, the preliminary results were reviewed and criticized by experts through Delphi method. Ultimately, the final draft was reviewed and approved by all the members of the Regional Research Ethics Committee. Findings: Overall, 62 articles were retrieved and studied. Conclusion: Since we did not find any reports of serious complications for fibroblast, keratinocyte and melanocyte cells, especially about their in-vivo uncontrolled proliferation, it is possible to give ethical approval for research in these fields (considering all ethical codes and principles). However, according to serious complications reported for skeletal myoblast cells transplantation, giving ethical approval for using this cell type in human research requires strict commitment to precise methods (such as inclusion criteria, patient follow-up methods, and prophylactic treatments). The ethical approval should be issued by the research ethics committee of the corresponding university after accurate reviews. Finally, repeating previous research which has resulted in arrhythmia and tissue injury is unethical and thus not recommended.

Background: One of the reasons of uncertainty in choosing a specific clinical specialty is wrong decision-making. This study was conducted to train professional decision-making skills to medical students at internship and externship course levels in the form of a workshop. We also reviewed the impacts of the workshop on reducing indecisiveness in selecting a clinical specialty. Methods: This was a quasi-experimental study on 43 medical students at internship and externship course levels at Isfahan University of Medical Sciences, Isfahan, Iran. Before holding the workshop, students completed the hesitation and indecision scales. The participants were taught about decision-making skills for 15 hours. Immediately after the course and a month later, the students completed the same questionnaires again. The information and scores related to the pre-test, post-test, and one-month follow-up were analyzed using t-tests in SPSS. Findings: There was a significant difference in scores of hesitation scale at pre-test, post-test, and follow-up (P = 0.033). However, there was no significant difference in the scores of indecision scale (P = 0.151). There was no significant correlation between scores of students and different educational levels, sex, and marital status (P > 0.05). Therefore, training on professional decision-making skills reduced hesitation in selecting clinical specialty among medical students. However, it had no significant impact on their indecision. Conclusion: The professional decision-making skills training course reduced uncertainty in selecting clinical specialty among medical students. They were thus satisfied with participation in the course. They were also willing to attend complementary programs on selecting clinical specialty. Therefore, such an educational course is recommended to be held for all students who like to continue specialized studies in medicine during their medical course, especially in the first year of university.

The first national medical science Olympiad suggested by Isfahan University of Medical Sciences was hold in 2009 in Isfahan. The venture had the mission to identify and flourish potentials in Iranian medical science students - the health system's capital. The ministry of health in collaboration with the affiliated universities hosted 364 medical science students. Students formed teams of three members and competed excitingly in a friendly atmosphere in solving problems which could help promote our health system or basic medical sciences. To reach better coordination, meetings with authorities of ministry of health and academic members of universities were held. 35 academic members from 13 universities formed committees to set questions/ problems to be discussed and solved. Questions were of Key features, scenario, script concordance, matching, and open ended types. Individual and group tests on three domains (clinical reasoning, basic science reasoning, and health system managerial reasoning) were held in 2 days each. To assess the quality of the tests and also the Olympiad itself, students were asked to take part in a survey. Most participants (94%) believed there was a difference between the Olympiad and the usual university exams. Also about 60% found the quality of the event satisfactory and 72% said they would encourage friends to take part in the following year’s Olympiad. It appears that such events, creating an exciting and happy atmosphere, could help nurture educational creativity in students and inspire them to go beyond routine studying and thus fill certain educational gaps in health system. The Olympiad being the first medical experience of the kind, further studies and modifications will certainly be necessary to improve it further.

Introduction: Health system management is regarded a chief duty and skill of health care providers. However, medical students do not receive enough training for it. The first national Olympiad for students of medical sciences was designed to motivate students for acquiring managerial skills, improve reasoning and problem solving skills, and also propagate team working in students in an excitingly competitive and joyful atmosphere. Methods: Designing a model for the olympiad included four phases: building up a framework for designing the exam questions, determining topics of the exam, setting the exam questions and administering it, and finally judging. In summer 2009 the first national olympiad for the students of medical sciences on reasoning & decision making in health system management was held in Isfahan University of Medical Sciences. The first two days of the five-day-long open source olympiad were spent on individual competition. The following three days were devoted to group competitions. Six groups of three Students competed in this part. Results: After 19 months, with the help of a large group of university teachers with related specialties, a framework for the selection of the exam questions was built up. The themes of the Olympiad were decided to be Health policy and health economics. The topic for group competition phase was current problems in implementation of the family physician project in Iran. In the individual competition phase, the students were to answer 194 questions and in the group phase they were asked 3 open-ended questions. 106 students studying different medical fields nationwide participated in the event 71 students (66.98%) were girls. most participants were students of medicine (33 students) and others were students of nursing (26 students), health management (20 students), and other fields of study (27 students). Conclusion: Considering the significance of medical students' awareness of heath system management and the importance of improving reasoning and decision making abilities in them, holding such examinations could facilitate the achievement of these objectives.

Clinical reasoning is not only a critical skill in medicine, but also central to the clinical practice. Considering that there is no method of assessing clinical reasoning based on the theoretical framework of medical expertise research, we could approach assessment in an innovative way taking the model of clinical reasoning as a guide. In this model three major components of clinical reasoning (i.e. information gathering, hypothesis formation and hypothesis evaluation) have been measured, treating them collectively as a single score that reflects clinical reasoning competency. This battery permits the inclusion of different formats of clinical reasoning tests that cannot be administered simultaneously and assesses different aspects of clinical reasoning. This article explains the process of designing and implementing the battery of clinical reasoning in the first Olympiad for medical sciences students using action research method.

Payesh2009; 8: 343-348Accepted for publication: 27 November 2008[EPub a head of print-17 August 2009] Objective(s): To evaluate the effect of menopausal training for husbands on perceived social support by peri menopausal women.Methods: In this clinical trial, 102 women aged 45-60 years were randomly assigned in two groups in Gonabad, Iran. Demographic questionnaire and social support scale completed by all of the women and knowledge questionnaire completed by their husbands, then face to face education about menopause were scheduled for husbands in intervention group. One month later all of the women completed social support scale and their husbands completed knowledge questionnaire.Results: The mean knowledge score of husbands in intervention group was higher after training (10.40 vs 7.35) and the difference was statistically significant (P

Introduction. Continuous evaluation is necessary for improving and promoting the quality of clinical education. The purpose of this study was to determine the views of nursing and midwifery students of Gonabad University of Medical Science about the condition of clinical education. Methods. This was a cross-sectional survey in which 140 nursing and midwifery students registered as day or night students were selected by census sampling method. They were studied using a questionnaire consisted of 4 sections about instructor’s performance, cooperation of staff, patients and students, facilities and equipments of clinical environment and clinical evaluation system. Data was analyzed by SPSS software using descriptive statistics, t-test, Mann Whitney and Pearson correlation coefficient. Results. Most of the students evaluated the instructor’s performance, good with the mean and standard deviation of 62.3±15.7, cooperation of staff, patients and students, at a borderline level(between good and intermediate) with the mean and standard deviation of 51.4±22.4, facilities and equipments, at an intermediate level with the mean and standard deviation of 30.64±19.2 and clinical evaluation system at an intermediate level with the mean and standard deviation of 37.6±27.7. There was no significant difference between nursing and midwifery students' viewpoints about different aspects of clinical education. Conclusion. In order to improve the situation of clinical education in nursing, it is recommended to provide facilities and equipments for clinical environments and revise the tools and process of clinical evaluation. These points have been confirmed by other studies as well. Improving instructors' performance and encouraging professional cooperation could lead to the improvement of clinical education.

The Yunis-Varón syndrome represents a rare autosomal recessive syndrome of easy recognition characterized by defective growth of the cranial bone along with complete or partial absence of the clavicles (cleidocranial dysplasia), absence of thumbs and halluces, distal aphalangia, ectodermal anomalies, growth retardation and poor outcome. The molecular genetic basis is unknown. Here, we report an 8 months old girl with Yunis-Varón syndrome, born to a consanguineously married, with normal parents. She had micrognathia, wide fontanels, prominent eyes, poor sucking, congenital heart diseases, asymmetric face, ambiguous genitalia, reduction anomaly in right hand including thumb, and hypoplastic distal phalanges of 3th fingers, and hypo plastic clavicles. She has glaucoma and lenses opacity. There is another similar case in her family. Karyotype is normal. She is the first Iranian known case of Yunis-Varón syndrome.