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Purpose Rib fractures are one of the most common causes of morbidity and mortality and are associated with abdominal solid organ injury (ASOI). The purpose of this study was to investigate the correlation of ASOI with the number, location, and involved segments of rib fracture(s) in blunt chest trauma. Methods This retrospective cohort study was conducted on patients with blunt chest trauma over the age of 15 years, who were hospitalized with the diagnosis of rib fractures from July 2015 to September 2020. After ethic committee approval, a retrospective chart review was designed and patients with a diagnosis of rib fractures were selected. Patients who had chest and abdominopelvic CT scan were included in the study and additional data including age, gender, injury severity score, trauma mechanism, number and sides of the fractured ribs (left/right/bilateral), rib fracture segments (upper, middle, lower zone) and results of chest and abdominal spiral CT scan were recorded. The correlation between ASOI and the sides, segments and number of rib fracture(s) was assessed by Pearson's correlation coefficient. Results Altogether 1056 patients with rib fracture(s) were included. The mean age was (42.76 ± 13.35) years and 85.4% were male. The most common mechanism of trauma was car accident (34.6%). Most fractures occurred in the middle rib zone (60.44%) and the most commonly involved ribs were the 6th and 7th ones (15.7% and 16.4%, respectively). Concurrent abdominal injuries were observed in 103 (34.91%) of patients and were significantly associated with middle zone rib fractures. Conclusion There is a significant relationship between middle zone rib fractures and ASOI. Intra-abdominal injuries are not restricted to fractures of the lower ribs and thus should always be kept in mind during management of blunt trauma patients with rib fractures.

Inflammation, oxidative stress, and hypertension trigger the development of chronic kidney disease (CKD). Zinc is known to have antioxidant and anti-inflammatory properties and a possible role in regulating blood pressure. The aim of this study was to investigate the correlation of serum zinc with matrix metalloproteinase-2 and-9 (MMP-2, MMP-9), advanced glycation end products (AGEs), and blood pressure in patients with CKD. This cross-sectional study included 90 patients with CKD. Serum zinc and the levels of MMP-2, MMP-9, AGEs, and creatinine were measured using validated biochemical methods. Three 24-h food recalls were completed to evaluate dietary zinc intake. Systolic and diastolic blood pressure (SBP, DBP) were measured using a digital sphygmomanometer. Participants' mean age was 60.68 ± 8.81 years. The prevalence of zinc deficiency in our participants was 10%. Serum zinc was negatively correlated with MMP-9 (r = - 0.231, p = 0.032) and creatinine (r = - 0.304, p = 0.004). However, after adjusting for confounding variables, the association between serum zinc and MMP-9 was near the significance level (β = - 0.174, p = 0.09) and zinc remained in the model as one of the predictors. Serum zinc was positively correlated with the dietary intake of zinc (r = 0.241, p = 0.025) and estimated glomerular filtration rate (eGFR) (r = 0.259, p = 0.015). In conclusion, our results showed that serum zinc might be one of the predictors of serum MMP-9 in patients with CKD. In addition, serum zinc was positively associated with its dietary intake and eGFR. Future longitudinal studies or clinical trials are required to reveal any causal association between zinc status and profibrotic or inflammatory biomarkers among patients with CKD.

Introduction: Accidents and their injuries are one of the major public health problems and have long been considered as a very destructive and deadly factor for humans in the world. The extensive damage caused by accidents in Iran is significant. This is an ecological study that was conducted with the aim of determining the trend and epidemiological pattern of injuries caused by accidents in victims who referred to the emergency department of Iranian hospitals in 2016. Methods: This study was performed based on secondary analysis of existing data. In order to collect the necessary information, all reports of the Iranian Ministry of Health and Medical Education on accidents and deaths in 2016 were used. Excel, SPSS and GIS software were used to analyze the results. Also, hierarchical analysis was used to cluster the provinces. Results: The highest frequency was related to the age group of ≥20 years (74%). Also, out of the total cases, 5013 people died and 358 were disabled. Out of 1483425 cases in 2015, 68.6% were men. The scene of the most accident was at home (36%), followed by the street (32%). The highest rate of accidents per 100 000 population was related to trauma (598.72) followed by traffic accidents (570.53). Highest incidence rate per thousand population was related to Qazvin (46.30) and Kermanshah (38.10) provinces and Sistan and Baluchestan province had the lowest incidence rate (2.9 per thousand). Conclusion: Organized policy-making and decision-making to prevent accidents can be one of the important health priorities and a necessary factor in promoting safety in Iran.

Background and Aim: Despite the anti-cancer and antimicrobial properties of licorice extract and lavender essential oil, some factors, such as low bioavailability and biodegradable, limit their therapeutic use. Using nanoparticles is a method to overcome these restrictions. This study aimed to investigate the anti-proliferative effects of nanoemulsion containing licorice extract and lavender essential oil on cancer cells; we also evaluated its antimicrobial properties in vitro. Methods & Materials: In this experimental study, nanoemulsions, containing licorice extract and lavender essential oil were developed by the spontaneous emulsion method. The anti-proliferative effect of nanoemulsion was investigated using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-2H-tetrazolium bromide (MTT) colorimetric method on two cell lines HepG2 and SK-MEL-3. To measure the antimicrobial effect of 4 standard strains of Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, Staphylococcus epidermidis, and Minimum Inhibitory Concentration (MIC) method was used. Ethical Considerations: This study was approved by the Ethics Committee of Kashan University of Medical Sciences (Code: IR.KAUMS.MEDNT.REC.1396.106). Results: The results of MTT test on HepG2 cells indicated that the concentrations of 630, 1250, and 2500 μg/mL nanoemulsions caused toxicity to the cell and led to the death of >50% of the cells (IC50=401μg/mL; P50% of the cells (IC50 = 82 μg/mL; P

Escherichia coli, a member of the Enterobacteriaceae family, is responsible for a considerable rate of inpatient and outpatient infections. Recently, the rate of antibiotic resistance in E. coli infections and the production of β-lactamase, such as extended-spectrum β-lactamase (ESBL) and metallo-β-lactamase (MBL), has increased dramatically worldwide. The aim of this study was to evaluate the rate of and risk factors for β-lactamase production and to identify antibiotic resistance patterns in the public hospitals of a medical university in Iran. This was a cross-sectional study of 250 positive E. coli cultures collected between 2016 and 2018. We recorded age, sex, sample type (urine, blood, pus, and ascites), ward of admission, history of antibiotic use, administration over the previous month, and history of hospitalization in the last 3 months. Antibiotic resistance was identified by means of disk diffusion and confirmed with an epsilometer test. ESBL and MBL production were also assessed. Among 250 E. coli cultures, 40 (16%) produced MBL, 98 (32.9%) produced ESBL, and 123 (49.2%) had a multidrug-resistant (MDR) phenotype. In multivariate analysis, the odds of detecting MBL-producing E.coli isolates were lower with blood samples (odds ratio [OR] 0.17; p = 0.024) and hospital stays of

Background COPD patients often require multiple therapies to enhance their lung function and reduce their symptoms in exacerbations. This study aimed to investigate the relative effects of combination adjunctive nebulized furosemide and salbutamol therapy versus single agent treatment in COPD patients. Methods Sixty-nine COPD patients were randomly divided into two groups. The first group (G1, 34 cases) received salbutamol in their first episode. The second group (G2, 35 cases) received furosemide in their first episode. Spirometry indices (FEV1, FVC, and FEV1/FVC), mMRC and BORG (COPD assessment) were assessed and recorded for all patients. To study the efficacy of combination adjunctive therapy, in 2nd episodes, the nebulized furosemide was added to nebulized salbutamol in the G1, and nebulized salbutamol was added to nebulized furosemide in G2. The aforementioned indices were then re-assessed. Results The mean age was (64.92 ± 11.71 years, 55% males. The use of nebulized furosemide and salbutamol as single agents slightly improved the spirometeric parameters, but it was not noteworthy compared to the significant improvement of the FEV1, FVC, FEV1/FVC, mMRC, and Borg parameters with combination therapy (p-value< 0.001). In the first episode, there was no difference in spirometeric indices, between groups (p-value > 0.1), so furosemide is considered as effective as nebulized salbutamol. Also, the results of sequential drugs administration, in the two groups was similar. Conclusion Conjunction of nebulized furosemide and salbutamol is more effective than single therapy and can be considered as preferred drug regimen without any reported side effect in the treatment of COPD., Highlights • Our study revealed. • Nebulized furosemide is as effective as nebulized salbutamol in stable COPD treatment. • Adding nebulized furosemide to nebulized salbutamol considerably improves thespirometry indices, helps to better management of COPD, without any side effect.

Objectives: The purpose of the present study was to determine the effect of chamomile extract on the prevention of peristomal skin complications. Methods: This single-blinded, placebo-controlled, randomized clinical trial was conducted on 80 ostomy patients who were referred to Koroush Health Clinic, Isfahan, Iran. For the participants in the intervention group, chamomile extract was applied topically on the peristomal skin. For the participants in the control group, distilled water was applied as a placebo. The intervention group participants’ peristomal skin was examined using the ostomy skin tool (OST) once a week for four consecutive weeks. The peristomal skin in the control group was assessed at the beginning and the end of the study. Results: The intervention and control groups were not significantly different in terms of gender, marital status, educational degree, ostomy type, chemotherapy history, and radiotherapy history. The scores of the OST indicated that after the intervention, the scores of skin complications (color change, secretion, and wound) around the stoma were significantly higher in the control group than in the intervention group (P < 0.05). Conclusions: Our findings showed that chamomile extract was effective in preventing peristomal skin complications and related side effects. The results of the present study can be used by health care professionals to manage peristomal skin complications.

Abstract: Acute liver injury (ALI) is a critical and fatal disorder associated with excessive Although considerable advances have been made in the early diagnosis and treatment of breast cancer, it is still one of the major causes of global cancer-related death in women over the last several decades. Phytochemicals have been shown to be promising agents in the prevention and treatment of breast cancer. Resveratrol is an important plant-derived polyphenolic compound with a variety of potent biological activities. It has been suggested that resveratrol can be used to prevent and treat various types of cancer, including breast cancer. Resveratrol can affect numerous signaling pathways in vitro, leading to the induction of cell cycle arrest and apoptosis, suppression of proliferation, reduction of inflammatory responses, and the inhibition of angiogenesis and metastasis. Nevertheless, studies of resveratrol in animal models of breast cancer have so far been disappointing.

Introduction Information technology (IT) is an important component of medical informatics. Information needs to be accepted by users to function effectively. At different ages and from different views, several models have been proposed and used to show factors affecting users' IT acceptance. However, such models are in need of frequent revision and development due to variable conditions. Aim The present research aims to design a new health IT acceptance model from Iranian users' views. The research aims both to design a model for status quo by reviewing previous models and consider features of Iranian users. Methods This is a correlative, cross-sectional study. Firstly, the primary model was presented by studying important IT acceptance models. Then, a structured questionnaire was designed and, after confirmation of validity and reliability of the questionnaire, it was given to users of information and health IT systems in different wards of hospitals in Iran. Data were analyzed by SPSS and Lisrel and the final model was designed by structural equations. Results The model showed that there are six key factors which are effective on attitude and use intention including performance expectancy, observability, effort expectancy, facilitating conditions, empowerment and subjective norms via three interface factors of perceived usefulness, perceived ease of use, self-efficacy. The size of technology use is an important factor in technology acceptance and application as well. Conclusion The present model has more details compared to the other models and can show a new image of important factors in technology acceptance and their relationships.

Professionalism is a set of behaviors that build trust in physicians’ relationships with patients and the public. The aim of this study was to assess professionalism among residents inKashan University of Medical Sciences, Kashan, Iran. This cross-sectional study was conducted on 139 residents recruited through the census method. Data were collected usingthe American Board of Internal Medicine Professionalism Questionnaire. The first part of the questionnaire was on residents’ personal characteristics, and the second part containedfifteen items in the three domains of professionalism, namely excellence, honor/integrity, and altruism/respect. The mean scores of the questionnaire and its domains were calculated and their relationships with residents’ personal characteristics were evaluated. The mean scores (± SD) of professionalism and its excellence, honor/integrity, and altruism/respect domains were 4.93 ± 2.4, 5.92 ± 1.85, 4.94 ± 3.39, and 4.35 ± 3.27, respectively (in a range of 0-10). Professionalism had significant relationships only with residents’ specialty and gender. The level of professionalism in residents was low, which requires the attention of educational authorities. Moreover, the mean score of professionalism among residents in surgical specialties was significantly lower than non-surgical specialties. Various factors can be considered in this regard and it cannot be concluded that the lower score means worse professionalbehavior.

Background and aim: Helicobacter pylori (H. pylori) is an important and common contagious human pathogen which may cause peptic ulcer and also gastric cancer. The definite diagnosis of it is made through invasive tests. Recently, non-invasive tests including serologic tests of serum and saliva have been conducted for diagnosis of H. pylori infection. In this research, the diagnostic values of serum and salivary serology were compared together to use salivary anti-H. pylori test as an alternative method in the future. Methods: During this prospective case-control study on patients who were candidates for endoscopy and gastric biopsy from March 2015 to April 2016 in Shahid Beheshti hospital, Kashan, Iran, serum and salivary samples were obtained for measurement of Immunoglobulin G (IgG) antibody levels against H. pylori by enzyme-linked immunosorbent assay (ELISA). Histopathology was the gold standard test. Statistical analysis was performed by SPSS software version 16. Statistical tests included Kolmogorov-Smirnov, independent-samples t-test, Chi- square, Mann-Whitney U, Kruskal-Wallis, McNemar and correlation. Results: Of 123 patients, sixty-one patients (49.6%) were H. pylori-positive according to histology. The median levels of anti-H. pylori antibodies in serum (p

Background Different studies have been conducted to find the best adjuvant therapies for depression management. There are controversies over the effects of aspirin as an adjuvant therapy for depression. Objective To determine the effects of combined sertraline and aspirin therapy on depression severity among patients with major depressive disorder. Methods This randomized clinical trial was conducted at Kargarnejad Psychiatric Hospital in Kashan, Isfahan, Iran, from September 1, 2016 to November 1, 2016. The study participants included 100 patients with major depressive disorder who were assigned to aspirin and placebo groups by the use of computer-generated random numbers. Patients in these groups respectively received sertraline-aspirin and sertraline-placebo for eight consecutive weeks. Patients were prescribed 80 milligrams of aspirin twice a day. Also, sertraline was administered at a dose of 50-200 milligrams daily. Beck Depression Inventory was employed for depression severity assessment at four time points, namely before, two, four, and eight weeks after the beginning of the intervention. Medication side effects were also assessed eight weeks after the beginning of the intervention. Data were analyzed by SPSS version 12.0, using Chi-square and the Independent-samples t-test (α=0.05). Results Both groups were matched in terms of age (p=0.46), gender (p=0.539), and depression severity (p=0.509, with mean score 33.5±4.1 vs. 32.8±5.9) at baseline. However, depression scores were reduced significantly four and eight weeks after initiation of therapy just in the sertraline-aspirin group (p Conclusion As an adjuvant therapy, aspirin can reduce depression severity among patients with major depressive disorder. Yet, further studies are needed to prove the effectiveness of aspirin and other anti-inflammatory agents in reducing depression severity. Trial registration The trial was registered at the Iranian Registry of Clinical Trials (http://www.irct.ir) with the IRCT ID: IRCT2016082829556N1. Funding The authors received financial support from Research Deputy of Kashan University of Medical Sciences, Kashan, Isfahan, Iran.

This study was performed to determine the effects of zinc supplementation on wound healing and metabolic status in patients with diabetic foot ulcer. The current randomized, double-blind, placebo-controlled trial was conducted among 60 patients (aged 40–85 years old) with grade 3 diabetic foot ulcer. Participants were randomly divided into two groups (30 participants in each group) to take either 220 mg zinc sulfate supplements containing 50 mg elemental zinc or placebo daily for 12 weeks. After the 12-week intervention, compared with the placebo, zinc supplementation was associated with significant reductions in ulcer length (−1.5 ± 0.7 vs. −0.9 ± 1.2 cm, p = 0.02) and width (−1.4 ± 0.8 vs. −0.8 ± 1.0 cm, p = 0.02). In addition, changes in fasting plasma glucose (−40.5 ± 71.0 vs. −3.9 ± 48.5 mg/dl, p = 0.02), serum insulin concentration (−8.0 ± 15.4 vs. +1.1 ± 10.3 µIU/ml, p = 0.009), homeostasis model of assessment-estimated insulin resistance (−3.9 ± 7.1 vs. +0.8 ± 5.9, p = 0.007), the quantitative insulin sensitivity check index (+0.01 ± 0.03 vs. −0.002 ± 0.02, p = 0.04) and HbA1c (−0.5 ± 0.8 vs. −0.1 ± 0.5%, p = 0.01) in the supplemented group were significantly different from the changes in these indicators in the placebo group. Additionally, significant increases in serum HDL-cholesterol (+4.1 ± 4.3 vs. +1.1 ± 5.1 mg/dl, p = 0.01), plasma total antioxidant capacity (+91.7 ± 213.9 vs. −111.9 ± 188.7 mmol/L, p

Background This study aimed to evaluate effects of hand reflexology on anxiety level in coronary angiography patients. Materials and methods This clinical trial recruited 80 eligible patients >6 months. The patients were randomly assigned to receive routine care plus either hand reflexology or a simple hand massage. Data were collected using the Spielberger State-Trait Anxiety Inventory. Both groups' anxiety levels were measured before (T0) and 30 min (T1) and 1 h after the intervention (T2). Findings The mean anxiety level in the intervention group decreased from 57.54 at baseline to 55.47 after the intervention (P = 0.0001). The values in the control group were 54.27 and 51.4, respectively. The two groups had statistically significant differences in the mean scores of anxiety at T0 and T1 (P = 0.003), T1 and T2, and T0 and T2 (P = 0.0001). Conclusion Hand reflexology could effectively decrease anxiety in coronary angiography patients.

SummaryObjective This study was designed to evaluate the effects of the dietary approaches to stop hypertension (DASH diet) on weight loss, anti-Mullerian hormone (AMH) and metabolic profiles in women with polycystic ovary syndrome (PCOS). Design, Patients and Measurements: A randomized controlled clinical trial was conducted among 60 overweight or obese patients with PCOS. Patients were randomly assigned to receive either low-calorie DASH (N=30) or control diet (N=30) for 12 weeks. The DASH and control diets were consisted of 52%-55% carbohydrates, 16%-18% proteins and 30% total fats; however, the DASH diet was designed to be rich in fruits, vegetables, whole grains, low-fat dairy products, cholesterol and refined grains. Both diets were equicaloric. Results Adherence to the DASH diet, compared to the control diet, resulted in a significant decrease in BMI (−1.6±0.5 vs −1.2±0.7 kg/m2, P=.02). Significant decreases in AMH (−1.1±3.1 vs +0.3±0.7 ng/mL, P=.01), insulin (−25.2±51.0 vs −1.2±28.8 pmol/L, P=.02), homoeostasis model of assessment-estimated insulin resistance (−0.9±2.0 vs −0.1±1.0, P=.02), free androgen index (FAI; −0.03±0.09 vs +0.06±0.21, P=.02) and malondialdehyde (MDA) levels (−0.5±0.4 vs +0.2±0.3 μmol/L, P

Background An adequate level of calcium intake during growth years can extensively help to stabilize calcium level and increase bone density. However, calcium intake in female school-age students is low. This study aimed to determine effect of educational programs on milk consumption based on the theory of planned behavior among 7th grade girl students in Kashan city, Iran. Materials and Methods: This studywas interventional quasi‑experimentalresearch. 220 girl students (110 for interventional group and 110 for control group), were selected by simple random sampling from schools in Kashan city, Iran. The researcher-made questionnaire based on theory of planned behavior used for data collection. Interventional programs were performed using lectures, poster, and pamphlet. The questionnaire was completed by the students twice, before and two months after the implementation of educational program. Data were analyzed by SPSS version 20.0 using descriptive statistics and independent t-test. Results: After the implementation of the educational programs, the rate of milk consumption at home significantly increased among the interventional group (P

There was inconsistent evidence showing that vitamin D intake may be associated with reduced cancer risk due to optimized metabolic profile and reduced oxidative stress. However, we are not aware of any study evaluating the effects of vitamin D supplementation on clinical response and metabolic status of patients with endometrial hyperplasia (EH). This research was done to evaluate the effects of vitamin D supplementation on clinical response and metabolic status of patients with EH. This randomized, double-blind, placebo-controlled trial was conducted among 60 women diagnosed with EH. EH diagnosis was made based on specific diagnostic procedures of biopsy. Participants were randomly assigned into two groups to intake either 50,000 IU vitamin D3 supplements (n = 30) or placebo (n = 30) every 2 weeks for 12 weeks. After the 12-week intervention, compared with the placebo, vitamin D supplementation increased serum-25(OH) vitamin D levels (+12.0 ± 10.4 vs. +1.9 ± 7.1 ng/mL, P

Introduction Hospital websites are important tools in establishing communication and exchanging information between patients and staff, and thus should enjoy an acceptable level of quality. The aim of this study was to identify proper models and criteria to evaluate the quality of hospital websites. Methods This research was a systematic review study. The international databases such as Science Direct, Google Scholar, PubMed, Proquest, Ovid, Elsevier, Springer, and EBSCO together with regional database such as Magiran, Scientific Information Database, Persian Journal Citation Report (PJCR) and IranMedex were searched. Suitable keywords including website, evaluation, and quality of website were used. Full text papers related to the research were included. The criteria and sub criteria of the evaluation of website quality were extracted and classified. Results To evaluate the quality of the websites, various models and criteria were presented. The WEB-Q-IM, Mile, Minerva, Seruni Luci, and Web-Qual models were the designed models. The criteria of accessibility, content and apparent features of the websites, the design procedure, the graphics applied in the website, and the page's attractions have been mentioned in the majority of studies. Conclusion The criteria of accessibility, content, design method, security, and confidentiality of personal information are the essential criteria in the evaluation of all websites. It is suggested that the ease of use, graphics, attractiveness and other apparent properties of websites are considered as the user-friendliness sub criteria. Further, the criteria of speed and accessibility of the website should be considered as sub criterion of efficiency. When determining the evaluation criteria of the quality of websites, attention to major differences in the specific features of any website is essential.

Introduction: Anxiety is among the most common problems experienced by coronary angiography (CA) candidates. Different modalities are used to manage anxiety. This study sought to examine the effects of a pranayama exercise on CA candidates’ anxiety. Methods: This double-blind randomized controlled trial was undertaken in 2015 on 80 eligible patients. The patients were randomly allocated to a control and an experimental group. Before undergoing angiography, patients in the experimental group performed sukha pranayama exercises. They were trained to breathe slowly and rhythmically at a rate of ten breathing per minute for five consecutive minutes. Patients in the control group only received routine pre-angiography care. Data collection tools were a demographic questionnaire and the Spielberger State Anxiety Inventory. The level of patients’ anxiety in both groups was measured before, half an hour after, and one hour after the intervention. The data were analyzed through doing the independent-sample t and the chi-square tests. Results: Before the intervention, the mean of anxiety score in the experimental group was 53.37, which significantly decreased to 40.75 after the intervention (P = 0.0001). In the control group, the mean of anxiety score decreased from 54.27 to 51.4. This decrease was not statistically significant. Moreover, between-group comparisons revealed significant differences between the groups regarding between-measurement mean differences of anxiety score (P < 0.01). Conclusion: Sukha pranayama is effective in alleviating CA candidates’ anxiety.

Background : This study was performed to evaluate the effects of carnitine administration on carotid intima‑media thickness (CIMT) and inflammatory markers in women with polycystic ovary syndrome (PCOS). Methods : This randomized, double‑blind, placebo‑controlled trial was conducted among 60 women diagnosed with PCOS according to the Rotterdam criteria, aged 18–40 years. Participants were randomly allocated into two groups to intake either 250 mg/day carnitine ( n = 30) or placebo ( n = 30) for 12 weeks. High‑resolution carotid ultrasonography was conducted at baseline and after the 12‑week intervention. Results : After the 12‑week intervention, compared with the placebo, carnitine supplementation resulted in a signifcant decrease in maximum levels of the left CIMT (-0.01 ± 0.02 vs. +0.002 mm ± 0.006 mm, P = 0.001), mean levels of the left CIMT (-0.01 ± 0.02 vs. +0.001 mm ± 0.01 mm, P = 0.001), maximum levels of the right CIMT (-0.01 ± 0.02 vs. +0.006 mm ± 0.01 mm, P < 0.001), and mean levels of the right CIMT (-0.01 ± 0.02 vs. +0.002 mm ± 0.01 mm, P = 0.001). Change in plasma nitric oxide (NO) (+2.4 ± 3.6 vs. +0.2 ± 2.3 μ mol/L, P = 0.007) was signifcantly different between the supplemented patients and placebo group. We did not see any signifcant effect in serum high sensitivity C‑reactive protein (hs‑CRP) following the supplementation of carnitine compared with the placebo. Conclusions : Overall, carnitine administration for 12 weeks to participants with PCOS had benefcial effects on CIMT and plasma NO, but did not affect serum hs‑CRP levels. Keywords : Carnitine, carotid intima‑media thickness, inflammation, polycystic ovary syndrome

Ageism implies negative views and attitudes towards older people. These unconscious behaviors could make the elderly feel as if they were no longer useful for the family and community. Ageism is common in healthcare services. The objective of this study was to develop a tool to assess ageism in nursing care in Kashan/Iran 2015. This psychometric study was carried out in four stages: literature review for item generation; content validity testing; exploratory factor analysis (EFA) for evaluation of construct validity; and reliability assessment. The data analyzed with SPSS version 16. The final questionnaire had 24 items. The total CVI and CVR were 0.88 and 0.57. Explanatory factor analysis identified 3 factors of respecting older adult in nursing care (14 items); age discrimination and negative views towards older adults (5 items); attention to older adult and their basic caring needs (5 items). The three factors could explain 49.54% of variance. The test-re-test correlation stood at 0.9. The internal consistency of the questionnaire was Cronbach’s alpha =0.85. A valid and reliable instrument for the evaluation of ageism in nursing care was developed in this study.

The purpose of this study was to evaluate the portal quality of educational hospitals affiliated to the universities of medical sciences in Iran. A descriptive cross-sectional study was conducted i...

This study aimed to determine the trends in outpatient cataract surgery and its determinants in the Islamic Republic of Iran between 2006 and 2010. In this cross-sectional study, 106 cataract surgery centres were selected in all provinces by multistage randomized cluster sampling. The number of centres in each province was determined from the number of cataract operations and the number of patient charts examined in each centre was proportionate to the number of cataract operations in that centre. The prevalence of outpatient surgery increased from 46.0% (95% CI, 35.3-56.8) in 2006 to 51.4% (95% CI, 40.2-62.7) in 2010 (P = 0.549). Patients stayed in hospital for more than one night after 10.5% (95% CI, 6.9-14.1) of operations. Use of phacoemulsification and topical anaesthesia increased the prevalence of outpatient surgery and decreased intraoperative complications. Although outpatient cataract surgery increased by 11.7%, use of methods such as phacoemulsification is not widespread, and more attention should be paid to the barriers to outpatient cataract surgery in the Islamic Republic of Iran.الاتجاهات السائدة في جراحة الكتاركت في العيادات الخارجية في جمهورية إيران الإسلامية، 2006-2010.حسن هاشمي، أكر فتوحي، فرهاد رضوان، حميد رضا جياسي، سهيلا عسغري، سامان مهذب - ترابي، كوروش اعتاد، عباس عي يكتا، مهدي خباز خوب.هدفت هذه الدراسة إلى تحديد الاتجاهات السائدة في جراحة الكتاركت (المياه البيضاء) في العيادات الخارجية ومحدِّداتها في جمهورية إيران الإسامية بن عامي 2006 و 2010. فانتُقيتْ في هذه الدراسة المقطعية 106 مراكز لجراحة الكتاركت في جميع المحافظات عن طريق اختيار العينة العنقودي العشوائي متعدد المراحل وحُدِّد عدد من المراكز في كل محافظة من خال عدد عمليات الكتاركت، وكان عدد مخططات المرضى التي فحصت في كل مركز متناسباً مع عدد عمليات الكتاركت في ذلك المركز. لقد ازداد انتشار جراحة العيادات الخارجية من (%95 CI 35.3-56.8) %46.0% في عام 2006 إلى 51.4% (%95 CI 40.2-62.7) في عام 2010 (p = 0.549). ومكث المرضى في المستشفى أكثر من ليلة واحدة بعد %10.5 (%95 CI 6.9-14.1) من العمليات. ولقد أدى استخدام استحلاب العدسة والتخدير الموضعي إلى زيادة انتشار جراحة العيادات الخارجية وإلى التقليل من حدوث المضاعفات أثناء العملية. عى الرغم من أن جراحة الكتاركت في العيادات الخارجية ازدادت بنسبة %11.7 فإن استخدام بعض الطرق – مثل استحلاب العدسة – ليس منتراً عى نطاق واسع، وينبغي إياء المزيد من الاهتام بالعوائق التي تحول دون إجراء جراحة الكتاركت في العيادات الخارجية في جمهورية إيران الإسامية.Tendances de la chirurgie ambulatoire de la cataracte en République islamique d’Iran, 2006-2010.La présente étude avait pour objectif de déterminer les tendances de la chirurgie de la cataracte en ambulatoire et ses déterminants en République islamique d’Iran entre 2006 et 2010. Dans cette étude transversale, 106 centres de chirurgie de la cataracte ont été sélectionnés dans toutes les provinces par échantillonnage aléatoire en grappes à plusieurs degrés. Le nombre de centres dans chaque province a été déterminé sur la base du nombre d’opérations de la cataracte et le nombre de dossiers de patients examinés dans chaque centre était proportionnel au nombre de chirurgies de la cataracte pratiquées dans ce centre. La prévalence des chirurgies de la cataracte est passée de 46 % (IC à 95 %, 35,3-56,8) en 2006 à 51,4 % (IC à 95 %, 40-62,7) en 2010 (p = 0,549). Les patients sont restés plus d’une nuit à l’hôpital après 10,5 % (IC à 95 %, 6,9-14,1) des opérations. Le recours à la phaco-émulsification et l’anesthésie topique faisait augmenter la prévalence de la chirurgie ambulatoire et réduisait les complications intra-opératoires. Bien que la chirurgie de la cataracte en ambulatoire ait augmenté de 11,7 %, l’utilisation de méthodes telles que la phaco-émusification n’est pas répandue, et davantage d’attention devrait être apportée aux obstacles qui s’opposent à la chirurgie de la cataracte en ambulatoire en République islamique d’Iran.

Purpose. To determine the prevalence and types of intraoperative complications of cataract surgery and examine potential risk factors. Methods. Data were obtained from the 2011 Iranian Cataract Surgery Survey in which information about cataract surgeries throughout the nation was collected. In the Province of Tehran, 55 centers and 1 week per season per center were randomly selected for sampling. In each center, the charts of all patients who underwent cataract surgery during the selected weeks (total of 20 weeks per center) were reviewed for data extraction. The prevalence of different types of intraoperative cataract surgery complications were determined, and their relationships with age, sex, surgical method, surgeon, and hospitalization time were examined. Results. The prevalence of intraoperative complications of cataract surgery was 4.15 (95 confidence interval, 0.94 to 7.36). The prevalence of posterior capsular rupture with vitreous loss, posterior capsular rupture without vitreous loss, retrobulbar hemorrhage, suprachoroidal effusion/hemorrhage, intraocular lens drop, and nucleus drop was 2.86, 0.69, 0.06, 0.39, 0.03, and 0.11, respectively. The prevalence of cataract surgery complications decreased from 6.95 in 2006 to 3.07 in 2010. The results of multiple logistic regression showed that surgery by residents, nonphacoemulsification methods of surgery, and patient age less than 10 years and more than 70 years were the risk factors for complications. Conclusions. This study evaluated the prevalence of intraoperative complications of cataract surgery for the first time in Tehran Province. The prevalence of complications was high in this study. To achieve the goals of the Vision 2020 Initiative and improve surgical quality, it is necessary to minimize complication rates. Factors to note for decreasing complication rates include type of surgery, surgeon experience, and patient age. Copyright A�© 2016 American Academy of Optometry.

To determine intraoperative complications of cataract surgery over the period 2006 to 2010.In this cross-sectional study, 106 of 272 cataract surgical centers in Iran were selected through multistage random cluster sampling from all provinces. In each province, the selected number of centers was proportionate to the number of cataract surgeries, and in each center, the selected number of charts was proportionate to the center's number of cataract surgeries, from which we retrieved intraoperative complications.The prevalence of intraoperative complications of cataract surgery was 5.04% (95% confidence interval, CI, 3.53-6.54%) in 2006, which decreased significantly to 3.44% (95% CI 1.84-5.04%) in 2010. The most common complication was posterior capsular rupture/vitreous loss which decreased from 4.29% (95% CI 2.93-5.66%) in 2006 to 2.81% (95% CI 1.3-4.31%) in 2010. The next most common complication was suprachoroidal hemorrhage at 0.56% (95% CI 0.25-0.87%) in 2006 and 0.46% (95% CI 0.3-0.62%) in 2010. The least common complication concerned intraocular lens (IOL)-drop. Complications were seen most with lensectomy, while phacoemulsification caused the least complications. Mean hospitalization time in uncomplicated cases was 0.59 days (95% CI 0.58-0.61 days) and in complicated cases 1.14 days (95% CI 1.07-1.20 days; p0.001).Complications of cataract surgery in Iran had a decreasing trend during 2006-2010. However, results from 2010 indicate that cataract surgical complications still need to be focused on. Hospitalization was longer for cases with complications, and further reducing this could help decrease costs of cataract surgery.

Pseudomonas aeruginosa is one of the most important opportunistic human pathogens worldwide. High prevalence of Multi Drug Resistant P. aeruginosa (MDRPa) in Iran is a serious problem for antimicrobial therapy. Several studies have reported the MDRPa in Europe and Asia. Due to the use of broad-spectrum antibiotics, bacterial resistance is increasing in Iran, located in Middle East. The present cross-sectional study was designed to investigate the prevalence of class1 integron, resistance gene cassettes and antimicrobial susceptibility profiles among isolates of P. aeruginosa in Al-Zahra Hospital, Isfahan City, central part of Iran from Jan-Sep 2014. The aim of this study was to determine the antimicrobial susceptibility, the prevalence of Class1 integron, resistance gene a measuring in Iran. A total of 231 P. aeruginosa isolates were collected from clinical specimens including urine (50.6%), tracheal tube (25.5%), wound (13.4%), blood (6.1%), catheter (2.2%), cerebrospinal fluid (1.7%) and sputum (0.4%) isolates from hospitalized patients (mean age: 50.27 ± 24.12 years).The majority of patients (68%) were male. Isolates were collected from different parts of the hospital as follows: ICU, Internal Medicine, Emergency care, Pediatrics, Nephrology, Transplant Center, General surgery and Infectious. Revealed data show a high rate of MDR P. aeruginosa isolates in the studied area; also, the result signifies the spread of aadA6 among clinical isolates in hospitalized patients.

Background In mild to moderate gallstone pancreatitis, cholecystectomy is the most appropriate treatment for prevention of further biliary attacks. However, the timing of cholecystectomy is not precisely determined. The present study was conducted to compare outcomes of very early (within 48 h) versus delayed (more than 1 week) laparoscopic cholecystectomy in patients with acute biliary pancreatitis (ABP). Methods This randomized clinical trial study was conducted in Shahid Beheshti Hospital of Kashan University of Medical Sciences from September 2016 to Mar 2019. Two hundred and eight cases with mild to moderate ABP were randomly assigned to 2 groups, with 104 patients in group 1 (operation within 48 h) and 104 in group 2 (operation after one week). Age, sex, biochemical parameters, clinical manifestation at the time of admission, operation time, recurrent biliary problems, relapse, peri-operative complications, conversion rate, and hospital length of stay in the two groups were recorded and compared. In addition, Ranson's score and Revised Atlanta criteria, the American Society of Anaesthesiologists Physical Status ASA-PS, Charlson Co-Morbidity Index (CCI), complexity of surgery and Clavien-Dindo score were also determined. Results There were no differences in demographics, peri-operative complications 4 (4%) vs. 4 (4%), P = 1), conversion rate (10.6% vs. 11.5%; P = 0.825) and procedure time (83 vs. 81 minutes, P = 0.110) between the two groups. There were no deaths in either group; however, the length of hospital stay was shorter in the early group compared to the delayed one, (3.66 ± 1.12 vs. 10.35 ± 1.76, P < 0.001). Conclusion Cholecystectomy within 48 h decreases significantly the length of hospital stay, without any difference in conversion rate, procedure time, or complication rate., Biological sciences; Health sciences; Surgery; Internal medicine; Acute biliary pancreatitis; Laparoscopic cholecystectomy; Mild to moderate acute biliary pancreatitis.

This study was carried out to determine the effects of magnesium and vitamin E co-supplementation on wound healing and metabolic status in patients with diabetic foot ulcer (DFU). The current randomized, double-blind, placebo-controlled trial was conducted among 57 patients with grade 3 DFU. Participants were randomly divided into two groups to take either 250 mg magnesium oxide plus 400 IU vitamin E (n = 29) or placebo per day (n = 28) for 12 weeks. Compared with the placebo, taking magnesium plus vitamin E supplements reduced ulcer length (β [difference in the mean of outcomes measures between treatment groups] -0.56 cm; 95% CI, -0.92, -0.20; p = 0.003), width (β -0.35 cm; 95% CI, -0.64, -0.05; p = 0.02) and depth (β -0.18 cm; 95% CI, -0.33, -0.02; p = 0.02). In addition, co-supplementation led to a significant reduction in fasting plasma glucose (β -13.41 mg/dL; 95% CI, -20.96, -5.86; p = 0.001), insulin (β -1.45 μIU/ml; 95% CI, -2.37, -0.52; p = 0.003), insulin resistance (β -0.60; 95% CI, -0.99, -0.20; p = 0.003) and HbA1c (β -0.32%; 95% CI, -0.48, -0.16; p

Therapeutic touch is emphasized by healthcare professionals for improvement of neonates' growth and development. However, inconsistencies exist regarding effects and methods of massage in neonates. The purpose of this clinical trial is to assess and comprise intervention and control groups regarding the effects of tactile-kinesthetic stimulation (TKS) by mothers on growth indices of healthy term neonates. Sixty healthy term neonates were randomly assigned into intervention and control groups. Mothers of neonates in the experimental group were trained to perform TKS for their newborns at home before feeding for at least 28 consecutive days, two times a day, and 15 min each time. Neonates in the control group were not required to receive this intervention. The neonates' growth indices were measured within 24 h after birth, and then at days 14 and 28. During the study and the three consecutive measurements, no significant difference was found between the mean weights, heights, and head circumferences of the neonates in the two groups (p > 0.05).

This study aimed to investigate the effects ofguided imagery on state and trait anxiety and sleep quality among hemodial ysis patients.This was a randomized controlled trial. A total of seventy hemodialysis patients were assigned through block randomization to either an intervention group to receive guided imagery or a control group to receive routine care services.The study was performed in the hemodialysis unit of Akhavan teaching hospital, Kashan, Iran.In addition to routine care services, patients in the intervention group received guided imagery six times a week for four successive weeks via listening to a guided imagery instructional compact disk and following the instructions.Before and four weeks after the intervention, state and trait anxiety and sleep quality were measured via Spielberger's State-Trait Anxiety Inventory and Pittsburgh Sleep Quality Index.The results of analysis of covariance showed that the intervention and the control groups significantly differed from each other respecting the posttest mean scores of state anxiety (adjusted mean difference: -9.11; 95% CI = -10.26 to_-7.96; P 0.001), trait anxiety (adjusted mean difference: -8.94; 95% CI = -10.31_to -7.57; P 0.001), and sleep quality (adjusted mean difference: -0.877; 95% CI = -1.51_to -0.24; P 0.007).Guided imagery can significantly alleviate anxiety and improve sleep quality among hemodialysis patients. Nurses are recommended to use guided imagery to alleviate hemodialysis patients' anxiety and improve their sleep quality.