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Actinic keratosis (AK) is a precancerous skin lesion associated with the development of squamous cell carcinoma. Approved topical treatments for AK are unmet needs. To evaluate the safety and efficacy of hydrogen peroxide topical solution 35% (H2 O2 ) with cryosurgery for the treatment of AKs. Eligible subjects were randomly assigned to receive H2 O2 and cryosurgery on each side of their scalp/face. Patients were assessed at baseline and after 3 months of follow-up. Efficacy was evaluated based on the Actinic Keratosis Area and Severity Index (AKASI) and dermoscopic assessments. Fifteen patients with 98 lesions completed the study. At the follow-up visit, the mean improvement of AKASI from baseline was 1.7 ± 0.9 for H2 O2 and 1.7 ± 0.8 for cryosurgery (p 0.05). Regarding safety, hypopigmentation occurred more frequently in the cryosurgery group (28.3% vs. 9.6%; p = 0.017). Moreover, patients endured more pain with cryosurgery application than H2 O2 (p < 0.001). The effect of H2 O2 solution was comparable to cryosurgery. This treatment was well tolerated and had a favorable safety in patients with AKs.

Background: So far, five types of prevention including: primordial, primary, secondary, tertiary and quaternary prevention levels have been defined in literatures. Aim: In this study, we have proposed “prevention of malpractice” as the other level of prevention. Methods: Qualitative comparison of the data, obtained from the review of conducted studies by using of scientific literatures, registered in PubMed, Google Scholar and Scopus sites. Results: Bringing dozens of examples of “malpractice” in the five areas of prevention. Conclusion: We concluded that, “malpractice” may be occurred at all levels of prevention and preventing it can be considered as the other level of prevention.

OBJECTIVE To determine the effectiveness of education in evidence-based medicine (EBM) on the knowledge, competency, and skills of otolaryngology residents of Tehran University of Medical Sciences (TUMS) at Amir-Alam and Imam Khomeini Hospitals. METHODS In a quasi-experimental (before-and-after) study, all ear, nose, and throat residents of TUMS (n = 41) entered the study. The residents underwent the modified Fresno test. Then, two EBM workshops with a similar content were held on 2 separate days in each hospital, with each session lasting 6 hours. The learned material was practiced in weekly journal clubs. Six months after the workshop, the modified Fresno test was applied again, and the results were analyzed. RESULTS A significant improvement in the modified Fresno test score was observed. The mean score of the modified Fresno test was 57.43 ± 22.07 before the workshop and 79.26 ± 22.48 after the workshop (P < 0.001). CONCLUSION The results of the study show that EBM education and practice of the learned materials in journal clubs can improve the knowledge and skills of residents. Further research with larger samples is needed to improve the precision of our findings and to increase confidence in the results. LEVEL OF EVIDENCE 2 Laryngoscope, 129:2291-2294, 2019.

Background Andropause is a middle-age condition in which men experience changes in their physical, spiritual and emotional health. The association between andropause and psychological symptoms such as depression are not very clear yet. Aims The objective of this study was therefore to determine the association between the ‘Aging Males Symptoms Scale’ (AMS) and depression. Methods A cross sectional study was conducted among 521 old men. To collect data, the AMS and the Patient Health Questionnaires 2 and 9 were used to screen depression, in addition to questions on background and fertility. Multiple linear regression analysis was used to assess the association between andropause symptoms and depression. Results Based on our results and the AMS score, 51.5 % of the study population had clinical symptoms of androgen disorder, 3.7 % of which had severe symptoms. There was a strong correlation between the AMS score and depression. Depression, diabetes, cigarette smoking and spousal age retained their significant associations even after entering the relevant demographic, anthropometric, smoking and disease variables in the multivariable model. As a positive predictive factor, depression had the strongest association with AMS. Conclusions Based on our results, there is a direct association between andropause symptoms and depression, where the increasing AMS score corresponds with the severity of depression. Discussion Our results show the need of screening for depression when evaluating andropause symptoms.

Psychological stress and illness among hospital residences have been subject to increasing scientific scrutiny; however very few studies have been published to describe the extent of health status and psychological stresses in residents in different specialties especially in our country that our study was mainly focused on this subject. Methods: The study subjects were medical residents in public hospitals covering 14 different specialties in Tehran in 2007. A self-administered questionnaire elicited information related to socio-demographic profile, specialty, duty hours, sleep quality, physical activity level, number of night shifts per month, mood changes, sense of depression after night shifts, fatigue, use of antidepressant and tranquilizer, and their opinion regarding their health status on a 4-point Likert scale. Results: 66.7% of participants were male with the mean age of 32.9 ± 4.2 years. 62.1% of the residents felt mood changes after nightly shifts that could adversely affect their daily living, quality of work, and social relationships. The overall prevalence of the use of antidepressant drugs was 20.0% which was significantly higher in women than men. Also, 24.4% of them reported consumption of sedative and hypnotic drugs. 15.6% reported complete healthy status while 9.4% reported partial illness. Complete healthy status was more reported among the residents of anesthesiology and pediatrics while illness was more reported by residents in pathology field. Residents’ satisfaction with their status was positively correlated with the year of residency and marriage, while dissatisfaction was more reported in divorced ones as well as in those with higher number of nightly shifts. Conclusion: Notable number of hospital residents in Iran experience significant stressors and emotional and mental health problems. Among all studies factors type of specialty, year of residency, female gender, number of nightly shifts, and single marital status were more important than other factors.

Although risk factors of Ischemic Heart Disease (IHD) are well known, knowledge about the distribution of these risk factors in different subgroups of patients can be used for designing preventive programs. The aim of this study was to assess differences of prevalence of IHD risk factors in elderly and non-elderly patients in their first Acute Myocardial Infarction (AMI). In this retros-pective study, elderly (age > 65; n = 1060) and non-elderly (age ≤ 65; n = 2228) patients with first AMI who were admitted into four teaching hospitals in Tehran between 1982 and 2005 were recruited. Risk factors containing male gender, systolic and diastolic hypertension (HTN), diabetes, hypertriglyceridemia, hypercholesterolemia, smoking and family history of IHD were compared between the two groups. Among different risk factors, diabetes and systolic HTN were more common in elderly than their non-elderly counterparts, and male gender, smoking, family history of IHD and dyslipidemia were more common in non-elderly patients than elderly ones (p < 0.05 for all comparison). Diastolic HTN showed no significant difference between the two groups. Findings of this study, stating difference of prevalence of risk factors in two elderly and non-elderly groups, can be used by health policy makers to conduct preventive programs for AMI in this country.

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

Introduction: Hypertension is one of the common problems associated with pregnancy that may be followed by eclampsia, acute renal failure, maternal death, premature delivery, intra-uterine growth restriction and other. This study was conducted to determine the results of pregnancies associated with hypertension in patients visiting in the Delivery Ward of Valiasr Hospital. Methods: A descriptive study was conducted on all the patients admitted to the aforementioned department and who possessed the inclusion criteria for hypertensive pregnancy. Results: Among the 1694 delivery cases examined, 173 cases had hypertension (9.8%). Among these, 75 (45%) had gesta-tional hypertension; 24 (14.8%) had preeclampsia-eclampsia; 30 (18%) had preeclampsia su-perimposed on chronic hypertension; 21 (13.5%) cases had chronic hypertension; and 13 (8%) had pregnancy-aggravated chronic hypertension. Ninety-six point three percent (96.3%) had a systolic blood pressure (BP) of 140 - 190 mmHg, and 3.7% had a systolic BP greater than 190 mmHg. Whereas 61.1% of diastolic blood pressure 90 - 110 mmHg and 38.9% of the mothers had diastolic BP greater than 110 mmHg. The HELLP (Hemolysis, Elevated Liver enzymes & Low Platelet count) syndrome was present in 4.9% of cases; 52.6% experienced premature delivery; 7.4% had IUFD (intra uterine fetal death); 9.9% had IUGR (intrauterine growth retardation); and 17.3% had LBW babies. Conclusions: Based on our results, hypertensive mothers who are younger and have lower weight babies at birth experience more perinatal complications. The unpleasant effects of hypertension in pregnancy warrant the need for training, routine prenatal care, the early detection and treatment of hypertension at younger ages of pregnancy, and follow-up after delivery.

Background: The sources of respiratory disorders commonly occurred during the Hajj ceremony are now challenging and its infectious or allergic nature remained unknown. The present comprehensive study was conducted to assess sources of respiratory disorders in Hajj pilgrims. Method: In this prospective observational study, blood samples of 130 pilgrims were taken for assessment of serum levels of infectious and allergic sources. The measurement of IgA, IgG, IgM was used for assessment of infectious reactions against microbial antigens, NBT test was employed to assess phagocytic functions, and the measurement of gamma interferon was used for assessing immunity status against infections. Also, measurement of IgE and IL-4 was applied as two markers for assessing allergic reactions. The ELISA test was also used to assess serum levels of immunoglobulin A, G, M, E, IL-4 and gamma interferon before and three weeks after returning from Hajj ceremony. All of the volunteers were followed up along the trip and the involved pilgrim’s characteristics were recorded. Results: The present study showed no significant change in the level of allergic biomarkers including IgE and IL-4, however the mean levels of IgM, gamma Interferon and NBT test were increased after the trip compared with before that. Conclusion: Infections play a major role in occurrence of respiratory disorders among Hajj pilgrims and thus the role of allergic sources is doubtful.

Seyyed M Razavi1, Mojgan Karbakhsh1, Mahdi Panah Khahi2, Soheila Dabiran1, Sara Asefi3, GhamarH Zaker Shahrak4, Ali R Bad Afrooz41Department of Community Medicine, 2Department of Anesthesiology, 3Department of General Practice, 4Clinical Skills Center, Tehran University of Medical Sciences, IranBackground: Every procedural skill consists of some microskills. One of the effective techniques for teaching a main procedural skill is to deconstruct the skill into a series of microskills and train students on each microskill separately. When we learn microskills, we will learn the main skill also. This model can be beneficial for tuition on procedural skills.Objective: In this study, we propose a stationed-based deconstructed training model for tuition of each microskill, and then we assessed the medical students’ self-perceived abilities.Methods: This quasi-experimental study was conducted in 268 medical students (536 matched pre- and post-questionnaires) at the surgical clerkship stage during five consecutive years in three teaching and learning groups. In this study, we taught each skill in 10 steps (proposed model) to the students. We then evaluated the students’ self-perceived abilities using a pre- and post-self-assessment technique. SPSS v13 software with one-way analysis of variance and paired t-tests were used for data collection and analysis.Results: Assessment of medical students’ perceived abilities before and after training showed a significant improvement (P < 0.001) in both cognitive and practical domains. There were also significant differences between the three teaching and learning groups (P < 0.001). There were no significant differences for the different years of training regarding the observed improvement.Conclusion: This study suggests that deconstructing the practical skills into microskills and tuition of those microskills via the separated structured educational stations is effective according to the students’ self-ratings.Keywords: clinical skills center, microskills, perceived ability, self-assessment, self-scoring stationed training

Aim: The objective of this study was to assess the quality of life (QOL) and its relation to sociodemographic factors among elderly living in Tehran. Methods: A descriptive/correlational study was conducted. The sample consisted of 5600 people aged 60 years or older from 11 districts of Tehran. QOL was measured with the 36-item short form questionnaire. Results: QOL was positively associated with education levels, having previous state jobs and being employees, and negatively associated with smoking and having disease. Compared to men, women had lower scores for overall QOL and its dimensions. Conclusion: Sociodemographic inequalities, smoking and having diseases should be the main targets for improving the QOL in the elderly population.

Meningioma is among the most common slow growing central nervous neoplasms, which recurs locally despite the benign histologic features. The aim of this study was to evaluate osteopontin and ki67 expressions in different histologic grades of meningioma in a group of Iranian people.In this cross-sectional study, first, the paraffin blocks with the definite pathological diagnosis of meningioma in 70 patients were cut by microtome, in 4-5 micron sizes and stained for immunohistochemical markers of osteopontin and ki67. Then, all samples were evaluated for positive immunoreactivity and contributing factors.Among 70 pateints studied, the mean for the Ki67 level was 8.6±12.3 and the mean for the osteopontinm IHC score was 45.2±77.9. There was a high correlation between markers, tumor recurrence and grade (P0.001). In addition, there was a significant direct correlation between ki67 and osteopontin levels (P0.001, r=0.760). In other words, as OPN and ki67 expressions increased, the chance of tumor recurrence increased.ki67 and osteopontin expressions in patients with meningioma can be used as good prognostic markers for tumor recurrence and for distinguishing the grade of meningiomas.

Background: Given the lack of consistency in the literature regarding the reliability of the ankle-brachial index (ABI) as a valid screening tool and an independent risk indicator of cardiovascular events and mortality, we compared it with angiography as a reference standard test. Methods: This case-control study, conducted between 2010 and 2011 in Tehran Heart Center, recruited 362 angiographically confirmed cases of coronary artery disease (CAD) and 337 controls. A standard protocol was used to measure the ABI and different CAD risk factors. Results: A low ABI had specificity of 99.7%, positive predictive value of 95.8%, negative predictive value of 49.8%, sensitivity of 64%, likelihood ratio of 24.07, and odds ratio (OR) of 22.79 (95%CI: 3.06–69.76). The role of the associated risk factors was evaluated with OR (95%CI), with the variables including gender 3.15 (2.30–4.30), cigarette smoking 2.72 (1.86–3.99), family history 1.72 (1.17–2.51), diabetes 1.66 (1.15–2.4), and dyslipidemia 1.38 (1.02–1.88). In a multivariate model, the following variables remained statistically significantly correlated with CAD [OR (95%CI)]: ABI 13.86 (1.78–17.62); gender 3.69 (2.43–5.58); family history of CAD 2.18 (1.41–3.37); smoking 1.69 (1.08–2.64); age 1.04 (1.02–1.06). Conclusions: A low ABI had specificity of 99.7%; however, because of its low sensitivity (64%), we should consider CAD risk factors associated with a low ABI in order to use it as a first-line screening test.

The drug ecstasy has been increasingly used for recreational purposes, especially among students. Teachers play an important role in altering student attitudes toward ecstasy. OBJECTIVE: The aim of this study was to access teacher knowledge and attitude toward ecstasy and its side effects. METHODS: In a cross-sectional study, 460 teachers from 20 public and 10 private schools were randomly invited to participate in the study between April 2005 and April 2006 and their knowledge and attitudes toward ecstasy were collected on the basis of a designed questionnaire. RESULTS: No significant correlation was found between knowledge about ecstasy and gender, whereas, there was a positive relation between knowledge and education level of the teachers (P = .033). Attitude was higher in female participants (P = .012), but was not related to the age of the teachers. We found no relation between attitude toward ecstasy and the teachers' education levels. CONCLUSION: Knowledge about ecstasy and its side effects was dependant on the teachers' education level, whereas their attitude toward ecstasy was dependent on the teachers' gender. Language: en

Purpose: One of the most significant current discussions is the effect of different levels of physical activity on health-related quality of life (HRQOL), but there have been no studies in Iran which investigate this issue. The aim of this study was to investigate the relationship between the level of physical activity and HRQOL in Iranian women. Methods: This was an analytical cross-sectional study conducted from October 2010 to January 2011 in Karaj’s gymnasiums. We selected gymnasiums using simple randomized sampling. The validated Persian short form 36-item HRQOL questionnaire version 2.0 (SF-36 v2) and the short form of the International Physical Activity Questionnaire were used for data collection. Based on IPAQ, participants were classified into two groups: one with a high level of physical activity (N=240) and another with a moderate level (N = 120). Results: The group with a high level of physical activity had significantly higher vitality scores (P=0.01) and lower role limitation-physical scores (P= 0.02) than the group with a moderate level. The high level of physical activity was associated with considerably higher scores in general health (73.94 ± 0.99 vs.70.82 ± 1.33) (P=0.06) and mental well-being (73.94 ± 1.18 vs.70.88 ± 1.82) (P =0.1) domains than moderate level. Conclusions: It seems that the high level of physical activity, compared with the moderate level, tends to have positive association with more domains of SF36 v2.