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Results in Journal Shiraz E-Medical Journal: 685

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Zahra Jalali, , Heidar Safarpour, , , Yasaman Mansoori, Seid Ali Malekhosseini
Shiraz E-Medical Journal; https://doi.org/10.5812/semj.110017

Abstract:
Background: This study aimed to determine the prevalence of post-transplant lymphoproliferative disorder (PTLD) based on the clinical and epidemiological characteristics of donors and pediatric transplant recipients. Methods: This cross-sectional study was conducted on the patients who had experienced liver transplantation at Shiraz Transplant Center, Shiraz, Iran, from April 2007 to March 2017. Data on the epidemiological characteristics, underlying diseases, dosage of immunosuppressive drugs, and duration of drug consumption from the time of liver transplantation until the onset of PTLD for transplant recipients, and donors’ age, sex, and family relationship with recipients were collected using a data-gathering form. Log rank test was employed to determine the variations in the distribution of survival in different sex and age groups. Results: The study findings indicated that 49 out of the 1207 children who had undergone liver transplantation developed PTLD, revealing a prevalence of 4%. The results showed no significant relationship between gender and the incidence of PTLD (P = 0.13). However, the mean age of the cases with PTLD was 4.93 ± 1.07 years at the time of transplantation, while non-PTLD patients showed a higher mean age at that time (7.80 ± 5.54). The mean dose of the immunosuppressive drugs (dose/kg) consumed by the recipients was as follows: tacrolimus = 0.2753 ± 0.23435, prednisolone = 0.6761 ± 0.62218, cellcept = 0.0724 ± 0.12963, and sirolimus = 0.1078 ± 0.08813. The average consumption period of the above-mentioned drugs from the time of transplantation until the onset of PTLD was 14.7 ± 14.409 months. Based on the results, the five-year survival rate was much lower in the patients with PTLD compared to the non-PTLD patients (31% Vs. 72.7%). The survival distribution was significantly different based on sex and age groups (P = 0.59 and P = 0.06, respectively). Conclusions: The prevalence of the clinical and epidemiological features of the PTLD in the patients under the present investigation was similar to those of the patients in other hospitals. Recognizing the clinical and epidemiological characteristics of transplant recipients with and without PTLD and donors can provide a basis for managing these patients.
Nader Saki, Amir Hossein Asadollah Pour, Hasan Abshirini, , Majid Karimi, Hossein Bagheripour, Arash Bayat
Shiraz E-Medical Journal; https://doi.org/10.5812/semj.112616

Abstract:
Background: Delay in early detecting of hearing loss (HL) and aural interposition in children have intense impacts on their speech and language expansion, academic progress, social skills, and psychological status. Objectives: The purpose of the current study was to assess the age of hesitancy, recognition, reinforcement, and interposition in children with bilateral severe to deep hearing loss. Methods: This cross-sectional study was conducted on children who were candidates for cochlear implant surgery at Khuzestan Cochlear Implantation Center, Ahvaz, Iran. The rehabilitative histories and children’s medical were utilized to record ages of hesitancy, recognition, reinforcement, and interposition for both groups of “high-risk” and “not-high-risk” children. Paired sample t-test was used to evaluate the middle ages of children between the “high-risk” and “not-high risk” groups. Results: A total of 389 children (205 boys and 184 girls) were included. The mean ages of hearing loss hesitancy, hearing loss recognition, fitting the hearing reinforcement devices, and interposition were 10.7 ± 7.1, 15.75 ± 9.4, 21.81 ± 8.1, and 26.32 ± 9.2 months, respectively. The average delays between the ages of hesitancy and recognition: 3.74 (P < 0.0001); recognition and reinforcement: 5.05 (P < 0.0001); reinforcement and interposition: 2.83 months (P < 0.0001) were obtained. There were no significant statistical differences in terms of four studied ages among the high-risk (n = 129) and not-high risk (n = 260) children (P > 0.05). Conclusions: The outcomes showed that there is a significant improvement in the average ages of hearing loss hesitancy, recognition, reinforcement, and interposition in Iran. However, there is still an obvious difference between these ages and those recommended by the Joint Committee on Infant Hearing.
Hamid Reza Samimagham, Mehdi Hassani Azad, Mohsen Arabi, Sara Ghazizadeh, Alireza Malektojjari, Meysam Hojjatipour, Dariush Hooshyar,
Published: 28 November 2021
Shiraz E-Medical Journal; https://doi.org/10.5812/semj.116995

Abstract:
Keywords Severity COVID-19 Remdesivir
Fatemeh Mirzaei, Fatemeh Cheraghi, Salman Khazaei, Mohammad Rezaei, Fatemeh Mohammadi
Published: 20 November 2021
Shiraz E-Medical Journal; https://doi.org/10.5812/semj.113583

Abstract:
Background: The disability to recognize emotional and mental states in others’ facial expressions is acknowledged as one of the major developmental-behavioral problems in children with autism. Therefore, it is necessary to study the effect of facial emotion recognition training on the interaction skills of children with autism. Objectives: The aim of this study was to investigate the effect of emotional facial recognition on the mother-child relationship in children with autism. Methods: The present clinical trial was conducted based on a pre-test post-test design. Children aged 6-12 years with high- or moderate-functioning autism were assigned to two groups using the random block sampling method. Children in the intervention group were trained in 10 45-min sessions each week for 10 weeks using 40 images related to four situations of happiness, sadness, anger, and fear. The mother-child relationship questionnaire was completed one day before and one day after the intervention in both groups by the research assistant. Data were analyzed with SPSS software version 22. Results: Emotional state training improved the mother-child relationship in the intervention group. There was also a statistically significant difference between the total scores of the mother-child relationship in the intervention group and the control group (p
Seyedeh Zahra Nahardani, Mahboubeh Rastgou Salami, Zohrehsadat Mirmoghtadaie, Mohammad Hasan Keshavarzi
Published: 16 November 2021
Shiraz E-Medical Journal; https://doi.org/10.5812/semj.105445

Abstract:
Context: The set of learning and experiences gained by learners is not limited to formal and explicit curriculum, and there are inevitably other factors besides the explicit curriculum. These factors are valuable opportunities that can enrich the learning experience and, on the other hand, are threats that challenge the education system if ignored. Objectives: The purpose of this review was to summarize evidence on the hidden curriculum in online education. Data Sources: This study is a systematized review of scientific-research articles in the field of hidden curriculum in online education. For this purpose, databases of Scopus, Ovid, web of science, PubMed, Google Scholar, ProQuest, ERIC, and Science Direct were searched. No restrictions were placed on the year of publication. Results: Out of 487 articles after excluding irrelevant articles, nine articles were included in this study for full-text review. Of the nine studies reviewed, the hidden curriculum in online education has been improved in one study. Individual characteristics of the learning environment (self-esteem, vulnerability, social acceptance, stress) in two studies, learning environment in five studies, interaction in three studies, teaching and evaluation methods in one study, rules and regulations in two studies, and teaching time in one study have been identified as the main factors behind the formation of a hidden curriculum in online education. Conclusions: The hidden curriculum is a reflection of what students receive in the learning environment; so we need to pay attention to this environment. A review of studies in the hidden e-learning curriculum showed that the hidden curriculum is important because it has a strong influence on the learners in many ways. Online education, like traditional education, has latent learning that can affect education.
Vahid Sheikhi,
Published: 16 November 2021
Shiraz E-Medical Journal; https://doi.org/10.5812/semj.118125

Abstract:
Background: Non-alcoholic fatty liver disease (NAFLD) and type 2 diabetes mellitus (T2DM) are major public health concerns. Besides the known risk factors, other risk factors, such as vitamin D deficiency, have been suggested for NAFLD. Objectives: This cross-sectional research aimed to investigate the relationship between serum vitamin D levels and NAFLD in a group of patients with T2DM. Methods: We investigated various clinical and biochemical parameters, including serum vitamin D level, liver function tests, and liver sonography in 1,110 adult patients with T2DM. The mean difference of numerical variables in NAFLD and non-NAFLD groups was analyzed with an independent sample t-test. Chi-square test was used to evaluate the association between two categorical variables. Results: Out of 1,110 patients with T2DM, 837 (75.4%) had NAFLD. The mean vitamin D level in diabetic patients with NAFLD was significantly lower than non-NAFLD group (19.71 ng/mL vs. 27.68 ng/mL, respectively; P < 0.001). Furthermore, 410 (49%) patients with NAFLD were found with vitamin D deficiency, while this value was 85 (31.1%) in non-NAFLD group. According to the results of univariate logistic regression analysis, vitamin D deficiency (OR = 3.87) and insufficient vitamin D (OR = 2.83) were the significant variables for NAFLD. Conclusions: There was a significant association between vitamin D deficiency and NAFLD in patients with T2DM.
, , Mehdi Shahmoradi, Zahra Ghaemmaghami,
Published: 16 November 2021
Shiraz E-Medical Journal; https://doi.org/10.5812/semj.116838

Abstract:
Background: Metabolic syndrome (MetS) criteria are different but interconnected cardiovascular risk factors, including dysglycemia, hypertension, abdominal obesity, and dyslipidemia. Objectives: We aimed to determine the prevalence of MetS, its components, and related factors in the south coastal area of Iran, Bandare-Kong non-communicable diseases (BKNCD). Methods: This population-based study was performed on the baseline data from participants of BKNCD, which has recruited participants from Bandare Kong city, one of the 18 distinct geographical areas included in the prospective epidemiological research studies in Iran (Persian). MetS was diagnosed based on the National Cholesterol Education Program (NCEP) criteria and the Iranian-specific cut-off for waist circumference (≥ 95 cm). The socioeconomic status (SES) was estimated by multiple correspondence analysis (MCA) based on participants’ different properties. Results: Of 3,927 participants included in this study, 2,230 (56.8%) were female. Age-standardized prevalence of MetS was 34.5%. The most common MetS component was central obesity (45.1%), followed by decreased high-density lipoprotein (42.6%), elevated fasting plasma glucose (39.9%), elevated triglyceride (37.7%), and increased blood pressure (37.5%). Besides, 84.7% of the subjects displayed at least one component of MetS. Binary logistic regression analysis revealed that women aged 65 - 70 years were at higher risk of having MetS compared to those aged 35 - 39 years (aOR = 12.37, 95% CI 7.54 - 20.30, P < 0.001). Also, living in rural areas was a risk for MetS in women (aOR = 1.55, 95% CI 1.18 - 2.03, P = 0.002). Employment and education were protective against MetS in women. Being overweight significantly increased the risk of MetS in both men and women. Obesity was more problematic for men (aOR = 16.66, 95% CI 11.65 - 23.81, P < 0.001) compared to women (aOR = 10.43, 95% CI 7.82 - 13.90, P < 0.001). Marital status, education, smoking status, and SES did not significantly predict MetS in men. Conclusions: A high prevalence of MetS was observed in this study, emphasizing central obesity, high TG, and low HDL. This calls on the government authorities to establish screening programs to identify individuals with a lower number of abnormal MetS components to prevent them from developing MetS and the resultant cardiovascular complications.
Mohammadreza Balooch Hasankhani,
Published: 15 November 2021
Shiraz E-Medical Journal; https://doi.org/10.5812/semj.116611

Abstract:
Background: The study and revision of postgraduates syllabus are very important aspects to promote the level of effectiveness of postgraduates' educations. Owing to the requirement of syllabus reform, especially when the speed of useful life of information in the world is less than a decade, it is a serious aspect for the educational programmers. Objectives: This study aimed to determine the view of biostatistics graduates on the syllabus of the courses, the achievement of learning aims, job requirements, and understanding their educational problems. Methods: The number of graduates was 245 in the levels of Master of Science (MSc) and PhD of biostatistics from Tehran, Iran, Shahid Beheshti, Tarbiat Modares University of Medical Sciences, and University of Social Welfare and Rehabilitation Sciences. The participants were graduated from 2011 to 2020. The data were collected by a questionnaire and analyzed using SPSS software. Results: Of PhD and MSc graduates, 48 (57.1%) and 70 (43.5%) participants declared, respectively, that they received the necessary theoretical and practical skills that they needed for their job. Also, clinical trial courses in both MSc and PhD periods were chosen by the graduates as the most significant courses, and one of the most applied courses in job requirements. Furthermore, statistical methods at MSc level and longitudinal data analysis at PhD level were chosen as the next important courses by the graduates, respectively. Conclusions: The findings show that the syllabus meets less than half of the graduates' job requirements, so it is not enough and is necessary to reform the contents of educational programs according to their job requirements.
Mostafa Shanbehzadeh,
Shiraz E-Medical Journal; https://doi.org/10.5812/semj.114456

Abstract:
Context: Contact tracing is a cornerstone community-based measure for augmenting public health response preparedness to epidemic diseases such as the current coronavirus disease 2019 (COVID-19). However, there is no an agreed data collection tool for the unified reporting of COVID-19 contact tracing efforts at the national level. Objectives: The purpose of this research was to determine the COVID-19 Contact Tracing Minimal Dataset (COV-CT-MDS) as a prerequisite to develop a mobile-based contact racing system for the COVID-19 outbreak. Methods: This study was carried out in 2020 by a combination of literature review coupled with a two-round Delphi survey. First, the probable data elements were identified using an extensive literature review in scientific databases, including PubMed, Scopus, ProQuest, Science Direct, and Web of Science (WOS). Then, the core data elements were validated using a two-round Delphi survey. Results: Out of 388 articles, 24 were eligible to be included in the study. By the full-text study of the included articles and after the Delphi survey, the designed COV-CT-MDS was categorized into two clinical and administrative data sections, nine data classes, and 81 data fields. Conclusions: COV-CT-MDS is an efficient and valid tool that could provide a basis for collecting comprehensive and standardized data on COVID-19 contact tracing. It could also provide scientific teamwork for health care authorities, which may lead to the enhanced quality of documentation, research, and surveillance outcomes.
Sajjad Azmand, , Maryam Fatemi
Shiraz E-Medical Journal; https://doi.org/10.5812/semj.118177

Abstract:
Context: COVID-19, like the other pandemics, apart from its impacts on peoples' health, has had diverse huge impacts on psycho-socio-economic aspects of societies globally. Hence, applying appropriate interventions to reduce the indirect burden of this pandemic is as important as patients’ care. Objectives: In this study, we aimed to review the main interventions against the economic and psychosocial impacts of the COVID-19 pandemic. Method: This scope review was conducted to determine what measures have been taken by governments against different non-medical (economic and psychosocial) consequences of the COVID-19 pandemic. The authors reviewed the relevant articles published from December 2019 to December 2020 through three databases of PubMed/MEDLINE, Scopus, and Google Scholar. The interventions in three areas of economic, social, or psychological were exerted, and in the review of the articles, the country and the target population were considered. Finally, the results were categorized and presented descriptively. Results: Regarding the negative consequences of the COVID-19 pandemic in psychosocial and economic aspects of societies, governments, especially in developed countries, have established measures to reduce the burdens of these consequences. Apart from interventions related to the general population, at-risk and vulnerable groups and also those with low socio-economic status are specific target populations for interventions. Conclusions: The future of the COVID-19 pandemic is uncertain and unpredictable. Governments and their decisions will play a vital role in determining the trend of the pandemic. Therefore, it is the responsibility of governments, especially in lower-middle-income countries (LMICs), to support vulnerable people and protect them against the devastating socio-economic and psychological effects of this pandemic using all their capacity.
Hamed Taheri, Roya Rafaiee, Hamed Ghazvini, Seyedeh Masoumeh Seyedhosseini Tamijani, Raheleh Rafaiee
Shiraz E-Medical Journal; https://doi.org/10.5812/semj.119448

Abstract:
Keywords SARS-CoV-2 Autoimmune Hemolytic Anemia COVID-19
Mohammad Bagher Khosravi, Farid Zand, Arvin Hedayati, Seyedeh Maryam Tabibzadeh, Ehsan Amiri-Ardekani,
Shiraz E-Medical Journal; https://doi.org/10.5812/semj.119033

Abstract:
Keywords Medical Education Shiraz Burnout COVID-19
, , , Fatemeh Azizmohammadi, Amir Keshavarzian
Shiraz E-Medical Journal; https://doi.org/10.5812/semj.115669

Abstract:
Context: according to the corruption perceptions index (CPI) 2018, Iran ranked 148 among 183 countries. This position shows the crucial importance of considering corruption and its negative effect on Iran and its health care system. In this review, we aimed to shed the light on corrupt practices in Iran’s health care system and recommend some practical strategies to combat them. Evidence Acquisition: This is a narrative review based on Vian's conceptual model of corruption in the health sector to evaluate and analyze corruption in Iran's health system. Review of the literature and documents without any time limitation were conducted in several databases including PubMed, Scopus, Web of Science, Google Scholar, and Farsi sources including Iran Medex, scientific information database )SID(, and Magiran, and also the official websites of the Ministry of Health and news agencies. Results: Unfortunately, to the best of our review, there is less published evidence about the extent and types of corruption in Iran's health system. Based on Vian’s model, reviewed literature revealed that Iran's health system is prone to corruption. This system is monopolistic and self-authorized, low transparent and accountable, and required law enforcement in many areas. Evidence to clarify the situation of citizen voice was not found. Conclusions: Based on this study, evidence shows corruption in financing, service provision, and resource generation of Iran's health system. It could affect not only performance of this system but also its responsiveness and effectiveness. To combat, Iran should apply multiple strategies such as; improving good governance, strengthening legal system over the health system, reducing monopoly and discretion stepwise and manageable, enhancing community participation, and finally updating ethics codes in the health system.
Hadi Hamidi Parsa, , Alireza Koohpaei, Babak Farzinnia, Mohsen Barouni
Shiraz E-Medical Journal; https://doi.org/10.5812/semj.114421

Abstract:
Background: The novel coronavirus disease 2019 (COVID-19) has placed heavy direct and indirect economic burden on the people and the health system. Objectives: The present study aimed to estimate the economic burden of COVID-19 in Qom Province, using the step-down cost accounting (SDCA) method. Methods: This descriptive, cross-sectional study included all COVID-19 patients in Qom Province from February 19, 2020, to June 19, 2020. The patients’ data were collected in the form of major cost groups with integrated health system (IHS), health information system (HIS), and a financial software called Roozamad. The governmental, out-of-pocket, and opportunity costs paid by patients and hospitals were calculated and evaluated using SDCA in Microsoft Excel software. Results: The incidence of COVID-19 infection was 518 per 100,000 populations in Qom Province in the aforementioned period. The total government costs for the treatment of the patients were calculated to be 2,229,216,930,370 Rials (8,916,867 $). Among the major governmental cost groups, personnel costs accounted for the highest total expenditures. In addition, out-of-pocket costs of patients and their families equaled 30,038,013,060 Rials (120,152 $). The costs of final service departments accounted for more than half of the total costs. The opportunity costs were calculated as 420 billion Rials (15.68% of total costs). Conclusions: According to the findings, the direct and indirect costs associated with the treatment of COVID-19 patients can impose a heavy economic burden on the households and health care system. Therefore, disease prevention strategies such as observing health protocols are recommended to reduce the burden of the disease.
Shiraz E-Medical Journal; https://doi.org/10.5812/semj.111526

Abstract:
Context: Persia has been the cradle of science across human history. Many of today’s concepts in science, such as the finite speed of light and alcohol distillation, were first proposed by Persian scientists. Mohammad ibn Zakariya Razi (Rhazes) is undoubtedly one of the greatest Persian scientists over human history. Evidence Acquisition: In this paper, in addition to a brief review of the history of pharmacy and chemistry sciences in Persia, Rhazes’ valuable books in the fields of pharmacy and chemistry, along with a brief description of them, were introduced. Data were extracted from different historical and bibliography books and also the citation databases of PubMed, Scopus, and Google Scholar. Results: Rhazes’ books and treatises in the fields of pharmacy and chemistry have been classified into three categories: 1) the books and treatises containing some sections on pharmacy like Al-Hawi fi al-Tibb (Liber Continens) and Al-Mansouri fi al-Tibb, 2) those written merely on pharmacy, like Qarabadin (pharmacopeia), and 3) the books focusing on alchemy (kimia), like Sirr al-Asrar (Secret of secrets) and Al Asrar (Liber Secretorum). Three volumes of Al Hawi fi al-Tibb were applied as a reference in pharmacology in Western universities for many years. Sirr al-Asrar is his most important book on alchemy, describing raw materials used in alchemy, experimental apparatus necessary for alchemical investigations, and detailed procedures for the chemical manipulation of arsenic and sulfur. Conclusions: These valuable manuscripts demonstrate the ancient heritage of Persians and the great roles and contributions of Persian scientists in the history of science.
Nazaninzahra Sepehri, , , Seyed Ali Hosseini, Kamran Moazzemi
Shiraz E-Medical Journal; https://doi.org/10.5812/semj.119138

Abstract:
Keywords SARS-CoV-2 COVID-19 Kidney Transplant Liver Transplant
Maryam Hashempour-Sadeghian, Mohammad Taghi Abbasi Shavazi
Shiraz E-Medical Journal; https://doi.org/10.5812/semj.114601

Abstract:
Background: One of the symptoms of mental health disorders is social isolation which refers to unfavorable social relationships with other people. Today, Internet use is an important predictor of social isolation. Objectives: The present study aimed to investigate the relationship between Internet use and social isolation (objective-subjective) in young and middle-aged individuals in the city of Shiraz. Methods: This cross-sectional study was conducted on 600 young and middle-aged (15 - 65 years old) individuals in Shiraz, Iran. Data were collected using three questionnaires (objective isolation with four subscales, subjective isolation with two subscales, and the amount of Internet use). Regression analyses were used to analyze the data. Results: Regression analysis showed that in objective isolation, Internet use increased just two subscales, including network diversity (P < 0.001) and the level of social participation (P < 0.001). It can be argued that the Internet has partly reduced social isolation in the objective dimension. In the subjective dimension, Internet use has increased the received social support (P < 0.001). Thus, Internet use would reduce the level of social isolation in the subjective dimension (P < 0.001). Although the significance level of the relationship between Internet use and social isolation is almost the same in both generations, the intensity of middle-aged relationships is higher than that in young people. Conclusions: Internet use has reduced social isolation; however, considering the low intensity of the reduction of isolation, it is argued that Internet use does not isolate people but just does not upgrade them much.
Zahra Salimi, Farshad Moradpour, Zahra Rashidi, Fatemeh Zarei, Mohammad Rasool Khazaei, Seyed Mojtaba Ahmadi
Shiraz E-Medical Journal; https://doi.org/10.5812/semj.112278

Abstract:
: Long-term potentiation (LTP) is one of the most important topics in neuroscience. It refers to a long-lasting increase in synaptic efficacy and is considered as a molecular and cellular mechanism of learning and memory. Neurotrophins play essential roles in different processes in the central nervous system (CNS), such as synaptogenesis, survival of specific populations of neurons, and neuroplasticity. Some evidence suggests that neurotrophins also participate in the synaptic plasticity related to learning and memory formation. Brain-derived neurotrophic factor (BDNF) is an important neurotrophic factor that is extensively expressed in the hippocampus and cerebral cortex, where it promotes neuroprotection, increases synaptogenesis and neurotransmission, and mediates synapse formation and synaptic plasticity. In this review, we first focused on the research investigating the effects of BDNF on synaptic plasticity and LTP induction and then reviewed the neuronal signaling molecules employed by BDNF to promote its effects on these processes.
Mina Biria, Hassan Torabzadeh, Seyed Mahsa Sheikh-Al-Eslamian, Niloofar Rostami-Fishomi, Maede Mokhber Dezfuli
Published: 26 September 2021
Shiraz E-Medical Journal; https://doi.org/10.5812/semj.112680

Abstract:
Background: This study aimed to assess the effect of adding propolis to glass-ionomer cements (GICs) on their antimicrobial and physical properties. Methods: For the evaluation of the antimicrobial properties of conventional (Fuji II) and high-viscous (Fuji IX) GICs containing propolis, 120 glass-ionomer disks with the dimensions of 10 × 2 mm were prepared in three groups of control, 25% propolis, and 50% propolis. Then, these GICs were placed in the Streptococcus mutans culture media. After 24 h of incubation, the inhibition zone diameters of the disks were recorded. For the evaluation of flexural strength, 30 samples (six groups of 5) with the dimensions of 2 × 2 × 25 mm were prepared and measured by a universal testing machine. The Kolmogorov-Smirnov test and SPSS software (version 21.0) were used for statistical analysis and ensuring normal data distribution. One-way analysis of variance was used for comparing the mean values of the groups, and Tukey’s HSD test was used for pairwise comparison of the groups. The duration of the study setup was 9 months. Results: An inhibition zone was not observed in any of the study groups. There was no significant difference between the flexural strength values of the three groups of the Fuji IX (P = 0.905) and also between the three groups of the Fuji II (P = 0.096). However, the Fuji IX samples had higher flexural strength values than the Fuji II glass-ionomer specimens (P < 0.001). Conclusions: The addition of different concentrations of propolis aqueous extract to conventional and high-viscous GICs did not have a significant effect on their antimicrobial properties and flexural strength.
, Siamak Salahi, AtosA Dorudinia, Payam Mehrian, Reza Naseri, Roshanak Modiri
Published: 19 September 2021
Shiraz E-Medical Journal; https://doi.org/10.5812/semj.117357

Abstract:
: Most primary small cells carcinoma develop from the lung, and extra-pulmonary small cell carcinoma accounts for less than 5% of all small cell carcinoma cases. In the head and neck region, the most common sites are the larynx and salivary glands; however primary involvement of the palate is extremely rare. The extra-pulmonary small cell carcinoma is similar to its pulmonary counterpart regarding morphology, immunohistochemistry, and electron microscopy features and derives from pluripotential stem cells that develop neuroendocrine features. There is growing evidence regarding the ability of extra-pulmonary small cell carcinoma to arise from pluripotent basilar cells capable of divergent differentiation with the consequence of arising neuroendocrine phenotype as a trans-differentiation phenomenon in the progression of an organ-specific carcinoma. The differentiation between primary and metastatic extra-pulmonary small cell carcinoma is challenging. There is also no standard guideline for treatment as it is a rare occasion, and there is no consensus between radiation oncologists and cancer surgeons about the best treatment strategy. In this study, a very rare case of hard palate small cell carcinoma with neuroendocrine pathology features is presented. To our best of knowledge, this is the third case report of extra-pulmonary small cell carcinoma involving the palate in the literature review. Knowing the clinical presentation and pathology characteristics of such rare tumor in addition to follow-up outcome can be highly useful to establish a reliable guideline for hard palate small cell carcinoma management.
Ali Reza Yusefi, Narjes Sadat Nasabi, Elham Amin, Shima Bordbar, Zahra Kavosi, Javad Shahmohammadi
Published: 19 September 2021
Shiraz E-Medical Journal; https://doi.org/10.5812/semj.110071

Abstract:
Background: Aging is considered a critical period of life, and paying attention to the needs of this stage is a social necessity. Objectives: This study aimed to investigate the association between communication skills and mental health of elderly patients who were hospitalized in the south of Iran hospitals in 2020. Methods: The present study is a descriptive-analytical study conducted on 386 elderly patients. The data of the present study were collected through a three-section questionnaire consists of demographic information, interpersonal communication skills, and mental health. The data were analyzed by descriptive and inferential statistical methods, Pearson correlation coefficient, t-test, ANOVA, and multiple linear regression tests in SPSS software version 23 and at a significance level of α = 0.05. Results: Elderly patients’ communication skills were assessed at a low level (67.01 ± 7.36). The mean score of total mental health among elderly patients indicated mild symptoms of mental disorders among them (177.84 ± 9.21). A significant association was also found between communication skills and mental health disorders among elderly patients (P < 0.001, r = -0.631). The results of multiple linear regression revealed that the components of understanding the message (P < 0.001), emotional control (P = 0.001), listening (P = 0.001), assertiveness (P = 0.005), and insight (P = 0.006) had a positive and significant impact on the mental health of elderly patients. Conclusions: Owing to the correlation between communication skills and mental health, it is recommended to develop and use supportive programs in the form of elderly health programs in medical centers to improve the mental health status of elderly patients.
Amir Bazrafshan, Asma Zendehbad,
Published: 14 September 2021
Shiraz E-Medical Journal; https://doi.org/10.5812/semj.109016

Abstract:
Background: Breaking bad news to patients is an unpleasant process, but it is essential for the medical team, which is giving information about a person’s illness; without proper planning, it leads to a negative impact on people’s feelings and quality of life. Cultural differences can be effective in telling bad news. Objectives: This study aimed to identify the attitudes of physicians, patients, and patients’ families towards breaking bad medical news. Methods: This cross-sectional study was performed among physicians, patients, and their families referred to Namazi Hospital, Shiraz, Iran, during 2016 - 2017. Their attitudes regarding how to tell bad news were evaluated by self-administrated questionnaires. Results: A total of 397 valid questionnaires completed by physicians, patients, and their families were analyzed in this study. All groups of participants preferred telling bad news to patients about the diagnosis of their disease; they also believed that in the case of a patient’s dissatisfaction, this information should not be given to other family members. Patients’ family members would rather tell lies to the patient about their diagnosis. Conclusions: There is a tendency towards not telling bad news in Iranian culture; Iranian people tend to protect those around them, and the desire to give bad news to those around them is lower than the tendency to hear bad news about one’s own illness. With increasing education, the tendency to telling bad news increases.
, Pir-Hossein Kolivand, Leila Kheyrati, Mostafa Sadeghi, Mina Hesami, Parisa Hasani-Sharamin,
Published: 14 September 2021
Shiraz E-Medical Journal; https://doi.org/10.5812/semj.113955

Abstract:
Background: COVID-19 pandemic, which started in late 2019, has brought various ups and downs worldwide. Planned policies were highly useful in the first wave of the COVID-19 pandemic in Iran. However, due to several reasons, the country faced the second wave. Objectives: The current study aimed to compare patients’ features in the first two waves of the COVID-19 pandemic in the city of Tehran, Iran. Methods: Following a retrospective, cross-sectional design, the current study was carried out on 5000 suspected/confirmed COVID-19 cases who were randomly selected from all cases transferred by ambulance to hospitals located in the city of Tehran. The first wave of the COVID-19 epidemic was from February 20 to May 04, 2020, and the second wave was from May 05 to August 05, 2020. Data for both waves, were collected using a researcher-made checklist. Results: In this study, data of 5000 suspected/confirmed COVID-19 cases were analyzed (2773 cases belonged to the first wave and 2227 to the second one). The mean age of patients (P < 0.001), the frequency of cigarette smoking (P < 0.001), opium abuse (P = 0.004), and the presence of underlying diseases (P < 0.05) were more frequent in the second wave than in the first one. The notable finding in this study was the significant increase of non-respiratory symptoms of patients in the second wave. The number of cases who reported close contact with COVID-19 patients was higher in the second wave. Also, hypoxia, intubation during the hospital stay, length of hospitalization, and mortality rates were significantly lower in the second wave. During the second wave, the odd ratio of positive findings in lung CT-scan was 3.4 (95% confidence interval: 2.51 to 4.55) compared to the first wave (P < 0.001). Conclusions: This study demonstrated considerable differences between the first and second waves of the COVID-19 pandemic concerning the patients’ features.
, Shahla Mirgaloybayat, Kobra Tahermanesh, Mohammad Hossein Mohammadi, Reza Saadat Mostafavi, , Mahmoodreza Madadian, Leila Allahqoli
Published: 13 September 2021
Shiraz E-Medical Journal; https://doi.org/10.5812/semj.114072

Abstract:
Background: One of the complications of cesarean section (C/S) is related to the incision site. Considering the effectiveness of platelet–rich plasma (PRP) on healing of wounds and management of scars, the present study aimed to inquire the effect of PRP on the thickness and completeness of the uterine scar. Methods: In a randomized double-blinded, placebo-controlled clinical trial, the women who underwent C/S from November 2019 to 2020 were included and randomized into two studied groups, including the control (n = 15) and intervention (n = 15) groups. In the intervention group, PRP, extracted from patients’ blood samples, was injected to the incision site (between decidua and myometrium), while the control group did not receive this treatment. The scar thickness of C/S as the primary outcome and postpartum hemorrhage as the secondary outcome were compared between the groups. Both groups were followed for 12 weeks. Results: The two groups (intervention and control) were not significantly different in terms of weight, height, BMI, age, parity, gravidity, duration of surgery, and blood hemoglobin (HB) level (P > 0.05). Comparison of scar characteristics showed the creation of a niche in the PRP group, which was almost one-fourth of that of the control group; a difference that was statistically significant (P = 0.002). The thickness of adjoining myometrium was comparable between the two groups. Mean uterine niche height in the intervention group was lower than in the control group, which was statistically significant (P = 0.048). The mean of residual myometrium thickness (RMT) in the intervention and control groups were 7.62 ± 0.95 and 5.6 ± 3.5 mm, respectively, a difference that was statistically significant (P < 0.001). Conclusions: Local injection of PRP is an effective and viable measure for reducing the uterine niche; therefore, it is suggested to be included in the routine wound care of CS. Future studies are needed to confirm PRP efficacy in different settings.
, Maryam Ebrahimi, Nasrin Sharifi, Masoumeh Rambod
Published: 12 September 2021
Shiraz E-Medical Journal; https://doi.org/10.5812/semj.109363

Abstract:
Background: Along with increasing population of the elderly in various countries, the incidence of falls and respective damages has also increased. Objectives: Given the numerous disagreements regarding the effectiveness of different interventions mentioned in various sources, the present study aimed to examine the effectiveness of the Stepping-On fall preventive program on the quality of life, fear of fall, and fall-preventive behaviors among community-dwelling older adults in Shiraz, Iran. Methods: This study is a single-blinded randomized interventional or clinical trial study conducted on 90 elderly people under the coverage of two large health centers during 2019 - 2020 in Shiraz, Iran. Multi-stage randomized sampling was used to select the participants who were randomly allocated to either of the intervention (n = 45) or control groups (n = 45). Data collection tools were the fall efficiency scale, fall prevention behaviors, and Lipad quality of life questionnaires. The intervention group participated in a 7-session Stepping-On program, while the control group received the same routine care. Collected data were analyzed with SPSS software version 22. Results: The findings indicated that the Stepping-On program was effective on the fear of falling scores (P = 0.008) and the quality of life of the elderly under study (P = 0.019) at follow-up time. However, there was no significant difference immediately after the intervention (P > 0.05). However, the mean score of fall-preventing behaviors increased during the course of the study and reached a significant level immediately after the study was conducted (P = 0.046) and the other two months later (P = 0.028). Conclusions: The Stepping-On program may apparently affect the study variables. Therefore, further research is suggested to confirm the effectiveness of this program so that it can be used across all healthcare centers for the elderly.
, Hamid Shokri, , Maryam Shirvani, Ali Soleimani, Roghayyeh Rostami
Published: 12 September 2021
Shiraz E-Medical Journal; https://doi.org/10.5812/semj.113890

Abstract:
Background: The awareness of people’s health knowledge and behavior on COVID-19 has helped guide education and health promotion policies, and examination of people’s opinions on governance measures against this disease will guide policymakers in making more decisions and responsiveness. Objectives: This study aimed to investigate people’s knowledge and behaviors toward COVID-19 and their views on adopted public policies against this disease in Maragheh, a city in the Northwest of Iran. Methods: This study was a cross-sectional, analytical study that was done in urban areas of Maragheh from 13 November to 20 December 2020. The sample size was estimated at 672 participants, and the sampling method was stratified random. The data collection instrument was a researcher-made questionnaire that consisted of four sections: demographic information, health behaviors, respondent’s knowledge of COVID-19, and their viewpoints on adopted public policies against this disease and was shared online. The one-way ANOVA, Pearson correlation, and multiple regression were used to analyze data with SPSS version 23. Results: The mean scores of people’s knowledge (6.42 ± 1.2) out of 9 and health behaviors (34.8 ± 3.9) of 36 were moderate. The majority of respondents had high levels of knowledge and also behavior about keeping the physical distance (98.5%) and proper handwashing (97.9%). Knowledge (β = 0.23) and male (β = -0.27) were the predictors of health behaviors (p < 0.001, F = 12.47). The investigation of myths on COVID-19 indicated that 17% and 41.1% of the respondents believed that alcohol consumption and using garlic and herbal drinks are effective in the prevention and 57.7% of them believed that holding the breath for 10 seconds is a sign of being healthy. People’s views on the COVID-19 control policies were assessed to be at the medium level (48.2 ± 7.5) of 65. The most effective policies against COVID-19 from the people’s opinions consisted of lockdown policies (96.4%), schools’ closure (95.9%), and constraints on intercity trips (91.3%). Conclusions: It seems necessary to strengthen measures on health knowledge promotion and implementation of health education interventions on protective behaviors of COVID-19 in such a way that right beliefs are replaced with wrong ones. Based on positive public opinions on Lockdown interventions, re-applying these policies is recommended to get the cities out of the high-risk situation.
Marzieh Latifi, Farzaneh Bagherpour, Arefeh Jafarian, Amirali Hamidiyeh, Ehsan Javandoost, Zeinab Mansouri, Maryam Pourhosien, Niloufar Tirgar, Amirmohammad Amirkhani, Sanaz Dehghani
Published: 5 September 2021
Shiraz E-Medical Journal; https://doi.org/10.5812/semj.116048

Abstract:
Background: Coronavirus disease 2019 (COVID-19) pandemic has had a great impact on reducing organ transplantation activities. Objectives: The aim of this study was to determine the donation and transplantation activities before and after COVID-19 outbreak in Iran. Methods: This retrospective study compared the donation and transplantation activities in two specific 9-month periods (December 2018 to March 2019 vs. March-December 2020). The questionnaire included the numbers of brain death confirmations, family consents, organ recoveries, and transplanted solid organs. The questionnaire was sent by email to the chief executive of the organ procurement unit. Results: A total of 15 organ procurement units responded to the survey. The largest reduction was seen in tissue transplantations (62.5%) during two time intervals. Brain death due to head trauma significantly decreased in two time intervals and suicide increased by 14.44% during the COVID-19 pandemic compared to 2018-2019 period. Significant reductions between the median of donation (P = 0.0187), median of potential donor (P = 0.005), median of family consent (P = 0.002), and median of eligible donor (P = 0.009) were observed during the two time periods. Conclusions: A significant reduction was observed in organ donation and transplantation during COVID-19 pandemic. Developing protocols and establishing new strategies for evaluation of organ donation to ensure the safety of organ recipients and medical staff is necessary.
, Seyed Pouya Paknezhad, Sanam Mohammadzadeh, Nafiseh Vahed, Zahra Vand Rajabpour, Mansour Rezaee,
Shiraz E-Medical Journal; https://doi.org/10.5812/semj.113099

Abstract:
Context: Procedural sedation (PS) plays an important role in facilitating emergency procedures. Dexmedetomidine is an alpha-adrenergic agonist which can play a role in this issue. This study aimed to systematically review the literature about the role of dexmedetomidine in PS in the emergency department (ED). Methods: In this study, several databases, namely PubMed, Embase, Ovid, ProQuest, Scopus, Web of Science, and Cochrane Library, were searched since 1999 up to November 30, 2020. The inclusion criteria in this study were randomized clinical trials performed on ED patients using dexmedetomidine for PS and articles only in the English language. The exclusion criteria were the studies that were not clinical trials or were not performed in the ED, low-quality studies or animal studies. Results: A total of 473 articles were identified in this study. Five studies fulfilled the inclusion and exclusion criteria. Three articles studied the adult population. One study used dexmedetomidine in an intranasal way, and one study used an intramuscular route for drug administration. Conclusions: Although the reviewed studies reported dexmedetomidine as a safe and effective agent for PS, there are not sufficient data on this issue. Therefore, it is required to perform further studies to a draw firmer conclusion.
Latif Panahi, Abolfazl Etebarian Khorasgani, Marzieh Amiri, Somaye Pouy
Shiraz E-Medical Journal; https://doi.org/10.5812/semj.108394

Abstract:
Background: Cerebral palsy is a leading cause of disability among children, and most of these children depend on their care provider or parents all the time. Mothers of these children spend a great amount of time taking care of them, which could have adverse effects on their mental health. Objectives: The present study was conducted to investigate the impact of the continuous care model (CCM) on the mental health of mothers with children suffering from cerebral palsy. Methods: This randomized clinical trial was performed among 80 mothers of hospitalized children with cerebral palsy. Subjects were randomly divided into the two groups of intervention and control. In the intervention group, the CCM was administered to the mothers up to eight weeks after discharge, and for the control group, only routine nursing education was provided to the mothers at hospital discharge. Before and one and eight weeks after the intervention, in both groups, the mothers' mental health was assessed using the General Health Questionnaire. Data were analyzed using SPSS version 21 through descriptive and inferential statistics. Results: The mean age of the mothers was 33.2 ± 2.1 years and 34.3 ± 2.2 years in the intervention and control groups, respectively. In the intervention group, the CCM had a positive effect on the mental health of mothers one and two months after discharge from hospital compared to before the intervention (P = 0.04, P = 0.02, respectively); however, in the control group, the mean score of mothers' mental health was decreased over time. No significant relationship was found between mental health and the demographic characteristics of the mothers (i.e., age, education, participation in any child caring programs, having anxiety, having any other children with cerebral palsy, and experiencing depression due to having a child with cerebral palsy) (P > 0.05). Conclusions: The CCM had a positive effect on the mental health of mothers of children with cerebral palsy. Thus, this intervention might be useful, but further studies are needed about the cost effectiveness of this intervention and its long-term impact on a larger sample.
Soolmaz Zare, Ali Akbar Faghihi, Samira Seif, Ali Asghar Hayat
Shiraz E-Medical Journal; https://doi.org/10.5812/semj.99707

Abstract:
Background: Pregnancy and childbirth are sensitive and particular periods in women’s lives. Midwives play an essential role in ensuring mother’s and fetus’s health by the recognition of the needs and complexities of this period. Midwives increase the quality of care, gain the trust of pregnant women, communicate more effectively with them, and increase their satisfaction and cooperation by following the ethical principles and standards that express their professional commitment to society. Therefore, the awareness of the principles of professional ethics and adherence to the Charter of Patients’ Rights is a critical element of the midwife’s success in ensuring mother’s and neonate’s health. Therefore, monitoring the observance of these principles by midwives, similar to other health care providers, is essential to improve the quality of services and ultimately parturients’ satisfaction. For this purpose, it is necessary to have a valid and reliable tool to assess midwives’ professional ethics status. Objectives: In this study, a questionnaire was developed to assess this issue by parturients, who are primary stakeholders in this process. Methods: This qualitative and quantitative study was performed to design a reliable and valid questionnaire evaluating midwives’ professional ethics by parturients. Based on the literature review and consultation with midwifery professors and staff, the initial questionnaire was prepared with 26 items. A survey of 15 experts evaluated the content and face validity ratio. The final questionnaire with 20 items was completed by 200 parturients hospitalized in Valiasr Hospital of Fasa University of Medical Sciences, Fars, Iran, within 2018 - 2019. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) assessed the construct validity. The reliability was confirmed by the determination of internal consistency. Results: The 26 items of the questionnaire defined in the first step were reduced to 20 items with a content validity ratio higher than 0.49 and a content validity index higher than 0.79. Using EFA and CFA, 20 items were included in two dimensions and confirmed. Its reliability was reported as 0.89 using Cronbach’s alpha. Conclusions: This study aimed to design a valid and reliable questionnaire for the assessment of midwifery professional ethics in the delivery process. One strength of the present study, compared to those of mentioned studies, is performing both EFA and CFA. In this study, some goals of EFA consist of determining questionnaire dimensions, standardizing questionnaires, reducing the items (from variables to factors), and assessing homogeneity and discrimination in construct validity. The EFA is often used in the early stages of research to collect information about the interactions in a set of variables. The obtained results revealed that the designed questionnaire is a valid and reliable tool for the evaluation of midwifery professional ethics by parturients, which can be applied in other studies in Iran.
, , Elahe Afshari, , Afshin Rakhsha, Kourosh Sheibani
Shiraz E-Medical Journal; https://doi.org/10.5812/semj.113994

Abstract:
Background: Adnexal mass is one of the most common gynecologic diseases among women of all ages. Methods: In this cross-sectional study, we enrolled 126 patients with large adnexal masses (≥ 10 cm) managed by laparoscopic surgery during 2013 - 2020. The rates of intraoperative complications, conversion to open surgery, and incidence of cancer were assessed. Results: Mean mass size was 15.08 ± 5.03 in all participants without significant difference based on the tumor type (P = 0.624). Mean age and operation time were higher in the malignant type compared to the benign type (P < 0.001). Type of surgery and frequency of intraoperative complications were also different among patients with different tumor types (P < 0.001 and P = 0.816, respectively). Conclusions: Our study showed that large adnexal tumors can be operated by laparoscopic approach, while the most important factor for increased surgical complications and duration was malignancy.
Shiva Mokhtari, Mahmoud Hajiahmadi, ,
Shiraz E-Medical Journal; https://doi.org/10.5812/semj.108945

Abstract:
Background: Height is an important factor for medical, nutrition, and forensic sciences; nevertheless, measuring proves to be a challenging task in some cases. In this respect, an alternative immediate, accurate, and possible anthropometric evaluation is needed. Objectives: This study was set to find a proper formula to estimate height from the lengths of the ulna and tibia in Iranian adults. Methods: A total of 500 healthy males and females aged 20-40 years were randomly selected from the volunteers’ pool for this cross-sectional study. Ulna and tibia lengths and standing heights were measured according to standard protocols. Ulna and tibia lengths were applied to find a reliable equation to predict stature accurately. Data were statistically analyzed by SPSS version 17 using regression, curve estimation, and linear model. Results: The mean (SD) heights of male and female participants were 176.45 (11.98) cm and 161.29 (10.11) cm, respectively, while the right and left ulna and the right and left tibia were 29.05 (1.63) cm, 29.03 (1.44) cm, 38.86 (1.33) cm, and 38.88 (1.25) cm, respectively. The correlation coefficients of r = 0.80 and r = 0.69 for males and females participants’ right ulna, respectively, showed a significant correlation with height. Hence, the new formula provided reliable results for stature estimation for northern Iran subgroups. Conclusions: Equations based based on right ulna length are more reliable and accurate for height prediction in both genders. It should be considered that these equations could be different among ethnically diverse populations, even in the northern Iranian population.
, Abed Ebrahimi, Isan Darvishi, Khadijeh Momeni,
Shiraz E-Medical Journal; https://doi.org/10.5812/semj.110822

Abstract:
Background: The control or reduction of anxiety before surgery is one of the most important components of preoperative care. The question is whether anxiety differs in male and female candidates for surgery. Objectives: The current study aimed to evaluate the effect of aromatherapy with Citrus aurantium on anxiety in men and women candidates for surgery. Methods: This single-blind randomized clinical trial was performed on 60 patients and controlled by placebo. The patients were divided into 30 subjects in the control group and 30 subjects in the aromatherapy group (inhaling C. aurantium essential oil). The patients completed the Spielberger state-trait anxiety inventory before and after the intervention. After collecting information, the questionnaire information was analyzed using SPSS software (version 16). Results: After aromatherapy, 20% of men had mild state and trait anxiety. Moreover, 80% of men had relatively mild state and trait anxiety. In the group of women, 20% of the cases had mild state and trait anxiety. Furthermore, 73.3% of women had relatively mild state and trait anxiety. Additionally, 6.7% of women had relatively severe anxiety. Anxiety reduced after the intervention among men and women (P < 0.001). In addition, the severity of anxiety among women in the control group increased after placebo intervention (P < 0.05). Moreover, the effect of C. aurantium aroma was further observed in women than men; however, there was no statistically significant difference (P > 0.05). Conclusions: The results of this study indicated that inhaling the C. aurantium aroma reduces anxiety in patients. Aromatherapy also has the potential to be replaced by chemical drugs due to fewer side effects and risks, and cost-effectiveness.
Heshmatollah Heidari, Aira Sabokseir, , Mehrdad Vossoughi, Ali Golkari
Shiraz E-Medical Journal; https://doi.org/10.5812/semj.115087

Abstract:
Background: Journal articles published by Iranian dental school faculty members have followed an upward trend Since 2000, based on: (1) the global growth rate; (2) the increase in the number of country’s dental schools and their relatively higher number of faculty members; and (3) the health ministry’s emphasis on research and scientific publications. Hence, it is important to keep ourselves up to date about the trend of scientific articles published by Iranian dental schools. Objectives: This study aimed to extract the number and quantitative value of articles authored by faculty members of Iranian dental schools that are indexed in three databases of SCOPUS, PubMed, and the Web of Science (WoS/ISI) from 2015 to 2019. Methods: A five-year cross-sectional study was conducted on the above-mentioned databases, using a similar strategy for all databases. Words “Iran” and “dent*” were searched in affiliations. The obtained results were investigated in-depth. The details of search results were checked out one by one. Only those articles with at least one author genuinely affiliated to an Iranian dental school were included for further assessment. The “number of articles” authored by at least one author and those with the “first author” affiliated to an Iranian dental school were counted. Then, the “quantitative value” or share of each author was calculated by dividing one by the number of authors of the article. The three variables were compared among databases, dental schools, and study years. Results: A total of 3922, 2473, and 2345 articles were retrieved from SCOPUS, PubMed, and WoS, respectively. Concerning SCOPUS and WoS databased, all three study variables had an increasing trend from 2015 to 2018 but decreased in 2019. In PubMed, however, the decline started from the beginning of the study period. Conclusions: The observed decline in the number of scientific papers produced or published at the end of the study period is worrying. The novel variable of “quantitative value” that was calculated in this study can be regarded as an appropriate and feasible indicator to determine the number of scientific papers published by individuals, dental schools, and the whole country’s dental research society, compared to other variables. Policymakers should rethink facilitating publication in accredited journals, especially those indexed in PubMed.
, Nasim Razavi, Sonia Dokohaki
Shiraz E-Medical Journal; https://doi.org/10.5812/semj.112779

Abstract:
Background: Considering the severity of the COVID-19 outbreak and its rapid person-to-person transmission and the challenges it has brought about in dentistry, especially in intraoral radiography, following the established guidelines in prescribing radiographs is of great prominence. Objectives: We aimed to evaluate the necessity of prescribed intraoral radiographs and to estimate the number of unnecessary prescriptions during the COVID-19 pandemic. Methods: This cross-sectional study was conducted among 143 patients with a mean age of 29.36 ± 14.11 years who visited the Radiology Department of Shiraz Dental School during the peak of the COVID-19 outbreak. Information, including gender, age, systemic diseases, referring department, and type and urgency of radiography, was collected using a checklist. Chi-squared test and Fisher’s exact test were run to assess the relationships between variables. Results: Among all the patients referred to the Radiology Department, the endodontics and oral medicine departments accounted for the highest percentage of referrals. The relationship between the necessity of radiography prescriptions and dental departments was significant (P < 0.05). The lowest rate of unnecessary referrals was reported in the Department of Endodontics (13.3%), whereas the highest rate of unnecessary referrals was attributed to the aesthetic and restorative dentistry departments (73.3%). There was a significant association between dental department and the type of prescribed radiographs (extraoral/intraoral). The Orthodontics Department was the only department with more extraoral radiograph prescriptions than intraoral radiographs. One-third of the prescribed intraoral radiographs and half of the extraoral radiographs were unnecessary, with a significant difference during the pandemic (P = 0.019). Conclusions: Although there has been some success in the development of COVID-19 vaccines, this pandemic will not be easily eradicated. Therefore, it is crucial to follow the established guidelines and postpone unnecessary dental procedures to improve the safety of our community and the world in general.
, Kamran Bagheri Lankarani, , Fatemeh Shaygani, Soodeh Jahangiri, Shahrokh Mousavi, Mohammad Reza Shaygani,
Shiraz E-Medical Journal, Volume 22; https://doi.org/10.5812/semj.118253

Abstract:
Keywords Health Social Studies Pandemic COVID-19
Sedigh Alipanahpour, Naeimeh Tayebi, Mahnaz Zarshenas,
Shiraz E-Medical Journal; https://doi.org/10.5812/semj.111809

Abstract:
Background: Abortion is an important pregnancy complication with short-term and long-term adverse physical and psychological effects on women. Objectives: The present study aimed to investigate the short-term physical and psychological effects of various types of medical abortion in pregnant women referring to educational and medical centers in Shiraz, Iran. Methods: In this cross-sectional study, among 5176 deliveries by the women referring to Shiraz Educational and Forensic Medicine Centers during a 4-month period, 437 pregnancies ended in abortion and thus were included in this study. A questionnaire was completed for each of the abortions, recording demographic characteristics and midwifery information. As well, the Mississippi Post Traumatic Stress Disorder Scale (M‑PTSD) was filled. Data were analyzed by SPSS software using appropriate statistical tests. Results: The most common physical complications of induced and spontaneous abortion were fever (10.3%) and the need for transfusion of blood products (4.6%). Among the patients who received abortion therapy, 73.1% had moderate stress due to psychological complications. Conclusions: Since the most common complications after abortion are fever, the need for blood transfusion, and bleeding, it is recommended to prepare a protocol to standardize post-abortion care. Most women in both induced and spontaneous abortion groups had moderate levels of stress. Due to the lack of attention to the mental health of the women experiencing abortion, it is necessary for these women to receive adequate supportive counseling, in addition to other medical services, after abortion.
, Mojtaba Qanbari Qalehsari, , , , Valiollah Padehban
Shiraz E-Medical Journal; https://doi.org/10.5812/semj.113782

Abstract:
Background: High adherence to antibiotic therapy is essential for complete cure, reduction of treatment costs, and prevention of drug resistance. Objectives: The aim of this study was to evaluate adherence to antibiotic treatment and its associated factors in patients after hospital discharge. Methods: This was a cross-sectional study. This study was conducted on 313 patients discharged from the hospital on antibiotics from October 6 to December 22, 2016. Demographic information of the participants was obtained at the time of discharge from the hospital, and the Morisky medication adherence scale was completed one week after discharge. Data were analyzed using descriptive statistics and the chi-square test at a significance level of < 0.05. Results: The mean age of patients was 44.17 ± 19.51 years, and 95% of them were discharged with only one oral antibiotic. The mean score of drug adherence in this research was 6.45 ± 1.41. Those under 40 years of age had poorer adherence to antibiotic treatment than patients aged over 40 years (P = 0.04). The patients who should have consumed antibiotics thrice a day forgot taking their medications more than others (P = 0.02). The patients who received antibiotics twice a day were less likely to discontinue their medication without informing their physicians (P = 0.03). Conclusions: Adherence to antibiotic treatment after hospital discharge is poor among patients. All patients, especially those under 40 years of age and those who should receive medications more often, must be given serious considerations for treatment adherence.
Ali Hosseinzadeh, Mohammad Hassan Emamian, , , Fariba Zare, , Ehsan Binesh, Amir Atashi, Shirin Mahmoudi,
Shiraz E-Medical Journal; https://doi.org/10.5812/semj.113670

Abstract:
Background: Coronavirus disease 2019 (COVID-19) is a coronavirus outbreak caused by severe acute respiratory syndrome coronavirus 2 infection. Objectives: This study aimed to investigate the relationship between laboratory variables and COVID-19 severity. Methods: A total of 731 confirmed cases were included in this study. Based on the clinical course of the disease, the patients were divided into non-severe (n = 599) and severe (n = 132) groups. The area under the curve was estimated for each of the significant predictive factors by the receiver operating characteristic curve. Youden’s index was used to determine the optimal cut-off points to predict the severity of COVID-19. Results: Out of 731 patients, 407 (55.56%) cases were male. The mean age value and age range of the patients were 58.37 and 1 - 98 years, respectively. The age (OR = 1.03, 95% CI: 1.02 - 1.05), international normalized ratio (INR) (OR = 2.09, 95% CI: 1.11 - 3.96), lactate dehydrogenase (LDH) (OR = 1.003, 95% CI: 1.001 - 1.1.003), and neutrophil/lymphocyte ratio (NLR) (OR = 1.08, 95% CI: 1.02 - 1.14) were associated with the severity of COVID-19 in the multivariate analyses. The areas under the curve of LDH, NLR, and INR for the diagnosis of disease severity were 0.76, 0.69, and 0.62, respectively. Conclusions: The results of this study revealed that LDH, NLR, and INR could help to discriminate between non-severe and severe COVID-19 cases. Therefore, clinicians can use these variables to improve therapeutic effects and reduce disease severity.
Shiraz E-Medical Journal; https://doi.org/10.5812/semj.110977

Abstract:
Background: Measuring healthcare workers’ (HCWs) knowledge, attitudes, and practices (KAPs) regarding isolation precaution is essential for infection control which needs a valid and reliable instrument. Objectives: This study aimed to assess differential item functioning (DIF) across gender and major for the knowledge and practice items of the questionnaire, previously designed in Shiraz, Iran. Methods: This cross-sectional survey was conducted on 1070 participants (males/females: 306/764; medical students/nurses: 466/624). The study instrument had three subscales with nine questions for each KAP subscale. The Mantel-Haenszel (MH) statistic was used. The DIF and differential test functioning (DTF) analyses were also performed in this study. Results: There were very similar DIF outcomes for the knowledge and practice subscales, with one or two items indicating moderate DIF but comparable total scores across genders. Across majors, several items showed large DIF for both subscales. It was found that large DTF affects major for both subscales. Conclusions: Our findings indicated large DIF and DTF levels of the questionnaire among medical students and nursing groups. More attention should be paid when developing the items. This study shows the importance of paying attention to valid evidence for instruments developed within the field of healthcare.
Khadijeh Asadisarvestani,
Shiraz E-Medical Journal; https://doi.org/10.5812/semj.111304

Abstract:
Background: One of the main concerns during cancer treatment is the occurrence of pregnancy due to its wide range of complications. Objectives: This study aimed to determine some influential factors on pregnancy during cancer treatment among women of reproductive ages that were under cancer treatment. Methods: This cross-sectional study investigated 133 women of reproductive age, who were under cancer treatment, as well as women who had undergone chemotherapy or radiotherapy up to one year ago in Sistan and Baluchestan Province. Data were collected from three medical centers in Zahedan from 2019 to 2020, using a researcher-made questionnaire. Results: Regarding the pregnancy rate, 23.0% of women had pregnancy during cancer treatment, including unintended (52.0%) and intended (48.0%) pregnancies that 55.0% of these pregnancies led to abortion, and 45.0% to livebirths. The results highlighted that during treatment women with and without pregnancy differed significantly in age (P = 0.001), ethnicity (P = 0.024), husband’s education level (P = 0.014), woman’s occupation (P = 0.021), couple’s agreement on number of children (P = 0.024), and physician consultation about contraceptives (P = 0.048). The main predictors of pregnancy were the woman’s age pregnancy (OR = 0.927, P = 0.011), occupation (OR = 0.358, P = 0.046), and ethnicity (OR = 2.49, P = 0.045). Conclusions: Considering the complications of pregnancy during cancer treatment, health planners should pay more attention to family planning for women under treatment, particularly in less developed regions.
Zeynab Hatamizargaran, Mohammadreza Sasani, Masoumeh Akhlaghi
Shiraz E-Medical Journal; https://doi.org/10.5812/semj.108643

Abstract:
Background: Recent data have suggested that nonalcoholic fatty liver disease (NAFLD) can occur in normal-weight subjects. This study examined the association of body fat percentage (BF%) with NAFLD and its risk factors in normal-weight individuals. Objectives: The present study aimed to explain the influence of body fat on the risk of NAFLD. Methods: A total of 59 subjects with body mass index (BMI) within the range of 18.5 - 24.9 kg/m2 were selected from referrals to two major university polyclinics in Shiraz, Iran, from April to June 2019. Fatty liver grade, anthropometric characteristics, body composition, and cardiometabolic risk factors were measured in this study. Results: Waist circumference (P = 0.012), fat mass (P < 0.001), triglycerides (TG) (P = 0.027), very-low-density lipoprotein (VLDL) (P = 0.007), and TG/high-density lipoprotein cholesterol (HDL-C) ratio (P = 0.003) increased; however, skeletal muscle mass decreased (P < 0.001) across the tertiles of BF%. The average of fatty liver grade was similar in the first and second tertiles; nevertheless, the fatty liver grade of participants in the third tertile was significantly higher (1.3 ± 0.9 vs. 0.4 ± 0.7; P = 0.005). In ordinal regression analysis, BF% (1.13; 95% CI: 1.04 - 1.22; P = 0.003), BMI (1.95; 95% CI: 1.02 - 3.74; P = 0.045), VLDL (1.77; 95% CI: 1.00 - 3.12; P = 0.049), and TG/HDL-C ratio (2.21; 95% CI: 1.26 - 3.86; P = 0.006) had positive associations with NAFLD; nonetheless, HDL-C (0.33; 95% CI: 0.16 - 0.67; P = 0.002) and dietary cholesterol (0.97; 95% CI: 0.95 - 0.997; P = 0.028) had inverse associations with NAFLD after the adjustments for age, gender, BMI, and physical activity. Conclusions: The results of this study suggested that within normal weight ranges, NAFLD occurs more frequently in individuals with higher BF%. In addition, BF% can be used as an important marker in NAFLD screening.
Mojdeh Banaei, Sanaz Safarzadeh, Azam Moridi, Mohammad Dordeh, Sareh Dashti, , Nasibeh Roozbeh
Shiraz E-Medical Journal; https://doi.org/10.5812/semj.112434

Abstract:
Objective: The increasing prevalence of COVID-19 in Iran has increased the risk for anxiety and stress in families. Due to the significance of the impact of family health on the society’s mental health and the fundamental role of marital relationships, which is an indicator of marital satisfaction, this study was conducted to investigate associated factors of marital satisfaction in Iranian women during the COVID-19 pandemic. Methods: This online cross-sectional study was carried out to assess associated factors of marital satisfaction in Iranian women during the COVID-19 pandemic from April 1 to April 20, 2020. The study sample consisted of 317 married women of childbearing age eligible to enter the study. Data were collected using a socio-demographic and obstetric questionnaire, the Female Sexual Function Index, the ENRICH Marital Satisfaction Scale, and the General Health Questionnaire. Data analysis was performed using SPSS software version 22. Results: A total of 317 married women participated in the study. The average age of the participants was 31.85 ± 6.94 years. Based on the multiple linear regression model, only five variables, including sexual satisfaction (B = 2.414, P < 0.001), physical symptoms (B = 0.245, P = 0.045), anxiety and insomnia (B = -0.319, P = 0.002), social dysfunction (B = 0.265, P = 0.003), and depression (B = -0.441, P < 0.001), could significantly predict marital satisfaction during the COVID-19 pandemic. Conclusions: Sexual satisfaction, physical symptoms, anxiety and insomnia, social dysfunction, and depression can significantly affect marital satisfaction during the COVID-19 pandemic. Therefore, planning to identify these factors and provide the appropriate strategy can increase marital satisfaction in times of crisis.
Zeynab Karimi, Shadi Fathizadeh, , , Samaneh Abolkheirian
Shiraz E-Medical Journal; https://doi.org/10.5812/semj.111708

Abstract:
Background: Crimean-Congo hemorrhagic fever (CCHF) is a viral zoonosis. Ranchers, butchers, and slaughterhouse workers run the risk of contracting the disease more than others. Objectives: This study was aimed at the evaluation of occupational behaviors and practices of butchers and meat industry workers regarding CCHF based on the health belief model (HBM). Methods: The present descriptive-analytical study was carried out among 207 local butchers working in slaughterhouses who were selected by cluster sampling in Qom City in the first six months of 2019. To collect data, a researcher-made questionnaire based on the HBM constructs was used. The validity and reliability of the questionnaire have been verified. The data were analyzed by SPSS version 21 using regression analysis and Pearson correlation coefficient. Results: A total of 141 (68.12%) of the participants used personal protective equipment, including appropriate workwear, gloves, mask, goggles, and boots when they had direct contact with raw meat products. There were significant positive relationships between CCHF preventive behaviors and perceived barrier structures (P = 0.003), perceived benefits (P = 0.004), perceived severity (P = 0.002), perceived susceptibility (P = 0.001), and cues to action (P = 0.001). Based on linear regression analysis, perceived susceptibility was able to predict 96% of the variance of CCHF preventive behaviors in Qom’s butchers. Conclusions: Perceived susceptibility is a predictor of CCHF preventive behaviors; thus, future plans and programs are suggested to be based on the HBM and emphasize increasing perceived susceptibility and other constructs of this model to improve the disease-preventing behaviors of butchers.
, , Shokrollah Mohseni, Anahita Fakherpour, Zabihollah Damiri, ,
Shiraz E-Medical Journal; https://doi.org/10.5812/semj.111491

Abstract:
Background: Due to the pandemic, COVID-19 cases and deaths are increasing unexpectedly and precipitately. More importantly, asymptomatic carriers could infect healthy people through sneezing, coughing, and talking. Therefore, mask usage is required to prevent and control COVID-19. Objectives: This study was aimed at examining the knowledge, attitude, and performance levels (KAP) of the Iranian population regarding mask usage to prevent and control the COVID-19 outbreak during a one-month period from early April to early May 2020. Methods: A researcher-made, validated, and reliable questionnaire consisting of 30 questions on knowledge, attitude, and performance regarding mask usage was utilized. Data collection was performed through the online method. To do so, the online questionnaire link was provided for the participants via social networks. The correct and wrong answers were scored 1 and 0 points, respectively. The final score of each dimension was calculated and classified as 0 - 50% (low), 51 - 75% (moderate), and 75% > (good). Results: A total of 1581 participants took part in the study. Although the participants had good attitude (74%) and performance (70.80%), but only 13.70% of them had good knowledge regarding mask usage. Also, significant differences were found between the participants’ knowledge and higher educational levels (P < 0.001). There were significant associations between the participants’ age, gender, educational level, and job and their knowledge and attitude levels (P < 0.05). Besides, female participants had higher performance scores than did male participants (P < 0.001). The participants with governmental jobs had significantly higher performance than unemployed ones (P < 0.001). Conclusions: The participants obtained low KAP scores; therefore, it is required to train and inform the society and enhance their KAP levels via social media regarding the importance of mask usage, including proper donning, doffing, cleaning, disinfection, and safely and hygienic disposal procedures of masks to prevent and control COVID-19.
, , Arezoo Dehghani, , Narges Rouhi
Shiraz E-Medical Journal; https://doi.org/10.5812/semj.112288

Abstract:
Background: The occurrence of an earthquake in Kermanshah province in 2017 leads to death and injury of its inhabitants. Assessment of the health system functions can lead to the provision of the necessary healthcare services for the affected population post-disasters. The present study is aimed to assess the health system functions after the Kermanshah earthquake. Objectives: Assessment of health system functions in the reproductive, pediatric, and environmental health dimensions in the affected regions of Kermanshah were the research objectives. Methods: This mixed methods study was conducted in the two phases of developing a tool and assessment of the main health system functions. Content validity and reliability were measured by CVR and CVI, and Cronbach's alpha, respectively. Assessment of health system functions was conducted by the participation of 100 affected households. Results: Firstly, the primary tool was designed using 31 primary items extracted from literature review and a qualitative study. CVR and CVI of the tool were 100%, and Cronbach's alpha was 0.97. The coverage of the reproductive, environmental, and children’s health services ranged from 90 to 100% since the first day to one year after the earthquake and between 30 and 60% from one year to two years post-earthquake. Conclusions: The assessment of health system performance can provide the necessary data for effective decision making and promoting health system functions. Further research is needed to assess the functions of the health system after other natural disasters rather than earthquakes.
Hamid Reza Samimagham, Mehdi Hassani Azad, Dariush Hooshyar, Mohsen Arabi, Zahra Reza Hosseini,
Shiraz E-Medical Journal; https://doi.org/10.5812/semj.116278

Abstract:
Keywords COVID-19 Gam-COVID-Vaccine Adverse Reactions
Nasim Shokouhi, Nafiseh Saedi, Mona Mohseni, Elham Feizabad, Sara Saeedi, Elaheh Miri Ashtiani
Shiraz E-Medical Journal; https://doi.org/10.5812/semj.112902

Abstract:
Background: Overactive bladder (OAB) syndrome, a condition with urgency, is often characterized by increased daytime frequency and nocturia. Overactive bladder is a highly prevalent condition that drastically impacts the quality of patients’ life. Objectives: This study was conducted to investigate sleep disturbance and fatigue in women with OAB by reliance on two validated questionnaires. Methods: This case-control study was performed among 70 patients recognized with OAB and 70 women in a control group. We employed validated questionnaires, namely PSQI and FSS, to comparatively assess sleep disturbance and fatigue symptoms, respectively. Results: The participants’ mean age was 44.50 ± 12.64 years old. The mean PSQI score was 13.24 ± 3.67 (range: 6 to 22), and the mean FSS score was 39.05 ± 15.12 (range: 9 to 63). Furthermore, the mean scores of PSQI (P < 0.001) and FSS (P < 0.001) were significantly higher in OAB women compared to the control group. In women with OAB, there was a significant positive correlation (P = 0.007) between PSQI and FSS scores. Furthermore, this correlation was observed between urgency urinary incontinence at night and PSQI (P = 0.047) and sleep disturbance (P = 0.023) and between nocturia and sleep efficiency (P = 0.012), sleep disturbance (P = 0.001), sleep latency (P = 0.007), and FSS score (P = 0.032). In addition, a significant direct correlation (P = 0.022) was found between urgency urinary incontinence during the day and daytime dysfunction. Conclusions: The study shows that sleep disorder is common in patients with OAB, and it seems that urinary problem assessment is a prerequisite for any sleep medication prescription.
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