Emotion-focused group therapy among women with premenstrual dysphoric disorder: A randomized clinical trial.

ObjectivePremenstrual Dysphoric Disorder (PMDD) contributes to couple burnout, reduced quality of life, sexual dysfunction, and social isolation. The present study aimed to investigate the effectiveness of emotion-focused group therapy (EFGT) in pain perception, self-compassion, sexual function, and couple burnout in women with PMDD. Method: Among married females with PMDD, 72 participants were selected and randomly assigned to experimental and waitlist control groups. EFGT was performed in 10 sessions for the subjects in the experimental groups. The McGill Pain Questionnaire, Self-Compassion Scale, Female Sexual Function Index and Couple Burnout Measure were used to collect data in the pre-test and post-test. To analyze the data, an analysis of covariance test was applied. Results: The findings demonstrated that EFGT was effective in pain perception (p < .001, η2=.80), self-compassion (p < .001, η2 = .86), sexual function (p < .001, η2 = .38), and couple burnout (p < .001, η2 = .70). Participants of EFGT improved well, were satisfied with treatment, and had a good therapeutic relationship. Conclusion: Implementing EFGT increased the components of self-compassion and sexual function, and reduced the components of pain perception and couple burnout. It seems that EFGT could be effective in women with PMDD.

Association of vitamin D receptor gene polymorphism with the occurrence of low bone density, osteopenia, and osteoporosis in patients with type 2 diabetes.

PURPOSE: This study aims to analyze the association between VDR gene polymorphism and the occurrence of "low bone density (LBD)/osteopenia/osteoporosis" or LBDOO in type 2 diabetes (T2D) patients among a clustered population in northwest of Iran. The studied VDR gene polymorphism included ApaI (rs7975232), BsmI (rs1544410), FokI (rs2228570), EcoRV (rs4516035) and, TaqI (rs731236). METHODS: In this population-based cross-sectional study, patients with T2D were identified within a group of 1266 participants based on self-report of diabetes, history of diabetes medication, and recorded laboratory data. Separately for each polymorphism and gender, crude and adjusted (age, BMI) odds ratios (ORs) were calculated for participants with T2D through logistic regression analysis. RESULTS: The prevalence of T2D was 16.41% in people residing in the city of Sanandaj in 2011. Of the participants with T2D, 13.92% and 81.29% had osteoporosis and vitamin D deficiency, respectively. In women, the tt genotype of the TaqI gene significantly decreased the risk of LBDOO versus the Tt genotype, after adjusting for BMI and age (adjusted OR:0.18, CI95%: 0.03-0.97). Conversely, the EE genotype of the EcoRV gene enhanced the risk of LBDOO versus the Ee genotype (adjusted OR:7.64, CI95%: 2.03-28.72). CONCLUSION: The polymorphism of both TaqI and EcoRV genes was associated with the risk of LBDOO in women with T2D. This is the first time a study has highlighted this effect for the polymorphism of the EcoRV gene; we believe that this study would serve as a basis for future studies.

Clinical manifestations, laboratory markers, and renal ultrasonographic examinations in 1-month to 12-year-old Iranian children with pyelonephritis: a six-year cross-sectional retrospective study.

BACKGROUND: Upper urinary tract infection (UTI) or pyelonephritis may increase the pathogenesis rate and risk of severe complications in children due to kidney atrophy. OBJECTIVE: A set of clinical symptoms, laboratory markers, and ultrasound findings were assessed to achieve the early diagnosis and prognosis of pyelonephritis in hospitalized pediatrics. METHODS: A cross-sectional study with 104 Iranian children (95 girls and 9 boys) aged 1 month to 12 years with acute pyelonephritis during 2012-2018 was conducted. The ultrasound examination of kidneys and urinary tract during hospitalization, the incidence of clinical symptoms, and laboratory markers in blood and urine were monitored to identify the best predictive factors of early diagnosis of this bacterial infection. RESULTS: Three-fourth of the patients had one of the four clinical symptoms of abdominal pain, constipation, dysuria, and vomiting, while others were asymptomatic. A much frequency of pyuria (88.46%), Escherichia coli in urine (92.31%), leukocytosis (81.73%), and high ESR (> 10 mm/h, 92.30%) and CRP (> 10 mg/L, 82.82%) was observed. The kidney and urinary tract ultrasonography only in 32.7% of children revealed findings in favor of pyelonephritis (cystitis, ureteral stones, and hydronephrosis). CONCLUSION: There was a high frequency of clinical signs and laboratory markers associated with pyelonephritis. Ultrasound alone was not an efficient tool to track febrile UTI as most patients presented normal sonography.

Prevalence of non-reporting of hospital medical errors in the Islamic Republic of Iran.

BACKGROUND: Medical errors frequently occur in health care facilities, jeopardizing patient safety and increasing associated costs. AIMS: This cross-sectional investigation examined the rates of and reasons for non-reporting of medical errors at Nemazee Hospital, Shiraz, Islamic Republic of Iran. METHODS: Self-administered questionnaires were completed by 283 staff members, including physicians, nurses and medical students. One-way analysis of variance, Fisher's least significant difference post hoc, Spearman correlation coefficient and intraclass correlation tests were used for statistical analyses. RESULTS: Almost all (95.8%) participants had observed at least 1 medical error during the previous year, with over half (50.5%) observing 3-10 errors. The preferred method for reporting medical errors among physicians and medical students was verbal and informal (40.3% and 41.8% respectively), while nurses preferred written forms (45.7%). The results indicated significant differences between groups concerning individual and organizational barriers in general, and among all sub-categories (P < 0.001). CONCLUSION: Concerns of legal entanglements and confidentiality issues were recognized as the main barriers to reporting medical errors.

Antimicrobial stewardship program (ASP): an effective implementing technique for the therapy efficiency of meropenem and vancomycin antibiotics in Iranian pediatric patients.

BACKGROUND: Antimicrobial stewardship program (ASP) is a distinguished method to improve the prescription and efficacy of antibiotics. AIM: The efficacy of ASP and conventional methods was compared to measure the effectiveness of meropenem (MPM) and vancomycin (VMN) antibiotics in pediatric patients. DESIGN: In an interventional quasi-experimental study, 135 children admitted in Children's Hospital affiliated to University of Medical Sciences in time periods of 2014-2015 and 2015-2016 were assessed. METHODS: The conventional and ASP methods in 2014-2015 and 2015-2016 were respectively utilized to provide the best antimicrobial therapy of MPM and VMN antibiotics in patient children. The data of mortality rate (MR), antibiotic prescription (AP), antibiotic dose (ADe), antibiotic duration (ADn), length of hospital stay (LOHS), and blood cultures (BCs) were compared across the years using the Chi square, independent t test, and Fisher's exact test. RESULTS: The levels of MR, AP, ADe, ADn, LOHS, and positive BCs using the ASP method in 2015-2016 were significantly lower those of in 2014-2015 using the conventional one (p < 0.05). CONCLUSIONS: The ASP method versus conventional one with a better efficacy can be employed as an antibiotic administration guide for MPM and VMN in the therapy of patients in community-based hospitals.

Iranian university students lifestyle and health status survey: study profile.

BACKGROUND: The physical health assessment of university students in Iran is a national large scale assessment examining health behaviors among tertiary education students. Understanding risky health behaviors which are the major sources of global mortality and morbidity in adulthood is the key objective of this assessment. METHODS: In academic year of 2012-2013, newly admitted students (N = 151,671) at 74 governmental eligible universities that had health center from 28 provinces were invited to participate in the health assessment program. The physical health behaviors of the students were evaluated by using questionnaire. The test-retest reliability method was applied to estimate the reliability of physical health questionnaire. After filling out the questionnaires, students were led to the examination room for the measurement of height, weight and blood pressure. RESULTS: From the total study population, 84,298 student's ages between 18 and 29 years old, were participated in the health assessment. The mean response proportion was 63%. The mean age of students was 21.5 ± 4.01, with 49.20% percent being <20 years old. 32.31% were between 20 and 24 years, 13.44% between 25 and 29 years, 69% of the participants were undergraduate 34.9% were master's students, and 2.9% were Ph.D. students. The mean BMI for total students was 22.5 ± 4.0 and regarding to gender, the mean BMI for male and female were 23.0 ± 4.1 and 22.2 ± 3.8 respectively. CONCLUSION: Analysis of student's findings will generate multiple studies which report different aspects of physical health of Iranian university students who constitute a large proportion of young adult aged 18-29 years in the country. This assessment also provides opportunity to compare Iranian student's behavioral patterns with the behavioral pattern of students worldwide.

Evaluation of a Web-based Error Reporting Surveillance System in a Large Iranian Hospital.

BACKGROUND: Proper reporting of medical errors helps healthcare providers learn from adverse incidents and improve patient safety. A well-designed and functioning confidential reporting system is an essential component to this process. There are many error reporting methods; however, web-based systems are often preferred because they can provide; comprehensive and more easily analyzed information. This study addresses the use of a web-based error reporting system. METHODS: This interventional study involved the application of an in-house designed "voluntary web-based medical error reporting system." The system has been used since July 2014 in Nemazee Hospital, Shiraz University of Medical Sciences. The rate and severity of errors reported during the year prior and a year after system launch were compared. RESULTS: The slope of the error report trend line was steep during the first 12 months (B = 105.727, P = 0.00). However, it slowed following launch of the web-based reporting system and was no longer statistically significant (B = 15.27, P = 0.81) by the end of the second year. Most recorded errors were no-harm laboratory types and were due to inattention. Usually, they were reported by nurses and other permanent employees. Most reported errors occurred during morning shifts. DISCUSSION: Using a standardized web-based error reporting system can be beneficial. This study reports on the performance of an in-house designed reporting system, which appeared to properly detect and analyze medical errors. The system also generated follow-up reports in a timely and accurate manner. Detection of near-miss errors could play a significant role in identifying areas of system defects.

Pulsed Dilution Method for the Recovery of Aggregated Mouse TNF-α.

BACKGROUND: The expression of mouse tumor necrosis factor alpha (TNF-α) in Escherichia coli is a favorable way to get high yield of protein; however, the formation of cytoplasmic inclusion bodies, which is the consequence of insoluble accumulated proteins, is a major obstacle in this system. To overcome this obstacle, we used a pulsed dilution method to convert the product to its native conformation. METHODS: Reducing agent and guanidine hydrochloride were used to solubilize inclusion bodies formed after TNF-(α) expression. Then, the refolding procedure was performed by pulsed dilution of the denatured protein into a refolding buffer. The properly-folded protein was purified by metal affinity chromatography. RESULTS: SDS-PAGE showed a 19.9 kDa band related to the mature TNF-(α) protein. The protein was recognized by anti-mouse TNF-(α) on western blots. The final concentration of the purified recombinant TNF-(α) was 62.5 µg/mL. CONCLUSIONS: Our study demonstrates the efficiency of this method to produce a high yield of folded mature TNF- (α).

Iran diabetes research roadmap (IDRR) study: a preliminary study on diabetes research in the world and Iran.

BACKGROUNDS: Diabetes is one of the most common metabolic disorders worldwide. This study aim was to provide detail analysis of diabetes research output and its trend in Iran as well as in the world and compare them. METHODS: Data was retrieved from PubMed database using a suitable search strategy and application of proper operator "AND", "OR" and "NOT". All English documents published from 2008 to 2012 were included. Meeting abstract, letter to the editor, guidelines, consensus and reviews were excluded. Obtained documents for Iran and world were categorized in eleven groups including diabetes management, education, paediatrics, nutrition, epidemiology, diabetes complications, stem cells, gestational diabetes mellitus (GDM), psychiatrics, genetics and prevention and were compared. RESULTS: Total number of DM publications was 59513 for world and 648 for Iran. Trend of DM publications was increasing during the 5 years with a growth rate of 22.5% for world and 23.4% for Iran. Contribution of Iran in the world diabetes output reached 1.08 in 2012. The most and the least number of DM documents were related to complications and preventions, respectively both in Iran and the world. Three leading countries with highest proportion of RCTs (randomized clinical trial) to their total DM publications were Italy, Germany and Iran. CONCLUSION: The most number of diabetes research was in the field of diabetes complication, management and genetics in the world as well as in Iran. During the 5-year period, despite of the world sanctions against Iran, diabetes research trend was increasing in Iran relatively parallel to the world research and sanction had no significant effect on Iran.

Transitional Meningioma After Fetal Liver-Derived Cell Suspension Allotransplant: A Case Report.

Diabetes mellitus is a disease with no definite cure. In recent years, stem cell transplant has led to treatment of various diseases including diabetes. We sought to report a type 1 diabetic patient with a brain mass, diagnosed as transitional meningioma, after a fetal hematopoietic stem cell transplant. A 57-year-old woman with type 1 diabetes who previously had undergone a fetal hematopoietic stem cell transplant, attended the clinic with a history of progressive bifrontal headaches accompanied by nausea, vomiting, and visual disturbances over the previous 8 months. Investigations revealed a 2-cm mass in the right temporal region. The patient underwent a craniotomy, and the lesion was removed and sent for pathological and genetic investigations. The results indicated transitional meningioma with the origin of transplanted fetal hematopoietic stem cells. To our knowledge, this is the first report of transitional meningioma as a result of stem cell transplant. Despite all unanswered questions about the safety of stem cell transplant, this novel therapy provides hope for patients with type 1 diabetes.

Mechanisms involved in altered bone metabolism in diabetes: a narrative review.

Many studies have shown that change in metabolism caused by diabetes can influence the bone metabolism in a way that quality and strength of bone is decreased. A 6 times and 2 times increased risk of fracture is reported in patients with type 1 and type 2 diabetes, respectively. There are several mechanisms by which diabetes can affect the bone. The fact that some of these mechanisms are acting in opposite ways opens the door for debate on pathways by which diabetes affects the bones. On the other hand, bone is not a simple organ that only get influence from other organs, but it is an endocrine organ that by secreting the agents such as osteocalcin, adiponectin and visfatin which can affect the insulin sensitivity and metabolism. In this paper we tried to briefly assess the latest finding in this matter.

Evaluation of fetal cell transplantation safety in treatment of diabetes: a three-year follow-up.

BACKGROUND: Rapidly increasing prevalence of diabetes throughout the world highlights the importance of looking for new treatment options for the disease such as stem cell therapy. With regard to the increasing attention towards stem-cell therapy as a curative treatment for diabetes in recent years, it is of crucial importance to ensure the safety of this novel therapeutic technique. In this study we aim to evaluate the safety of fetal liver-derived cell suspension allotransplantation in the diabetic patients who had attended a clinical trial in 2007. METHODS: 44 out of a total number of 56 patients who had undergone either fetal liver-derived cell suspension allotransplantation or placebo injection in 2007 (IRCT number: 138811071414 N10) were contacted and recruited for the evaluation of possible complications. Patients were referred to a designated ophthalmologist and cardiologist to be screened for retinopathy and cardiovascular diseases. 24-hour urine was collected and tested for the evaluation of nephropathy; and, neuropathy was assessed by means of neuropathic symptoms and monofilament test. RESULTS: There were no life-threatening complications nor significant differences in terms of evaluated diabetes complications ( retinopathy, neuropathy, nephropathy and cardiovascular diseases ) between the case and control groups. However, one case of meningioma was reported. CONCLUSIONS: Findings of our study demonstrated that stem cell transplantation can be considered a relatively safe procedure apart from one case of meningioma; it did neither cause any life-threatening complications nor increased the rate of the diabetes micro- and macrovascular complications.

The effect of fetal liver-derived cell suspension allotransplantation on patients with diabetes: first year of follow-up.

Stem cell-based therapies have recently opened up new horizons for treatment of various types of diseases including diabetes mellitus. However, long-term efficacy and safety of these novel modalities still remain a serious question. Hereby, we aim to report the one-year follow-up results in the diabetic patients who underwent fetal liver-derived hematopoietic stem cell allotransplantation. Fifty six patients with type one (n=30) and type two (n=26) diabetes, aged 10-58 years old (32.8 ± 16.3) were divided into the intervention and placebo group. The patients in the intervention group underwent fetal liver-derived hematopoietic stem cell transplantation while the patients in the placebo group received 5 ml of normal saline both via an intravenous route. The patients were visited at regular intervals to evaluate the efficacy of transplantation in glycemic control as well as possible complications. In the 6th month of the follow-up, there was a significant decrease in HbA1c levels in all groups without any rise in the fasting c-peptide. However, none of the precipitants transiently or continuously became insulin free in the first year after transplantation. It can be concluded that, in this study, fetal liver-derived hematopoietic stem cell transplantation had no significant effects on glycemic control. The heterogeneity of our patients might account for the negative results. Hence, longer follow-up results will be reported in the near future.

Erythropoietin for acute multiple sclerosis in patients with optic neuritis as a first demyelination event.

OBJECTIVE: To investigate the safety, tolerability, and short-term efficacy of treatment with erythropoietin in patients with optic neuritis as a first demyelination event. METHODS: We conducted this randomized double-blind pilot study in the Shiraz University of Medical Sciences, Shiraz, Iran, from March 2007 to January 2009. The participants were patients aged 18-45 years with optic neuritis and at least 3 hyperintense lesions on T2-weighted and FLAIR MRI, but no clinically definite multiple sclerosis (MS). They were randomized into 2 groups. The case group (5 patients) received intravenous methyl prednisolone (1000 mg/24 hours) and intravenous erythropoietin (20,000 unit/24 hours) for 5 consecutive days, and the control group (5 patients) received intravenous methyl prednisolone at the same dose as the case group, and a placebo. The groups were followed for one year and compared for adherence to protocol, adverse drug effects, mean duration of conversion to clinically definite MS, and MRI changes. RESULTS: All patients tolerated the protocol. One patient who received erythropoietin developed cerebral venous sinus thrombosis and anti-cardiolipin antibody positivity. One patient in the control group, but no patients in the case group, fulfilled the McDonald criteria for MS during the follow-up period, but none of the participants in either group developed clinically definite MS according to the Poser criteria. CONCLUSION: Erythropoietin may be effective, but should be used with caution.

Stem cell therapy in treatment of different diseases.

Stem cells are undifferentiated cells with the ability of proliferation, regeneration, conversion to differentiated cells and producing various tissues. Stem cells are divided into two categories of embryonic and adult. In another categorization stem cells are divided to Totipotent, Multipotent and Unipotent cells.So far usage of stem cells in treatment of various blood diseases has been studied (such as lymphoblastic leukemia, myeloid leukemia, thalassemia, multiple myeloma and cycle cell anemia). In this paper the goal is evaluation of cell therapy in treatment of Parkinson's disease, Amyotrophic lateral sclerosis, Alzheimer, Stroke, Spinal Cord Injury, Multiple Sclerosis, Radiation Induced Intestinal Injury, Inflammatory Bowel Disease, Liver Disease, Duchenne Muscular Dystrophy, Diabetes, Heart Disease, Bone Disease, Renal Disease, Chronic Wounds, Graft-Versus-Host Disease, Sepsis and Respiratory diseases. It should be mentioned that some disease that are the target of cell therapy are discussed in this article.

A randomized clinical trial on the effect of low-level laser therapy on chronic diabetic foot wound healing: a preliminary report.

BACKGROUND AND OBJECTIVES: Low-level laser therapy (LLLT) has been shown to promote chronic wound healing in conditions of reduced microcirculation. In this preliminary study, we report the results of using LLLT to heal foot ulcers in patients with diabetes mellitus. MATERIALS AND METHODS: Twenty-three patients with a diabetic foot wound for at least 3 months were included in this double-blind randomized clinical trial. Patients were randomized to receive placebo treatment (n = 10) or LLLT (n = 13) (685 nm, energy density 10 J/cm(2)) in addition to conventional therapy. Patients were followed for 20 weeks. Ulcer size reduction and the number of patients with complete healing were compared between the LLLT and placebo groups. RESULTS: There were no significant differences in baseline characteristics of patients and foot ulcers receiving LLLT and placebo treatment. At week 4, the size of ulcers decreased significantly in the LLLT group (p = 0.04). After 20 weeks, in the LLLT group, eight patients had complete healing and in the placebo group only three patients experienced complete wound healing. The mean time of complete healing in LLLT patients (11 weeks) was less than that in placebo patients (14 weeks) though the difference was not statistically significant. CONCLUSIONS: The study provides evidence that LLLT can accelerate the healing process of chronic diabetic foot ulcers, and it can be presumed that LLLT may shorten the time period needed to achieve complete healing.

Clinical and molecular genetic spectrum of congenital deficiency of the leptin receptor.

BACKGROUND: A single family has been described in which obesity results from a mutation in the leptin-receptor gene (LEPR), but the prevalence of such mutations in severe, early-onset obesity has not been systematically examined. METHODS: We sequenced LEPR in 300 subjects with hyperphagia and severe early-onset obesity, including 90 probands from consanguineous families, and investigated the extent to which mutations cosegregated with obesity and affected receptor function. We evaluated metabolic, endocrine, and immune function in probands and affected relatives. RESULTS: Of the 300 subjects, 8 (3%) had nonsense or missense LEPR mutations--7 were homozygotes, and 1 was a compound heterozygote. All missense mutations resulted in impaired receptor signaling. Affected subjects were characterized by hyperphagia, severe obesity, alterations in immune function, and delayed puberty due to hypogonadotropic hypogonadism. Serum leptin levels were within the range predicted by the elevated fat mass in these subjects. Their clinical features were less severe than those of subjects with congenital leptin deficiency. CONCLUSIONS: The prevalence of pathogenic LEPR mutations in a cohort of subjects with severe, early-onset obesity was 3%. Circulating levels of leptin were not disproportionately elevated, suggesting that serum leptin cannot be used as a marker for leptin-receptor deficiency. Congenital leptin-receptor deficiency should be considered in the differential diagnosis in any child with hyperphagia and severe obesity in the absence of developmental delay or dysmorphism.

Photodynamic therapy of head and neck basal cell carcinoma according to different clinicopathologic features.

BACKGROUND AND OBJECTIVES: We aimed to treat different pathologic types of basal cell carcinomas (BCCs) using photodynamic therapy (PDT). STUDY DESIGN/MATERIALS AND METHODS: Thirty lesions in six patients underwent PDT. The photosensitizer used was Photoheme, a hematoporphyrin derivative IX. It was injected intravenously at the dose of 2-3.25 mg/kg. After 24 hours, the lesions were illuminated by laser light (lambda = 632 nm, light exposure dose = 100-200 J/cm2). Lesions were evaluated pre and post-operatively and at follow-up sessions (of up to 6 months). RESULTS: After a single session of PDT, the average response rate in different histopathologic kinds of basal cell carcinoma (e.g., ulcerative, superficial, nodular, and pigmented forms) were 100%, 62%, 90%, and 14%, respectively. In patients who responded completely, the cosmetic results were excellent and there were no recurrence at 6th month of follow-up. CONCLUSION: Although PDT seems to be an effective treatment modality for superficial, ulcerative, and nodular BCCs, it is not recommended for pigmented lesions.