The effect of an educational program based on Roy's adaptation model on the quality of life of patients suffering from heart failure: A clinical trial study.

AIM: Heart failure is a progressive, debilitating disease with exacerbated physical and psychological symptoms that reduces the quality of life of patients. Nursing intervention based on nursing theories could help in the adaptation of patients to the disease and improving quality of life. The aim of this study was to determine the effect of an educational program based on Roy's adaptation model on the quality of life of patients with heart failure. METHODS AND MATERIAL: In this randomized controlled trial, 76 patients with heart failure were allocated to either the intervention or control group through a blocked randomization method. The data were collected between May and October 2017. The intervention group received oral and written educational programs for 4 weeks. Minnesota quality-of-life questionnaire and Roy's adaptation model-based evaluation form was completed at the beginning of the trial, and 1 month after the completion of the study. RESULTS: Intervention patients showed statistically significantly improved scores on the physiologic, role function, independence-interdependence dimensions and the total score of Roy's adaptation model over time compared with control patients (p < .05). The mean score of all of the three quality-of-life dimensions and total score of quality of life increased significantly (p < .05). CONCLUSION: The study results help nursing staff detect the stimuli and the behaviors of patients with heart failure. Roy's adaptation model can be used as a standard practice to increase adaptation to the disease and improving quality of life.

Prevalence of Chlamydia trachomatis in Pregnant Iranian Women: A Systematic Review and Meta-Analysis.

Several studies have been conducted regarding the prevalence of Chlamydia trachomatis, Mycoplasma hominis, and Ureaplasma urealyticum in pregnant Iranian women. However, it is necessary to combine the previous results to present a general assessment. We conducted the present study based on systematic review and meta-analysis studies according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We searched the national and international online databases of MagIran, IranMedex, SID, MedLib, IranDoc, Scopus, PubMed, ISI Web of Knowledge, and Google Scholar search engine for certain MeSH keywords until June 16, 2017. In addition, heterogeneity, sensitivity analysis, subgroup analysis, and publication bias were performed. The data were analyzed using random-effects model and Comprehensive Meta-Analysis version 2 and P value was considered lower than 0.05. The prevalence of Chlamydia trachomatis in 11 surveyed articles that assessed 2864 pregnant Iranian women was 8.74% [95% confidence interval (CI): 5.40-13.84]. The prevalence of Chlamydia trachomatis was estimated 5.73% (95% CI: 2.09-14.73) and 13.55% (95% CI: 11.23-16.25) by enzyme-linked immunosorbent assay (ELISA) and polymerase chain reaction (PCR), respectively which the difference was not significant (P=0.082). The lowest and highest prevalence of Chlamydia trachomatis was estimated in Tehran province [4.96% (95% CI: 2.45-9.810)] and Ardabil province [28.60% (95% CI: 20.61-38.20)], respectively. This difference was statistically significant (P<0.001). Meta-regression for the prevalence of Chlamydia trachomatis based on year of the studies was significant with increasing slope (P=0.017). According to the systematic review, the prevalence of Mycoplasma hominis and Urea plasma urealyticum indicated 2 to 22.8% (from 4 articles) and 9.1 to 19.8% (from 3 articles), respectively. There was no evidence of publication bias (P value for Begg and Eggers' tests was 0.161 and 0.173, respectively). The prevalence of Chlamydia trachomatis is high among pregnant Iranian women. Screening pregnant women as part of preventive measures seem necessary considering the potential for maternal and fetal complications.

Prophylaxis against Deep Venous Thrombosis in Patients Hospitalized in Surgical Wards in One of the Hospitals in Iran: Based on the American College of Chest Physician's Protocol.

BACKGROUND: There is not enough studies to determine the frequency of using the prophylaxis against deep venous thrombosis (DVT) based on the American College of Chest Physician's (ACCP) guidelines in Iran. Thus, providing such statistics is essential to improve thromboprophylaxis in hospital. The present study aimed to determine the frequency of using the prophylaxis against DVT based on ACCP guidelines in patients hospitalized in surgical wards in one of teaching hospital in Ilam, Iran. METHODS: In a cross-sectional, the samples were selected among medical records of patients who were hospitalized and underwent surgery in surgical wards of the hospital from April 2012 to September 2013. Type of prophylaxis was determined based on ACCP guidelines. After reviewing inclusion and exclusion criteria, patients' data were extracted from medical records based on required variables. RESULTS: In reviewing 169 qualified samples, 46.2% (78 patients) were women. Of these, 132 patients were at risk of DVT and needed prophylaxis, only 39 patients (29.5%) received prophylaxis. Thromboprophylaxis based on ACCP guidelines had been fully implemented only in 30 cases (22.7%) of patients with the risk of DVT.. The highest thromboprophylaxis was in the intensive care unit (46.6%) and neurosurgery (37.5%), and the least rate was in urology (0%). CONCLUSIONS: As the results of this study, there are differences between clinical practice and the ACCP guidelines recommendation in prophylaxis against DVT. Thromboprophylaxis has not been implemented based on ACCP guidelines in more than 75% of patients with the risk of DVT. Thus, new strategies are needed to implement thromboprophylaxis against DVT in Iranian hospitals.

Epidemiology of hepatitis B in pregnant Iranian women: a systematic review and meta-analysis.

Perinatal transmission is one of the most common routes of hepatitis B virus (HBV) transmission. This study aims to identify the epidemiological features of HBV among pregnant Iranian women. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Two authors independently searched several online databases without time limit until May 2017. The databases include Magiran, Iranmedex, SID, Medlib, IranDoc, Scopus, PubMed, Science Direct, Cochrane, Web of Science and Google Scholar. The data were analyzed based on a random-effects model using Comprehensive Meta-Analysis software version 2. Thirty-seven studies were included in the meta-analysis. The prevalence of HBV among pregnant Iranian women was 1.18% (95% CI: 0.09%-1.53%). The prevalence of HBV among pregnant women living in urban and rural areas was 1.60% (95% CI: 0.06%-4.30%) and 1.70% (95% CI: 0.09%-3.2%), respectively. The prevalence of HBV among housewives and working pregnant women was 4.3% (95% CI: 1.4%-12.5%) and 1.2% (95% CI: 0.02%-5.8%), respectively. The risk of developing an HBV infection was significantly associated with illiteracy (p = 0.013), abortion (p = 0.001), blood transfusion (p < 0.001) and addicted spouse (p = 0.045). However, no significant relationship was observed between HBV infection and urbanization (p = 0.65), occupation (p = 0.37), history of surgery (p = 0.32) or tattooing (p = 0.69). Vaccination coverage (receiving at least a single dose) in pregnant women was 9.8% (95% CI: 5.3%-17.5%). The prevalence of HBV among pregnant women is lower than in the general population of Iran. HBV vaccination coverage was low among pregnant Iranian women. Therefore, health policy-makers are recommended to enforce immunization programs for HBV vaccination among high-risk pregnant women.

Hearing loss in Iranian thalassemia major patients treated with deferoxamine: A systematic review and meta-analysis.

BACKGROUND: Hearing disorders are reported in thalassemia patients treated with deferoxamine. This study aimed to assess hearing loss in Iranian thalassemia major patients treated with deferoxamine. METHODS: This review article was designed based on PRISMA guidelines. To review the literature, two researchers studied national and international databases including Iranmedex, Magiran, Medlib, SID, Scopus, PubMed, Science Direct, Web of Science and Google Scholar without time limit until May 2017. Cochran's Q test and I2 index were used to assess the heterogeneity of the studies. The data were analyzed using Comprehensive Meta-Analysis software version 2 and p<0.05 was considered significant. RESULTS: A total of 17 articles involving 1,835 Iranian thalassemia major patients treated with deferoxamine were included in the meta-analysis. The overall prevalence of hearing loss was estimated 27.3% (95% confidence intervals (CI): 19-37.6). The prevalence of sensorineural, conductive and mixed hearing loss was estimated 10.6% (95% CI: 5.7-18.8), 14.6% (95% CI: 10.5-20.6) and 9.1% (95% CI: 5.6-14.6), respectively. No significant differences were noted regarding the relationship hearing loss and mean serum ferritin (P=0.29) and average daily deferoxamine (P=0.30). Meta-regression model showed an increased significance in the prevalence of hearing loss based on the year of studies (p<0.0001). CONCLUSIONS: There is a high prevalence of hearing loss in Iranian thalassemia major patients treated with deferoxamine. Therefore, periodic hearing assessments and regular check-ups after the initiation of chelation therapy are necessary.

Prevalence of diabetes, impaired fasting glucose and impaired glucose tolerance in patients with thalassemia major in Iran: A meta-analysis study.

BACKGROUND: This study aimed to investigate the prevalence of diabetes, impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) in Iranian patients with thalassemia major. METHODS: The current study has been conducted based on PRISMA guideline. To obtain the documents, Persian and English scientific databases such as Magiran, Iranmedex, SID, Medlib, IranDoc, Scopus, PubMed, ScienceDirect, Cochrane, Web of Science, Springer, Wiley Online Library as well as Google Scholar were searched until December 2015. All steps of the study were conducted by two authors independently. To the high heterogeneity of the studies, the random effect model was used to combine studies. Data were analyzed using STATA Version 11.1 software. RESULTS: Thirty-two studies involving 3959 major thalassemia patients with mean age of 16.83 years were included in the meta-analysis. The prevalence of diabetes in Iranian patients with thalassemia major was estimated as 9% (95% CI: 6.8-10.5) and estimated rate was 12.6% (95% CI: 6.1-19.1) for males and 10.8% (95% CI: 8.2-14.5) for females. The prevalence of IFG and IGT were 12.9% (95% CI: 7-18.8) and 9.6% (95% CI: 6.6-12.5) respectively. No relationship between serum ferritin and development of diabetes was noted. CONCLUSION: The prevalence of diabetes, IFG, and IGT in patients with thalassemia major in Iran is high and accordingly requires new management strategies and policies to minimize endocrine disorders in Iranian patients with thalassemia major. Screening of patients for the early diagnosis of endocrine disorders particularly diabetes, IFG, and IGT is recommended.

Epidemiology of Toxoplasma gondii among blood donors in Iran: A systematic review and meta-analysis.

INTRODUCTION: Asymptomatic Toxoplasma gondii transmitted from blood donors to receiving patients has become a concern. Numerous articles have been published on the epidemiology of T. gondii in blood donors in Iran and a systematic review of the results shows quite different findings, hence this study was conducted to determine the seroprevalence of T. gondii in Iranian blood donors using meta-analysis. METHODS: We searched for epidemiological studies that were published until July 2016 in eight English databases including: Scopus, PubMed, Ovid, Science Direct, Cochrane, Web of Science, Springer, Wiley Online Library, and four Iranian databases: Magiran, Iranmedex, SID and Medlib as well as Google Scholar. To estimate pooled estimator, regarding high heterogeneity and significance of I2 index, Random effects model was used. Data analysis was conducted using Review Manager Ver5.3.5 and P<0.05 was considered significant. RESULTS: Among 10 studies with a sample size of 4538 Iranian blood donors, the seroprevalence of T. gondii was calculated to be 34.4% (CI95%: 24.9-43.9). The rate in males and females was 33.36% (CI95%: 19.92-46.81) and 37.63% (CI95%: 20.81-54.45), respectively. The seroprevalence of IgM and IgG antibodies among blood donors were 2.74% (CI95%: 0.55-4.92) and 31.84% (CI95%: 20.61-43.08), respectively. The seroprevalence of T. gondii was significantly associated regarding blood group (P=0.04), but this relation was not significant with blood transfusion (P=0.62). CONCLUSION: The results of this review indicate a high seroprevalence of T. gondii (about one-third) in Iranian blood donors and emphasizes the importance of screening the seroprevalence of T. gondii of donated blood in Iranian Blood Transfusion Organization.

Vitamin D status in Iranian pregnant women and newborns: a systematic review and meta-analysis study.

BACKGROUND: Vitamin D deficiency is a common health problem worldwide. The present study was conducted to assess the vitamin D status in Iranian pregnant women and newborns. METHODS: A systematic review was conducted following PRISMA guidelines. The Scopus, PubMed, Science Direct, Cochrane, Web of Science, CINAHL, Magiran, Iranmedex, SID, Medlib, IranDoc databases, and Google Scholar were searched until 2017. The data were combined using random effects model. p < 0.05 was considered significant. RESULTS: In 23 studies including 6,127 Iranian pregnant women were eligible for inclusion. The prevalence of vitamin D deficiency based on cutoff points of 10, 20, and 30 ng/ml was estimated to be 42.42% (95%CI: 26.90-57.93), 55.84% (95%CI: 31.75-79.93) and 80.82% (95%CI: 71.20-90.45), respectively. The mean 25-hydroxyvitamin D [25(OH)D] concentration was estimated to be 15.69 ng/ml (95%CI: 14.39-17.00) in pregnant women. The mean 25(OH)D concentration was estimated to be 14.97 ng/ml (95% CI: 10.63-19.31) in Iranian newborns. The difference in mean 25(OH)D concentration between pregnant women and their newborns was significant (p = 0.0002). CONCLUSIONS: Vitamin D status in Iranian pregnant women and newborns are critical. Therefore, paying attention to the issue of vitamin D deficiency in this group should be a health priority in Iran.

Effect of lavender scent inhalation on prevention of stress, anxiety and depression in the postpartum period.

BACKGROUND: Stress, anxiety, and postpartum depression are the most common problems among women in their childbearing age. Research has shown that aromatherapy administered during labor reduces anxiety in mothers. With regard to the specific biological conditions in postpartum period and the subsequent drop in hormone levels, this study investigated the effect of lavender on prevention of stress, anxiety, and postpartum depression in women. MATERIALS AND METHODS: In a clinical trial, 140 women admitted to the obstetric and gynecological unit were randomly divided into aromatherapy and non-aromatherapy groups immediately after delivery. Intervention with aromatherapy consisted of inhaling three drops of lavender essential oil every 8 h with for 4 weeks. The control group received routine care after discharge and was followed up by telephone only. After 2 weeks, 1 and 3 months of delivery, women were assessed by the 21-item Depression, Anxiety, and Stress Scale and the Edinburgh stress, anxiety, and depression scale in the two groups. Data analysis was performed by Mann-Whitney, analysis of variance (ANOVA), and post hoc tests. Level of significance was set as 0.05 for all tests. RESULTS: The results showed that the mean stress, anxiety, and depression at time point of 2 weeks (P = 0.012, P < 0.0001, and P = 0.003, respectively) and stress, anxiety, and depression scores at time points of 1 month (P < 0.0001) and 3 months after delivery (P < 0.0001) were significantly lower in the study group compared with the control group. CONCLUSIONS: Inhaling the scent of lavender for 4 weeks can prevent stress, anxiety, and depression after childbirth.

Differentiation of P19 embryonal carcinoma stem cells into insulin-producing cells promoted by pancreas-conditioned medium.

The ability of embryonal carcinoma )EC (stem cells to generate insulin-producing cells (IPCs) is still unknown. We examined the trophic effects of pancreas-conditioned medium (PCM) on in vitro production of IPCs. Initially, P19 EC cells were characterized by the expression of stem cell markers, Oct3/4, Sox-2 and Nanog. To direct differentiation, P19-derived embryoid bodies (EBs) were induced by selection of nestin-positive cells and treatment with different concentrations of PCM. Morphological studies documented the presence of islet-like cell IPCs clusters. The differentiated cells were immunoreactive for ß cell-specific proteins, including insulin, proinsulin, C-peptide and insulin receptor-ß. The expression of genes related to pancreatic ß cell development and function (PDX-1, INS1, INS2, EP300 and CREB1) was confirmed by qPCR. During differentiation, the expression of EP300 and CREB1 increased by 2.5 and 3.1 times, respectively. In contrast, a sharp decrease in the expression of Oct3/4, Sox-2 and Nanog by 4, 1.5 and 1.5 times, respectively, was observed. The differentiated cells were functionally active, synthesizing and secreting insulin in a glucose-regulated manner. Network prediction highlighted crosstalk between PDX-1 transcription factor and INS2 ligand in IPC generation and revealed positive regulatory effects of EP300, CREB1, PPARA, EGR, KIT, GLP1R, and PKT2 on activation of PDX-1 and INS2. This is the first report of the induction of IPC differentiation from EC cells by using neonate mouse PCM. Since P19 EC cells are widely available, easily cultured without feeders and do not require special growth conditions, they would provide a valuable tool for studying pancreatic ß cell differentiation and development. Copyright © 2016 John Wiley & Sons, Ltd.