Comparative evaluation of the effects of Withania somnifera with pentoxifylline on the sperm parameters in idiopathic male infertility: A triple-blind randomised clinical trial.

In this triple-blind randomised clinical trial, we compared the effects of Withania somnifera and pentoxifylline on the sperm parameters in idiopathic male infertility. One hundred infertile male patients were randomly allocated into either W. somnifera or pentoxifylline groups. Patients in the herbal group received six capsules containing 5 g/daily of W. somnifera root, and subjects in the pentoxifylline group received six capsules containing 800 mg/daily of pentoxifylline and placebo for 90 days. Sperm parameters were analysed at the beginning and end of the study. W. somnifera increased mean sperm count (12.5%) and progressive motility (21.42%) and improved sperm morphology (25.56%) compared to the baseline (p = .04, p = .001 and p = .000 respectively). Moreover, pentoxifylline increased mean semen volume (16.46%), progressive motility (25.97%) and improved sperm morphology (13.28%) versus the baseline (p = .02, p = .003 and p = .01 respectively). Intergroup comparison showed no significant differences between the two groups regarding semen volume (p = .11), sperm count (p = .09), morphology (p = .12) and progressive motility (p = .77) after treatment. No major complication was reported in either of the two groups. W. somnifera, a traditional medicine remedy, improves sperms parameters in idiopathic male infertility without causing adverse effects. Therefore, this medication can be considered to be an alternative to pentoxifylline in this regard.

Mitochondrial DNA G13708A variation and multiple sclerosis: Is there an association?

BACKGROUND: Multiple sclerosis (MS) is considered a pathogenetic enigma. Recently, efforts to implicate genetics in human susceptibility to MS have identified an important role of mitochondrial DNA (mtDNA). G13708A is a common mtDNA variation associated with MS in specific populations. This study tested the hypothesis that the mtDNA G13708A variation is associated with MS in an Iranian population. MATERIALS AND METHODS: Blood samples were collected from 100 MS patients and 100 unrelated healthy controls. DNA was extracted using a salting-out method, followed by polymerase chain reaction (PCR) amplification. For assessment of restriction fragment length polymorphism (RFLP), PCR products were restricted by restriction enzyme Mva I. Thereafter, the restriction products were assessed by means of an ultraviolet (UV) transilluminator following electrophoresis with 3% agarose gel. Accuracy of the genotyping procedure was assessed by direct sequencing. RESULTS: The mtDNA G13708A variation was found in 17 cases (17%) and 19 controls (19%) (P=0.7, OR: 0.8, 95% CI: 0.3-1.9). CONCLUSION: The findings of the present study fail to support the hypothesis that the G13708A mtDNA variation is associated with MS in the selected Iranian population.

Iranian public trust in health services: evidence from Tabriz, Islamic Republic of Iran.

This study investigated public trust in health services in Tabriz, Islamic Republic of Iran. A crosssectional household study was conducted in 2014, using random cluster sampling. A total of 1050 households were enrolled in the study and a valid questionnaire was used to collect data through interviews. The mean score for public trust in health services in Tabriz (out of 100) was 53.91 ± 13.7. People had most trust in professional expertise and lowest in macro-level policy. Specialists, pharmacy doctors and nurses were the health providers that enjoyed the highest levels of trust. It is concluded that public trust in health services in Tabriz is low and policy-makers need to employ appropriate policies to improve patients' experience of health services.

Iranian public trust in health services: evidence from Tabriz, Islamic Republic of Iran

This study investigated public trust in health services in Tabriz, Islamic Republic of Iran. A cross-sectional household study was conducted in 2014, using random cluster sampling. A total of 1050 households were enrolled in the study and a valid questionnaire was used to collect data through interviews. The mean score for public trust in health services in Tabriz [out of 100] was 53.91 +/- 13.7. People had most trust in professional expertise and lowest in macro-level policy. Specialists, pharmacy doctors and nurses were the health providers that enjoyed the highest levels of trust. It is concluded that public trust in health services in Tabriz is low and policy-makers need to employ appropriate policies to improve patients' experience of health services

La présente étude visait à étudier la confiance du public dans les services de santé de Tabriz, en République islamique d'Iran. Une étude transversale des ménages a été conduite en 2014, à l'aide d'un sondage aléatoire par grappe. Un total de 1050 ménages ont participé à l'étude, et un questionnaire validé a été utilisé pour collecter des données au cours d'entretiens. Le score moyen de la confiance du public dans les services de santé à Tabriz [sur un échantillon de 100 individus] était de 53,91 +/- 13,7. Les individus faisaient davantage confiance à l'expertise professionnelle et se fiaient moins aux politiques concernant les soins de santé dans leur ensemble. Les spécialistes, les docteurs en pharmacie et les personnels infirmiers étaient les prestataires de santé qui jouissaient des taux de confiance les plus élevés. En conclusion, on peut dire que la confiance du public dans les services de santé à Tabriz est basse et que les responsables politiques doivent recourir à des politiques appropriées pour améliorer l'expérience des services de santé vécue par les patients

Prehospital treatment of burns: a qualitative study of experiences, perceptions and reactions of victims.

BACKGROUND: The manner in which burns are initially managed, at an incident scene, can affect the extent and depth of burn wounds and their final prognosis. The aim of this study was to understand people's experiences, perceptions and reactions towards the initial management of burns and fire accidents in Ardabil Province, Iran. METHODS: In a qualitative study, 48 burn victims accompanied by their caregivers were enrolled. Focus group discussion (FGD) was used to collect data. All the interviews were recorded, transcribed and analysed using content analysis method. RESULTS: Four categories of information were retrieved in this study, including fire control, scald and burn wound management, seeking medical consultation and severity indicators. Uncertainty regarding what to do when someone catches fire was an evident finding that was explored through the discussions. The results revealed that transferring the patient to the hospital most often takes place after initial treatments administered at home. People believed that cooling a burn wound for a time longer than a few seconds may harm the wound. A strong belief in the efficacy of traditional remedies was disclosed when the statements of participants revealed that traditional or home-made remedies were widely used either to control pain immediately after burn and later during the wound repair process to accelerate the repair or to control the infection and prevent oedema and scar. Among these remedies, pennyroyal and grated potatoes seemed to be the most popular ones. Pennyroyal was thought to prevent infection and potatoes were used to relieve pain. People doubted the capability of health-care workers who work in rural health houses. People considered electrical burns and burns on the chest to be the most severe types of burns. CONCLUSION: Inappropriate perceptions regarding initial management of burns existed among the participants that should be addressed in future quantitative research or through developing programmes on secondary prevention of burns.

Uterine leiomyoma and its association with menstrual pattern and history of depo-medroxyprogesterone acetate injections.

BACKGROUND AND AIM: Despite the high prevalence of uterine leiomyoma, according to recent review studies there is uncertainty and a paucity of information regarding its predisposing or protective factors. The aim of this study was to assess the possible association between menstrual cycle pattern and occurrence of surgically treated myomas and also to check if depo-medroxyprogesterone acetate (DMPA) injection earlier in reproductive life can affect the later occurrence of myomas needing surgical treatment. METHODS: In a case-control study in Ardabil, 85 women with definite diagnosis of surgically treated uterine leiomyoma and 154 community controls were enrolled. Possible predictors of myoma including menstrual cycle and menstrual bleeding patterns were assessed. Data were analyzed using SPSS software (SPSS, IBM, Somers, NY). Odds ratios were used as the main statistic in assessing the strength of observed associations. RESULTS: Mean age of the participants was 41.8 ± 8.5 years. Length of menstrual cycle was associated with myoma and a higher likelihood of myoma was observed among those having shorter menstrual cycles (P < 0.05). Number of menstrual bleeding days was also associated with surgically treated myoma and longer bleeding periods increased the likelihood of myoma (P < 0.05). Only one of the eight women who had a history of depo-medroxyprogesterone acetate injections had developed surgically treated uterine leiomyoma and the others belonged to the control group without a history of surgical treatment for uterine leiomyoma. CONCLUSION: Menstrual cycle pattern is associated with developing leiomyomas requiring surgical treatment. DMPA, other than its role in myoma treatment, is also assumed to have a role in preventing myomas, but due to the small sample size in this study, larger scale prospective trials are needed in the future.

Risk factor investigation for cardiovascular health through WHO STEPS approach in Ardabil, Iran.

OBJECTIVES: Reliable evidence is the keystone for any noncommunicable disease (NCD) prevention plan to be initiated. In this study we carried out a risk factor investigation based on the WHO Stepwise approach to Surveillance (STEPS). METHODS: The study was conducted on 1000 adults between 15 and 64 years of age living in Ardabil province, north-west Iran during 2006, based on the WHO STEPS approach to surveillance of risk factors for NCD. At this stage only the first and second steps were carried out. Data were collected through standard questionnaires and methods analyzed using STATA version 8 statistical software package. RESULTS: 29.0% of men and 2.6% of women were current daily tobacco smokers. The mean number of manufactured cigarettes smoked per day was 18.9 among current daily smokers. Smoking was most prevalent among men of low-income families and those of lower education. The mean body mass index (BMI) was 26.6 kg/m(2), and was significantly correlated with systolic blood pressure. 58.9% were overweight or obese; 18.0% had raised blood pressure and 3.7% had isolated systolic hypertension. The mean number of servings of fruit consumed per day was 1.1; 33.1% had low levels of activity. Combined risk factor analysis showed that 4.1% of participants were in the low-risk group (up to 5.1% among men and 3.2% among women). Those in the high-risk group comprised 25.6% in the 25- to 44-year age group and 49.7% in the 45- to 64-year age group. Mean BMI increased by age in both sexes at least at the first three decades of adult life. CONCLUSION: Based on observed status of risk for cardiovascular health, burden of cardiovascular diseases is expected to increase if an effective prevention strategy is not undertaken.

Prevention-oriented epidemiology of burns in Ardabil provincial burn centre, Iran.

In preventing burns, it is essential to know how they occur and which population groups, environments and heating appliances can be targeted for prevention work. The aim of this study was to determine the epidemiological characteristics of burns leading to hospitalisation in the northwest of Iran with a focus on the pre-event phase of injury. Between 2007 and 2008, 237 burn victims hospitalised in Ardabil provincial burn centre were enrolled into a descriptive study. A questionnaire was filled in during hospital stay for all patients, with a focus on obtaining information necessary for prevention purposes. Males constituted 56% of victims. Mean age was 22 years. The most severe burns occurred between the ages of 18 and 32 years, and were mainly flame related. Both in case of flame and non-flame burns, women suffered more severe burns and mortality than men. However, with respect to non-flame burns of which most were scalds, the majority of the severe cases involved children under the age of 5 years. More than 80% of burns occurred at home. The kitchen was the main place of injury in 47% of cases, followed by living rooms in 28%. Nearly 45% of burns were scalds and 47% were flame burns. The main container was the samovar in 37%, followed by kettles in 32% and pots in 22%. The overturning of a container was the major mechanism of contact with hot liquids in 86%. Bumping into a container was the main scenario of a scald injury, constituting nearly 70% of the cases. The difference between flame and non-flame burns in the distribution of burns in extremities was not statistically significant, but head and neck burns were 3.7 times more likely to be caused by flame. The two most important injury patterns, more common among women, were getting burned while using a camping gas stove or while refilling the chamber of kerosene-burning appliances without first extinguishing them. Domestic burns among children and young women are a priority in injury-prevention programmes. Camping gas stoves, valors (traditional dual-purpose heating and cooking appliances) and samovars can be considered as target appliances for burn-specific home-safety-promotion efforts in this area or in similar settings.

Age pattern of the occurrence of breast cancer in the northwest of Iran.

Breast cancer represents 27% of the cancers and 19% of the cancer deaths in female population. The aim of this study was to document the age pattern of the incidence of breast cancer in Iranian female population in the northwest region of the country. The study subjects were 1764 patients with breast cancer diagnosed/registered in the six university clinics between 1988 and 2008 in the northwest of Iran. The highest occurrence rates were observed for the birth year cohorts 1940-1949 (for 59-69 years old), 1950-1959 (for 49-58 years old), and 1960-1969 (for 39-48 years old). Among these three cohorts, the highest rate was observed in 1950-1959 birth year cohort (284.38 per 100,000 female populations, 95% CI: 260-310). This rate was significantly higher compared with the similar rates of other birth cohorts. There was no statistically significant difference between various years in terms of the average age at the diagnosis of breast cancer in our study setting. Despite the previous research reports, we found no significant difference between the mean ages at diagnosis of breast cancer from 1988 to 2008 in Iranian female population.

Applicability of new supervised statistical models to assess burn injury patterns, outcomes, and their interrelationship.

The aim of the study was to investigate the possibility of using supervised statistical models to assess burn injury patterns, outcomes and their interrelationship. Using burn study data, a preliminary principal component analysis was carried out and two separate clusters were observed. Observations were split into two classes and analysed by partial least squares (PLS) regression discriminant analysis to assess possible predictors of each class. To assess predictors of total body surface area burned (TBSA), the orthogonal projections to latent structures (OPLS) model was used after PLS regression. The identified classes were later designated as high-risk burn victims and low-risk burn victims. Female gender fell into the high-risk class. Many possible predictors were found to be associated with burn injury extent, after modelling the natural logarithm of TBSA by OPLS. The fitted model explained 76% of variation in Y. It excluded up to 9% of orthogonal variation captured in two orthogonal components. This seems to be the first application of the OPLS model in public health epidemiology. The results of this study were promising regarding the use of supervised models in injury pattern analysis.

Symptomatologic versus neuroimaging predictors of in-hospital survival after intracerebral haemorrhage.

Symptomatological prediction of Intracerebral haemorrhage (ICH) mortality is a simple and effective method compared to pathological predictors. In this study we considered consciousness level as an easily measurable predictor and compared it to haemorrhage location, intraventricular penetration and haemorrhage size derived from Computerized Tomography (CT) to predict mortality using a parametric survival analysis model. Two hundred and thirty eight ICH patients from a neurology hospital ward were enrolled into this comparative study. Patient history was documented with respect to mortality and a questionnaire outlining background variables and medical history was completed for them. Consciousness level was clinically evaluated by a physician while haemorrhage size and location were determined via computerized tomographic scanning reports. Data were entered into the computer and analyzed according to the Weibull parametric survival analysis model using STATA 8 statistical software. Males constituted 47.1% of the 238 patients, 52.9% were females. The age range of the patients varied from 13 to 88 years, with a mean age of 62.4 +/- 13.6 (Mean +/- SD). Half of the patients survived more than 20 days. Using the Weibull regression model, the only significant independent symptomatological predictor of mortality was found to be the level of consciousness. Cumulative hazard during the 90 days was compared for different levels of consciousness. Application of Weibull to pathological predictors of ICH mortality showed that the two independent predictors were haemorrhage size and intraventricular penetration. Results of statistical modelling didn't provide evidence of priority for pathological predictors of survival compared to easily measurable levels of consciousness as a symptomatological predictor. Easily measurable symptoms of level of consciousness can be used as a survival predictor of stroke due to intra-cerebral haemorrhage when compared to pathological indicators.

Relatively higher norms of blood flow velocity of major intracranial arteries in North-West Iran.

BACKGROUND: Transcranial Doppler (TCD) is a noninvasive, less expensive and harmless hemodynamic study of main intracranial arteries. The aim of this study was to assess normal population values of cerebral blood flow velocity and its variation over age and gender in a given population. FINDINGS: Eighty healthy volunteers including 40 people with an age range of 25-40 years (group1) and 40 persons with an age range of 41-55 years (group2) were studied. In each group 20 males and 20 females were enrolled. Peak systolic, end diastolic and mean velocities of nine main intracranial arteries were determined using TCD. Mean age of the studied volunteers was 31.6 +/- 4.50 years in group one and 47.2 +/- 4.3 years in group two. Mean age among males was 40 years and among females it was 39. Mean blood flow velocity in middle, anterior and posterior cerebral arteries, vertebral and basilar arteries was 60 +/- 8, 52 +/- 9, 42 +/- 6, 39 +/- 8 and 48 +/- 8 cm/sec respectively. Cerebral blood flow velocities among females were relatively higher than males. Cerebral blood flow velocity of left side was relatively higher than right side. CONCLUSION: Compared to previous studies, cerebral blood flow velocity in this population was relatively higher.

Low dose vaginal misoprostol versus prostaglandin E2 suppository for early uterine evacuation: a randomized clinical trial.

Misoprostol is a cheap product of prostaglandin E1 which has gained interest in pregnancy termination. The aim of this study was to compare the effect of vaginal misoprostol and prostaglandin E2 suppository in pregnancy termination before 20 weeks of gestational age. In this clinical trial, 111 participants under 20 weeks of gestational age who needed pregnancy termination were enrolled. They were divided into two groups misoprostol and prostaglandine E2 treatment. Fifty four people received vaginal misoprostol as 25 microg per 4 h up to 3 days and 57 participants received prostaglandine E2 vaginal suppositories. Data were analyzed using SPSS software. Mean age of participants was 27.5 years and its standard deviation was 6.1 years. Mean gestational age was 13.1 weeks based on sonographic measurement and it was 14.5 weeks by LMP estimation. Mean induction to evacuation time was 3.1 days and in misoprostol group was 2.4 +/- 0.88 days. Half of the patients in control group and 70% of them in misoprostol group succeeded pregnancy termination in 48 h. Vaginal misoprostol compared to prostaglandine E2 vaginal suppository has higher efficacy in shorter time.

Predictors of functional improvement among patients with hip fracture at a rehabilitation ward.

To determine possible predictors of FIM scores in patients with hip fracture at discharge a prospective cohort study of 117 patients with either DHS or hip arthroplasty admitted to a rehabilitation service was done. They were classified into four subgroups of underweight (BMI < 18.5), normal (18.5 < BMI < 24.9), overweight (25 < BMI < 29.9) and obese (30 < BMI < 35). Functional evaluations using FIM score as well as sitting, standing, walking days and length of stay for each patient were assessed by a highly skilled therapist at rehabilitation admission; discharge and a post discharge follow up. Recovery was significant in terms of motor subscale. No significant correlation was evident between hospitalization and discharge time with respect to cognitive subscale. The study showed only the age and FIM score at hospitalization to be the independent predictors of total FIM score at discharge. Elevated BMI has not adverse effect on FIM gains in patients with hip fractures. Simple surgery methods such as DHS revealed earlier recovery time than complicated procedures.

Contralateral eye comparison on changes in visual field following laser in situ keratomileusis vs photorefractive keratectomy for myopia: a randomized clinical trial.

Study purpose was to compare the changes of Visual Field (VF) during laser in situ Keratomileusis (LASIK) VS photorefractive keratectomy (PRK). This randomized, double blind, study involved 54 eyes of 27 Myopia patients who underwent LASIK or PRK procedures for contralateral eyes in each patient. Using Humphrey 30-2 SITA standard, the Mean Defect (MD) and Pattern Standard Deviation (PSD) were evaluated preoperatively and three months after surgery. At the same examination optical zone size, papillary and corneal diameters were also evaluated. There was no clinically significant difference in PSD and MD measurements between treated eyes with LASIK or PRK in any zone pre and postoperatively. VF may not be affected by corneal changes induced by LASIK or PRK three months after surgery.

Clinical and transperineal ultrasound findings in females with stress urinary incontinence versus normal controls.

Study was aimed at comparing clinical and transperineal ultrasound findings of females with stress urinary incontinence and normal controls. Between 2004 and 2005, 40 women with stress urinary incontinence (mean age 47.5 years) diagnosed by history via ICIQ-SF (International consultation on Incontinence Questionnaire-Short Form) and 40 healthy female volunteers without any incontinence or LUTS (mean age 42.1 years) underwent transperineal ultrasonography for determination of posterior urethrovesical (beta) angle, bladder neck funneling and hypermobility of urethra. These findings were compared between patients and controls with regard to clinical data. Beta angle wider than 130 degrees, bladder neck funneling and hypermobility of urethra with transperineal ultrasonography were more common among cases than controls. LR (Likelihood Ratio) for urinary incontinence of these parameters was 2.5, 2.1 and 2, respectively. Perineal ultrasonography is highly associated with clinical findings. Hypermobility of urethra had highest sensitivity for diagnose of stress urinary incontinence but the specificity of bladder neck funneling in perineal sonography was higher.

Compared therapeutic efficacy between intralesional bleomycin and cryotherapy for common warts: a randomized clinical trial.

UNLABELLED: In spite of many available studies on bleomycin and cryotherapy in treating warts, little head to head research is done to compare efficacy of these treatments. Our aim was to compare the therapeutic effects of intralesional bleomycin and cryotherapy on common warts of the hands and feet. In this clinical trial 44 patients above 12 years of age referred to the dermatology clinic of Bouali University Hospital were enrolled. The patients were required to have warts on at least two symmetric limbs (hands or feet). The warts located on right and left limbs of each patient were examined and counted. Each patient received both cryotherapy and intralesional bleomycin on his or her warts. The two treatment types were randomly allocated to either right sided or left sided warts. Each patient was evaluated at 2 week intervals and retreated if necessary up to three times. Data were analyzed by SPSS 11 and EPI Info 2002 statistical packages. The mean number of warts was 5.2 on upper limbs and 4.6 on lower limbs. In 86.4 percent of the cases all warts on the limb side treated by intralesional bleomycin were cleared compared with 68.2 % for cryotherapy (P<0.05). Relative risk for the effect of bleomycin compared to cryotherapy in this regard was 1.27 (1

Prevention oriented epidemiologic study of accidental burns in rural areas of Ardabil, Iran.

PURPOSE OF STUDY: Burns are one of the leading causes of injury-related deaths in Iran. We conducted a study to investigate features of burns in rural areas of Ardabil Province from October 2004 through March 2005, with an aim to providing content for effective prevention programs. BASIC PROCEDURES: This study employed longitudinal prospective methodology. The study population included all patients presenting with burns to local health care facilities during the study period. MAIN FINDINGS: A total of 1179 cases were studied. Most of the cases (59.4%) were females. Mean of age of victims was 22.3+/-19 years in females and 13.6+/-17 years in males. The vast majority (91.2%) of burns occurred at home. More than two-thirds of burns were because of hot liquids or steam. The majority of scald burns resulted during use of heating devices such as samovars, gas stoves, valors and picnic gas stoves. Overturning and spilling of hot liquids were the most common injury mechanisms. PRINCIPLE CONCLUSIONS: Prevention programs should focus on children and adult women. Prevention efforts should target home environments and focus on prevention of scalding burns.

The first rapid onset optic neuritis after measles-rubella vaccination: case report.

During the largest mass campaign for measles-rubella (MR) vaccination 33,000,000 people with an age range of 5-25 years were vaccinated in Iran. Some complications were encountered, including a rare case of optic neuritis. In the past 30 years of medical literature, five cases of optic neuritis have been reported but all of them were developed at least 8 days after vaccination. We are supposed to report the first case of rapid onset optic neuritis in which the complication came out just in few hours in a 16 years old boy.