Iranian Red Crescent Medical Journal <p>The Iranian Red Crescent Medical Journal (IR<span style="color: #ff0000;">C</span>MJ) is an international, open access, peer-reviewed, monthly, and ISI- Journal, affiliated to&nbsp;<strong>Iranian Hospital- Dubai</strong>, publishes original scientific studies in English that have direct clinical significance on&nbsp;<span style="color: #0033ff;">Basic Science, Clinical Medicine, Humanitarian Assistance, Trauma, and Disaster Management</span>.&nbsp;The journal strives to strengthen connections between research and practice, so enhancing professional development and improving practice within the field of medicine. Original papers submitted to this journal which do not adhere to the Instructions for Authors will be returned for appropriate revision to be in line with the Instructions for Authors. They may then be re-submitted.</p> ZamenPub en-US Iranian Red Crescent Medical Journal 2074-1804 A Randomized Controlled Clinical Trial on Therapeutic Effects of Teicoplanin and Vancomycin after Cardiac Surgery due to MRSA infective endocarditis in ICU Patients <p><strong>Background</strong>: Infective endocarditis (IE) is a relatively rare disease but with significant rates of morbidity and mortality. The goal of IE treatment is to eradicate the foci of infection, including antimicrobial therapy with or without surgery. The decision on the selection of an empirical therapy regimen is diverse and based on patient characteristics. Vancomycin and teicoplanin are bacteriostatic glycopeptide antibiotics used for the treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections, including MRSA-IE, and patients allergic to penicillin who are infected with methicillin-sensitive Staphylococcus aureus.</p> <p><strong>Objective</strong>: The current study aimed to compare the efficacy and adverse effects of vancomycin and teicoplanin in the treatment of patients with MRSA-IE.</p> <p><strong> Materials and Methods</strong>: This parallel, randomized, and controlled trial study was carried out on the efficacy and safety of teicoplanin versus vancomycin in the treatment of MRSA endocarditis within August 2012 and April 2017. The present study recruited adult patients with a definite or possible diagnosis of IE based on the Modified Duke Criteria. A central computer-generated random number list was used to allocate the patients (1:1) to the treatment with teicoplanin or vancomycin. Vancomycin was intravenously administered at a dose of 30 mg/kg/day in two doses. Teicoplanin was administered at a loading dose of 6-12 mg/kg every 12 h in four doses and then continued once a day.</p> <p><strong>Results</strong>: Out of 86 patients screened with suspected IE, 66 patients were randomly assigned to the vancomycin (n=33) and teicoplanin (n=33) groups. The mean age values of the study subjects were 41±11.8 and 39±13.1 years in the vancomycin and teicoplanin groups, respectively. In addition, 27 patients (81.8%) in the vancomycin group met the criteria for microbiological cure, compared to 25 subjects (89.3%) in the teicoplanin group. In this regard, the observed difference was not statistically significant (P=0.41). Moreover, 26 (78.8%) and 23 (82.1%) patients in the vancomycin and teicoplanin groups achieved clinical cure, respectively (P=0.97). Overall, the patients in the vancomycin group experienced more adverse events in comparison to those of the teicoplanin group (P=0.04). The rate of acute kidney injury over time, especially in the first week of therapy, was higher in the vancomycin group than that reported for the teicoplanin group (P=0.05). Six and four patients in the vancomycin and teicoplanin groups required dialysis, respectively. The use of dialysis was not different between the two groups (P=0.88). Seven (21.3%) and five (17.9%) patients in the vancomycin and teicoplanin groups died, respectively, which was not statistically different between the two groups (P=0.74).</p> <p><strong> Conclusions</strong>: It was concluded that the administration of vancomycin or teicoplanin does not significantly change the outcome of patients undergoing empirical treatment for MRSA-IE. This finding indicates the patients are similar in clinical outcomes and mortalities despite some adverse effects, such as skin rashes; therefore, teicoplanin can be considered a treatment choice for these diseases.</p> khondabi Neda Behzadnia Zargham Hossein Ahmadi Mandana Chitsazan Payam Tabarsi Hamidreza Jamaati Alireza Bahadorbeigi Seyed MohammadReza Hashemian Copyright (c) 2021-01-03 2021-01-03 23 1 10.32592/ircmj.2021.23.1.69 Induction of analgesia using atorvastatin in experimental diabetic neuropathy through NMDA receptor and inflammatory cytokine inhibition <p><strong>Background:</strong> Diabetic neuropathy is a complication of diabetes causing damage to the nerves.</p> <p><strong>Objectives:</strong> Considering the neuroprotective anti-inflammatory antioxidant characteristics of statins, the current study aimed at determining the effects of atorvastatin on diabetic neuropathy through assessing the involvement of N-methyl-D-aspartic acid (NMDA) receptor, factors of oxidative stress, and inflammatory cytokines in rats with diabetes.</p> <p><strong>Methods:</strong> Male rats were randomly assigned into six groups of the saline- and atorvastatin-treated controls, and streptozotocin (STZ)-induced diabetic animals treated with vehicle, diabetic animals treated with morphine (5 mg/kg), and rats treated with atorvastatin (10 mg/kg/day for 10 weeks) alone or in combination with NMDA receptor agonist. The hot plate and formalin tests were carried out on the rats. Moreover, malondialdehyde level, catalase and superoxide dismutase activities, levels of interleukin 1 beta (IL-1β), interleukin 6 (IL-6), and tumor necrosis factor alpha (TNF-α) in the dorsal root ganglia (DRG) of the animals were measured. Finally, the expression of the NMDA receptor in DRG was investigated in the current study.</p> <p><strong>Results:</strong> Diabetes resulted in analgesia in all tests, and pretreatment with atorvastatin exacerbated diabetes-induced analgesic effects in the hot plate and early phase of the formalin test (P≤0.01 and P≤0.05 in comparison to those reported for the diabetic vehicle-treated group, respectively). The injection of NMDA could reverse the atorvastatin-induced analgesia in the hot plate test (P≤0.05). Diabetes caused to increase the levels of IL-1β, IL-6, and TNF-α in DRG in comparison to those reported for the control group (P≤0.05). Furthermore, the pretreatment of rats using atorvastatin could significantly reverse the increase in TNF-α level (P≤0.05).</p> <p><strong>Conclusions:</strong> Atorvastatin showed analgesic properties, which might be acting through NMDA receptors and reduction of inflammatory cytokines.</p> <p>&nbsp;</p> Karim Hemati Mohammad Yahya Karimi Azam Hosseinzadeh Meysam Abolmaali Nabaa Najjar Mohamad-Reza Aghanoori Vahid Nikoui Copyright (c) 2021-01-03 2021-01-03 23 1 10.32592/ircmj.2021.23.1.454 Promotion of extrinsic apoptosis pathway in HCT-116 human colorectal cancer cell line by sodium butyrate as histone deacetylase inhibitor <p><strong>Background: </strong>Colorectal cancer (CRC) has already been considered the fourth leading cause of mortality worldwide as the genes involved in apoptotic pathways and alterations of reversible epigenetic have an important role in the progression of CRC.</p> <p><strong>Objectives: </strong>The current study aimed to evaluate the effect of sodium butyrate as a histone deacetylase inhibitor on the alterations of the gene expression of <em>FAS</em>, <em>Fas ligand </em>(<em>FASL</em>), <em>Death&nbsp;receptor&nbsp;4</em> in HCT-116 CRC cell line.</p> <p><strong>Methods: </strong>HCT-116 cell line was cultured in Dulbeccoʼs Modified Eagle&nbsp;Medium. The cytotoxicity effect of sodium butyrate on HCT-116 was evaluated using 3-(4, 5-dimethylthiazol-2-yl)-2, 5- diphenyltetrazolium bromide assay for three incubation times (i.e., 24, 48, and 72 h). The half-maximal inhibitory concentration (IC50) values were determined. The optimum concentration was within the range of 6.25-200 mM. The cellular ribonucleic acid was extracted, and complementary&nbsp;deoxyribonucleic acid was synthesized. Finally, the alterations of the gene expression of <em>FAS</em>, <em>FASL</em>, <em>DR4</em>, <em>DR5</em>, and <em>TRAIL</em> were assessed by real-time polymerase chain reaction (PCR).</p> <p><strong>Results: </strong>The IC50 levels for three incubation times were 50, 12.5, and 6.25 mM, respectively. The obtained results of real-time PCR demonstrated a significant increase in the gene expression of <em>TRAIL</em>, <em>DR5</em>, and <em>FAS</em> in comparison to that of the untreated cells as the control group at the three incubation times. The <em>DR4</em> gene expression significantly increased in comparison to that reported for the control group at 48 and 72 h of incubation. In addition, <em>FASL</em> gene expression remarkably decreased at the three incubation times.</p> <p><strong>Conclusions: </strong>Sodium butyrate could show cytotoxicity effect on CRC cell lines through the induction of death receptors in the extrinsic apoptotic pathway. The obtained results of this study revealed that the optimum effect of sodium butyrate is an incubation time-dependent and concentration-dependent manner.</p> <p>&nbsp;</p> <p>&nbsp;</p> Ainaz Mashayekhi Flora Forouzesh Mohammadreza Mashayekhi Copyright (c) 2021-01-03 2021-01-03 23 1 10.32592/ircmj.2021.23.1.190 Residue Content of Organophosphorus Pesticides and their Toxic Metabolites in Greenhouse-Grown Tomatoes during Pre-Harvest Interval and Post-Harvest Processing: A Kinetic Study <p><strong>Background:</strong> Organophosphorus pesticides (OPPs) have a wide application throughout the world and exert adverse effects on human health. Moreover, these chemical compounds are responsible for thousands of deaths per year worldwide. Kinetic and mathematical models could be used to optimize the application of pesticides on fruits and vegetables and monitor their residues. &nbsp;&nbsp;</p> <p><strong>Objectives:</strong> The present study aimed to model the dissipation of diazinon and chlorpyrifos in different conditions, such as household conditions (e.g., storage at room and refrigerator temperatures, as well as cooking) and field condition for greenhouse tomatoes.</p> <p><strong>Methods:</strong> A multi-residue analysis of diazinon, chlorpyrifos, and their oxon derivatives was established by gas chromatography-tandem mass spectrometry. The limit of quantification (LOQ), recovery, precision, linearity, and the limit of detection (LOD) were evaluated to ensure that the method was able to effectively determine the studied pesticides in the tomato samples. The linear and nonlinear kinetic models were presented for chlorpyrifos and diazinon residues in tomato using zero-order, first-order, and second-order equations.</p> <p><strong>Results:</strong> Based on the best fitting models for diazinon in the case of laboratory treatment at the refrigerator, room, and boiling temperatures, the half-lives were calculated as 18.79 days, 11.41 days, and 45.39 min, respectively. The half-life of diazinon was lower than that of chlorpyrifos in both field and laboratory treatments.</p> <p><strong>Conclusion:</strong> Modeling the removal of the pesticides indicated that the nonlinear first- and second-order models were the best fitted models for the dissipation of both pesticides in field and post-harvest conditions.</p> Reza Shokoohi Mohammad Taghi Samadi Manoochehr Karami Ali Heshmati Mostafa Leili samira Khamutian Copyright (c) 2021-01-03 2021-01-03 23 1 10.32592/ircmj.2021.23.1.33 Hazard Assessment of Iran Provinces based on the Health Ministry Tool in 2019 <p><strong>Background</strong>: Iran is a disaster-prone country, which is subjected to various hazards, such as floods, earthquakes, fire, and traffic accidents.</p> <p><strong>Objectives:</strong> This study aimed to determine the priority and risk of various hazards threatening the public in different provinces of Iran in 2019.</p> <p><strong>Methods</strong>: This cross-sectional study was carried out from March to September 2019 using data related to 31 provinces of Iran. The assessment was conducted using hazard assessment tools presented by the Iranian Ministry of Health. A total of 70 natural, man-made, and complex hazards were analyzed in this study. The data were collected by holding sessions and conducting individual and group interviews with the officials of provincial Red Crescent Societies as well as reviewing the databases of the Red Crescent Society and the Disaster Management Organization. The participants consisted of operation analysis experts.</p> <p><strong>Results</strong>: In terms of the frequency of occurrence, earthquake (12: 38.7%), traffic accidents (7: 22.6%), and flood (6: 19.4%) obtained the highest priority in different provinces in descending order. Furthermore, regarding the total scores of hazards in all provinces, flood (78.6), earthquake (75.3), traffic accidents (71.9), drought (60.1), and building collapse (58.1) had the highest priority in descending order.</p> <p><strong>Conclusion</strong>: Given the extreme vulnerability of Iran to various disasters, authorities should develop strategic plans to reduce the risks associated with high-priority disasters. In addition, crisis and disaster management policymakers must develop separate detailed disaster response plans for each hazard in order to increase the preparedness at organizational and community levels. Public training can also raise awareness among the public and help people cope better with various hazards.</p> Ahmad Soltani Farshid Alaedini Navvab Shamspour Milad Ahmadi Marzaleh Copyright (c) 2021-01-03 2021-01-03 23 1 10.32592/ircmj.2021.23.1.204 Frailty Syndrome in Older Adults and Related Sociodemographic Factors in the North of Iran: A Population-Based Study <p><strong>Background: </strong>The global incidence rate of frailty syndrome among older adults aged 60 and over has been estimated to be 43.4 cases per 1000 persons/years.</p> <p><strong>Objectives:</strong> This study aimed to determine the prevalence of pre-frailty and frailty syndromes in community-dwelling older adults and assess the correlated sociodemographic factors.</p> <p><strong>Methods:</strong> All elderly people recruited in the second phase of the Amirkola Health and Ageing Cohort Project, including 2135 older adults aged ≥60 years living in Amirkola, North of Iran, were invited to participate in this study using the census method. The standard "FRAIL" scale was used to assess the frailty syndrome. The individuals who obtained a score of three or more and one or two were classified as frail and pre-frail cases, respectively.</p> <p><strong>Results:</strong> Totally, 2010 older adults with a mean age of 70.41±7.65 years were included in this study. Out of them, 672 (33.4%; 95% CI: 31.37-35.50%) cases met the criteria for frailty syndrome, and 874 (43.5%) individuals were regarded as pre-frail. The prevalence of frailty was significantly higher in females (50.8%; 95% CI: 47.58-54.05%), compared to males (18.7%; 95% CI: 16.41-21.05%). Multivariate logistic regression analysis revealed that age ≥85 (OR=7.27; 95% CI: 4.12-24.46) and female gender (OR=2.67; 95% CI: 2.30-9.95) had the highest effect on frailty in older adults.</p> <p><strong>Conclusion:</strong> One out of every three elderly people (aged ≥60) in Amirkola, North of Iran, had frailty syndrome. Older age, female gender, lower education level, low level of satisfaction with income, marital status (single), living alone, and unemployment increased the risk of frailty in older adults.</p> Fatemeh Talaee Boura Seyed Reza Hosseini Simin Mouodi Reza Ghadimi Ali Bijani Copyright (c) 2021-01-03 2021-01-03 23 1 10.32592/ircmj.2021.23.1.249 Challenges of the program to reduce the amount of hospitalized patients in the Iran health system: a qualitative study <p><strong>Background: </strong>The health transformation plan was put into action in Iran, in 2014, with 8 service packages. This plan was not implemented as a pilot and therefore, various problems and barriers have since emerged.</p> <p><strong>Objectives:</strong> The current study investigated the challenges of out of pocket in the health system of Iran.</p> <p><strong>Methods:</strong> This applied study was conducted qualitatively with a semi-structured interview on 30 of the policy makers and planners of the in Iran health system in 2020, using the purposeful sampling method. The obtained data were entered into MAXQDA10 software, and analyzed through content analysis approach.</p> <p><strong>Results: </strong>From data analysis, 5 themes: Weakness in the structure of health expenditure management, Weakness in the structure of policy and planning, effectiveness and low efficiency of the health system,Weakness in the opportunities facing the Ministry of &nbsp;Health, consequences of the program were categorized&nbsp; in 12 concept and 79 sub-themes and challenges were extracted.</p> <p><strong>Conclusion:</strong> By identifying the opportunities and challenges of out-of-pocket (OOP) payment, the results of this study could provide a suitable framework for monitoring and evaluation of the payment reduction program in the Iran health system and a good way for policy makers and planners in different stages of the program</p> <p>&nbsp;</p> <p>&nbsp;</p> <p>&nbsp;</p> <p>&nbsp;</p> esmaeil rezazadeh gahraman mahmoudi Fatemeh Dabaghi Copyright (c) 2021-01-20 2021-01-20 23 1 Retrospective investigation of anticoagulant complications in long term after mechanical heart valve replacement surgery in Turkey <p><strong>Background:</strong> Patients with mechanical heart valve replacement surgery (MHVRS) should be followed up in terms of prosthetic valve-related and open heart surgery complications. This study aimed to determine the anticoagulant complications in long term in patients with MHVRS.</p> <p><strong>Methods</strong>: This retrospective and descriptive study was conducted in a university hospital, İzmir, Turkey. &nbsp;The data were collected from July to December 2019. In total, 73 patients referring for regular check-ups to the hospital with intervals not exceeded more than 90 days, and those who had international normalized ratio (INR) measurements for January-April-July-October 2018 were included in this study.</p> <p><strong>Results:</strong> The mean age of the patients was obtained at 58.98±12.89 years, and 53.4% (n=39) of the cases were male. Moreover, the mean follow-up period was estimated at 65.98±28.47 months. According to the results, complications developed in 60 patients (82.2%). The first hospitalized unit was the emergency department. The factors affecting the development of complications after MHVRS were evaluated, and a difference was found regarding gender (X<sup>2</sup>=6.18, P=0.013), comorbidities (X<sup>2</sup>=25.58, P=0.018), and monthly referral for regular check-ups to the hospital &nbsp;(X<sup>2</sup>=5.20, P=0.023). There was no relationship between the INR levels and the development of complications. Furthermore, the results of evaluating the factors affecting the number of hospitalizations after MHVRS revealed that monthly referral to hospital for check-ups (t=3.18, P=0.002) and history of previous valve surgery (Z=201.00, P=0.03) affected the number of hospitalizations.</p> <p><strong>Conclusions:</strong> It was observed that patients frequently refer to the emergency department and struggled with various complications. Moreover, it was found that the patients had frequent bleeding and refer to the emergency service repeatedly. Accordingly, there is a need for interventional studies to reduce postoperative complications and provide the therapeutic INR level.</p> eda ayten kankaya Özlem Bilik tuğra gençpınar Copyright (c) 2021-01-23 2021-01-23 23 1 The Evaluation of Training Program for Nursing Students on Testicular Cancer and Testicular Self-Examination <p><strong>Background:</strong> Testicular self-examination (TSE) is one of the most effective ways for the early detection of testicular cancer. The Medical Association and American Urological Association recommend raising the awareness of TSE and educating the public in this regard for early diagnosis.</p> <p><strong>Objectives:</strong> The present study aimed to evaluate the effect of the training given to nursing students for testicular cancer and TSE on the knowledge levels of the students.</p> <p><strong>Methods:</strong> The current single-group pretest-posttest quasi-experimental study was carried out on the students continuing their education and training in the Faculty of Health Sciences of a university in Turkey within 2018 and 2019 (n=83). No sample selection was made for the determination of the study subjects (n=56). The research data were collected using a questionnaire. The data were evaluated by appropriate statistical methods, and a p-value of less than 0.05 was considered statistically significant.</p> <p><strong>Results:</strong> The students participating in the study were within the age range of 20-26 years. In addition, 51.8% of the study subjects were male. Moreover, 58.9% of the students in the study stated that they did not receive any training for testicular cancer and TSE. Furthermore, 80.4% of the male students did not perform TSE 43.6% of whom reported that they did not know how to do it. However, the mean test scores of the participants for testicular cancer and TSE were reported as 12.84 and 15.73 prior to and after the training, respectively, . Nevertheless, the rate of TSE among the students was previously reported as 19.6% and increased to 100% after the training.</p> <p><strong>Conclusions:</strong> In this study, it was concluded that the participants, even with an ordinary awareness-raising campaign, could be informed about testicular cancer and TSE. It is recommended to raise the awareness of society in this regard through well-planned educational activities.</p> <p>&nbsp;</p> <p>&nbsp;</p> Selen OZAKAR AKCA Tugba CENGIZ Dilara AYDIN Simge DIKER Tugba OZDEMIR Copyright (c) 2021-01-23 2021-01-23 23 1 Comparison of the Hearing Results of Total Ossicular Chain Autogenous Mastoid Cortical Bone Ossiculoplasty and Titanium Total Ossicular Replacement Prosthesis in Patients with Cholesteatoma <p><strong>Background: </strong> No studies have investigated the results of ossicular chain reconstruction using mastoid cortical bone ossiculoplasty (MCBO) and titanium total ossicular replacement prosthesis (TiTORP) in Austin-Kartush Group D cholesteatoma patients with severe middle ear risk index (MERI).</p> <p><strong>Objectives:</strong> The present study aimed to compare the hearing results of MCBO and TiTORP in Austin-Kartush Group D cholesteatoma patients with severe MERI who underwent ossicular chain reconstruction during primary surgery.</p> <p><strong>Methods</strong>: The hearing results of 28 adult cholesteatoma patients who underwent tympanomastoidectomy and ossicular chain reconstruction with MCBO (n=15) or TiTORP (n=13) were analyzed in the current study. The postoperative hearing was tested 12 months after the surgery.&nbsp; The hearing-related functional success rate was determined in accordance with the American Academy of Otolaryngology-Head and Neck Surgery Foundation criteria.</p> <p><strong>Results:</strong> When all patients were taken into account, the mean preoperative and postoperative air-bone gaps (ABG) were reported as 32.2 decibel (dB) and 17.6 dB, respectively, (P&lt;0.001). In 57.1% of the patients, the mean postoperative ABG was ≤ 20 dB. The mean preoperative and postoperative ABGs of the MCBO group were obtained at 29.9 and 16.2 dB, while these values were reported as &nbsp;35.0 and 19.3 dB in the TiTORP group (P=0.001 and P&lt;0.001, respectively). Hearing-related functional success rates were calculated at 60.0% and 53.8% in MCBO and TiTORP groups, respectively, without any significant difference between the groups (P= 0.743).</p> <p><strong>Conclusion: </strong>As evidenced by the obtained results, MCBO and TiTORP can provide similar and successful hearing results in Austin-Kartush Group D patients with cholesteatoma; nonetheless, MCBO is a more cost-effective option in this regard.</p> Mehmet Fatih Karakus Kursat Murat Ozcan Suleyman Emre Karakurt Mustafa Colak Fakih Cihat Eravci Ali Riza Yagmur Mehmet Ali Cetin Haci Huseyin Dere Copyright (c) 2021-01-23 2021-01-23 23 1