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> en-US (Ahmad Soltani MD, PhD) (N. Gonabadi) Mon, 26 Jul 2021 00:00:00 +0430 OJS 60 Effect of Melatonin on Reversing Multidrug Resistance by Targeting Phosphatase and Tensin Homolog in Leukemia Cancer Cells Background: Recently, melatonin has attracted massive attention due to its anticancer effect on various human malignancies. It has also been demonstrated that melatonin is useful in combating resistance against conventional chemotherapeutics. Objective: This study aimed to evaluate melatonin’s effects on multidrug resistance (MDR) in human myelogenous leukemia cells. Methods: Melatonin’s cytotoxicity on the K562 and K562/doxorubicin (DOX) cell lines was assessed using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. The expression and activity of P-glycoprotein (P-gp) were measured as well. The mRNA and protein expression levels of tensin homolog deleted on chromosome ten (PTEN) was assessed in cells. Eventually, apoptosis in cancer cells was measured through Annexin V/PI staining. Results: Treatment with melatonin significantly increased the cytotoxicity of DOX on resistant K562 cells. The expression and activity of P-gp were attenuated following melatonin treatment. In addition, melatonin upregulated PTEN in K562/DOX cells. Melatonin also augmented apoptosis in combination with DOX. Conclusion: Melatonin effectively increased the cytotoxic effects of DOX in K562/DOX cells through down-regulation of P-gp and up-regulation of PTEN in resistant K562 cells. Vahid Rameshknia, Moireh Movahhedi, Abbas Akhavan, Maryam Majidinia, Bahman Yousefi Copyright (c) 2021 Iranian Red Crescent Medical Journal Fri, 30 Jul 2021 18:43:01 +0430 Design and Validation of Performance Evaluation Model of National Accreditation Schemes in Hospitals: A Mixed-Method Study Background: Performance evaluation of accreditation schemes has can improve the quality of hospital accreditation significantly. An effective accreditation system is one that performs the accreditation process properly and achieves acceptable results. Objective: This study aimed to design and validate the performance evaluation model of national accreditation schemes in hospitals. Materials and Methods: This study was performed in a mixed method. The performance evaluation dimensions of the national accreditation models for hospitals were identified, classified, and modeled using the qualitative research method. The quantitative aspect of the obtained model was tested using structural equation modeling. Results: All identified variables were classified into six dimensions including causal conditions, strategic conditions, axial phenomenon, context conditions, intermediary/interventional conditions, and consequence. The results of the quantitative part suggested that the proposed model had a good fit and its validity and reliability were confirmed. Conclusions: The results of the present study revealed that the performance evaluation model of national accreditation schemes in hospitals had a good fit and might be used as an effective model in accreditation organizations as a roadmap to better evaluate accreditation schemes, such as those used in hospitals. Seyed Payam Paymard, Leila Najafi, Esrafil Roshdi Copyright (c) 2021 Iranian Red Crescent Medical Journal Fri, 30 Jul 2021 18:53:38 +0430 Effectiveness of escitalopram in the reduction of pain, anxiety, and depression in patients with breast cancer: A randomized single-blind controlled trial <p><strong>Background:</strong> Pain, anxiety, and depression are common but often neglected problems in patients with cancer.&nbsp;</p> <p><strong>Objectives:</strong> Considering the importance and impact of anxiety and depression as common psychiatric symptoms in people with cancer, the present study aimed to assess the effectiveness of escitalopram in the reduction of pain, anxiety, and depression in patients with breast cancer.&nbsp;</p> <p><strong>Methods:</strong> This single-blind controlled trial was conducted on 32 patients diagnosed with breast cancer who were referred for modified radical mastectomy (2018-2019). The intervention group received daily oral capsules containing 10 milligrams of escitalopram for four weeks, while the control group received placebo capsules containing starch on a daily basis. Hospital Anxiety and Depression Scale (HADS)&nbsp;and Visual Analogue Scale were administered to the patients at the commencement of the study and four weeks after the intervention. In addition, at baseline examination, personality factors were assessed by the NEO Five-Factor Inventory-3 questionnaire.</p> <p><strong>Results:</strong> Based on the results, the scores of HADS anxiety, total HADS, and pain reduced after the intervention in the case group; however, the HADS depression score demonstrated a slight increase. A significant difference was observed between the case and control groups for HADS anxiety score after the intervention (P=0.01). The correlation of personality characteristics with HADS anxiety and depression subscales pointed out a significant negative correlation between the HADS depression score and conscientiousness (r=-0.40; P&lt;0.05).</p> <p><strong>Conclusion: </strong>Due to minor side effects of escitalopram, this drug is suggested to be used for the reduction of anxiety symptoms and pain intensity in patients with breast cancer.</p> Novin Nikbakhsh, Zohreh Hasani, Alireza Azizi, Ebrahim Zabihi, Atefeh Ghanbari, Razieh Salehian, Sussan Mouodi Copyright (c) 2021 Iranian Red Crescent Medical Journal Tue, 03 Aug 2021 00:00:00 +0430 Identify Key Performance Indicators for Designing Emergency Department dashboard in a referral Cardiac Hospital <p><strong>Background:</strong> Today, organization management in healthcare organizations needs to monitor and evaluate performance for better decision and policy making.</p> <p><strong>Objectives:</strong> This study aimed at determining the Key Performance Indicators using software and a management dashboard.</p> <p><strong>Methods:</strong> This study searched several articles discussing Key Performance Indicators of emergency departments. A comprehensive list of indicators was obtained and presented to an expert panel with a wide range of experiences. The experts finalized the key performance indicators. A second round was performed to confirm the performance using Smart Pilates software. Based on the final panel’s rating, a list of Key Performance Indicators was developed to be used. The extracted data was prepared to enter into the computer system to design the dashboard using QlickView software. Subsequently, according to the type of indicator, the dashboard was designed by special software.</p> <p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</p> <p><strong>Results:</strong> The extracted 14 Key Performance Indicators of emergency departments were determined in three dimensions of input, process, and output. Following that, the project team designed a dashboard with 14 Key Performance Indicators.</p> <p><strong>Conclusion:</strong> To design and develop a dashboard, the management of information was essential for organizations. It is recommended that managers use Key Performance Indicators for evaluating and monitoring emergency departments. Moreover, it can be used for planning and evaluating the performance in emergency departments.</p> Mahnaz Mayelafshar, Feridoun Noohi , Leila Riahi, Aniseh Nikravan Copyright (c) 2021 Iranian Red Crescent Medical Journal Tue, 03 Aug 2021 11:30:35 +0430 Return to Work of Lymphoma Survivors After Autologous Stem Cell Transplantation: A Single-Center Cross-Sectional Study <p><strong>Background: The effectiveness</strong>&nbsp;of autologous stem cell transplantation (ASCT) in patients with relapsed/refractory lymphoma is accepted by all authors. After ASCT, the 5-year overall survival rates can reach up to 80%. However, returning to work after ASCT and the employment status of these patients are unknown.</p> <p><strong>Objectives: </strong>This study aimed to examine the rate of not returning to work in the post-treatment period and the factors that may affect the employment status of patients who underwent ASCT with the diagnosis of relapsed/refractory lymphoma.</p> <p><strong>Methods:</strong> This cross-sectional study was conducted from January to June 2020. It was performed on patients within the age ranges of 18-65 who had undergone ASCT with the diagnosis of relapsed or refractory lymphoma and were in remission without recurrence one year after ASCT.</p> <p><strong>Results: </strong>In total, 80 (74.8%) out of 107 patients included in the study were male, and the median age was 49.0 (21-63). Majority of participants were primary school graduates (n=66, 61.7%) and married (n=90, 84.1%). Before ASCT, 30 (28.0%) patients worked in the private sector and 17 (15.9%) of them were self-employed. The median follow-up time was 34.8 months (12.4 - 124.7 months). During this follow-up period, 35 (57.3%) out of 61 patients did not return to work. Most of these patients had retired (n=29, 47.5%). It was observed that having a higher education level (OR: 0.32 [0.14-1.22] 95% CI, p:0.041) and being a public employee (OR: 0.30 (0.12-0.97) 95% CI, p:0.033) are independent factors that reduce the risk of not returning to work.</p> <p><strong>Conclusion: </strong>It was found that more than half of the patients did not return to work. The low level of education and employment in non-public sectors posed the risk of not returning to work. It may be possible for patients to return to work with well-planned options, such as part-time shifts.</p> Jale Yıldız, Bahar Uncu Ulu, Semih Başçı, Tahir Darçın, Mehmet Bakırtaş, Derya Şahin, Hikmetullah Batgi, Nuran Ahu Baysal, Dicle İskender, Alparslan Merdin, Tuğçe Nur Yiğenoğlu, Merih Kızıl Çakar, Mehmet Sinan Dal, Fevzi Altuntaş Copyright (c) 2021 Iranian Red Crescent Medical Journal Tue, 03 Aug 2021 00:00:00 +0430 Evaluation of Chest CT Findings within the Reporting and Data System of Patients with Suspected COVID-19 Infection <p><strong>Purpose: </strong>This study aimed to evaluate the diagnostic performance of the coronavirus disease 2019 (COVID-19) imaging reporting and data system (CO-RADS) scoring system in admitted patients with suspected COVID-19 infection.</p> <p><strong>Methods</strong><strong>: </strong>This retrospective study included all patients admitted to our hospital with COVID-19 pneumonia suspicion within March 20-May 15, 2020, who were examined by both computed tomography (CT) and real-time reverse transcription polymerase chain reaction (rRT-PCR) at initial presentation. Four radiologists, who were blinded to the rRT-PCR results and medical history, assessed all images independently and classified the CT findings according to the CO-RADS scoring system previously defined. Diagnostic value of the scoring system and interobserver agreement in rRT-PCR positive-negative groups and for CO-RADS 1-5 were evaluated.</p> <p><strong>Results: </strong>In this study, 274 (153 men and 121 women; median age=49; interquartile range [IQR] 25-62 years) rRT-PCR positive and 437 (208 men and 229 women; median age=46; IQR 32-64 years) rRT-PCR negative individuals were included. It was found that CO-RADS had a good diagnostic performance with area under the receiver operating characteristic roc curve of 0.857. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were obtained at 81.9%, 89.4%, 75.7%, 92.5%, and 84.8%, respectively. The interobserver agreement of four radiologists in CO-RADS 1 and 5 was substantial to almost perfect according to the kappa values. Other CO-RADS&nbsp; scores showed a fair to moderate agreement. The interrater agreement was slightly higher in the PCR (-) patient group than in the positive one.</p> <p><strong>Conclusion: </strong>In conclusion, CO-RADS was a successful scoring system for distinguishing highly suspicious cases in terms of COVID-19 infection lung involvement, showing high interobserver agreement.</p> <p><strong>&nbsp;</strong></p> <p><strong>&nbsp;</strong></p> ibrahim halil sever, bahattin ozkul, bedriye koyuncu sokmen, nagihan inan gurcan Copyright (c) 2021 Iranian Red Crescent Medical Journal Tue, 03 Aug 2021 14:13:02 +0430 Healthcare System Functions in Iran and Successful Developing Countries Regarding Access to Universal Health Coverage: A Comparative Study <p><strong>Background and objective</strong>: Universal health coverage is considered a prerequisite for human health and security. Therefore, the current study aimed to evaluate and compare the healthcare system functions in Iran with those in successful developing countries in terms of universal health coverage (UHC).</p> <p><strong>Methods</strong>: In this comparative study, three developing countries, namely Turkey, Thailand, and China, were selected based on former studies, and the model presented by the World Health Organization in 2000 was used to compare and analyze the data. The required information from the selected countries was collected through searching the Pub Med and Scopus databases using the following keywords: “Health system review”, “Health system transition”, “International profiles of healthcare systems”, “Financing”, “Resource generation”, “Service provision”, “Universal health coverage”, and “Health system reform”.</p> <p><strong>Results</strong>: The evaluation of the healthcare system's function in four countries showed that the public sector's share of total health spending was much higher than the private sector in both Thailand and Turkey. The issues of integration of insurance funds and risk accumulation and the existence of a strong buyer organization should be considered. The comparison of the payment system in the studied countries showed that the per capita method was used in all primary cares, and the inpatient diagnostic group (diagnosis-related group), fee for service, and salaries and rewards were more focused in the context of hospitalization. The majority of hospitals in the studied countries were state-owned; however, the important point was the presence of different non-university public hospitals in these countries, compared to Iran.</p> <p><strong>Conclusion</strong>: In general, one way to reach the UHC is to utilize the experiences of successful countries in establishing and maintaining this issue.</p> Nahid Hatam, Yegane Partovi, Seyed Reza Najibi, Milad Ahmadi Marzaleh, Seyede Maryam Najibi Copyright (c) 2021 Iranian Red Crescent Medical Journal Mon, 02 Aug 2021 09:58:32 +0430 Human papillomavirus infection and risk of breast cancer in Iran: a meta-analysis <p><strong>Background</strong>: Breast cancer is the most common malignancy and a leading cause of death in women. Viruses are known to be the risk factors for breast cancer. The present study aimed to evaluate the association between human papillomavirus (HPV) and the development of breast cancer in Iranian women by a systematic review and meta-analysis.</p> <p><strong>Methods: </strong>The international databases, including Web of Science, Embase, PubMed, Cochrane, and Scopus, were searched in this study. Furthermore, relevant studies published on the association between HPV and breast cancer were identified using the appropriate keywords. The data were analyzed in Stata software (version 14) using the random-effects model.</p> <p><strong>Results</strong>: In total, 18 studies were found eligible to be included in this study. The total sample size was determined at 2466 cases with the mean ages of 47.25 and 39.9 years for experimental and control groups. The overall findings showed a significant relationship between developing breast cancer and HPV infection. The results also revealed that the HPV infection increased the risk of breast cancer in women 5.02 fold more than those without HPV infection (95% CI: 3.46-7.29, I2=65.2%, P=0.003). In addition, the prevalence of HPV infection among women with breast cancer was estimated at 25.66% (95% CI: 17.34-34.95, I2=86%, P=0.000).</p> <p><strong>Conclusion: </strong>HPV infections, especially high-risk HPVs, are significantly frequent in breast cancer samples and should be considered an important risk factor for developing breast cancer. <strong>&nbsp;</strong></p> Hassan Nourmohammadi, Sara Yousefzadeh Shoushtari, Lila Joybari, Maryam Ghasemi, Abas Ghaysouri, Kambiz Keshavarz Copyright (c) 2021 Iranian Red Crescent Medical Journal Tue, 03 Aug 2021 09:36:19 +0430