Iranian Red Crescent Medical Journal https://ircmj.org/index.php/IRCMJ <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 publisher@ircmj.org (Ahmad Soltani MD, PhD) publisher@ircmj.org (N. Gonabadi) Thu, 14 Oct 2021 12:30:48 +0330 OJS 3.3.0.7 http://blogs.law.harvard.edu/tech/rss 60 Assessment of Health Literacy among Patients with Diabetes: Developing a Model for improving Health Literacy https://ircmj.org/index.php/IRCMJ/article/view/1515 <p><strong>Background:</strong> Health literacy refers to the skills and abilities people acquire, analyze, and understand regarding basic health information and services they need so that they can contribute to their health issues and make the right decision. Also, given the importance of diabetes in the world and in Iran, as well as the impact of health information literacy on quality of life and control of diabetes, this study was conducted to evaluate health information literacy of type 2 diabetic patients and design an information service model for promoting their health information literacy.</p> <p><strong>Method:</strong> In this study, semi-structured interviews were used to collect the qualitative data needed to present the model. In the qualitative method, semi-structured interviews were conducted with 14 health literacy experts selected through purposive sampling. Grounded Theory method was then used for analyzing interviews and explaining related dimensions and components.</p> <p><strong>Results:</strong> We identified 5 categories (nutritional factors, media development, physical activity, inclusive education, and racial and age consciousness) and the core category of "Type 2 diabetes recognition".</p> <p><strong>Conclusion:</strong> It was found that diabetes Type 2 is heavily influenced by lifestyle and education factors. Finally, according to the interviews, a model was developed to improve the health literacy of diabetic patients.</p> <p><strong>&nbsp;</strong></p> Mahboobeh Kamali, Maryam sarrafzadeh Copyright (c) 2021 Iranian Red Crescent Medical Journal https://ircmj.org/index.php/IRCMJ/article/view/1515 Thu, 21 Oct 2021 00:00:00 +0330 Upregulation of miR-21 and miR-106b in plasma and tissues as a possible prognostic marker in aggressive breast cancer https://ircmj.org/index.php/IRCMJ/article/view/547 <p><strong>Background</strong>: The miRNAs are referred to small non-coding RNAs (consisting of 18 to 25 nucleotides). Functional studies have shown their functions to be oncogenes or tumor suppressor genes in different types of cancers. The miR-106b and miR-21 have been identified to participate in the biological behaviors of cells. This study aimed to evaluate the tissue and plasma levels of miR-21 and miR-106b in patients with breast cancer who were diagnosed with ductal carcinoma.</p> <p><strong>Methods:</strong> In total, 40 cases of breast cancer patients 180 samples were examined in this project. Samples included ductal carcinoma breast tumors (n=40), normal breast tissues of the margin of the tumor (n=40) and 20 samples from unaffected mammary tissue of females undergoing reduction mammoplasty (control group), plasma samples of patients with breast cancer (n=40), and plasma of non-affected individuals (n=40). The expression levels of miR-106b and miR-21 were determined using SYBR Green real-time RT-PCR assay in breast tissues and plasma of cancerous patients in comparison to the controls.</p> <p><strong>Results</strong>: MiR-106b and miR-21 revealed much higher expression in tissues and plasma of patients with breast cancer in comparison to that in the group of control (P&lt;0.001). High levels of mir-106b and miR-21 expression in plasma and tumor tissues were highly correlated with tumors in higher stages and lymph node involvement (P&lt;0.0001).</p> <p><strong>Conclusions</strong>: Based on the obtained results, upregulation of miR-106b and miR-21 in the plasma of patients with breast cancer can act as a possible non-invasive biomarker for breast cancer prognosis. Further follow-up studies are required to confirm this.</p> Andia Seyedi Moghaddam , Mahdieh Salimi, Hossein Mozdarani, Najmeh Ranji Copyright (c) 2021 Iranian Red Crescent Medical Journal https://ircmj.org/index.php/IRCMJ/article/view/547 Thu, 14 Oct 2021 00:00:00 +0330 Effect of dexmedetomidine on oxidative stress response and expression of intracellular adhesion factor-1 (ICAM-1) and S100B in patients with traumatic brain injury https://ircmj.org/index.php/IRCMJ/article/view/270 <p class="western"><span style="color: #000000;"><span style="font-family: Times New Roman, serif;"><span style="font-size: small;"><strong>[Abstract] Objective: </strong></span></span></span><span style="color: #000000;"><span style="font-family: Times New Roman, serif;"><span style="font-size: small;">To study the effect of dexmedetomidine on oxidative stress response and the expression of intracellular adhesion factor-1 (ICAM-1) and S100B in patients with traumatic brain injury (TBI). </span></span></span><span style="color: #000000;"><span style="font-family: Times New Roman, serif;"><span style="font-size: small;"><strong>Method</strong></span></span></span><span style="color: #000000;"><span style="font-family: Times New Roman, serif;"><span style="font-size: small;">: TBI patients treated in our hospital from May 2017 to April 2019 were enrolled in the study and divided into control group and treatment group by random number table method. The treatment group was administered with dexmedetomidine injection via intravenous pump on the basis of conventional treatment in the control group. Glasgow coma scale (GCS) and Glasgow outcome scale (GOS) were used to evaluate patients’ injury, recovery and prognosis. ELISA method was taken to detect 4 oxidative stress index levels including serum superoxide dismutase (SOD), lipid peroxidation (LPO), malondialdehyde (MDA) and total antioxidant capacity (TAC), as well as ICAM-1 and S100B levels at admission and at different time points after operation. </span></span></span><span style="color: #000000;"><span style="font-family: Times New Roman, serif;"><span style="font-size: small;"><strong>Results</strong></span></span></span><span style="color: #000000;"><span style="font-family: Times New Roman, serif;"><span style="font-size: small;">: At 3d and 14 d after operation, the treatment group had higher GCS score than the control group (</span></span></span><span style="color: #000000;"><span style="font-family: Times New Roman, serif;"><span style="font-size: small;"><em>P</em></span></span></span><span style="color: #000000;"><span style="font-family: Times New Roman, serif;"><span style="font-size: small;">&lt;0.05).At 30 d, 90 d and 180 d after discharge, the treatment group had higher GOS score than the control group (</span></span></span><span style="color: #000000;"><span style="font-family: Times New Roman, serif;"><span style="font-size: small;"><em>P</em></span></span></span><span style="color: #000000;"><span style="font-family: Times New Roman, serif;"><span style="font-size: small;">&lt;0.05). At 3d, 5d, and 14d after operation, the treatment group had higher SOD activity than the control group (</span></span></span><span style="color: #000000;"><span style="font-family: Times New Roman, serif;"><span style="font-size: small;"><em>P</em></span></span></span><span style="color: #000000;"><span style="font-family: Times New Roman, serif;"><span style="font-size: small;">&lt;0.05). Immediately after operation, at 3d, 5d, and 14d after operation, the treatment group had higher LPO level than the control group (</span></span></span><span style="color: #000000;"><span style="font-family: Times New Roman, serif;"><span style="font-size: small;"><em>P</em></span></span></span><span style="color: #000000;"><span style="font-family: Times New Roman, serif;"><span style="font-size: small;">&lt;0.05); at 3d, 5d, and 14d after operation, blood MDA level gradually decreased in both groups, which was lower in the treatment group than in the control group (</span></span></span><span style="color: #000000;"><span style="font-family: Times New Roman, serif;"><span style="font-size: small;"><em>P</em></span></span></span><span style="color: #000000;"><span style="font-family: Times New Roman, serif;"><span style="font-size: small;">&lt;0.05); at 3d, 5d and 14d after operation, the treatment group had higher TAC activity in the blood than the control group (</span></span></span><span style="color: #000000;"><span style="font-family: Times New Roman, serif;"><span style="font-size: small;"><em>P</em></span></span></span><span style="color: #000000;"><span style="font-family: Times New Roman, serif;"><span style="font-size: small;">&lt;0.05). At 3d, 5d and 14d after operation, the treatment group had lower S100B level than the control group (</span></span></span><span style="color: #000000;"><span style="font-family: Times New Roman, serif;"><span style="font-size: small;"><em>P</em></span></span></span><span style="color: #000000;"><span style="font-family: Times New Roman, serif;"><span style="font-size: small;">&lt;0.05). </span></span></span><span style="color: #000000;"><span style="font-family: Times New Roman, serif;"><span style="font-size: small;"><strong>Conclusion</strong></span></span></span><span style="color: #000000;"><span style="font-family: Times New Roman, serif;"><span style="font-size: small;">: Dexmedetomidine can relieve TBI-induced oxidative stress state and reduce the levels of brain injury markers (ICAM-1, S100B), which has a protective effect on the brain tissue with TBI.</span></span></span></p> Mingxin Ji, Peng Zhao, Yunfeng Cui, Xinyu Li Copyright (c) 2021 Iranian Red Crescent Medical Journal https://ircmj.org/index.php/IRCMJ/article/view/270 Thu, 14 Oct 2021 00:00:00 +0330 Challenges of Hypertension Prevention in the Social Determinants of Stress: A Qualitative Study https://ircmj.org/index.php/IRCMJ/article/view/915 <p><strong>Background: </strong>Human life is tied with the stress caused by economic, political, social, and cultural problems, which may lead to physical and mental diseases. In such stressful conditions, people make lifestyle changes that put them at high risk for developing hypertension.</p> <p><strong>Objectives: </strong>Accordingly, this study investigated the prevention and management of hypertension as a major public health challenge in Iran.</p> <p><strong>Methods:</strong> Semi-structured interviews were conducted with managers, health policymakers, social medicine specialists, and faculty members. All interviews were recorded, transcribed verbatim, and analyzed using thematic content analysis. The MAXQDA18 software was applied to facilitate the organization of codes and themes.</p> <p><strong>Results:</strong> Interviews were conducted with 17 participants. The analyses resulted in five themes including, educational policies, cultural policies, urban transport policies, organizational policies, and economic policies. A total of 13 subthemes were also extracted from the data.</p> <p><strong>Conclusion: </strong>Findings have indicated the stressors factors, stemming from macro-policies and mismanagement of government. To reduce the burden of hypertension and improve people's living conditions, health-oriented policies should be designed and implemented in all sectors.</p> Fatemeh Arabi Basharic, Ali Janati , Rahim Khodayari -Zarnaq , Mohammad Zakaria Pezeshki, Noora rafiee, Masoume Gholizadeh Copyright (c) 2021 Iranian Red Crescent Medical Journal https://ircmj.org/index.php/IRCMJ/article/view/915 Thu, 14 Oct 2021 00:00:00 +0330 Effectiveness of Differential Reinforcement of Other Behaviors in Reducing Non-suicidal Self-Injurious Behaviors in Adolescents https://ircmj.org/index.php/IRCMJ/article/view/872 <p><strong>Background:</strong></p> <p><strong>Objective:</strong> This study aimed to investigate the effectiveness of differential reinforcement of other behaviors in reducing non-suicidal self-injury behaviors in adolescents.</p> <p><strong>Methods:</strong> A single-subject A-B-A-B design was used in this study. The statistical population included male adolescents with self-injurious behaviors, the families of whom were seeking treatment for these behaviors. In total, four adolescents were recruited from a psychology clinic in Tehran, Iran, using convenience sampling. Participants were observed at 6, 8, 10, and 12 sessions at baseline phases of A<sub>1</sub> and A<sub>2</sub>, followed by 12 intervention sessions after each baseline phase. The intervention included differential reinforcement of other behaviors. If the participants showed no self-injury behavior within a specific time duration, a reward was provided. Non-suicidal self-injury behaviors included self-harm, hair pulling, severe itching, pinching, wound manipulation, and hand biting. The frequency of these behaviors was assessed during each session. Visual analysis of graphed data, percentage of non-overlapping data, and mean percentage improvement were used for data analysis. </p> <p><strong>Results:</strong> The results showed a fairly reliable effect for the intervention on reducing the target behavior, as indicated by a frequency reduction from phase A<sub>1</sub> to B<sub>1</sub> and A<sub>2</sub> to B<sub>2</sub> and by a frequency elevation by the intervention withdrawal from B<sub>1</sub> to A<sub>2</sub>. The average percentage reduction across participants was obtained at 56%. However, a low rate of self-injury remained consistent for the participants.</p> <p><strong>Conclusion:</strong> The results provided further evidence on the effectiveness of differential reinforcement of other behaviors in reducing self-injury behaviors. Although the intervention could reduce self-injury substantially, it seemed that it could not eliminate the behavior.</p> <p> </p> Fatimah Nosrati; Ali Massah Bavani, Baghr Ghobari Bonab Copyright (c) 2021 Iranian Red Crescent Medical Journal https://ircmj.org/index.php/IRCMJ/article/view/872 Thu, 14 Oct 2021 00:00:00 +0330 The Clinical Trial of COVID-19 Patients: The Effectiveness of Emotion-Focused Therapy on Post- Traumatic Stress and Depression https://ircmj.org/index.php/IRCMJ/article/view/998 <p><strong>Background: </strong>At the end of 2019, the world faced a phenomenon that plunged all human beings into extreme fear and anxiety. A new type of coronavirus began to spread among people around the world, and this was the beginning of one of the greatest pandemics and its problems in the world.</p> <p><strong>Objectives: </strong>The present study aimed to study the effect of Emotion-Focused Therapy (EFT) on reducing post-traumatic stress and depression among Covid-19 patients. The statistical population was all English language students at the University of Tehran who had recovered from Covid-19. A total of three students (with a mean age of 22±2 years old) were selected from those who had recovered from Covid-19 using convenience sampling.</p> <p><strong>Results:</strong> The data were analyzed using visual inspection, Reliable Change Index (RCI), and percentage change formula. The results of the study indicated that the mean improvement of post-traumatic stress variable for the three patients in the post-treatment and follow-up was 42.39% and 41.54%, respectively. Additionally, this value for the depression variable was 60.78 and 60.22% in the post-treatment and the follow-up.</p> <p><strong>Conclusion:</strong> Based on the results of the study, EFT was effective on post-traumatic stress and depression in students infected with Covid-19. Therefore, it is recommended to use this treatment to reduce post-traumatic stress and depression in patients with Covid-19.</p> <p> </p> Masoud Sadeghi, Zahra Moradi, Milad Salimi Chegenie Copyright (c) 2021 Iranian Red Crescent Medical Journal https://ircmj.org/index.php/IRCMJ/article/view/998 Thu, 14 Oct 2021 00:00:00 +0330 FACTORS AFFECTING SENTINEL LYMPH NODE METASTASIS IN PATIENTS WITH BREAST CANCER UNDERGOING SENTINEL LYMPH NODE BIOPSY BEFORE OR AFTER SYSTEMİC THERAPHY https://ircmj.org/index.php/IRCMJ/article/view/1086 <p><strong>Background and Objective</strong></p> <p>The status of axillary lymph node (ALN) along with clinical and histopathological factors is considered an important prognostic factor in invasive breast cancer. The tendency to spread to SLN may differ depending on the biological, clinical and histopathological features of tumors. If we know the factors that affect SLNM, we may not need to perform SLNB in some groups. The aim of the study was to investigate the factors affecting SLNM in patients who underwent surgery and SLNB before (surgery group) or after (neoadjuvant group) systemic theraphy in the light of current biological characteristics of tumors and patients.</p> <p><strong>Methods</strong></p> <p>The study included patients who were operated for breast cancer and underwent SLNB in the general surgery clinic of our institute between January 2017 and August 2019. The study included a total of 1,050 patients, 900 patients in the surgery group and 150 patients in the NAC group.</p> <p><strong>Results</strong></p> <p>In surgery group, multivariate analyses showed that grade III, LVI, Her2 (+) and TN increases the risk of metastasis. In neoadjuvant therapy group, multivariate analyses showed Pre-NAC clinical findings of LN metastasis and luminal A subtypes as effective factors.</p> <p><strong>Conclusions</strong></p> <p>Knowing the factors affecting sentinel lymph node metastasis can provide clues for the type of intervention, reconstruction and RT planning of patients to be operated directly or after neoadjuvant chemotherapy.</p> Mehmet Furkan Sagdic, Cemil Yuksel, Serdar Culcu, Bulent Aksel, Cihangir Ozaslan, Suat Kutun, Lutfi Dogan Copyright (c) 2021 Iranian Red Crescent Medical Journal https://ircmj.org/index.php/IRCMJ/article/view/1086 Thu, 14 Oct 2021 00:00:00 +0330 Ability of Laboratory Findings Upon Admission to Predict Lung Involvement and Its Severity in COVID-19 Patients Requiring Hospitalization https://ircmj.org/index.php/IRCMJ/article/view/1183 <p><strong>Background: </strong>The struggle of humanity with Coronavirus disease 2019 (COVID-19) infection, which affected the whole world and caused severe social and health crises, continues without deceleration.</p> <p><strong>Objectives:</strong> This study aimed to determine the relationship between the abnormal laboratory parameters upon admission and the intensity of lung involvement using chest computerized tomography severity score (CT-SS).</p> <p><strong>Methods:</strong> This single-center study evaluated a total of 242 patients who were admitted to our hospital due to COVID-19 with positive polymerase chain reaction (PCR) test results. The patients were divided into three groups of no involvement on thorax CT images, mild involvement, and moderate-severe involvement.</p> <p><strong>Results: </strong>The mean ages of groups 1 (n=42), 2 (n=123), and 3 (n=77) were 38±10.6, 56.3±16, and 61±15.6 years, respectively (P&lt;0.001). The three groups showed significant differences in terms of hypertension, diabetes mellitus, heart rate, oxygen saturation, lymphocyte count, platelet-lymphocyte ratio (PLR), systemic immune inflammation index (SII), ferritin, troponin-I, erythrocyte sedimentation rate (ESR), and c-reactive protein (CRP) values (P&lt;0.001). The CRP (R=0.545, P&lt;0.001), ferritin (R=0.481, P&lt;0.001), and SII (R=0.473, P&lt;0.001) were moderately and positively correlated with CT-SS, while neutrophil-lymphocyte ratio (R=0.404, P&lt;0.001), PLR (R=0.371, P&lt;0.001), and ESR (R=0.327, P&lt;0.001) were mildly and positively correlated with CT-SS.</p> <p><strong>Conclusion:</strong> The results of the present study showed that elevation in CRP, as well as ferritin and SII values upon admission to the hospital was significantly correlated with CT-SS. The results also revealed that the presence of lung parenchyma involvement might be predicted in PCR positive COVID-19 patients without the need for thorax CT. Furthermore, it is believed that this information will provide great convenience to the clinicians who first welcome the patient in terms of predicting COVID-19 lung involvement.</p> Yusuf Ata, Ahmet Kagan As, Mesut Engin, Nurcan Kacmaz Kat, Tirdad Setayeshi, Sadık Ahmet Sunbul, Cuneyt Eris, Ufuk Aydın, Filiz Ata, Tamer Turk Copyright (c) 2021 Iranian Red Crescent Medical Journal https://ircmj.org/index.php/IRCMJ/article/view/1183 Thu, 14 Oct 2021 00:00:00 +0330 Designing a branding model for providing healthcare services in Iran https://ircmj.org/index.php/IRCMJ/article/view/1317 <p><strong>Background:</strong> Branding in the field of healthcare services leads to transparency and utility in the type of services, differentiation of services in the minds of patients, and their trust in health centers. Therefore, the present study aimed to provide a branding model in the field of healthcare services.</p> <p><strong>Methods: </strong>A mixed-method approach was utilized to develop a branding model for providing healthcare services. The study population for the qualitative phase included 20 academic and organizational experts using snowball sampling and the Delphi technique. For the quantitative phase, 830 people who were referred to health centers were selected as service recipients, and 415 medical staff were selected as health care providers. The validity of the questionnaire was confirmed by face, content, and structural validity; moreover, its reliability was confirmed by Cronbach's alpha of 0.96. Quantitative data were presented by EQS software (version 6.1) with confirmatory factor analysis and structural equations.</p> <p><strong>Results:</strong> According to the results of factor structure and measurement equivalence, the branding of healthcare services had six main themes of competitive position, brand equity, brand accessibility, brand consolidation in the minds of clients and the market, branding strategies, and consumer-brand relationship with 19 sub-themes for clients and providers (Comparative fit index=0.9, Tucker Lewis index=0.8, Root mean square error of approximation=0.085, Root mean square error=0.049). Moreover, the items had a good fit and internal consistency at significant levels (P&lt;0.05).</p> <p><strong>Conclusion:</strong> According to the results, six main themes of competitive position, brand equity, brand accessibility, brand consolidation in the minds of clients and the market, branding strategies, and consumer-brand relationship with 19 sub-themes can be used in the field of health services branding.</p> Masoomeh Abdi Talarposhti, Ghahraman Mahmoudi, Mohammad Ali Jahani Copyright (c) 2021 Iranian Red Crescent Medical Journal https://ircmj.org/index.php/IRCMJ/article/view/1317 Thu, 14 Oct 2021 00:00:00 +0330 Laparoscopic Cholecystectomy in Situs Inversus, a Novel Port Placement Technique, Two Case Reports, and Review of Literature https://ircmj.org/index.php/IRCMJ/article/view/1168 <p><strong>Background: </strong>Situs Inversus Totalis (SIT) is a rare and silent autosomal recessive disease in which all organs are on the opposite side. Diagnosis of gallbladder diseases will be difficult due to these anatomical changes. Laparoscopic cholecystectomy is the standard treatment for gallbladder diseases but is technically challenging for patients.</p> <p><strong>Case presentation:</strong> Two 52- and 64-year-old women with known SIT who complained of intermittent epigastric pain and nausea after eating fatty and bulky meals were examined. With the help of abdominal ultrasound, a gallbladder on the left side of the abdomen with multiple gallstones was shown.</p> <p><strong>Conclusion:</strong> Since the successful primary cholecystectomy was performed on a patient with SIT in 1991, several modifications have been made for port insertion. Surgeons try to overcome technical problems by making various adjustments compared to conventional laparoscopic cholecystectomy.</p> <p>Laparoscopic cholecystectomy in patients with SIT is safe. However, laparoscopic cholecystectomy is challenging due to anatomical changes in the SIT. Our proposed method of port placement helps right-handed surgeons for safer and easier dissection.</p> <p> </p> Alireza Tavassoli, Tooraj Zandbaf, Alireza Rezapanah Copyright (c) 2021 Iranian Red Crescent Medical Journal https://ircmj.org/index.php/IRCMJ/article/view/1168 Thu, 14 Oct 2021 00:00:00 +0330 Subacute thyroiditis as evidence of SARS-CoV2 related autoimmune disorders and case descriptions https://ircmj.org/index.php/IRCMJ/article/view/1134 <p><strong>Context: </strong>Subacute thyroiditis has been classified as an auto inflammatory condition and occurs mainly due to a viral infection. According to the pathogenesis of SARS-CoV2 infection, which is mainly based on the uncontrolled inflammatory immune response, several studies have investigated the possible association between SARS-CoV2 and subacute thyroiditis. In this regard, we aimed to review and organize these studies.</p> <p><strong>&nbsp;</strong><strong>Evidence Acquisition:</strong> First, we observed and provided evidence on the possible roles and mechanisms of SARS-CoV2 in inflammatory and autoimmune diseases, and then we discussed the findings on the association between subacute thyroiditis and SARS-CoV2 infection.</p> <p><strong>Results:</strong> Regarding other autoimmune and inflammatory disorders, together with previous experience on the role of viruses in the pathogenesis of subacute thyroiditis, as well as studies on the inflammatory mechanism of SARS-CoV2 infection, support this hypothesis that SARS-CoV2 may initiate subacute thyroiditis.</p> <p><strong>Conclusions:</strong> Evidence so far suggests that subacute thyroiditis should be considered as a later symptom of covid-19.</p> Maryam Karimifard, Jalal Eshagh Hoseini, Ashraf Mohamadkhani, Malihe Akbari Copyright (c) 2021 Iranian Red Crescent Medical Journal https://ircmj.org/index.php/IRCMJ/article/view/1134 Thu, 14 Oct 2021 00:00:00 +0330