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. Ghayour) Sat, 28 Nov 2020 00:00:00 +0330 OJS 60 Effects of Preoperative Oral Carbohydrate Loading on Preoperative and Postoperative Comfort in Patients Planned to Undergo Elective Cholecystectomy: A Prospective Randomized Controlled Clinical Trial <p><strong>Background:</strong> Cholecystectomy is a widespread abdominal procedure. A period of 8-hour-fasting for this relatively rapid surgery negatively affects the patients’ comfort.</p> <p><strong>Objectives: </strong>The current study aimed to evaluate the effects of the presurgical intake of carbohydrate on patients’ comfort.</p> <p><strong>Materials and Methods:</strong> This prospective study was carried out on 42 cholecystectomy patients (with the&nbsp;American Society of Anesthesiologists grade of I-II) divided into two groups. The patients in group 1 underwent laparoscopic cholecystectomy after an 8-hour-fasting period. The subjects in group 2 received a carbohydrate-rich solution with 12.5% dextrose before the surgery (125 g of sugar melted in 1 L of water; 800 and 200 mL 8 and 2 h before the surgery, respectively). Thirst, hunger, and nausea at the 9<sup>th</sup> preoperative hour and 30 min before the surgery in addition to nausea and vomiting at the 2<sup>nd</sup>, 8<sup>th</sup>, and 24<sup>th</sup> postoperative hours were assessed in both groups.</p> <p><strong>Results:</strong> The mean age and body mass index (BMI) values of the patients were 48.38±12.68 years and 29.85±5.20 kg/m², respectively. The mean operational time was 36.5 min (range: 26-114 min). No difference was observed between the two groups in terms of age, BMI, and operational time. The investigation 30 min before cholecystectomy revealed that the rates of hungry and thirsty patients were higher in group 1, compared to those reported for group 2 (P=0.003 and P=0.032). Nevertheless, at the 2<sup>nd</sup> and 8<sup>th</sup> postoperative hours, the rate of patients complaining of nausea were higher in group 2 in comparison to that of group 1 (P=0.048 and P=0.014).</p> <p><strong>Conclusions:</strong> It is suggested that the intake of carbohydrate-rich fluids up to the preoperative 2<sup>nd</sup> hour decreased presurgical hunger/thirst. The results of this study are in line with the findings of previous studies. It is believed that the intake of CHO-rich solutions up to 2 h before surgery may provide comfort by decreasing hunger/thirst. Nevertheless, it is necessary to take into account a potential rise in a feeling of nausea among these patients.</p> Mehmet Ali Gök, Mehmet Tolga Kafadar, Serkan Fatih Yeğen Copyright (c) Thu, 26 Nov 2020 08:55:29 +0330 Effects of N-Acetyl Cysteine on the Expression of Matrix Metalloproteinases 2 and 9 in the Lung Tissue of Rats Exposed to Cadmium <p><strong>Objectives:</strong> This study aimed to investigate the effect of cadmium (Cd) on the matrix metalloproteinases (<em>MMPs</em>) -2 and -9 expression in the lung, and the role of N-acetylcysteine (NAC) in preserving the lung cells against Cd toxicity.&nbsp;</p> <p><strong>Methods: </strong>The rats were randomly divided into five groups of G1 (control), G2 (single dose of Cd), G3 (continuous dose of Cd), G4 (single dose of Cd+NAC), and G5 (continuous dose of Cd+NAC). The level of Cd in the blood and lung tissue was measured by atomic absorption spectroscopy. Moreover, the expression of <em>MMP2 </em>and <em>MMP9</em> genes was considered using RT-PCR.</p> <p>&nbsp;</p> <p><strong>Results: </strong>Single and continuous exposure to Cd caused a significant increase in serum and the lung tissue of Cd in G2 (0.23±0.04 mg/L and 0.35±0.047 μg/g tissue) and G3 (0.50±0.068 mg/L and 0.81±0.063 μg/g tissue) groups, compared to other groups (P&lt;0.001). The NAC supplementation significantly decreased Cd levels in the serum and lung tissue samples of rats exposed to single or continuous Cd (P&lt;0.001). Furthermore, exposure to a single and continuous dose of Cd caused a significant increase in the <em>MMP2 </em>expression by 3.24-fold (P=0.003) and 11.9-fold (P&lt;0.001), respectively. Additionally, single and continuous dose treatment of Cd led to a significant increase in the <em>MMP9</em> expression by 3.20-fold (P=0.004) and 7.54-fold (P&lt;0.001), respectively. The NAC treatments decreased the expression of <em>MMP2</em> and <em>MMP9</em> in the lung of rats exposed to single or continuous Cd.&nbsp;</p> <p><strong>Conclusion: </strong>The Cd exposure was strongly associated with the accumulation of Cd and overexpression of <em>MMP2</em> and <em>MMP9 </em>in the lung tissue. Moreover, the NAC can protect the lungs against Cd toxicity by decreasing Cd and down-regulating <em>MMP</em>s.</p> Armaghan Shirinsokhan, Zeinab Khazaei Koohpar, Najmeh Ranji, Fatemeh safari Copyright (c) Mon, 30 Nov 2020 10:23:39 +0330 Investigation of the Psycho-Social Factors Affecting the Adoption of a Healthy Nutrition Style in Women with a History of Gestational Diabetes Using Structural Equation Modeling <p><strong>Background and aims:</strong> Women with a history of gestational diabetes mellitus are the main high-risk group for type 2 diabetes; however, a healthy nutrition style can reduce the risk of developing diabetes in this group. The present study aimed to determine the psycho-social factors that affect the adoption of a healthy nutrition style in women with a history of gestational diabetes.</p> <p><strong>Materials and Methods:</strong> This cross-sectional study was conducted based on the Health Action Process Approach (HAPA) in the west of Mazandaran province, Iran in 2019. A total of 165 women with a history of gestational diabetes in a recent pregnancy were selected using the convenience sampling method. The required data were collected using a demographic characteristic form, a healthy nutrition style questionnaire, and a researcher-made questionnaire based on HAPA model constructs. Moreover, structural equation modeling was used for data analysis.</p> <p><strong>Results:</strong> Based on the results, the data were fit to the model (Tucker–Lewis index=0.924, comparative fit index=0.928, root mean square error of approximation=0.045, χ<sup>2</sup>/degrees of freedom=1.332). The model constructs predicted 23% and 51% of intention variance and nutrition style variance, respectively. Action self-efficacy and risk perception were the most important predictors of intention. In addition, planning and recovery self-efficacy significantly predicted a healthy nutrition style.</p> <p><strong>Conclusion:</strong> As the first step, using the HAPA for the prediction of the nutrition style of women with a history of gestational diabetes was confirmed. Therefore, this model can be used to design educational interventions to prevent diabetes.</p> banafshe mohamadi, Nourossadat Kariman, Zahra Kashi, Isa Mohammadi zeidi, Hamid Alavi Majd Copyright (c) Thu, 26 Nov 2020 09:26:18 +0330 Discrimination between seroclearance and seroconversion in hepatitis B using CD4+ CD25+ CD127- FoxP3+ T Regulatory cells <p><strong>Background: </strong>Hepatitis B is a viral disease that can be chronic. The Treg population during hepatitis appears to have an important role in controlling disease progression.</p> <p><strong>Objectives:</strong> The present study aimed to determine the level of Tregs in patients with chronic hepatitis B (CHB) at different stages of the disease.</p> <p><strong>Methods: </strong>This study was carried out on 90 patients with CHB followed-up for an average of 10 years and divided into hepatitis B surface antigen (HBs Ag+), seroconverted (HBs Ag- and hepatitis B surface antibody [HBs Ab+]), and serocleared (HBs Ag- and HBs Ab-) groups. Then, 5 ml of the blood sample was taken, and the peripheral blood mononuclear cells (PBMCs) were separated using Ficoll. The surface markers, including CD4, CD25, and CD127, and FoxP3 intracellular marker were measured in the PBMCs. Isotype was considered the control for each sample. The samples were read by the FACSCalibur 4-color flow cytometer (BD Biosciences, San Jose, CA, USA) and analyzed using FlowJo software. The levels of aspartate aminotransferase, alanine transaminase, α-fetoprotein, platelets, white blood cells, and hemoglobin were extracted from the patients’ records.</p> <p><strong>Results:</strong> The mean age values of the HBs Ag+ (n=35), seroclearance (n=27), and seroconversion (n=28) groups were 43.97±11.86, 47.26±12.95, and 47.39±10.40 years, respectively. The frequency of CD4<sup>+</sup> CD25<sup>+</sup> FoxP3<sup>+</sup> (Treg) was higher in the HBs Ag+ group than that reported for the other two groups. The Treg population demonstrated a significant difference between the serocleared and seroconverted groups; however, the Treg frequency was higher in the seroconverted group in comparison to that of the other two groups. The Treg/T-Activator ratio was significantly higher in the HBs Ag+ group than those reported for the two other groups.</p> <p><strong>Conclusions</strong>: CD4<sup>+</sup> CD25<sup>+</sup> FoxP3<sup>+</sup> T cells are the important subgroups of Treg cells affecting immune suppression.</p> <p>&nbsp;</p> Jila Masrour-Roudsari , Mohammad Reza Hasanjani Roushan , Yousef Yahyapour, Rahim Barari Savadkoohi , Ali Bijani , Mousa Mohammadnia-Afrouzi Copyright (c) Thu, 26 Nov 2020 10:02:51 +0330 Transcriptional expression of Bcl-2, Her2, VEGF, and hTERT in Caki-1 human renal cancer cells with modulation of Cornus mas extract <p><strong>Background:</strong> Herbal medicines, particularly those rich in polyphenolic compounds, have been proposed to be chemotherapeutic factors, which can modulate several pathways associated with cancer. To gain mechanistic insights into the anti-proliferative impacts of Cornus mas extract (CME), this study investigated the expression changes of several prominent genes, which involved in malignancy with therapeutic potential.</p> <p><strong>Materials and Methods:</strong> To perform the research, Caki-1 cancer cells were incubated for 72 h with 250 µg/ml of CME upon the cells with ribonucleic acids (RNAs) extracted for identified alterations of human telomerase reverse transcriptase (hTERT), vascular endothelial growth factor (VEGF), human epidermal growth factor receptor 2 (Her2), and B-cell lymphoma-2 (Bcl-2) gene expressions by a quantitative reverse transcription-polymerase chain reaction. The changes in protein expression were analyzed by the western blot method. Cell apoptosis was detected using the flow cytometry technique. &nbsp;</p> <p><strong>Results:</strong> Cornus mas extract caused down-regulated Bcl-2 as an anti-apoptotic 4.34-fold gene expression. Moreover, Her2 oncogene messenger RNA expression was inhibited by 250 µg/ml concentration of ~10-fold CME. The antitumor activity of CME was pronounced in its potent anti-angiogenic potential, as CME resulted in a striking decrease in ~125 fold-expression of VEGF compared to the untreated control. In contrast, CME led to ~2.6 fold up-regulation of hTERT in Caki-1 cancer cells.</p> <p><strong>Conclusion:</strong> Overall, various molecular pathways were formed to interplay with Caki-1 cells, which depend on the active phenolic compound of CME. It is recommended to perform further studies to investigate the effect of unique polyphenols of the total extract of CME to establish therapy with replication-competent adenovirus as an effective strategy.</p> Juan Ji, Shufen Hou, Yan Gao, Xinli Feng, Song Li Copyright (c) Fri, 27 Nov 2020 17:34:18 +0330 Effectiveness of the Transdiagnostic Integrated Treatment Program in Emotion Regulation of Mothers and Anxiety of Children with Type I Diabetes <p><strong>Background:</strong> Type I diabetes (T1D) is recognized as one of the most prevalent chronic diseases in children. It is accompanied by potentially life-threatening&nbsp;complications which affect the mood, personality, and emotions of children and their families.</p> <p>Objectives: The present study aimed to assess the effectiveness of the transdiagnostic integrated treatment program in emotion regulation of mothers and anxiety of children with TD1.</p> <p><strong>Methods</strong><strong>:</strong> The present experimental ‎study was conducted using the pretest-posttest follow-up control group design. The statistical population included all children with TD1 within the age range of &nbsp;9-11 years and their mothers who were referred to Iran Diabetes Association in Tehran in 2019-2020. The statistical sample was selected via the convenience (purposive) sampling method from among children with TD1 and their mothers, and the subjects were randomly assigned to two experimental and control groups. The Cognitive Emotion Regulation Questionnaire (CERQ) developed by Garnefski et al. and Spence Children’s Anxiety Scale (SCAS) were completed in the pretest, posttest, and follow-up. Diabetic children and their mothers received 15 sessions of the transdiagnostic integrated treatment protocol, while no special training was provided to the control group.</p> <p>Results: The results of the present study indicated that the three measurements performed in pretest, posttest, and follow-up significantly differed regarding children's anxiety and mothers' emotion regulation strategies (e.g., catastrophizing, coping and acceptance, positive thinking, and blaming others) pointing to the effectiveness of transdiagnostic treatment (P= 0.000).</p> <p><strong>Conclusion:</strong> The obtained results suggested the effectiveness of the integrated transdiagnostic treatment program in reducing the anxiety of children with type 1 diabetes and improving the emotion regulation of their mothers.</p> sogand Ghasemzadeh, zahra naghsh Copyright (c) Thu, 26 Nov 2020 10:12:42 +0330 Designing and Psychometric Evaluation of Morbid Obesity Quality of life Questionnaire: A Mixed Methods Study <p><strong>Background: </strong>Morbid obesity negatively affects all aspects of quality of life (QOL); therefore, the assessment of QOL can be a useful criterion to evaluate obesity outcome.</p> <p><strong>Objective:</strong> The present study aimed to design a QOL questionnaire in morbid obesity and assess its validation features.</p> <p><strong>Methods</strong>: This sequential-exploratory mixed-methods study was conducted in both qualitative and quantitative stages. The qualitative stage was carried out through 20 semi-structured interviews with morbidly obese people. Furthermore, the initial items of the questionnaire were obtained by a review of related literature. In the next stage, face, content, and construct validity were assessed. The construct validity was examined by exploratory factor analysis with 319 people. Moreover, Cronbach’s alpha and test-retest correlation coefficient were calculated to evaluate the reliability of the questionnaire. Furthermore, confirmatory factor analysis was assessed.</p> <p><strong>Results: </strong>Based on the results of the quantitative stage, an 80-item pool was extracted. The exploratory factor analysis yielded six factors that explained 50.62% of the variance. The factors of one to six were as follows: self-dissatisfaction (15 items), functional disorders (7 items), spiro-mental experiences (11 items), perso-social isolation (7 items), physical changes (7 items), and financial pressure (3 items). The final Cronbach’s alpha coefficient of the 50-item questionnaire was calculated at 0.94. Moreover, the intra-class correlation coefficient between the test and retest scores was estimated at 0.97. All indicators of confirmatory factor analysis demonstrated that goodness of fit was acceptable for each factor. Furthermore, this questionnaire had appropriate interpretability, feasibility, and did not have any floor and ceiling effects.</p> <p><strong>Conclusion:</strong> This valid and reliable questionnaire can be used as a suitable measurement tool for assessing the QOL of morbidly obese people in Iran and other countries with similar cultural features. This questionnaire can improve the quality of future clinical research on obesity. In addition, health care providers can perform a peculiar role in the provision of efficient services to patients to prevent obesity and its associated complications.</p> Negar Yazdani , Farkhondeh Sharif , Nasrin Elahi , Abbas Ebadi , Vahid Hosseini Copyright (c) Thu, 26 Nov 2020 10:07:05 +0330 Frequency of inflammatory cell types in polyps of patients with diffuse sinonasal polyposis and association with effective factors in recurrence <p><strong>Background: </strong>Sinonasal polyposis (SNP) is a chronic disease of nasal and paranasal sinus mucosa. Nasal polyps can be divided into two groups based on inflammatory cells’ types, namely eosinophilic and neutrophilic polyps. Eosinophilic chronic rhinosinusitis responds to corticosteroids; however, this response is less in the neutrophilic type.</p> <p><strong>Objectives:</strong> The present study aimed to determine the frequency of inflammatory cell types in the polyp tissue of patients with diffuse SNP and its association with effective factors in recurrence.</p> <p><strong>Materials and Methods:</strong> This cross-sectional study was carried out on 130 patients with diffuse SNP referring to the Ear, Nose, and Throat&nbsp;(ENT) clinics of Tabriz University of Medical Sciences, Tabriz, Iran, using random sampling. The severity of the disease was assessed by the Sinonasal Outcome&nbsp;Test 20&nbsp;(SNOT-20) questionnaire filled out by an ENT surgeon. Computed tomography scans were graded by the Lund-Mackay score. The variety of the cells were determined following hematoxylin-eosin staining and pathologist LM examination; then, the obtained data were statistically evaluated and their associations with the previously known factors of recurrence in other studies were reported.</p> <p><strong>Results:</strong> The most frequent cells were eosinophils, and mast cells showed the lowest frequency of inflammatory cells in the polyps of patients with diffuse SNP. Eosinophilic polyps were more common in female patients. There was no significant difference between inflammatory cells associated with age, history of surgery, and SNOT-20 score. A significant relationship was only observed between the Lund-Mackay scores of neutrophil and mast cell polyps.</p> <p><strong>Conclusions:</strong> The investigation of the dominant inflammatory cell in the histopathology sample of the sinonasal polyps can help in tracking and rationalizing patient management and expectations.</p> <p>&nbsp;</p> <p>&nbsp;</p> Ali reza lotfi, nikzad shahidi, monireh halimi, seyedeh naffiseh eshagh hosseini Copyright (c) Thu, 26 Nov 2020 10:18:19 +0330 Correlations of PD-1/PD-L1 Gene Polymorphisms with Susceptibility and Prognosis in Non-Hodgkinʼs Lymphoma among Iranian Population <p><strong>Background:</strong> The activities of programmed cell death 1 (PD-1) and programmed death ligand-1 (PD-L1) have already been identified in various cancers. However, in non-Hodgkinʼs lymphoma (NHL), the prognostic value of <em>PD-1</em>/<em>PD-L1</em> gene polymorphisms and expression levels remains unclear.</p> <p><strong>Objectives:</strong> The present study aimed to investigate the relationship between the genetic polymorphisms of <em>PD-1</em>/<em>PD-L1</em> genes and NHL in the Iranian population.</p> <p><strong>Methods</strong>: Four single-nucleotide polymorphisms (SNPs) of <em>PD-1</em>/<em>PD-L1</em> genes were examined in 134 NHL patients and 134 healthy controls using polymerase chain reaction-restriction fragment length&nbsp;polymorphism. The expression levels of <em>PD-1</em>/<em>PD-L1</em> genes were analyzed using real-time polymerase chain reaction.</p> <p><strong>Results</strong>: The obtained results of the current study demonstrated that PD-L1 rs2890685 (A&gt;C) SNP (P&lt;0.0001) was significantly associated with the increased risk of NHL. The AA genotype of PD-L1 rs2890685 polymorphism was observed to be more prevalent in the NHL patients, compared to that reported for the healthy controls. There was no significant association between PD-L1 rs4143815, PD-1 rs11568821, and PD-1rs2227981 SNPs with the risk of NHL. Furthermore, the obtained findings showed that the messenger ribonucleic acid transcription levels of both <em>PD-1</em> and <em>PD-L1</em> were significantly higher in the NHL patients than those reported for the healthy controls (P&lt;0.001).</p> <p><strong>Conclusions:</strong> According to the results of the current study, there was an association between functional PD-L1 rs2890685 polymorphism and risk of NHL, suggesting that the genetic variant of <em>PD-L1</em> might be a possible prognostic marker for the prediction of the risk and development of NHL.</p> <p>&nbsp;</p> hosnie hoseini, Parichehreh Yaghmaei, Gholamreza Bahari, Saeed Aminzadeh Copyright (c) Thu, 26 Nov 2020 10:28:53 +0330 Potential Adverse Drug Reactions of Chloroquine in the Treatment of COVID-19 <p><strong>Background:</strong> Since December 2019, the coronavirus disease 2019 (COVID-19) has broken out in Wuhan, Hubei Province, China. Due to the highly pathogenic and infectious characteristics, COVID-19 spread across China and later globally and became a severe pandemic. To date, there have been no efficacious specialized drugs to treat COVID-19. The China-issued Diagnosis and Treatment of Pneumonia Caused by Novel Coronavirus (Trial version 6) added the chloroquine phosphate to the antiviral treatment protocol for infected adults.</p> <p><strong>Methods:</strong> In this review, government documents and authoritative guidelines on COVID-19 were collected from the official website of organizations related to health and medicine. Research articles related to chloroquine and its application for COVID-19 treatment were searched and acquired from the PubMed platform. Facts and data related to the use of chloroquine were summarized in several parts.</p> <p><strong>Results: </strong>Recently, there has been an increase in research on the use of chloroquine for the treatment of COVID-19. This drug is utilized as an antimalarial and antiviral medication. There are some concerns and cautions on the clinical application of chloroquine, about which clinicians should be informed during this global pandemic. The present review summarized data on the mechanism of action, drug-drug interaction (DDI), and adverse drug reaction (ADR) of chloroquine and pharmaceutical care for special patients in order to provide a reference for the rational use of this drug in COVID-19 patients.</p> <p><strong>Conclusions: </strong>Currently, there is mixed evidence on the efficacy of chloroquine in the treatment of COVID-19. Potential DDIs and ADRs, as well as pharmaceutical care, for special patients should be considered in fighting against the pandemic.</p> Guangfei Wang, Qiaofeng Ye, Yidie Huang, Jinmiao Lu, Yiqing Zhu, Lin Zhu, Xiaoxia Li, Junqi Zhang, Ziwei Li, Jianger Lan, Zhiping Li Copyright (c) Thu, 26 Nov 2020 09:08:49 +0330