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) Wed, 30 Sep 2020 00:00:00 +0330 OJS 60 Effects of Hydro-alcoholic Extract of Pumpkin Seeds on Oogenesis Pathway, Liver, and Kidney of Female Rats <p><strong>Background</strong><strong> and Objectives</strong><strong>:</strong> Pumpkin seed extract can be a good alternative to hormone replacement therapy since it is rich in phytoestrogens. In this regard, the present research aimed to investigate the effect of hydro-alcoholic extract of pumpkin seeds on the oogenesis pathway, liver, and kidney of female rats.</p> <p><strong>Materials and</strong> <strong>Methods: </strong>This experimental study was performed on 64 Wistar female rats (including 32 adults and 32 immature rats). The adult rats were randomly divided into three experimental and one control groups (n=8 per group). Moreover, the immature rats were allocated to groups in a similar manner. The experimental groups 1, 2, and 3 received a hydro-alcoholic extract of pumpkin seed in doses of 20, 50, 100 mg/kg, respectively, via intraperitoneal injection for 21 consecutive days. For the purposes of the study, blood samples were taken one day after the last injection to determine the serum levels of female hormones as well as renal and hepatic factors. The ovaries, livers, and kidneys of the rats were also separated for histological tests.</p> <p><strong>Results:</strong> Based on the results, significant increases were observed in the bodyweight of all immature rats; estrogen levels in the adult experimental group 3 and immature experimental groups 2 and 3; progesterone and creatinine levels in the immature experimental group 3; aspartate aminotransferase, total protein, unstable angina (UA), and the renal diameter in the immature experimental groups 1 and 2; follicle-stimulating hormone in the adult experimental group 3 and the immature experimental groups 1 and 2; luteinizing hormone and Graafian follicles in the adult experimental group 3; and atretic follicles in the immature experimental group 1 and 3 (P&lt;0.05). Moreover, significant decreases were observed in the alkaline phosphatase in the adult experimental group 3; total protein, UA, and renal diameter in the immature experimental group 3; diameters of proximal and distal tubule as well as Henle’s loop in all immature rats; diameter of glomerular in the immature experimental groups 1 and 2; diameter of the renal cortex, glomerular, and Bowman's capsule in the adult experimental groups 2 and 3; secondary follicles in the adult experimental group 1, immature experimental groups 1 and 3; and primitive and early follicles in all the adult rats, compared with the control group (P&lt;0.05).</p> <p><strong>Conclusion: </strong>Based on the findings, it can be concluded that the pumpkin seeds provide the nutritional needs of the body at the onset of sexual maturity, prepare the body for sexual maturity, and regulate female sex hormones without having adverse effects on the hepatic tissues. However, it must be noted that its consumption at the onset of sexual maturity requires dosage determination and further <em>studies</em>.</p> samaneh motamed jahromi, sadegh niami jahromi Copyright (c) Wed, 30 Sep 2020 14:40:13 +0330 Auditing the Accuracy of Medical Diagnostic Coding based on International Classification of Diseases, Tenth Revision <p><strong>Background: </strong>Medical diagnostic coding is used for the ease of retrieval and accuracy of medical information classification in health information systems. This information is the main source of decision making for health managers and policymakers in planning, epidemiological, and medical research at different levels.</p> <p><strong>Objectives:</strong> The present study aimed to audit the accuracy of the&nbsp;ICD-10 (International Classification of Diseases, Tenth Revision) medical diagnosis code.</p> <p><strong>Methods: </strong>The present cross-sectional study was performed on a sample of 692 hospitalized cases in 9 educational centers affiliated to Shahid Beheshti University of Medical Sciences in the first half of 2020. The content validity of the checklist was determined in this study, and the obtained data were analyzed in SPSS software using descriptive statistics.</p> <p><strong>Results:</strong> The average accuracy of coding for the main medical diagnoses across all subjects was 70%, signifying that 30% of medical records contain coding errors. The highest and least accuracy values of diagnostic coding were 80% and 47%, respectively. The application of standard abbreviations and file legibility were recognized as variables affecting code accuracy. The highest precision percentage of codes attributed to other medical diagnoses, including ICD-10-based comorbidity and complication, was in 84%-85% of the participants.</p> <p><strong>Conclusion:</strong> Given the importance of all-encompassing coding in retrieving medical information, research, and macro-health policymaking, the coding accuracy audit must be conducted on a regular basis. The interaction between coders and healthcare providers, coders' training, and improving the documentation process exerts a significant impact on the enhancement of coding accuracy.</p> Seyed Hadi Mirhashemi, Nahid Ramezanghorbani, Farkhondeh Asadi, Mehrnaz Hajiabedin Rangraz Copyright (c) Wed, 30 Sep 2020 15:10:29 +0330 Evaluation of Iranian CRF and ESRD Patients admitted to Medical Centers of Mecca & Medina in Hajj travel of 2012 &2013; Causes & Outcome <p><strong>Background: </strong>Chronic renal failure<strong> (</strong>CRF) and end-stage renal disease (ESRD) are among the underlying reasons for the hospitalization of expeditionary pilgrims to Mecca. This study aimed to evaluate the reasons and consequences of sending the patients with CRF and ESRD to Mecca to perform rites&nbsp;of&nbsp;pilgrimage.</p> <p><strong>Methods:</strong> This retrospective cross-sectional study assessed the profiles of all pilgrims in 2012 and 2013. The independent variables were awareness and unawareness of the patients with CRF and patients on dialysis; moreover, the dependent variables were reasons for referral and hospitalization in hospital, probable death rate, and indications of dialysis in an emergency.</p> <p><strong>Results: </strong>Out of all Pilgrims, 2416 (1.76% of the total pilgrims’ population) cases had CRF, out of whom 1.15%, 10.47%, and 88.36% of the patients were on dialysis, aware, and unaware of their disease, respectively. Furthermore, 93 (3.9%) patients with CRF were hospitalized during Hajj. Cardiovascular disease (41%) and respiratory diseases (20%) were the most common reasons for patients’ hospitalization.</p> <p><strong>Conclusion: </strong>It is suggested that the glomerular filtration rate of the pilgrims be calculated before sending them to Hajj; moreover, the patients with CRF should be screened accurately. Proper vaccination and cardio check-up&nbsp;are necessary before the&nbsp;Hajj expedition. Considering low-salt diet and adequate fluid intake in patients with CRF during Hajj can minimize patients' referral to hospitals.</p> Seyed Mansour Gatmiri, Najmeh Shamspour, Farzaneh Sadat Minoo, Mahboob Lessan-Pezeshki Lessan Pezeshki, Navvab Shamspour, Aminreza Tabatabei Copyright (c) Wed, 30 Sep 2020 15:19:11 +0330 Evidence-Based Dentistry Among Iranian General Dentists and Specialists: A Knowledge, Attitude, and Practice Study <p><strong>Background:</strong> The use of evidence-based dentistry (EBD) as the integration of investigations and clinical decisions has been a focus of attention in recent years.</p> <p><strong>Objectives:</strong> The present study aimed to evaluate the knowledge, attitude, and practice of EBD among Iranian dentists in 2019.</p> <p><strong>Methods:</strong> A total of 140 self-administered questionnaires with 57 items were distributed among dentists in the 2019 exhibition of Iranian dentists. Moreover, 60 self- administered questionnaires were sent to five different dentistry schools in Iran. The analyses were carried out using the Chi-square test, independent samples t-test, and Pearson correlation.</p> <p><strong>Results:</strong> A total of 119 fully-responded self-administered questionnaires were analyzed in this study. The dentists attending EBD workshops obtained significantly higher scores of knowledge. The Cochrane Library, manufacturer’s brochures, and evidence-based guidelines were used the least for clinical decisions. Consultation with colleagues, use of textbooks, and personal judgment were mostly utilized for clinical decisions. In addition, 93.3% of the participants stated sensible uncertainties in their clinical decisions. The most important barriers to EBD were the need for long discussions with patients, lack of skills in the critical appraisal of articles, and lack of motivation in dentists with the incidence rates of 62.2%, 62.2%, and 39.5%, respectively.</p> <p><strong>Conclusions:</strong> Due to the low levels of EBD knowledge among Iranian dentists, it is recommended to give further close attention to increasing the knowledge in this regard. However, their high enthusiasm for participation in EBD workshops and enhancement of EBD skills is promising.</p> Surena Vahabi, Mahshid Namdari, Mohammadreza Vatankhah, Kamyar Khosravi Copyright (c) Wed, 30 Sep 2020 15:20:15 +0330 Changes of Occupational Noise-Induced Hearing Loss due to Working in the Steel Industry and Associated Effective Factors: Application of Bayesian Multivariate Multilevel Modeling using Skew Distribution <p><strong>Background: </strong>There have been a limited number of studies on the relationships between time and occupational and demographical variables with the mean changes of low-frequency hearing (LFH) and high-frequency hearing (HFH).</p> <p><strong>Objectives:</strong><strong>&nbsp;</strong>This study investigated the rate of occupational noise-induced hearing loss (NIHL) due to working in the steel industry and associated effective factors.</p> <p><strong>Materials and Methods: </strong>This historical cohort study was conducted within 2000 to 2010. Two LFH and HFH definitions of NIHL were used in this study. The average changes of LFH and HFL were considered the response variables. In addition, time and occupational (i.e., shift work and work experience) and demographic (i.e., age and educational level) variables were regarded as the independent variables. For data analysis, Bayesian multivariate multilevel modeling using skew distribution and OpenBUGS (version 3.2.2) and R (version 2.13.2) software were used in this study.</p> <p><strong>Results: </strong>The present study was performed on 1,959 male workers with a mean age of 36.64±3.92 years. Among these subjects, 913 (46.6%), 134 (6.8%), and 912 (46.6%) participants were day workers, weekly-rotating shift workers, and routinely-rotating shift workers, respectively. The obtained results showed that age, work experience, educational level, and shift work had significant relationships with the changes of LFH and HFH.</p> <p><strong>Conclusions: </strong>Overall, the findings of this 10-year historical cohort study demonstrated a relationship between time and demographic and occupational variables with the changes of LFH and HFL. Therefore, it is recommended to design preventive measures to reduce the deleterious effects of such variables on LFH and HFL.</p> Abolfazl Nikpour, Mohammad Gholami Fesharaki Copyright (c) Wed, 30 Sep 2020 15:21:16 +0330 A Scenario-based Modelling Study of the Prevention of Myocardial Infarction in Iran <p><strong>Background and Objectives:</strong> Globally, cardiovascular disease (CVD) is the number one cause of mortality. In this regard, this study aimed to provide policies for the management of CVD by focusing on the reduction of myocardial infarction (MI) mortality rate in Iran.</p> <p><strong>Materials and</strong> <strong>Methods:</strong> The sequential mixed methods design will be employed to foresight the prevalence of MI in Iran in the next 10 years. This study consists of five phases and in the first phase, the risk factors of cardiovascular disease will be investigated using a systematic review. In the second phase, the uncertainty and impact of those factors will be demonstrated by the experts. Moreover, the impact/uncertainty grid will be used to identify the drivers that are less important and critical uncertainties. In the third phase, the cross-impact matrix will be developed by Scenario wizard, and the scenario logic and the scenarios will be developed. Once the scenario logic is established, details can be added to the scenarios. The next phase consists of statistical estimations of the rate of mortality due to heart attack using artificial neural networks. Finally, the policies will be developed based on the opinions of the panel of experts. The initial results will be published in mid-2020.</p> <p>&nbsp;<strong>Results:</strong> This future study will develop policies to prevent from MI with scenario-based and modeling approaches. The findings can be useful for healthcare professionals and it can improve our understanding of the future of MI to enhance the management of MI patients.</p> <p>&nbsp;<strong>Conclusion:</strong> The obtained policies will help policymakers to make evidence-based decisions, re-design structures, and processes of healthcare interventions, and also plan to decrease MI mortality rate.</p> Gisoo Alizadeh, Kamal Gholipour, Reza Dehnavieh, Mohamamd Asghari JafarAbadi, Mehrdad Azmin, Ahmad Khanijahani, Rahim Khodayari-Zarnaq Copyright (c) 2020 Iranian Red Crescent Medical Journal Wed, 30 Sep 2020 15:22:33 +0330 Assessment of Risk Factors for Severe Coronavirus Disease 2019 among Iranian Patients <p><strong>Background: </strong>The outbreak of Coronavirus Disease 2019 (COVID-19) has led to a major concern for those who are more vulnerable to infections.</p> <p><strong>Objectives</strong>: This study aimed to evaluate the most important risk factors for severe COVID-19 pneumonia.</p> <p><strong>Methods</strong>: This retrospective study included information on clinical and epidemiological features of 105 patients with severe COVID-19 pneumonia hospitalized in Tajrish Hospital, Tehran, Iran. Initially, the medical records of the patients were investigated, and an interview was conducted based on a pre-prepared checklist to seek information about symptoms, past medical history, medication history, and behavior before hospitalization.&nbsp;&nbsp;&nbsp;</p> <p><strong>Results</strong>: Out of 105 participants, 76 (72.5%) cases were male, and 54 (51.4%) patients were older than 54 years old. The majority of the patients (n=18; 17.1%) had both hypertension and diabetes (n=12; 11.4%). Metformin (n=36; 34.3%) was the most used medication amongst the studied patient. In addition, 24 (22.9%) patients were recreational hookah smokers, and the majority (75%) of them were under the age of 46 years old. Eventually, 19 patients were excluded from the study, of whom 11 individuals had diabetes, and 10 cases were using metformin.&nbsp;</p> <p><strong>Conclusion</strong>: Apparently, hookah smoking played a critical role in the spread of COVID-19 in Iran and has made younger people more susceptible. In addition to older age, the immunosuppressive effects of Metformin seem to make diabetic patients with an impaired immune system more vulnerable to severe COVID-19 pneumonia. More studies on the immune system of vulnerable individuals by identifying their differences can help to protect them.</p> Seyedreza Mirsoleymani, Seyyed Mojtaba Nekooghadam, Milad Ahmadi Marzaleh, Mahmoudreza Peyravi, Ahmad Soltani, Simintaj Sharififar, Rita Rezaee, Mahnaz Ahmadi, Hossein Akbarialiabad Copyright (c) 2020 Iranian Red Crescent Medical Journal Wed, 30 Sep 2020 15:23:45 +0330 Incidence and Prognostic significance of Signet Ring Cell Histology in Gastric Cancer. A cross sectional study from Turkey <p><strong>objective:</strong> The present study aims to evaluate the incidence of &nbsp;signet ring cell (SRC) histology in patients with gastric cancer and its prognostic significance on the disease stage.</p> <p><strong>Methods:&nbsp; </strong>Between November 2006 and September 2019, 309 patients were reviewed retrospectively in Kartal Koşuyolu High Specialization Training and Research Hospital Gastroenterology Surgery clinic in Turkey and the clinicopathological features and survival status were examined in the presence of ring cell histology.</p> <p><strong>Results: </strong>Of the patients, 71.4% had gastric cancer with a non-SRC histology and 28.6% had an SRC histology. The presence of an SRC histology was found to be associated with young age (p=0.007), advanced depth of wall invasion (p=0.001), number of positive lymph nodes (p=0.022) and presence of vascular invasion (p=0.044). The presence of an &nbsp;SRC histology was associated with good prognosis in patients with stage I gastric cancer (p=0.045), but with poor prognosis in patients with stage III disease (p=0.034). The study found no significant association between stage II disease and overall survival.</p> <p><strong>Conclusions: </strong>The present study found survival to be associated with good prognosis in stage I, and poor prognosis in stage III among patients with gastric cancer with SRC histology. No prognostic significance could be established for overall survival.</p> orhan uzun, Aziz serkan SENGER, Selçuk GÜLMEZ, Cem Batuhan OFLUOGLU, Ayhan ÖZ, Sinan OMEROGLU, Erdal POLAT, Mustafa DUMAN Copyright (c) Thu, 01 Oct 2020 13:25:01 +0330 Value Of High-Resolution Computed Tomography in the Differential Diagnosis of Imported COVID-19 and Seasonal Influenza Pneumonia <p><strong>Background:</strong> Nowadays, the world is facing COVID-19 pandemic, and seasonal influenza is also sweeping the world. Therefore, it is essential to make an early differential diagnosis between imported COVID-19 and seasonal influenza pneumonia.</p> <p><strong>Objectives:</strong> The present study aimed to determine the diagnostic value of high-resolution computed tomography (HRCT) imaging characteristics for imported coronavirus disease 2019 (COVID-19) and seasonal influenza pneumonia.</p> <p><strong>Methods:</strong> The HRCT imaging features with 22 cases of imported COVID-19 and 39 cases of seasonal influenza pneumonia were retrospectively analyzed in the current study. The patients with COVID-19 or influenza were diagnosed according to the World Health Organization guidelines and were confirmed following positive reverse transcription-polymerase chain reaction(RT-PCR) analysis of respiratory secretion samples.&nbsp;</p> <p><strong>Results: </strong>Both imported COVID-19 and influenza demonstrated multiple lesions. In the former, the lesions were mostly distributed in the subpleural of peripheral lung (90.9%), and some of them showed an anti-butterfly wing sign (18.2%; P&lt;0.05). In the latter, the lesions were distributed around the bronchial vascular tree with subpleural lesions in peripheral lung (33.3%); nonetheless, they were fewer than those observed in the former (P&lt;0.05). There were some differences in ground-glass opacity (GGO) (95.5% vs. 66.7%, respectively, P&lt;0.05), consolidation (68.2% vs. 12.8%, respectively, P&lt;0.05), and crazy paving sign (86.4% vs. 10.3%, respectively, P&lt;0.05). The air bronchogram sign in the former appeared earlier than those in the latter. When both GGO lesions were mixed, the latter had more solid areas and higher density.</p> <p><strong>Conclusions:</strong> The different chest HRCT features of COVID-19 and seasonal influenza pneumonia can provide considerable evidence for the early diagnosis of imported COVID-19 and seasonal influenza pneumonia and can be of great help for the prevention and control of COVID-19.</p> Yuange Li, Shiliang Long, Yue Zhao, Zhan Ge, Weiquan Wu, Jun Xia Copyright (c) Thu, 01 Oct 2020 13:26:29 +0330 Difference in Relative Telomere Length Between Sudanese and Chinese Individuals <p><strong>Background:</strong> Racial/ethnic variations in the relative telomere length have been clearly described or infrequently studied. The relative telomere length has emerged as a biological aging marker; however, the difference in the telomere length between Sudanese and Chinese individuals is unclear.</p> <p><strong>Objectives:</strong> The present study examined the difference in the relative telomere length between Sudanese and Chinese individuals.</p> <p><strong>Methods:</strong> The blood samples of Sudanese and Chinese healthy individuals were randomly collected, and their deoxyribonucleic acid was obtained in this study. The relative telomere length was measured by quantitative polymerase chain reaction. The difference in the relative telomere length was analyzed using the Mann-Whitney U test. The degree of distribution in the relative telomere length was assessed using a two-sample Kolmogorov-Smirnov Z test.</p> <p><strong>Results:</strong> According to the obtained results, the difference in the relative telomere length between Sudanese and Chinese individuals was statistically significant (P&lt;0.05). The frequency of the relative telomere length distributed in Chinese individuals was statistically higher than that reported for the Sudanese subjects (P&lt;0.05).</p> <p><strong>Conclusions: </strong>A great difference was observed in the relative telomere length between Sudanese and Chinese populations indicating the difference between Sudanese and Chinese races.</p> Abdelhakam Tamomh, Hui Liu Copyright (c) Tue, 06 Oct 2020 13:39:08 +0330 Mechanical thrombectomy for perioperative acute ischemic stroke: Two noncardiac and non-neurosurgical case reports and a literature review <p><strong>Background:</strong> Perioperative acute ischemic strokes (PAISs) are rare; however, they have potentially catastrophic complications and outcomes. Endovascular therapy is the standard care in appropriately selected patients with acute ischemic stroke; nonetheless, there are no guidelines on the treatment of PAIS, and the majority of the patients receive conservative treatments.</p> <p><strong>Objectives:</strong> This study aimed to present two cases of mechanical thrombectomy (MT) for the treatment of PAIS.</p> <p><strong>Clinical presentation: </strong>The first patient was a 43-year-old female who fell into a coma and had left limb dysfunction three h after undergoing hysteromyomectomy with a National Institute of Health Stroke Scale (NIHSS) score of 22. A right middle cerebral artery (M1) occlusion was detected on computed tomography angiography (CTA) leading to MT. The modified Rankin Scale (mRS) score was obtained at 1 three months after treatment. The second patient was a 59-year-old male who suddenly fell into a coma and had right limb dysfunction three h after undergoing a lung cancer operation with NIHSS score of 24. The CTA showed a left M1 occlusion leading to MT. The mRS score was 1 three months after treatment. Both patients were admitted to and treated in the Wuxi Clinical College of Anhui Medical University, Wuxi, China, in 2018.</p> <p><strong>Conclusion</strong>: The PAIS is a rare but serious complication after noncardiac surgery. In both cases, diagnosis and treatment were very difficult. Further evidence was provided to regard MT as a useful and safe method to treat PAIS.</p> Xun Zhu, Hong Li, Zhonghua Shi, Li Zhang, Xiaoyan Feng, Lixiang Yang, Jiaming Cao, Junhui Chen Copyright (c) Wed, 07 Oct 2020 13:23:41 +0330