Iranian Red Crescent Medical Journal <p>The Iranian Red Crescent Medical Journal (IR<span style="color: #ff0000;">C</span>MJ) is an international, open access, peer-reviewed, monthly, and ISI- Journal, affiliated to&nbsp;<strong>Iranian Hospital- Dubai</strong>, publishes original scientific studies in English that have direct clinical significance on&nbsp;<span style="color: #0033ff;">Basic Science, Clinical Medicine, Humanitarian Assistance, Trauma, and Disaster Management</span>.&nbsp;The journal strives to strengthen connections between research and practice, so enhancing professional development and improving practice within the field of medicine. Original papers submitted to this journal which do not adhere to the Instructions for Authors will be returned for appropriate revision to be in line with the Instructions for Authors. They may then be re-submitted.</p> ZamenPub en-US Iranian Red Crescent Medical Journal 2074-1804 Xanthogranulomatous Cholecystitis: Our Clinical Experience <p><strong>Background:</strong> Xanthogranulomatous cholecystitis is a rarely encountered chronic inflammatory condition presenting with severely proliferated fibrotic tissue. It usually spreads the neighboring organs, imitates gallbladder cancer and may lead to difficulty in cholecystectomy.</p> <p><strong>Objectives</strong><strong>:</strong> The present study was directed towards reviewing the results of medical examinations and surgery for xan-thogranulomatous cholecystitis and providing proper surgical treatment for patients with xanthogranulomatous cholecystitis.</p> <p><strong>Methods:</strong> This is an observational study in which clinical features of thirty six patients with diagnosis of cholecystitis who were operated in our institute between 2012 and 2019 and found as xanthogranulomatous cholecystitis on pathology were analyzed.</p> <p><strong>Results:</strong> The rate of xanthogranulomatous cholecystitis in cholecystectomy patients was found to be 0.6 % (36/5999) in the hospital where this study was performed over 7 years. Xanthogranu-lomatous cholecystitis was not accompanied by gallbladder carcinoma in any of these cases. Xanthogranulomatous cholecystitis could not be diagnosed in any of the patients prior to surgery. Radiological imaging performed before surgery demonstrated cholelithiasis in 29 patients (80.6 %), thickening of the gallbladder wall in 28 patients (77.8%), and suspicious cancer in two patients (5.6%). However, none of the cases of xanthogranulomatous cholecystitis had concomitant gallbladder cancer.&nbsp; Nine&nbsp; (25%) patients underwent open cholecystectomy and Twenty seven patients (75 %) were scheduled to have laparoscopic cholecystectomy, but six of these patients&nbsp; (16,8%)&nbsp; were converted to open cholecystectomy.</p> <p><strong>Conclusion:</strong> To conclude, it is still difficult to distinguish xanthogranulomatous cholecystitis from other gallbladder diseases both before and during surgery. The gallbladder commonly adheres to the neighboring organs and tissues and make surgical treatment difficult. A challenging laparoscopy is commonly converted to open surgery, which results in higher rates of complications as compared with standard open or laparoscopic cholecystectomy.</p> Osman Erdogan Alper Parlakgumus Alper Sozutek Umit Turan Zeynel Abidin Tas Oktay Irkorucu Copyright (c) 2021 Iranian Red Crescent Medical Journal 2021-11-15 2021-11-15 23 11 10.32592/ircmj.2021.23.11.1266 Comparison of rarely seen tumors of the colorectal region clinicopathologically <p>Background: Majority of colorectal neoplasms are adenocarcinomas but there is a small percentage of tumors from other histological cell lines</p> <p>Method: One thousand one hundred patients who were applied surgical treatment due to colorectal cancer at general surgical clinic between years of 2010-2020 were examined. Patients have been grouped as Diffuse large b cell lymphoma (DLBCL) (group1), Malignant melanoma (group2), Medullary carcinoma (group3), Neuroendocrine tumor (group4) and they were included in the study in this way. In the groups,clinicopathological data of patients and their survival periods have been compared. </p> <p>Results: Twenty patients are included in our study: Group 1 was composed of 5, Group 2 was composed of 4, Group 3 was composed of 3, and Group 4 was composed of 8 patients. Emergency application rate (60%) was higher in Group 1 (p: 0.004). A verage age was above 50 in 4 groups and there was no difference between groups (p:0,966).Tumor diameter was on average (cm)(8 vs 6,55 vs 5,4 vs 3,75 p:0,073) in the groups, The number of lymph nodes dissected were (13 vs 14.5 vs 19 vs 19 p:0.373) The number of metastatic lymph nodes were ( 0 vs 1.5 vs 0 vs 0.5 p:0.188). Survival was significantly shorter in the malignant melanoma group, the longest survival was in the neuroendocrine tumor group (15.625vs8.5vs20 vs 40.857 p:0.001)</p> <p>Conclusions: Although clinicopathological features and postoperative follow-up results were similar, there were differences in survival among patients. Maligant melanoma histopathological type had a worse prognosis than other tumors</p> Muhammet Akyüz Ugur Topal Mahmut Kültüroğlu Erdogan Sozuer Fatih Dal Tutkun Talih Kemal Deniz Hizir Akyildiz Copyright (c) 2021 Iranian Red Crescent Medical Journal 2021-11-15 2021-11-15 23 11 10.32592/ircmj.2021.23.11.1404 Structure Model of Foresightful Export Oriented Strategies for Iran Pharmaceutical Industry: Using a Fuzzy DEMATEL Method <p><strong>Background:</strong> Export orientation is one of the main approaches in developing Iran's pharmaceutical industry as a key health-related part of industries. It is necessary to identify, formulate and implement some foresightful strategies and strategic plans toward adopting the export approach in the Iran pharmaceutical industry.</p> <p><strong>Objectives:</strong> This paper aims to identify, prioritize and develop a structure model of foresightful export-oriented strategies and strategic plans for Iran's pharmaceutical industry.</p> <p><strong>Methods:</strong> Data gathering for identifying strategies conducted through literature review and some interviews with pharmaceutical industry experts analyzed through qualitative content analysis. Then fuzzy DEMATEL technique is used to prioritize and develop cause and effect and structure the model of identified strategies.</p> <p><strong>Results:</strong> Policy modification, privatization, smart self-sufficiency in production, knowledge management in both national policy and industry firm's levels, and quality improvement in all aspects of production and products were identified as foresightful export-oriented strategies and plans for Iran pharmaceutical industry.</p> <p><strong>Conclusion:</strong> Privatization is the most effective and important foresightful export-oriented strategy in Iran's pharmaceutical industry.</p> Abdollah Jassbi Mostafa Jafari Mohammad Mahdavi Mazdeh Mansour Maleki Copyright (c) 2021 Iranian Red Crescent Medical Journal 2021-11-15 2021-11-15 23 11 10.32592/ircmj.2021.23.11.1113 Use of Penalized Count Regression to Determine Factors Affecting the Length of Stay of Trauma Patients in the Intensive Care Unit <p><strong>Background:</strong> Trauma is considered an important issue in most countries. Identification of the factors affecting the length of stay (LOS) in the intensive care unit (ICU) plays a crucial role in controlling the costs and complications of prolonged hospitalization.</p> <p><strong>Objectives: </strong>This study aimed to identify the factors affecting the LOS of trauma patients in the ICU using stepwise and new penalized variable selection methods in count data regression.</p> <p><strong>Methods:</strong> The patients’ information was evaluated in Emtiaz Hospital and Shahid Rajaee trauma center in Shiraz from March 2016 to September 2017. Count regression model was used to determine the factors affecting the LOS of patients in the ICU using penalized variable selection including, Enet, Snet, and Mnet.</p> <p><strong>Results:</strong> The mean age of the patients (n=382) was obtained at 36.7±16.7 years, and the majority (88.4%) of the patients were male. The mean LOS in the ICU was determined at 6.2±6.6 days. Mnet with a negative binomial distribution outperformed the other penalized variable selection methods. A Glasgow Coma Scale (GCS) of less than 9 (IRR=1.7), blunt brain trauma (IRR=1.8), chest trauma (IRR=2.2), and oxygen saturation of less than 90 (IRR=1.2) increased the LOS of trauma patients in the ICU.</p> <p><strong>Conclusions:</strong> Penalized variable selection methods effectively ignore or control the existing correlations between predictors. Amongst the penalized models, Mnet provided more acceptable results with smaller Akaike information criterion and fewer predictors. According to this penalty, the most important factors affecting the length of stay were chest trauma, blunt brain trauma, GCS, and oxygen saturation rate. Most clinical studies on trauma have also shown the importance of these factors.</p> Zahra Shayan Shahram Paydar Fatemeh Maghsoudi Ali Taheri Akerdi Leila Shayan Copyright (c) 2021 Iranian Red Crescent Medical Journal 2021-11-15 2021-11-15 23 11 10.32592/ircmj.2021.23.11.1278 A Survey of HIV/AIDS Awareness Campaign based on the Kirkpatrick Model <p><strong>Background</strong>: Acquired immunodeficiency syndrome (AIDS) is a pandemic and a health challenge in the world, posing a serious risk to people from all walks of life. Awareness Campaign has been increasingly used in recent years to convey persuasive messages to perform specific behaviors in the target group. The present study aimed to determine the effectiveness of AIDS prevention and awareness campaign in students using Kirkpatrick’s Evaluation Model.</p> <p><strong>Methods</strong>: This cross-sectional study was conducted in border areas of Sarvabad City, Iran, in 2018. A total of 564 high school students were randomly selected. This research was performed based on the Kirkpatrick model which considers the effectiveness of training programs in four levels of reaction, learning, behavior, and results. The required data were collected by a questionnaire based on the Kirkpatrick model. The media used in this campaign included: banners, pamphlets, videos, and training by health experts. Data were analyzed in SPSS software (version 20).</p> <p><strong>Results:</strong> The most attractive media used in the awareness campaign for participants were training provided by health professionals (speech and Q&amp;A session), as well as educational videos, pamphlets, and banners, respectively. Based on the results, students' awareness and behavior significantly improved after the campaign by 51.6% and 25.6%, respectively (P≤0. 00).</p> <p><strong>Conclusion</strong>: As evidenced by the results of the present study, the Kirkpatrick model was effective and can be employed to evaluate the awareness campaign since it demonstrates the positive changes caused by training in reaction, learning, and behavior. Therefore, effectiveness evaluation in all subjects needed to be improved through the implementation of optimizing training design.</p> Afshin Bahmani Copyright (c) 2021 Iranian Red Crescent Medical Journal 2021-11-15 2021-11-15 23 11 10.32592/ircmj.2021.23.11.1429 Geographic Distribution of Excess Mortality Rate duo to COVID-19 in Iranian Population: An Ecological Study <p><strong>Introduction:</strong> COVID-19 has raised world concern since it emerged in Wuhan, China in December 2019. &nbsp;The direct and indirect death rates in the world and in Iran have increased significantly after the occurrence of this pandemic in the world.</p> <p><strong>Objective:</strong> In this study EMR estimated by Multilevel Poison Regression then this estimation compared to the historical trends, to obtain total death related to the COVID-19 in addtion the geographic distribution of EMR has been presented for Iran country.</p> <p><strong>Materials and Methods: </strong>All-cause mortality count of each province of Iran from March 21, 2013 to June 20, 2020 downloaded from National Organizationfor Civil Registration (NOCR). The data from spring of 2020 (March 20, 2020 to June 20, 2020) remove from data and then the multilevel poison model has been used to estimate all-cause mortality in spring 2020 then excess mortality attributable to COVID-19 (the difference between the numberof registered and expected deaths) has been calculated.</p> <p><strong>Results: </strong>The results of this study showed that Iran’s EMR in spring 2020 was 23% (Male=25%, Female=21%). More result also showed that four category low (EMR≤5%, n=3), moderate (5 %&lt; EMR&lt;20%, n=10), high (20 %&lt; EMR&lt;40%, n=16) and very high (40≤EMR, n=2) EMR.</p> <p><strong>Conclusion: </strong><strong>&nbsp;</strong>Due to the diverse EMR in different provinces of Iran, the type of management of provinces with low and moderate EMR can be used as a suitable model to control EMR in provinces with high and very high EMR.</p> Mohammad Gholami Fesharaki alireza molaei Copyright (c) 2021 Iranian Red Crescent Medical Journal 2021-11-15 2021-11-15 23 11 10.32592/ircmj.2021.23.11.1208 Iran may become the center of challenges in Middle East for outbreak of delta variant-COVID-19 <p>During the past three decades, the Middle East has been one of the important areas that has experienced three major viral epidemics. COVID-19 as a pulmonary disease was first reported in China in the early third decade of the 21st century and quickly infected Asian countries, the Middle East, and then the entire world. The pandemic has caused widespread financial damage and life-threatening, but the exact extent of the damage is still unclear. The high prevalence of COVID-19 has created fright in public societies and disrupted many everyday tasks. The disease has various clinical symptoms that are updated daily by different researchers. Many countries that do not have the sufficient tools to prevent, identify and treat the virus still have major challenges in controlling the disease. The Middle East, where Iran has been under heavy economic and political sanctions, has faced widespread disease and deaths due to lack of facilities. These challenges affected not only Iran but also many neighboring countries and other related countries. Recently, concerns have doubled with the outbreak of the delta variant-COVID-19 because the risk of hospitalization and the rate of spread are higher. The purpose of this review was to present the latest on the symptoms, pathogenicity and host immune responses, Etiology and Epidemiology, transmission routes and impact of Middle Eastern countries, especially Iran, and its role in the spread of the disease.</p> Pegah Shakibnia Razieh Heidari Ahmadi Faezeh Fallah Farnoosh Ebrahimzadeh Amin Sadeghi Dosari Ali Mojtahedi Nayereh Hajipour Maryam Sharifi Luyeh Majid Taati Moghadam Copyright (c) 2021 Iranian Red Crescent Medical Journal 2021-11-15 2021-11-15 23 11 10.32592/ircmj.2021.23.11.1394 The Effect of Anti-anxiety Medications on the Clinical Symptoms of Anal Fissure: A Randomized Clinical Trial <p><strong>Background:</strong> Fissure is a common chronic anorectal disease that causes symptoms such as pain, burning, bleeding, and psychiatric problems. One of the psychiatric complications is anxiety, which might be an etiologic factor or secondary to the disease.</p> <p><strong>Materials and Methods:</strong> A total of 160 patients with anal fissure were randomly divided into two groups (80 patients treated with anti-anxiety medications along with standard anal fissure treatment and 80 patients with standard anal fissure treatment alone) after obtaining patient consent and demographic data. Then, the symptoms have recorded after treatment.</p> <p><strong>Results: </strong>The results of our study indicated that the administration of anti-anxiety medications in patients with anal fissures relieved pain and anxiety scores among all patients. The anti-anxiety medications were more effective on patients younger than 40 years, men with less than two weeks duration of illness, and baseline anxiety greater than 26.</p> <p><strong>Conclusion: </strong>A high prevalence of anal fissures affects the quality of life of patients. Besides the lack of effective treatment that shortens the pain and recovers patients faster, anti-anxiety medications such as benzodiazepines can use along with standard anal fissure treatment to reduce pain and anxiety in patients with acute anal fissure.</p> Ali Mirsadeghi Narges Novin Seyed Mohammad Ali Raisolsadat Maryam Javanbakht tooraj zandbaf Copyright (c) 2021 Iranian Red Crescent Medical Journal 2021-11-15 2021-11-15 23 11 10.32592/ircmj.2021.23.11.1167 Experimental Study of Rhein Inhibiting the Invasion and Migration of the HepG2 Cells by Extracellular Signal-Regulated Kinase Signaling Pathway <p><strong>Background</strong><strong> and Objectives: </strong>This study aimed to investigate the effect of rhein on the proliferation, invasion, and migration of the HepG2 cells through the extracellular signal-regulated kinase (ERK) signaling pathway.</p> <p><strong>Methods:</strong> Human hepatoma cell line (HepG2) was treated with different concentrations of rhein (Rhein treatment group) and cultured in a culture medium alone (control group). The proliferation activity of the cells was determined by methyl Thiazolyl Tetrazolium colorimetry. Transwell assay detected the invasion and migration of the cells in each group. Cell scratch test was used to detect the migration ability of cells in each group. Excella-phospho ERK (p- ERK) activity was determined by ELISA after treatment with 50μ mol/L rhein at different times. Western blot was employed to detect the ERK protein expression in the HepG2 cells treated with 50 μmol/L of rhein.</p> <p><strong>Results:</strong> The proliferation activity, invasion, and migration ability of the HepG2 cells in the rhein-treatment group were all decreased, compared to the control group (P&lt;0.05), and the p-ERK relative activity of the HepG2 cells treated with rhein was decreased (P&lt;0.05).</p> <p><strong>Conclusion:</strong> Rhein inhibits the invasion and migration of the hepatocellular carcinoma cells possibly by inhibiting the ERK pathway.</p> <p> </p> Yan Wang Lin Liu Na Li Junhua Zhou Lijian Du Copyright (c) 2021 Iranian Red Crescent Medical Journal 2021-11-15 2021-11-15 23 11 10.32592/ircmj.2021.23.11.1310 Social Mental Health during COVID-19 Pandemic in Iran: A cross-sectional study among the general population of Razavi Khorasan province, Iran <p>Background: The potential impact of the novel coronavirus pandemic on social mental health has become a great concern and the current situation can cause different mental disorders. According to the importance of mental health, we performed this study to evaluate the mental health status of the general population of Iran in Razavi Khorasan province.</p> <p>Methods: The online survey was conducted and made available for the general population of Razavi Khorasan through the snowball sampling technique within a week. the demographic information, contact history with COVID-19, and physical symptoms history of COVID-19 were collected by the survey. To maintain the population's mental health status, the Depression, Anxiety, and Stress Scale (DASS-21) were used. Filling the online survey by a maximum of two members of a family was considered to reduce the risk of bias.</p> <p>Results: Finally, 461 responders from Razavi Khorasan province were included in this study. In total, 41.8% of responders investigated the depression symptoms, 32.1% were in anxiety mood and 34.5% had stress symptoms. The ratio of men to women was approximately 1:2. Most responders were in the of 30-40 years and the most frequent marital status was being single. Families with 3-5 members were organized the 81.5% of responders. Near one-third of the studied population was in bachelor as educational status.</p> <p>Conclusion: According to our study paying attention to the general population’s mental health status is important during the COVID-19 pandemic and conducting protocols to prevent or reduce the risk of mental disorders that can be caused by the current situation.</p> Maliheh Dadgarmoghaddam Mona Najaf Najafi Alireza Ebrahimi Ali Talaei Neshat Najafnajafi AmirAli Moodi Ghalibaf Copyright (c) 2021 Iranian Red Crescent Medical Journal 2021-11-15 2021-11-15 23 11 10.32592/ircmj.2021.23.11.1010 An uncommon presentation of varicose vein <p><strong>Background:</strong> Pulsating varicose vein is a very rare clinical manifestation and mostly has been reported with tricuspid regurgitation or right ventricular dysfunction. The exact etiology and treatment options for this disease are rarely reported in the literature.</p> <p><strong>Case Presentation:</strong> This article presents the case of a 45-year-old woman with varicose veins in both her lower limbs when she came to our department. Venous ultrasound showed arterial-like pulsations in both superficial and deep veins of the lower extremities, and echocardiography showed severe tricuspid regurgitation. We administered compression therapy with elastic stockings, and the symptoms of the patient were significantly relieved. In addition, in this article, we reviewed other cases reported in the current literature and discussed appropriate treatment options for this disease.</p> <p> </p> Xinpei Ren Zhoupeng Wu Yukui Ma Copyright (c) 2021 Iranian Red Crescent Medical Journal 2021-11-15 2021-11-15 23 11 10.32592/ircmj.2021.23.11.1203 Association between Maternal and Fetal MTHFR C677T and MTRR A66G Polymorphisms with the Risk of NTDs: A Systematic Review and Meta-Analysis Study <p><strong>Background:</strong> Neural tube defects (NTDs) are classed as multifactorial birth defects of the brain and spinal cord that arise during embryonic development. Although the etiology is not well understood, NTDs are reported to be prevented by maternal folic acid supplementation before and during early pregnancy. This meta-analysis study aimed to assess the association between fetal and maternal methylenetetrahydrofolate reductase (MTHFR) C677T and methionine synthase reductase (MTRR) A66G polymorphisms with the risk of NTDs.</p> <p><strong>Methods:</strong> The PubMed, Scopus, and Springer Link databases were searched (from March 2000 to November 2020) for the literature on the association between MTHFR C677T and MTRR A66G polymorphisms with the risk of NTDs.</p> <p><strong>Results:</strong> In total, 33 studies were reviewed in the present study, and it was revealed that, unlike MTRR A66G polymorphism, MTHFR C677T was statistically associated with the risk of NTDs in the overall population. The results of subgroup analysis showed that the Indian subcontinent subgroup with maternal MTHFR C677T polymorphism and the European subgroup with fetal MTHFR C677T polymorphism was significantly susceptible to NTDs.</p> <p><strong>Conclusion:</strong> The obtained results revealed that, unlike MTRR A66G, maternal and fetal MTHFR C677T polymorphism was significantly associated with NTDs. Subgroup analysis also demonstrated that folic acid deprivation can be considered the main cause of MTHFR C677T polymorphism in some areas.</p> Reza Mahdian Joibari Abolfal Movafagh Alireza Molaei Copyright (c) 2021 Iranian Red Crescent Medical Journal 2021-11-15 2021-11-15 23 11 10.32592/ircmj.2021.23.11.1350