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 Enhancement of the Differentiation Potential of Adipose Tissue-Derived Mesenchymal Stem Cells into Insulin-Producing Cells Using Flavonoid Compounds in Diabetic Rats <p><strong>Background: </strong>Differentiation of stem cells into pancreatic beta cells is a global challenge in reconstructive medicine for the treatment of diabetes. Studies have shown that compounds derived from walnut green skin can differentiate stem cells into beta cells. Flavonoid compounds appear to be the main cause of this differentiation.</p> <p><strong>Objectives:</strong> This study examined the effect of flavonoid compounds in walnut green skin on the differentiation of pancreatic beta cells.</p> <p><strong>Methods:</strong> The present study conducted the differentiation of adipose tissue-derived mesenchymal stem cells (AD-MSCs) into insulin-producing cells under flavonoid extract at doses of 50 and 100 mg/ml for three weeks. For diabetic rats, streptozotocin was injected intraperitoneally at a dose of 60 mg/kg. To evaluate cell differentiation, this study utilized morphology, dithizone (DTZ) staining, insulin-proinsulin production, insulin beta-receptor by the immunofluorescence method, and insulin measurement by the ELISA method. Serum glucose, cholesterol, and lipids were measured by enzymatic colorimetric, enzyme kit, and autoanalyzer, respectively. The expression of pancreatic cell-specific genes, including Pancreatic and Duodenal Homeobox 1 (Pdx1) and Neurogenin-3 (Ngn3), was also assessed by real-time PCR.</p> <p><strong>Results:</strong> Differentiated cells transformed from spindle-shaped to circular or clustered cells under the influence of flavonoid compounds with their specific DTZ staining being positive. The expression of insulin-proinsulin markers, beta receptors, and insulin secretion was also confirmed. Decreased blood lipids and glucose, as well as increased expression of Pdx1 and Ngn3 insulin-producing genes, were significant in the treatment groups (P&lt;0.05).</p> <p><strong>Conclusion:</strong> The findings showed that flavonoid compounds could effectively induce the differentiation of AD-MSCs into insulin-producing cells.</p> Sima Mashayekh Mahnaz Azarnia Esmail Fattahi Reza Moghadasali Copyright (c) 2022 Iranian Red Crescent Medical Journal 2022-07-24 2022-07-24 24 7 Nurses' Experience of Care Challenges of Hospitalized Patients with Obesity: A Qualitative Content Analysis Study <p><strong>Background</strong>: Nurses have difficulties in caring for patients with obesity (PWO) due to their large size and complex care needs. As there have been few studies on these challenges, it is necessary to identify them for PWO through access to nurses’ experiences.</p> <p><strong>Objectives:</strong> This study aimed to explain the nurses’ experiences of the challenges of caring for admitted PWO.</p> <p><strong>Methods</strong>: This qualitative study was performed on 12 nurses working in two large urban teaching hospitals in Iran. They were selected using the purposive sampling method. Data were collected using semi-structured interviews during 2018-2020. Content analysis and MAXQDA software (version 10) were used to analyze data.</p> <p><strong>Results</strong>: According to the results, "threat to the patient safety" was the main theme extracted from nurses’ experiences, which included three categories, namely "from care difficulty to inaccurate care", "exacerbation of clinical complications", and "limited self-care". The category of "from care difficulty to inaccurate care" consisted of the subcategories of "care difficulty" and "inevitability of performing inaccurate care". The category of "exacerbation of clinical complication" was composed of the subcategories of "domino-like deterioration of the clinical condition", "multiple physical problems", "patient injury", and "death". The category of "limited self-care" included the subcategories of "patient difficulties with personal hygiene", "limited ability to move/change position", and "inability to meet defecation needs".</p> <p><strong>Conclusion</strong>: According to nurses, "threat to patient safety" was the main challenge of caring for PWO. Patients with obesity could receive competent care from nurses who have a thorough awareness of the obesity threat to patient safety.</p> Maryam Bagheri Abbas Heidari Zahra Sadat Manzari Copyright (c) 2022 Iranian Red Crescent Medical Journal 2022-07-24 2022-07-24 24 7 Comparison of Non-teaching Hospitals and Teaching Hospitals: in Iran as an Integrated Medical Education System and Health Services <p><strong>Background:</strong> Hospitals, like other organizations, are complex social systems influenced by elements such as staff, resources, and structures that work to achieve specific goals. In terms of goals and missions, hospitals are divided into teaching and non-teaching categories. There are many differences in the nature and needs of these two types of hospitals that must be considered for proper operation by policy makers and managers.</p> <p><strong>Objectives: </strong>The present study investigated the comparison of non-teaching and teaching hospital in Iran.</p> <p><strong>Method</strong>: a qualitative study was conducted using semi-structured interviews according to an interview guide with 40 Iranian hospital managers and policy makers through a purposive sampling in 2021. Thematic analysis using inductive approach and MAXQDA 10 was used for data analysis.</p> <p><strong>Results</strong>: According to the results Main categories extracted as follows: legal and social responsibility, cost-effectiveness and efficiency, supply of resources, empowerment of human capital, goals and mission, external and internal communications, revenue-cost management, organizational structure, customer satisfaction, organizational behavior, clinical and support departments, hospital processes, type and level of services, manpower, performance evaluation, organizing the teaching mission.</p> <p><strong>Conclusion: </strong>complexity and instability of command unity in teaching hospital, understanding the differences of organizational hierarchy, developing a mechanism to cover costs for clients, considering increase the legal and social responsibility of the management team, prioritizing organizational goals, coordinating policy demands with Providing resources, funding the teaching mission, organizing the multiple supervisory organizations, transparent communication between hospital and colleges, understanding the complexity of processes, considering the change of individual and group communication, considering change the performance appraisal system and pay for performance were the practical findings that policymakers should be considered in providing the resources and facilities needed for hospitals based on the type of function.</p> <p> </p> <p> </p> niusha shahidi sadeghi hasan abolghasem gorji Copyright (c) 2022 Iranian Red Crescent Medical Journal 2022-07-24 2022-07-24 24 7 Effects of Endoscopic Submucosal Dissection in Patients with Early Gastric Carcinoma on Postoperative Life Satisfaction and Serum Livin, Epidermal Growth Factor, and IL-8 Levels <p><strong>Background</strong>: Few studies have investigated the changes in postoperative quality of life; serum Livin, epidermal growth factor (EGF), and IL-8 levels; and traumatic stress in patients with early gastric carcinoma after endoscopic submucosal dissection.<br /><strong>Objectives:</strong> We aimed to determine the effect of endoscopic submucosal dissection on postoperative life satisfaction and serum Livin, EGF, and IL-8 levels in early gastric carcinoma patients.<br /><strong>Methods</strong>: Seventy-three early gastric carcinoma patients were divided into the control (n = 35) and observation (n = 38) groups based on surgical approaches and were retrospectively analyzed.<br /><strong>Results</strong>: The operative time, gastrointestinal recovery time, length of hospital stay, perioperative bleeding, EQ-VAS scores, GAS and MTL levels were significantly superior to those in the control group, whereas serum Livin, EGF, IL-8 and CRP levels as well as the total incidence of postoperative complications were significantly lower in the observation group than in the control group (all <em>P</em> &lt; 0.05).<br /><strong>Conclusion</strong>: Endoscopic submucosal dissection in early gastric carcinoma patients provides the advantages of a short operative time, less perioperative bleeding, rapid postoperative recovery, and less traumatic stress and postoperative complications as well as reduced serum Livin, EGF, IL-8, and tumor marker levels.</p> Lu Xing Qiupeng Du Copyright (c) 2022 Iranian Red Crescent Medical Journal 2022-07-24 2022-07-24 24 7 Incidence of Atypical Change and Risk of Breast Cancer in Patients with Gynecomastia <p><strong>Background:</strong>Although it is generally accepted that gynecomastia poses no risk of male breast cancer (MBC), the incidence of atypical changes observed in gynecomastia and their effects on the risk of MBC has been investigated recently.</p> <p><strong>Objectives: </strong>Therefore, with follow-ups in our series, the present research was conducted to determine the incidence of atypia and its effect on breast cancer in gynecomastia cases.</p> <p><strong>Methods:</strong></p> <p>A total of 151 breast tissues were surgically removed from 108 patients between the ages of 12-90. Atypia was investigated based on gynecomastia in the preparations sampled from these tissues.</p> <p><strong>Results:</strong> Around 22 simple hyperplasia, eight atypical ductal hyperplasia (ADH), and one ductal carcinoma in situ were found in 151 breast tissues. Breast cancer was not observed in any patients during the follow-up period. Atypical ductal hyperplasia was seen in younger patients compared to simple hyperplasia (<em>P</em>=0.021). No relationship was observed between lesion size and the incidence of atypia (<em>P</em>=0.538).ICC values for seven components of geriatric nursing-specific Mini-CEX ranged from 0.639 to 0.919, indicating an acceptable level of reliability for this scale. The mean score of overall geriatric competence was (M= 6.12, SD=.33), which indicated that the geriatric competencies of students enrolled in the study were at a satisfactory moderate level. The highest and the lowest mean scores were observed in history taking /communication (M= 6.71, SD=.71) and physical examination skills (M= 4.99, SD=.67), respectively.</p> <p><strong>Conclusion:</strong> According to the findings of this study, ADH determined in cases with gynecomastia pose no risk of breast cancer in parallel with the current data in the literature. However, it is accepted that the presence of atypia based on gynecomastia needs to be investigated in series with a large number of cases.</p> <p> </p> <p> </p> Ramazan Ucak Emir Çapkınoğlu Canan Tanık Fevziye Kabukcuoglu Copyright (c) 2022 Iranian Red Crescent Medical Journal 2022-07-24 2022-07-24 24 7 Efficacy and Safety of Concurrent Chemoradiotherapy with Docetaxel for Locally Advanced Breast Carcinoma after Modified Radical Mastectomy <p><strong>Background: </strong>Breast cancer is a common term for a malignant tumor that arises from the epithelial component of the breast. Concurrent chemoradiotherapy’s efficacy and safety are controversial, considering the impact on patients' quality of life.<br /><strong>Objective:</strong> To investigate the efficacy and safety of concurrent chemoradiotherapy with docetaxel in locally advanced breast cancer who have received a modified radical mastectomy.<br /><strong>Methods: </strong>A cohort of 110 female patients with locally advanced breast cancer were included in the present study and divided by chemoradiotherapy mode into a concurrent chemoradiotherapy group (n=58) and a sequential chemoradiotherapy group (n=52). The two groups were compared with respect to clinical efficacy, levels of tumor markers across vascular endothelial growth factor (VEGF), and carcinoembryonic antigen (CEA).<br /><strong>Results: </strong>The overall response rate came at 45.83% in the concurrent group and 40.48% in the sequential group. There was no remarkable difference in VEGF and CEA levels between the two groups (P &lt; 0.05); After treatment, the levels were significantly lower than those in the same group before treatment (P &lt; 0.05). The median survival time was 26 months in the concurrent group and 25 months in the other group, while their 3-year survival rates varied greatly (79.17% for the concurrent VS 69.05% for the sequential) (P&gt;0.05).<br /><strong>Conclusion: </strong>The chemotherapy protocol with a combination of cyclophosphamide, fluorouracil and epirubicin with concurrent docetaxel presented higher efficacy and prolonged the overall survival in locally advanced breast cancer patients who had undergone a radical mastectomy, while it did not significantly increase the toxicity.</p> Juanni Wang Chunyan Wei Wei Liu Baofeng Wang Qiang Han Copyright (c) 2022 Iranian Red Crescent Medical Journal 2022-07-24 2022-07-24 24 7 Mobile Health Intervention Effect on Health-Related Quality of life among Cardiac Syndrome X Patients <p><strong>Background</strong>: Cardiac syndrome X(CSX) is a heart condition associated with Microvessel dysfunction, causing angina with severe chest pain. The CSX often severely impairs the quality of life and imposes a considerable additional cost burden on the health care system.</p> <p><strong>Objective: </strong>The present study aimed to assess the effectiveness of mobile health (mHealth) intervention on health-related quality of life (HRQoL) among CSX patients.</p> <p><strong>Methods:</strong> This randomized control trial (RCT) study was conducted at the Clinic of Tehran Heart Centre from March to August 2019. A total of 100 CSX outpatients were selected by randomized sampling and assigned to the intervention (n=50) and control groups (n=50). This study was focused on the effectiveness of the mHealth intervention in HRQoL. The pre-test and post-test were conducted via questionnaires.</p> <p><strong>Results: </strong>Repeated measure MANOVA test for both groups across time pointed to a significant difference between the two groups in HRLQoL subscales at a 0.05 level of significance (F (3,95) = 7.358; P&lt;0.001; Wilk's Λ = 0.811, η2= 0.189). The result indicated the positive effect of the intervention on HRQoL for CSX patients. Bonferroni test also revealed that the experimental and control groups did not differ significantly in three subscales of the questionnaire in the pre-test (P&gt;0.05); nonetheless, they were significantly different in the post-test (P&lt;0.05).</p> <p><strong>Conclusion: </strong>The HRQoL is considered an essential outcome measure in cardiac diseases, especially CSX, which is associated with impaired HRQoL. As evidenced by the results of the current study, the mHealth program, as a low-cost intervention, can promote the HRQoL among these patients.</p> Soraya Malekzadeh Copyright (c) 2022 Iranian Red Crescent Medical Journal 2022-07-24 2022-07-24 24 7 Investigation of the Apoptotic Effect of Levofloxacin on Ovarian Follicles of NMRI Mice and its Anticancer Effect on Human Ovarian Cancer Cell Line <p><strong>Background:</strong>Levofloxacin is a fluoroquinolone antibiotic with extensive anti-bacterial effects.</p> <p><strong>Objectives: </strong>This research surveyed the cytotoxicity effects of levofloxacin on ovarian follicles of mice in both <em>in vitro</em> and <em>in vivo</em> conditions, as well as its anticancer effect on human ovarian cancer cell line (SKOV3).</p> <p><strong>Methods:</strong> For <em>in vitro</em> study, the ovaries of animals were isolated and treated with levofloxacin at doses of 1, 2, 5, and 10 µg/ml for 6 days. For <em>in vivo</em> study, animals were treated with levofloxacin at concentrations of 100, 200, 400, and 800 mg/kg for 24 days. Histopathological and morphological examinations of ovarian tissues were performed. Real-time PCR and Western Blot techniques were performed to analyze apoptosis-related genes and proteins of ovarian tissues.</p> <p><strong>Results:</strong> Levofloxacin at higher concentrations caused morphological changes and remarkably decreased the number of primary, secondary, and adult follicles compared to the control group. The percentage of viable SKOV3 cells was 10.12%, 7.63%, and 2.17% following exposure to levofloxacin (at a concentration of 800 μg/ml) for 24, 48, and 72 h, respectively. The half-maximal inhibitory concentration of levofloxacin against SKOV3 was found to be 181.1, 74.84, and 27.58 μg/ml at 24, 48, and 72 h, respectively. The percentage of SKOV3 cells apoptosis following exposure to levofloxacin after 72 h at 20, 80, and 200 μg/ml doses was 11%, 42%, and 52%, respectively. Real-time PCR revealed up-regulation of <em>Bax</em> and <em>Caspase-3</em> genes after exposure to levofloxacin in SKOV3 cells, whereas the expression of <em>Bcl2</em> was significantly decreased in a concentration-depended manner.</p> <p><strong>Conclusion:</strong> The present study demonstrates that levofloxacin induces apoptosis of both ovarian follicles and human ovarian cancer cell lines.</p> <p> </p> <p> </p> Sedigheh Sadat Borhani Nasim Hayati Roodbari Nasrin Heidarieh Kambiz Roshanaei Copyright (c) 2022 Iranian Red Crescent Medical Journal 2022-07-24 2022-07-24 24 7 COVID-19 patients from hospitalization to tracheostomy, the experience of a ‎high volume center <p><strong>Background</strong>: Decision-making and planning considering tracheostomy are not clear yet.<br /><strong>Objectives</strong>: We aimed to report tracheostomy rates in different settings of admitted patients and compare tracheostomy outcomes in COVID-19 and non-COVID patients regarding both technics including surgical and Percutaneous dilational tracheostomy.<br /><strong>Methods</strong>: From Feb. 2020 to May 2021 admitted patients at Masih Daneshvary hospital were assessed respecting intubation and tracheostomy rate. Different aspects of tracheostomy and outcome were compared in both methods of tracheostomy including surgical vs. percutaneous. Among Non-COVID patients, 15 ICU admitted patients with different etiologies of pneumonia who required mechanical ventilation and tracheostomy were randomly selected and were compared with COVID patients.<br /><strong>Results</strong>: A total of 7748 covid19 patients were admitted and an average rate of 12.7% of the patients were admitted to ICU with an intubation rate of 5.13%. Tracheostomy was performed for a total of 36 patients for prolonging intubation with a trend including of range of 0.1 to 1.45% in 16 months. Regarding method, 24% and 33.3% of patients in surgical method and PDT groups were survived respectively, (P = 0.44). In non COVID, surgical tracheostomy and PDT was performed in 26.5% and 40%, respectively (P = 0.5). Mortality rate was 72.2% and 20%, respectively, (P = 0.003).<br /><strong>Conclusion</strong>: Given the fact that in some centers tracheostomy is delayed till the PCR test for covid19 turned to negative, so, we recommend making an effort to reduce this complication and giving the proper information to the patients at risk of stenosis.</p> Mojtaba Mokhber Dezfuli Omid Mosafaeii Rad Fariba Ghorbani Behrooz Farzanegan Elham Mir-Moeini Mohammad Behgam Shadmehr Copyright (c) 2022 Iranian Red Crescent Medical Journal 2022-07-24 2022-07-24 24 7 Psychological problems and increased stress in pregnant women in the prevalence of Omicron variant Zahra Taati Moghadam Majid Taati Moghadam Copyright (c) 2022 Iranian Red Crescent Medical Journal 2022-07-24 2022-07-24 24 7