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 (Dr. Ahmad Soltani) (Zeynab Bayat) Mon, 30 Jan 2023 23:35:58 +0330 OJS 60 Histopathological Evaluation of Endometrial Biopsies in Different Age Groups: A Tertiary Care Experience in Turkey <p><strong>Background:</strong> An endometrial biopsy primarily aims to determine endometrial cancer and hyperplasia with atypia at an early stage.</p> <p><strong>Objectives:</strong> This study aims to evaluate the indications, histopathological diagnoses, and the number of endometrial biopsies performed in our clinic, according to the age groups of patients, in light of the literature.</p> <p><strong>Methods:</strong> A retrospective review was conducted on the file data of 4,965 patients who underwent endometrial biopsy for non-obstetric reasons between 2014-2021. The patients were divided into five groups, according to their age. Pathology diagnoses were classified as benign endometrial pathology, premalignant-malignant pathology, and insufficient for diagnosis.</p> <p><strong>Results:</strong> The most common biopsy indication was abnormal uterine bleeding (61.9%), while the most common histopathological result was benign endometrial pathologies (75.3%). Endometrial cancer was also detected in 3% of the patients. The highest diagnosis of benign endometrial pathology among age groups was 96.6% in those below 35. The comparison of age groups in the diagnosis of premalignant-malignant pathology revealed that the highest diagnosis rate was 32.1% in those 65 years and over. Furthermore, the evaluation of the relationship between indications and material adequacy showed that the highest rate of insufficient for diagnosis pathology was in the postmenopausal patient group (34.0%). Moreover, insufficient for diagnosis and endometrial surface epithelium results were highest in patients over 65 (46.7%).</p> <p><strong>Conclusion:</strong> Patients aged 55-64 and those over 65 had the highest rate of endometrial cancer and insufficient for diagnosis biopsy results. Therefore, dilation and curettage may be recommended while taking a biopsy from patients in this age group.</p> Begum Kurt, Tulay Koc, Serkan Celikgun, Caglar Yildiz Copyright (c) 2023 Iranian Red Crescent Medical Journal Mon, 30 Jan 2023 00:00:00 +0330 Three-dimensional Motion Analysis of Sacroiliac Joint Mobility: A Reliability Study <p><strong>Background: </strong>Sacroiliac joint (SIJ) movement has been investigated in many studies using a motion analysis system; however, the reliability of this method has not been well defined yet.</p> <p><strong>Objectives: </strong>This study aimed to investigate the reliability of measuring the three-dimensional (3D) movement of the SIJ through the motion analysis system.</p> <p><strong>Methods:</strong> A total of 10 healthy participants performed three forward flexions from a standing position twice in one session with an interval of 30 minutes. The movements were captured by the VICON motion analysis system, and the motion of the sacrum relative to each innominate was estimated in three plans of movement. The test-retest reliability was calculated with the average of three trials using the intraclass correlation coefficient (ICC) with a 95% confidence interval (CI).</p> <p><strong>Results:</strong> The measurements demonstrated good to excellent reliability (ICC: from 0.61 to 0.97) that was achieved for the SIJ motion variables.</p> <p><strong>Conclusion:</strong> The outcomes of this study showed that the 3D motion analysis can be used for the evaluation of SIJ mobility due to its acceptable reliability.</p> Ahmad Bahramian Parchekouhi, Noureddin Karimi, Mohammad Yousefi, Farhad Tabatabai Ghomsheh, Leila Rahnama Copyright (c) 2023 Iranian Red Crescent Medical Journal Mon, 30 Jan 2023 00:00:00 +0330 Pharmacotherapy Analysis for Hospitalized Patients with COVID-19 (Prescriptions, Costs, and Outcomes) <p><strong>Background: </strong>The COVID-19 pandemic has caused many economic problems worldwide, in Iran as well, causing Hospitals to face many financial problems.</p> <p><strong>Objectives: </strong>Based on documented data on pharmacotherapy, costs, and its effectiveness, this study aimed to analyze the costs and outcomes of hospitalized patients with COVID-19 under pharmacotherapy in Iran.</p> <p><strong>Methods:</strong> This research was a retrospective analytical descriptive study. Relevant data of the COVID-19 hospitalized patients’ were extracted from the Hospital’s Medical Records Department. All items of direct medical costs, such as visits, nursing services, consuming materials, laboratories, imaging, medical operations, medications, and beds, were extracted by reviewing COVID-19 hospitalized patients’ files in different wards of the Shohada Ashayer Hospital in Khorramabad city in 2021<em>.</em></p> <p><strong>Results:</strong> A total of 399 patients were examined in this study. The total direct medical costs per patient was 338.63 US$. Of note, the highest cost was related to medicine (32.56%), more than the cost of bed (22.77%). The most commonly used drugs were Lopinavir (95%) and Azithromycin (90%), and the highest medicine cost per patient was related to Immunoglobulin (64.32 US$) and Remdesivir (46.91 US$).</p> <p><strong>Conclusion:</strong> Medicine and hospitalization costs accounted for the largest share of the total treatment costs of patients. Therefore, reducing bed costs requires home treatments and outpatient injections. Furthermore, due to rising drug costs, prescriptions should be based on standard treatment protocols.</p> Hadi Hayati Copyright (c) 2023 Iranian Red Crescent Medical Journal Mon, 30 Jan 2023 00:00:00 +0330 Mask Use Scale: A scale development study <p><strong>Background: </strong>The correct use of face masks is one of the most effective ways to prevent the transmission of COVID-19 and other respiratory infections. <strong><br /></strong><strong>Objectives: </strong>This study aimed to develop a valid and reliable measure to assess attitudes and behaviors related to mask use in social settings. <strong><br /></strong><strong>Methods: </strong>A methodological study was conducted with 489 people aged 18 years and older. Data were collected using a sociodemographic information form and the Mask Use Scale. The data were evaluated using descriptive statistics, exploratory and confirmatory factor analysis, dependent-samples t-test, Pearson correlation analysis, and Cronbach’s alpha internal consistency coefficients. <strong><br /></strong><strong>Results: </strong>Of the 48 items in the draft scale, 10 items with item-total correlations below 0.30 were removed from the scale. All remaining items had positive and significant item-total correlation coefficients (p&lt;0.001). Mean scores in the test and retest showed no significant difference (p&gt;0.05). Cronbach’s alpha coefficients were .76 for the mask use subscale, .77 for the hygiene subscale, .78 for the cloth mask subscale, .77 for the requirement subscale, .80 for the mask selection subscale, and .93 for the entire scale. <strong><br /></strong><strong>Concluison: </strong>The Mask Use Scale is a valid and reliable tool and can be used to determine adults’ attitudes and behavior related to the use of face masks in social settings.</p> Rojjin Mamuk, Melike Dişsiz Copyright (c) 2023 Iranian Red Crescent Medical Journal Mon, 30 Jan 2023 00:00:00 +0330 The Relationship between Anxiety Resulting from COVID-19 and Mental Health in the Population Over 18 Years Old in Qaemshahr County, Iran, 2021 <p><strong>Background:</strong> COVID-19 is the third pandemic of the 21<sup>st</sup> century, is highly contagious, and can cause anxiety due to the development of serious physical problems and reduction of quality of life. Anxiety is a psychological state experienced by nearly all humans in life. However, it is considered a mental disorder if it exceeds its moderate level. Therefore, this study aimed to determine the anxiety level, mental health, and their related factor in the population above 18 years old in Qaemshahr County.<br /><strong>Methods:</strong> This descriptive, correlational study was conducted on 400 individuals in Qaemshahr County. Given the population of this county, convenience sampling was employed to select 40% of the participants from the rural population and 60% from the urban population. The data were collected using a demographic questionnaire (7 items), the Corona Disease Anxiety Scale (CDAS) including somatic (physical) anxiety and psychic (mental) anxiety sections, and the 12-item General Health Questionnaire (GHQ). Descriptive and inferential statistical tests (multiple linear regression analysis, independent sample t-test, one-way ANOVA, and Pearson’s test) were used in the SPSS 25 software for data analysis.<br /><strong>Results:</strong> The mean score of mental health was 22.93±8.9, which accounted for 63.69% of the total score of the questionnaire. The total mean score of anxiety was also 9.46±6.89, which contributed to 31.53% to the total score of the questionnaire. According to the results, physical anxiety per se predicted 31% of the dependent variable (mental health).<br /><strong>Conclusion: </strong>The results showed a significant negative correlation between mental health and anxiety resulting from COVID-19. In other words, the higher the anxiety level, the lower the level of mental health would be. Anxiety also acted as an underlying variable threatening health. Moreover, the mean score of mental anxiety was higher in married, divorced, and widowed participants than in single ones.</p> Atefeh Haghparast, Jamshid Yazdani-Charati, Freshteh Khatti-Dizabadi, Goljahan Javadi, Erfan Oladi, Zohre Haghparast, Fatemeh Haghparast, Milad Ahmadi Marzaleh Copyright (c) 2023 Iranian Red Crescent Medical Journal Mon, 30 Jan 2023 00:00:00 +0330 Healthcare Workers’ Experiences of Strategies in Caring for Patients with Obesity: A Qualitative Content Analysis <p><strong>Background: </strong>Healthcare workers try their best to deal with the challenges of caring for patients with obesity (PWO). However, no study has addressed the strategies used in taking care of PWO. Healthcare workers’ experiences of these strategies can facilitate the challenges of caring for these patients.</p> <p><strong>Objectives: </strong>This study aimed to explain healthcare workers’ experiences of the strategies used in caring for PWO.</p> <p><strong>Methods:</strong> A conventional content analysis (Graneheim and Lundman’s approach) was conducted during 2018-2021. A total of 25 personnel (including nurses, physicians, and nursing assistants) who experienced working with PWO at least for three years in two large teaching hospitals in Iran were selected by purposeful sampling. Semi-structured interviews were conducted to collect the data and the MAXQDA software (version 10) was used to analyze them.</p> <p><strong>Results:</strong> The findings introduced help-seeking to provide care as the most important strategy used by healthcare workers to deal with the challenges of caring for PWO. The four categories included help-seeking in performing clinical procedures, help-seeking in general care with assistance, help-seeking in the patient’s treatment course, and help-seeking for patient safety.</p> <p><strong>Conclusion:</strong> Healthcare workers, particularly nurses, seek help from others to meet all the care and treatment needs of patients and provide better care with the least negative consequences for patients and themselves.</p> Maryam Bagheri, Abbas Heydari, Zahra Sadat Manzari Copyright (c) 2023 Iranian Red Crescent Medical Journal Mon, 30 Jan 2023 00:00:00 +0330 Progress of Development in Generations of the National Hospital Accreditation Program in Iran <p><strong>Background: </strong>Studies have often examined the challenges presented to the implementation of accreditation. Nonetheless, after developing and implementing four generations of accreditation over 25 years, multiple questions have been left unanswered regarding the number of resolved challenges, the emergence of new challenges and problems, as well as the mitigation of these problems by policymakers and managers for the next generations.</p> <p><strong>Objectives: </strong>Therefore, the present study aims to explain the development progress of the last two generations of the National Hospital Accreditation Program (NHAP) with the previous versions in Iran.</p> <p><strong>Methods:</strong> As a qualitative research, Semi‐structured interviews were conducted in 2020. Through purposive sampling, 20 hospital managers at different levels with experience in all four generations participated. Thematic analysis was used to analyze.</p> <p><strong>Results:</strong> The themes included designing the measurement criteria, the supervisor's performance (university and ministry), the hospital's performance, the measurement process, as well as announcing the results and outcomes. Moreover, the status of the development of the national accreditation with previous versions was explained in categories, including improvable points, improved problems, and cases of deterioration.‎</p> <p><strong>Conclusion:</strong> The revision process of the NHAP in Iran is indicative of an upward trend, and almost proper modifications have been made. Significant changes have been made since the third generation. Changes in performance-oriented and highlighted patient safety have been very helpful. Changing the assessment of universities affiliated to Ministerial, which is trying to become partly external evaluation. In addition, some positive changes have been achieved in the fourth generation, including a significant reduction in criteria, more professional evaluators, elimination of document uploads, and the definition of outpatient criteria. The improvable points were as follows: defining some measurement criteria, limitations of physicians' criteria, evaluating input instead of output, lack of medical guidelines, failure to pay attention to hospital-type criteria, lack of continuous monitoring of universities, and lack of motivation mechanisms for new criteria.</p> Aidin Aryankhesal, Niusha Shahidi Sadeghi, Sorur Mazhari, Rafat Bagherzadeh, Hadi Kalantari Copyright (c) 2023 Iranian Red Crescent Medical Journal Tue, 31 Jan 2023 00:00:00 +0330 Pattern and Severity of Traumatic Renal Injury: A Three-Year Study at Single Level One Trauma Center in Southern Iran <p><strong>Background: </strong>Renal trauma is among the most important trauma challenges. Better management of traumatic renal patients is necessary to improve the patients’ clinical outcome.</p> <p><strong>Objectives: </strong>This study aimed to analyze the pattern, severity, mechanism of injury, and outcome in renal trauma.</p> <p><strong>Methods:</strong> This cross-sectional study was conducted in the largest trauma center in southern Iran from March 2018 to June 2022. Adult patients with diagnosed renal trauma based on abbreviated injury scale guideline were included. Variables of age, gender, anatomy of injury, mechanism of injury, lenghth of hospitalization, level of blood pressure, severity of injury, and the outcome of patients have been collected.</p> <p><strong>Results:</strong> In total, 4,416 traumatic patients were admitted to the Emergency Department of the Hospital during the study time, of which 46 cases had traumatic renal injury. The rate of renal injury in the level one trauma center in southern Iran was 0.96%, and the death rate in renal injury victims was 12(26.1%). Most of the injured with renal injury were men 39(84.8%). Blunt trauma was the dominant type of trauma in most victims with renal injury 34(73.9%). Thirty-seven percent (n=17) of traumatic renal injury victim was in mild level (grade 1 and 2), and 16(34.8%) in severe level (grade 4 and 5). Renal injury was mostly associated with thorax injury (n=46) as extra-abdominal organ injury, and liver injury (n=16) and spleen (n=15) as intra-abdominal organ injury.</p> <p><strong>Conclusion:</strong> The results of the present study showed that the severity of injury in patients with renal injury is high, and it is usually associated by injury to other body organs. It is suggested that the traumatic patients should be immediately examined for renal injury in the resuscitation department due to the high mortality rate and severity of these patients.</p> Mehrdad Karajizadeh, Mahnaz Yadollahi, Najmeh Bordbar, Zahra Ghahramani Copyright (c) 2023 Iranian Red Crescent Medical Journal Mon, 30 Jan 2023 00:00:00 +0330 Effect of Livergol on the Liver Function and its Histopathological Changes in Doxorubicin-Treated Rats <p><strong>Background:</strong> Doxorubicin (DOX) is an effective anti-cancer medicine with serious side effects on healthy organs, especially the liver.</p> <p><strong>Objectives:</strong> The present study aimed to investigate the histopathology and effects of Livergol (Liv), a product of <em>Silybum marianum</em>, on serum levels of hepatic parameters in long-term DOX-treated rats.</p> <p><strong>Methods:</strong> Sixty three male Wistar rats were divided into seven groups, namely the control, sham, and experimental groups 1-5, which received certain doses of DOX, Liv, and their combination for 2 months. To produce a cumulative dose, 10 doses of 2 mg/kg DOX were intraperitoneally administered once every 6 days. Moreover, 150 and 300 mg/kg daily doses of Liv were gavaged to the experimental groups 2-5. In addition, blood samples were taken, serum levels of hepatic functional factors and liver enzymes were measured, and hematoxylin-eosin staining was performed to evaluate liver histopathology. The results were analyzed between experimental and control groups by analysis of variance and Tukey tests and the significance level was considered at &lt; 0.05.</p> <p><strong>Results:</strong> The serum levels of triglyceride, cholesterol, low-density lipoprotein, total and direct bilirubin, and liver enzymes in the DOX + Liv300 and Liv150 groups showed a significant decrease, compared to the DOX group. While high-density lipoprotein, albumin, and total protein showed a significant increase. Liver tissue in DOX + Liv300 and Liv150 groups did not show any damage. In addition, the serum level of liver enzymes, lipid profile, biochemical factors, and liver histopathology in the Liv300 and Liv150 groups were similar to those in the control group.</p> <p><strong>Conclusion: </strong>The findings demonstrated that the oral administration of Liv powder can prevent liver side effects of DOX in rats.</p> Marzieh Niakan, Habibollah Johari, Mehrdad Shariati Copyright (c) 2023 Iranian Red Crescent Medical Journal Mon, 30 Jan 2023 00:00:00 +0330 Identification of the Gap in Pre-hospital Knowledge and Skills of the Red Crescent Society Rescuers of the Islamic Republic of Iran <p><strong>Background: </strong>Natural and manmade disasters affect public health directly and indirectly. As statistics show, 31 of the 42 types of natural disasters in the world occur in Iran; therefore, preparation is necessary to effectively manage them. To this end, it is essential to train experienced and professional personnel to work in disaster fields.</p> <p><strong>Objectives: </strong>This study aimed to evaluate the gaps in pre-hospital knowledge and skills among the rescuers of the Red Crescent Society of the Islamic Republic of Iran to increase the effectiveness of pre-hospital training courses for rescuers across the country.</p> <p><strong>Methods:</strong> This study was conducted with a descriptive qualitative method in two months through targeted in-depth interviews with the personnel of aid and relief centers, staff, volunteers, and pre-hospital skills training instructors of the Red Crescent Society. The inclusion criteria were having a bachelor’s degree or above and at least seven years of work experience (including teaching and responding to operations), as well as willingness to participate in the study. To determine the gaps in pre-hospital knowledge and skills in the Red Crescent society, the interviews were conducted in a semi-structured manner. A total of 31 interviews were conducted, which were written verbatim, and the codes were extracted manually. Finally, thematic analysis was used to analyze the data.</p> <p><strong>Results:</strong> After analyzing the text of the interviews, 98 codes were extracted, which after removing duplicate codes and reanalyzing, were divided into two categories of knowledge and skills, each of which had 10 subcategories.</p> <p><strong>Conclusion:</strong> It seems that the pre-hospital theoretical and skill training courses of the Red Crescent Society failed to fill the knowledge and skill gaps identified in this research in terms of content and skills. Therefore, these courses can be revised based on the findings of this study. It is also necessary to identify the weight of each of the themes and investigate their impact on the efficiency of rescuers’ performance through a supplementary quantitative study, which we suggest as a topic for future research.</p> Ahmad Soltani, Nader Ghanizadeh, Milad Ahmadi marzaleh, Hadi Mahmoodi, Marjan Akbari, Ali Mobini Dehkordi Copyright (c) 2023 Iranian Red Crescent Medical Journal Mon, 30 Jan 2023 00:00:00 +0330