Iranian Journal of

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Introduction: Anethum is an herbal medicine composed of the three plants species Anethum, Fumaria and Cichorium, and has been widely marketed and prescribed as lipid-lowering agent in Iran in recent years. No controlled clinical trial of this medicine has so far been carried out, however. We studied the efficacy and short-term side effects of Anethum in patients with isolated hypertriglyceridaemia.
Methods: 151 people (54 men and 97 women) with serum triglyceride ≥250mg/dl and serum cholesterol <240mg/dl were enrolled in this study. Participants were randomly assigned to one of four treatment groups: Anethum, nicotinic acid, clofibrate, and placebo. They were seen at the Doctor Shariati University Hospital lipid clinic once every two weeks. Serum lipid profile was measured at 2 and 4 months after start of therapy. Relevant patient details, including sex, body mass index, mean total cholesterol and high-density lipoprotein, cigarette smoking, previous myocardial infarction, physical activity, and oral contraceptive use were recorded before enrolment.
Results: Four months after treatment was started, serum triglyceride had decreased 12.5% in the Anethum group and 6.8% in the placebo group (p=0.999). During the same period, serum triglyceride had decreased 48.8% in the nicotinic acid group and 54.4% in the clofibrate group (p=0.006 with respect to both placebo and Anethum). Furthermore, the nicotinic acid group showed a 7.8% decrease in serum total cholesterol (p=0.009 with respect to the other three groups). HDL-C decreased 9.8% in the Anethum group, 17.5% in the nicotinic acid group, 8.1% in the clofibrate group, and 9.1% in the placebo group (p=0.149 between first three groups and placebo). 81.8% of the nicotinic acid, 57.1% of the clofibrate, 8.0% of the Anethum and 30% of the placebo group experienced side effects during the same period. The most common complaints in the Anethum were actually non-specific ones.
Conclusion: We conclude that Anethum does not exert any therapeutic effect on isolated hypertriglyceridaemia.

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Background: Clinical trial is the standard method to assess efficacy of a medical intervention. Because of its experimental nature, meaning that subjects are exposed to an intervention with uncertain outcome and according to historical evidences of criminal researches, clinical trial is of something of a lightning rod for ethical concerns. Ethical issues surrounding clinical trials are very pervasive and in many respects, they are as important as the Methodological issues. Patients place a great deal of trust in clinical investigators and often participate in trial when the chance of personal benefit is low. The clinical investigators must continue to earn this trust by demon storable commitment to ethical standards.
Methods: In this article after reviewing the appropriateness and necessity of clinical trial and its required methodological characteristics, ethical issues consisting importance of protocol, informed consent, study on vulnerable subjects, compensation, conflict of interest and responsibility of ethical committees in evaluation of clinical trial will be discussed.
Conclusion: To assess efficacy of a medical intervention, clinical trial is ethicly not only inevitable but also necessary. However it doesn't reduce necessity of attention to the participants rights.

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Background: While the results of genetic research have increased our medical knowledge, promoted health and treatment of illness, some unique ethical problems arise about this type of research. Genetic information is often considered "special", or different from other kinds of medical information because of its close association with individual identity, which is due in part to the common assumption that genes are determinative of human health and characteristics. Thus there is potentially risk of harmful events genetic research participants including stigmatization or discrimination by employers and insurers. In addition, the fact that genetic information about an individual reveals information about relatives, creates new and complex ethical issues, particularly regarding privacy and confidentiality.
Methods: Given the importance of this subject, we searched PubMed, Medline and Ovid for some keywords such as "genetic research" and "ethics" during the recent decade. We compiled the article by reference to valid searched articles and some books.
Results & Conclusion: Informed consent, confidentiality, ownership of genetic information, family/cultural considerations, storage and future use of genetic samples, counseling and supervision contrivances are some respect important general ethical concerns which this paper discuss about briefly

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Responsiveness formally is defined as "the ability of health system to meet the population's legitimate expectations regarding their interaction with the health system, apart from expectations for improvement in health or wealth" and the population legitimate expectations have been defined in terms of international human rights norms and professional ethics. World Health Organization has considered responsiveness as one of health system goals and a part of system performance assessment. This organization has developed a frame work for responsiveness measuring, according to which the concept of responsiveness has been operationalised in eight domains including: 1)respect for dignity , 2)autonomy, 3)confidentiality, 4)prompt attention, 5)quality of basic amenities , 6)communication , 7)access to social support network and 8)choice of health care providers. There is merit in improving responsiveness even if the other intrinsic goals are not affected. Responsiveness information can be used by policy makers for improving well being of people and their satisfaction.

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Medicine had never been error free. Medical society has responsibility to reduce the rate of medical errors and should respect to people and patients rights in the case of error occurrence to maintain their trust. Waiver of cause of medical errors, what is of importance is recognizing the ethical duty of physician toward her patient in the case of error commitment. In this paper at the first, the medical error is defined and its causes and its prevalence in different countries are reviewed. Next we will discuss normative and descriptive ethics of approach to medical error. Then barriers to disclosure will be mentioned. Finally important practical points in medical error disclosure and necessity of cultural changes in health systems to support disclosure and make experience and educational opportunities out of errors are discussed. According to principles of respect to autonomy and beneficence, physicians have to disclose their errors to patients. To support and courage them, a systemic approach to medical error and providing an a field free of judgment and blame are operative and necessary.

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Assessing of outcomes and risk factors in the form of qualitative variables is common in the most of medical studies and the research objectives are defined as the relationship between these variables. This paper introduces the concepts and basic and applied statistical tests to examine the relationship between these variables in these studies, including chi-square tests. Principles and method of calculating the statistics and hypothesis testing to assess the relationship between qualitative variables (or difference in proportions between groups), were presented taking into account relevant considerations. The method of reporting findings were introduced in the context of contingency tables, for all types of chi-square tests. To investigate the relationship between two binary or multi-category qualitative variables, Pearson chi-square test (in the case of establishing Cochran conditions), Yates continuity correction for small samples, in the case of not establishing Cochran conditions exact P-Value calculated on the basis of exact tests, trend chi-square test for ordinal qualitative variables and McNemar chi-square test for related samples should be used. In addition for tables larger than 2 × 2, when the overall relationship was significant, post hoc tests with appropriate correction is required. In each of these situations, examples based on research, calculations of tests were performed and their results were presented. To investigate the relationship between a set of risk factors and nominal or ordinal qualitative variables, the introduced analyses are recommended considering the situation and purpose of the proposed study.

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The P-Value cannot present a complete measure of association in medical studies considering the association between categorical variables. In such situations, measures are required to reveal the clinical importance of relation along with their statistical significance, as the effect size. This paper aims to introduce the measures of associations for categorical variables and inferences about them in these studies. Principles and method of calculating measures of associations and inference about them including confidence interval and hypothesis testing were presented to assess the relationship between qualitative variables for all types of medical studies taking into account relevant considerations. Additionaly, the method of reporting of findings were introduced in the context of contingency tables. To investigate the relationship between two binary qualitative variables, should be used the Odds Ratio in cross-sectional or case-control studies, the relative risk in cohort studies, and prevalence ratio in cross-sectional studies and risk difference in all type of studies along with their confidence intervals and/or their significance tests considering the independent or related groups of studies. Additionally, for bigger than 2 by 2 tables, the method of calculating of above mentioned measures considering a reference category and other measures such as Phi, Crammers V, contingency and uncertainty coefficients , Lambda, Gamma, Summers D, Kendals tau-b and tau-c would be recommended. In each of these situations, based on research based examples, calculations of tests were performed and their results were presented. To investigate the relationship between a set of risk factors and binary and multi-category qualitative variables, the introduced analyses are recommended considering the situation and purpose of the proposed study.

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Background: Vitamin D deficiency is an unrecognized epidemic and a common health problem worldwide. The objective of our study was to determine the prevalence of vitamin D deficiency and its relationship with overall and abdominal obesity in adolescent girls. Methods: This cross-sectional, descriptive study was conducted on girls aged 14-17 years whom were selected by multistage random sampling from four districts of Boukan. Questionnaires about general characteristics, dietary intake and physical activity were completed by interviewing with the subjects. Anthropometric measurements were performed. Fasting blood samples were collected for determining of serum of 25 (OH) D levels. Data was analyzed by using SPSS software and descriptive statistics tests and partial correlation test. Results: The Mean of serum 25(OH) D was 7.26 (SD 2.81) ng/ml and 100% of subjects had vitamin D insufficiency. According to CDC (Centers for Disease Control and Prevention) criteria the prevalence of overweight, obesity and abdominal obesity were 18.5%, 1.4% and 26.4% respectively. There were significant reverse correlation between serum 25(OH) D and WC (r= -0.112, p=0.047). Conclusion: The Results of this study indicate that vitamin D deficiency is a major health problem among studied adolescents. Given the reverse association between vitamin D status and abdominal obesity appropriate approaches are needed to improve vitamin D status and lowering the prevalence of obesity among adolescents. Such conditions may prevent prevalence of chronic disease in adolescents' lives over the coming years.

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In medical studies, measures are required to reveal the effect of exposures and interventions and also the precision of measurements. This paper aimed to introduce the measures of effect and agreement and inferences about them in these studies. Principles and method of calculating measures of effect and agreement and inference about them were presented for all types of medical studies taking into account the relevant considerations. To assess the effect of risk factors on outcomes in case-control and cohort studies, and to determine the relevant effect, the attributable risk and fraction in the exposed group and population were used along with their confidence intervals. Also the relative risk reduction, absolute risk reduction and number needed to treat were applied as the measures of effect of intervention in the interventional studies especially in trails. The sensitivity, specificity and related measures along with their confidence intervals were computed for diagnostic accuracy and screening studies. In addition it is needed to evaluate the precision of measurements using standard error of measurements, ICC, Altman and Bland’s limits of agreement and Lin’s concordance correlation coefficient for quantitative variables and using kappa and weighted kappa for nominal and ordinal variables. In each of these situations the results of research based examples were presented along with the methods of their calculations.To assess the measures of effect and agreement, the mentioned analyses are recommended considering the situation and purpose of the study.

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There are situations in medical studies, wherein it is impossible to use the methods based on normal distribution (parametric methods). This paper objects to introduce common nonparametric methods and the inferences based on the methods in medical studies. Principles and method of calculations along with the software codes for common nonparametric methods and inference based on them were presented taking into account the considerations relevant to choose the nonparametric methods and their relative efficiency with examples in medical studies. In the situation where the assumptions are not satisfied, the nonparametric methods should be used without caution to lose the efficiency or even with higher efficiency of these methods. To compare a non-normal or ordinal variable between two groups Mann-Whitney test, to compare a non-normal or ordinal variable among more than two groups Kruskal-Wallis test, to compare a non-normal variable between two related situations or matched groups Wilcoxon test and to compare an ordinal variable between two related situations or matched groups Sign test should be used. In each of these tests the results of research based examples were presented along with the methods of their calculations. To assess the relation or difference in all types of medical studies, these tests are recommended considering the situation and purpose of study.

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Background: The prevalence of overweight, obesity and related complications is increasing rapidly in the world. Also, treating this disease in the presence or absence of co-morbidities has become a challenge. In this article, based on the clinical recommendations of the American Endocrinology Association and the American College of Endocrinology, a comprehensive clinical guide has been written for the stages of treating obese patients and its individualization, and it has been tried to be adjusted as much as possible based on the conditions in Iran.
Methods: with a specific search strategy, a complete search was performed in PubMed, Scopus, ISI Web of Science, EMBASE and Google Scholar Cochrane databases. Then, the best clinical guidelines suitable for the Iranian society were selected and using the opinions of specialists and clinical experts, a clinical guideline was prepared for the treatment of obesity in Iranian adults.
Results: In this article, in continuation of the previous article, we answered the questions number 4 to 6 regarding the stages of obesity treatment and its individualization in adults of Iranian society, and presented a total of 60 recommendations in this regard.
Conclusion: In this part of the clinical guide for obesity in Iranian adults, we tried to have a special view on the treatment of these patients and by providing evidence-based recommendations and statements, the treatment process was personalized as much as possible for patients with special conditions so that decision-making in this regard is facilitated for the relevant colleagues in this field.

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Background: Diabetes is a chronic disease where the body cannot use or store glucose properly. Diabetes occurs when the pancreas is unable to produce insulin, or the body cannot use the insulin produced. Nowadays, diabetes is a common disease worldwide, and providing automated methods for its diagnosis is critically important.
Methods: This paper introduces a novel method for diagnosing diabetes using artificial intelligence (AI) algorithms. The proposed method is based on metaheuristic and classification algorithms. The simulated annealing (SA) metaheuristic algorithm was used for feature selection. Diabetes diagnosis was performed using the improved K-nearest neighbor (KNN) classification algorithm. In addition to the proposed method, the performance of two other methods, named MVMCNN and WKNN, was studied for diabetes diagnosis.
Results: The proposed method has been compared practically with the two other methods for diagnosing diabetes. The comparisons are based on the accuracy rate of disease diagnosis. In the experiments, the proposed method (SAKNN) demonstrated 95% accuracy, the MVMCNN method showed 93% accuracy, and the WKNN method demonstrated 90% accuracy. Thus, the proposed method outperformed the others. The proposed method also had acceptable performance in terms of time and several other criteria.
Conclusion: The proposed method for diagnosing diabetes, using metaheuristic and classification algorithms, provides higher accuracy compared to other methods. These results indicate that the proper use of AI techniques can offer effective solutions for the automatic diagnosis of diabetes and can be used as an auxiliary tool for doctors and researchers.