Tehran University Medical Journal

Background: Menopause is a critical and sensitive period and has a common symptom of vasomotor signs, psychologic changes and sleep disorders. With regarding the citalopram complications and effects of Iranian herbs, the aim of this study was to compared the therapeutic effect of the combination of area part of Melissa officinalis and fennel fruits extract with Nigella sativa powder with citalopram on menopausal symptoms of post-menopausal women.
Methods: This randomized clinical trial was conducted in Islamic Azad University of Pharmaceutical Sciences, Tehran, Iran, from April 2015 to October 2017. 56 postmenopausal women referred to the clinics of Gorgan health centers with the age between 45 and 65 years, natural menopause confirmed by amenorrhea for at least 12 months, discomfort a hot flash were randomized to two treatment groups. Group 1 (28 patients) received 1000 mg (Melissa officinalis extract, Nigella saliva powder, and fennel fruits) and Group 2 (19 subjects) received 20 mg citalopram in an eight-week course of treatment (1 per day for each group). The frequency of the variables in the Menopause-Specific Quality of Life Questionnaire (MENQOL) was compared in the two groups before and post intervention. The questionnaire included of twenty-nine questions in four domains of vasomotor, psycho-social, physical and sexual symptoms.
Results: The mean age in the herbal treatment group was 47.78±5.5 years and in the citalopram group was 46.4±4.9 years, and t-test did not show this difference in two groups (P=0.362). There was no significant difference in the improvement of menopausal symptoms compared to the citalopram group in the combined product group, but the feeling of anger and fatigue in the citalopram group was greater after treatment (P=0.03).
Conclusion: The present study showed that the combination of Nigella Sativa, Melissa officinalis extract, and fennel fruits generally do not reduce menopausal symptoms in postmenopausal women, and it's just the feeling of anger and fatigue has been better than the citalopram group.

Pregnancy as a natural event leads to changes in various aspects of physiology, psychology, and social life. The adoption of a health promoting lifestyle is an important strategy for achieving the desired outcomes of pregnancy and is important on the future health of mother and child. The aim of this study was to assess the various aspects of health promotion behaviors during pregnancy. The data was obtained with advanced search in the Iranmedex, Magiran, Scientific Information Database (SID), IranDoc, PubMed, Google Scholar, Web of Science and Scopus databases. Articles containing full text were collected using the proper keywords for Persian articles and their equivalent in Mesh included “Health promotion" OR "Behavior health "OR “Health Promoting Lifestyle” AND pregnancy for English articles with a time limitation of 2010 to 2017. At first 3247 articles obtained after reviewing and evaluation of the references, 4 Persian and 25 English articles with observational and qualitative design were included. A review of studies showed that finding a way to pass pregnancy safely is the most important concern for mothers. Pregnant women do some actions to reach favorable outcomes and they have a high incentive to adopt health behaviors during pregnancy due to fear of fetal health, but there is some obstacle to adopt health behaviors including individual factors like that lack of time and inadequate information about pregnancy or health-related functions and social factors including health system problems and cultural factors. In addition age, level of education, individual’s beliefs and factors associated with pregnancy such as high-risk pregnancy and environmental factors such as social support and health system performance play an important role in the adoption of health behaviors. In order to increase the potential of pregnant women to adopt healthy behaviors, changing the health system approach and paying attention to social determinants of health, in order to carry out the necessary interventions, it is recommended to conduct qualitative studies and appropriate design for deep study of the subject in the cultural background.

Background: Genital warts are one of the most common sexually transmitted infections, 1% of sexually active population have anogenital warts (AGWs). According to previous studies, the disease affects people's quality of life and imposes financial costs on health systems.
Methods: The present study is a case-control study at spring of 2018. The quality of life of 65 patients with anogenital warts that were referred to Boali-sina Hospital in Sari, Iran compared with 65 control subjects. The World Health Organization Quality of Life Brief (WHOQOL-BREF) questionnaires was used.
Results: According to the results, among the patients with anogenital warts, the quality of sexual contact in majority them were not affected by the disease (70%). The total cost of treatment was less than the monthly income of the family until the time of participating in the study (92%). There was no significant difference between the mean and standard deviation of physical health scores and mental health scores in the control and patient groups. (Respectively P=0.14, P=0.93). There was no significant relationship between the mean of physical health scores with disease severity. However, there was a significant difference between the mental health score in the two groups of patients with low and high levels of severity (P=0.01). Physical health scores in the whole sample have a significant relationship with gender, so that, in women, physical health score was lower than that of male, but the mean score of mental health in both male and female patients was not significantly different (P=0.18). In the control group the score of mental health was lower in women (P=0.041).
Conclusion: In patients with anogenital wart, quality of life doesn’t change significantly, although, mental health scores directly related with disease severity.

Background: Using alcohol is one of the most important death factors that can be prevented. Lifestyle-related diseases are at the top cause of mortality and burden of disease, whereas most of them can be prevented. Considering the growing importance of diseases related to lifestyle (including alcohol abuse), providing evidence-based clinical guidelines for diseases and life-style related conditions which are in accordance with the newest scientific findings and with cultural and economic conditions in each country are required. The aim of this study was to develop a clinical guideline for prevention and control of alcohol consumption.
Methods: The type of study is initiation of a method or a scientific/administrative system (health system management studies) that uses the National Pattern of Localization of Clinical Guidelines in 2017 in Taleghani Hospital of Shahid Beheshti University of Medical Sciences, Tehran, Iran, by using the reviewed clinical guidelines, which was conducted by the end of 2017 based on organizational criteria, the availability of the full version of the clinical guideline and its up-to-datedness, and the appraisal of guidelines for research and evaluation (AGREE) scoring system. This clinical guideline was developed based on 5A Model (Assess, Advise, Agree, Assist and Arrange).
Results: In order to prevent and control alcohol abuse, a clinical guideline was developed based on five clinical guidelines including United States Preventive Services Task Force (USPSTF), Healthy lifestyle guideline (ICSI), the guidelines for preventive activities in general practice in Australia (RACGP), The Australian population health guide to risky behavioural risk factors in general practice (SNAP), and the guidelines related to lifestyle and wellbeing by the National Institute of Clinical Excellence of England (NICE) in the form of 5A model.
Conclusion: The best practice is according to the existing clinical guidelines for prevention and control of alcohol use screening, brief intervention (1-2 sessions) and behavioral counseling, treatment with cognitive behavioral interventions (2-6 sessions) and, if necessary, referrals to higher treatment centers. Referral is recommended for patients who have signs of substance dependence and need a level of care beyond brief service.

Background: Psychosocial issues and quality of life are important components at the patients diagnosed with chronic hepatitis B and C. Hepatitis is a chronic liver disease that can affect quality of life of patients. In this study, we compared the quality of life between patients with hepatitis B and C and finally presented a structural model about it.
Methods: In a prospective analytic study, 86 patients with hepatitis B and 86 with hepatitis C who referred to the Rasoul-e-Akram Hospital in Tehran from April 2015 to April 2018 were compared regarding the quality of life and health-related quality of life. The clinical and radiographic data of patients were extracted from their medical records. The 36-item short-form health survey (SF-36) was used for the evaluation quality of life and health-related quality of life. The questionnaire consisted of 36 questions in eight sub-scales (physical performance, physical role, physical pain, general health, vitality, social role, emotional role, and mental health).
Results: Generally, the quality of life score was significantly lower in patients with hepatitis C (34.13±9.37) than patients with hepatitis B (51.5±10.5) (P=0.001). Except for the physical role and vitality, all other SF-36 subscales were significantly lower in the HCV patients group (P>0.05). Based on the results of logistic regression, the emotional dimension of patients was reported as most important effect on the quality of life in patients [(OR=9.15, 95% CI=(4.11-15.41), P=0.001)]. Based on the results of linear analysis, hepatitis type [(B=4.21, P=0.001)], patient income [(B=2.57, P=0.001)], the level of education [(B=2.9, P=0.014)] and the gender of patients [(B=2.77, P=0.023)] were reported as most important factors affecting the quality of life of patients, respectively. There was no significant difference between age, body mass index and smoking reported in patients' quality of life (P>0.05).
Conclusion: According to the results of this study, the quality of life in patients with hepatitis C was significantly lower than the quality of life in patients with hepatitis B.

Background: Gastric cancer (GC) is considered as one of the most common types of cancer worldwide with poor prognosis and generally limited treatment options. Recent studies have indicated that HER2, MDM2, MYC, MET, and TP53 play an important role in the development of gastric cancer. Therefore, the aim of this study was to evaluate the incidence of amplification/deletion of these genes in patients with gastric cancer.
Methods: In this descriptive study, a total of 37 gastric cancer tissue samples from GC patients including 23 males (62.2%) and 14 females (37.8%) referred to the Hematology-Oncology and Stem Cell Research Center of Shariati Hospital, Tehran, from March 2015 to February 2016 were evaluated. The patient's age at diagnosis ranged from 33 to 85 years (median: 65 years). The amplification pattern of HER2, MDM2, MYC and MET genes and TP53 deletion were investigated by fluorescence in situ hybridization (FISH) technique performed on 3 to 5 micron section obtained from formalin-fixed and paraffin-embedded cancer tissues.
Results: The tumors were preferably identified at the distal stomach (54.05%) in comparison to tumors arising from the gastric cardia. The tumor size varied between 2 and 5 cm (average, 3.5 cm). Seven of the cases (19%) had advanced tumors at the time of diagnosis. HER2, MDM2, MYC, MET and TP53 copy number alteration were successfully determined in all samples obtained from the GC patients. HER2, MDM2, and c-MYC genes were amplified in 2 (5.41%), 1 (2.7%) and 3 (8.11%) of 37 patient samples, however, MET gene amplification and TP53 deletion were not observed in the obtained GC tissue samples. Co-amplification of HER2, MDM2, and MYC genes, and co-amplification of HER2 and MYC genes were detected in one patient.
Conclusion: The results of this study indicate the low frequency of MDM2, HER2 and MYC genes in gastric cancer patient and their copy number alterations may provide diagnostic and prognostic marker for GC patients.

Background: TRX training is a new training method that has beneficial effects on improving balance and strength. However, the role of these types of training on the factors associated with function and mitochondrial biogenesis is not understood. Therefore, the purpose of present study was to determine the effect of eight weeks of TRX training on serum levels of Peroxisome proliferator-activated receptor-γ coactivator 1α (PGC-1α) and citrate synthase in overweight women.
Methods: All subjects gave written informed consent after a detailed description of the study procedures. The protocol of this study was approved by the Research Ethics Committee of Sport Sciences Research Institute (SSRI) in Iran. The present study was experimental and was conducted in Shahid Ghaffari women's club in Tehran under the supervision of Alzahra University from May 2018 to January 2019. For this purpose, 30 overweight women after primary alignment on basis of body mass index (25-30 kg/m2) were divided into two groups: control (n=14) and TRX training (n=16). The TRX training protocol was performed for eight weeks and 3 sessions per week, which included 6 main movements (squat, rear deltoid row, biceps curl, chest press, low row, rotational ward) that lasted 60 minutes per session. According to consideration the physical condition of each person, the subjects were free to modulate the exercise intensity by changing the body inclinations. Each exercise provided 4 sets of 12 repetitions separated by one-minute rest. Blood sampling was performed in two stages of pre-test and 48 hours after the last session of the exercise in overnight fasting state. After collection of serum samples, enzyme-linked immunosorbent assay (ELISA) method was used to measure serum levels of PGC-1α and citrate synthase.
Results: The results showed that TRX training caused no significant change in the body weight and body mass index compared to the control group. In addition, TRX training increased significantly the serum levels of PGC-1α and citrate synthase compared to the pre-test and the control group.
Conclusion: The findings of the present study indicated that eight weeks of TRX training could increase serum levels of PGC-1α and citrate synthase in overweight women.

Background: Opioid poisoning is the most common type of poisoning in intensive care units (ICUs). This group usually includes patients who have been drug abusers for a long time and now require hospitalization either because of acute overdose or due to side effects of routine opioid use. This study aimed to compare the severity and prognosis of patients using common mortality predictors Sequential Organ Failure Assessment (SOFA), Simplified Acute Physiology Score (SAPS II), Acute Physiology And Chronic Health Evaluation (APACHE II, APACHE IV) on different days of hospitalization.
Methods: This cross-sectional study was performed on all patients with opioid poisoning admitted to the ICU, Imam Reza Hospital, Mashhad, Iran, from the beginning of April 2016 to March 2017 (Persian Calendar). For all poisoned patients enrolled in the study, the four mortality predicting tools were filled daily in the first three days of hospitalization and then every other day until discharge from the ICU or patient's death.

Background: Polycystic ovary syndrome is the most common disorder in the endocrine system. Hyperandrogenism, hyperinsulinemia, chronic ovulation, and infertility are important Complications of PCOS. Health-related quality-of-life (HRQoL) has a significant reduction in women with polycystic ovary syndrome (PCOS). This reduction can be due to many disorders including: menstrual and sleep disorders, hirsutism, marital issues, infertility, and emotional/psychosocial problems. The purpose of current study was to investigate the role of sleeping and other environmental factors affecting the quality of life in patients with polycystic ovary syndrome. 
Methods: This case/control study was conducted in 2017 in two groups: control and study (PCOS). The inclusion criteria were women aged 20-40 with a body mass index (BMI)<28. Exclusion criteria included no disease and no medication for all women. The participants were 180 women who were referred to the infertility center of Imam Khomeini Hospital in Tehran. Four questionnaires including Demographics (40 questions), sleep quality (PSQI) (19 items 0-3), quality of life (GHQ) (28 items) and psychometric (DASS-42) with their consent form were filled out. Student’s t-test and Chi-square were used to compare the variables between two groups and the Pearson correlation coefficient to examine the relationship between lifestyle dimensions.

Background: Given the huge mental, psychological, and economic impact imposed on patients with chronic renal failure, it seems quite necessary to study life satisfaction in such individuals in to order to provide the necessary information and plan for appropriate services. In form of a systematic review and meta-analysis, the present study was conducted in to order to compare the quality of life in two groups of patients, one undergoing hemodialysis and the other recipients of a kidney transplant.
Methods: In order to fulfill the objective of the present study, among innumerable researches carried out in this field, through the implementation of a meta-analysis checklist nine researches were found to be qualified for the final meta-analysis (specific consideration was given to the following criteria: hypothesis, research method, statistical population, sample size, sampling method, measurement tool, and statistical analysis method). All related studies conducted from June 1995 to July 2016 in Iran.

Results: After treatment in placebo group the level of LDL-C (median 0.90 mg/dl to 0.82, P=0.008) and HDL-C (median 0.40 mg/dl to 0.35, P=0.090) were decreased, while in the empagliflozin group the levels of LDL-C (median 0.87 mg/dl to 0.96, P=0.875) and HDL-C (median 0.38 mg/dl to 0.48), P=0.007) increased. Treatment with Empagliflozin and placebo had no significant effect on changing the levels of total cholesterol, TG and eGFR (P>0.05). The weight loss and FBS reduction in the empagliflozin group were significantly higher than placebo (P=0.001 and P=0.048, respectively).

Background: In the current study, a hybrid feature selection approach involving filter and wrapper methods is applied to some bioscience databases with various records, attributes and classes; hence, this strategy enjoys the advantages of both methods such as fast execution, generality, and accuracy. The purpose is diagnosing of the disease status and estimating of the patient survival.
Methods: Feature selection algorithms have been modeled in Matlab R2021a during April and May 2022 in the framework of statistical pattern recognition. First, the features are ranked based on normalized mutual information, as a metric of relevance and redundancy of features, and accordingly, an optimum feature subset with the highest accuracy of classification is selected. Two feature selection algorithms, i.e., inclusion of features enhancing the classification accuracy and exclusion of irrelevant features are applied to the interest datasets, subsequent to the mini-batch k-means clustering of records.

Results: At the end of the execution of both feature selection methods, evaluation metrics including accuracy, precision, recall, and F1 score are measured and compared. Both proposed feature selection approaches for the molecular biology, hepatitis C virus (HCV), and E. coli bacteria datasets result in the precision and recall scores more than 98 percent, meaning that there are few false positives and false negatives in the linear support vector machine (LSVM) classification. Regarding the HCV dataset, selection of nine relevant features among the thirteen present ones using the feature exclusion method yields the classification accuracy and F1 score of 98.92 percent and 99.02 percent, respectively. The feature inclusion approach also results in an accuracy of 98.78 percent with a slight discrepancy. Conclusion: The results reveal superior strength of the feature selection methods used here for life science datasets with higher-order features such as protein/gene expression database. The potentials to generalize to other classifiers and automatically specify the optimal number of features during the feature selection procedure make these approaches flexible in many data mining applications for the life sciences.

Background: Improving the quality of life of patients is the main goal of therapeutic interventions in chronic diseases. One way to achieve this is to decrease the severity of symptoms. The aim of this study was to investigate the effect of curcumin capsule on quality of life and symptoms of patients with irritable bowel.
Methods: This clinical trial study was performed on 60 patients with irritable bowel syndrome referred to Amir al-Momenin Hospital in Arak city from April to September 2018, using convenience sampling and Extra-intestinal symptoms severity scale and WHOQOL_BREF tools. The patients were divided into two groups of intervention and control, curcumin capsules were used in the first one, and in the second one, placebo capsules were used twice a day after lunch and dinner for four weeks. All patients were examined at the beginning of the study, the fourth week and three months later, in terms of quality of life, severity and frequency of symptoms and possible complications. During this period, the patients were followed up on a monthly basis through phone calls, and the contact number of the researcher was provided to the patients to call in case of any problems or questions.

Results: The average age of the curcumin group was 35 years and for the placebo group was 36.43 years. There was no significant difference in the quality of life between the curcumin and placebo groups after the intervention (P>0.05). Significant were found between the curcumin and placebo groups after the intervention (P<0.05). Conclusion: The results of this study showed that there was a significant difference between curcumin and placebo in improving the clinical symptoms of patients, but the quality of life of patients in both curcumin and placebo groups did not change significantly after the intervention.

Background: The objective of this study was the transcultural adaptation of the Rotator cuff quality of life (RC-QOL) questionnaire and the determination of the reliability and validity of the questionnaire in the Persian-speaking population with rotator cuff disease.
Methods: This study was conducted in Isfahan from April 2022 to February 2023. The participants consisted of 56 people with rotator cuff pathology. The process of adapting and translating the questionnaire was done with the methodology presented previously by Beaton et al. Content validity was first tested by a group of orthopedic and physical medicine and rehabilitation specialists and then through a pilot study consisting of 15 Persian-speaking patients with rotator cuff disease. Test-retest reliability was established with an intraclass correlation coefficient. Internal consistency was calculated using Cronbach's alpha. The measurement's error estimation was calculated with the standard error of the measurement. Reproducibility evaluation was measured with a 3-day interval between the completion of the test-retest questionnaire.

Results: The age range of the participants was 34 to 68 years (55% men and 45% women). The mean (standard deviation) of the total score of the RC-QOL questionnaire was 44.33(10.81) and ranged from 17.35 to 70.88. Cronbach's alpha was 0.971, which showed high internal consistency. The intraclass correlation coefficient was 0.99, indicating high test-retest reliability. The mean values (standard deviations) of the DASH and SPADI questionnaires were equal to 77.66(13.69) and 66.66(18.25), respectively. The results of the study showed excellent and significant convergent validity of the RC-QOL questionnaire with both the DASH and SPADI questionnaires. The correlation value with the DASH and SPADI questionnaires was equal to 0.907 and 0.941, respectively. Conclusion: The Persian version of the RC-QOL questionnaire is a valid and reliable tool to evaluate the quality of life in patients diagnosed with rotator cuff injuries.

Results: Analysis of the results showed significant improvements (P<0.05) in the exercise group compared to the control group in the subscales of physical functioning and fatigue within the quality of life assessment. Additionally, notable differences were found between the groups on the fatigue intensity scale. However, No significant difference was observed in the patients' Body Mass Index (BMI) measurements. Conclusion: Progressive resistance training of the lower limbs enhances the quality of life and reduces fatigue in patients with SMA type III.

Background: Diabetic kidney disease is a common complication of diabetes and the most common cause of end-stage kidney disease worldwide. Empagliflozin is associated with slower progression of kidney disease and a lower incidence of kidney complications. So, the aim of the study is to compare renal outcomes in type 2 diabetic patients with and without empagliflozin.
Methods: This research is a cross-sectional study based on the information contained in the files of patients referred to Imam Khomeini and Golestan hospitals in Ahvaz in 1400-1401. Inclusion criteria included age over 18 years, type 2 diabetes, HGA1c less than or equal to 9, GFR between 30 and 60 ml/min/1.73 m2, use of empagliflozin for more than or equal to three months, and urinary albumin to creatinine ratio greater than 30 mg/dL. Exclusion criteria included patients not attending the clinic for follow-up during the study, proteinuria due to glomerulonephritis, type 1 diabetes, vaginitis, UTI, and liver failure based on history.
Based on this, 136 people with type 2 diabetes were included in the study and were randomly divided into two drug and control groups, one group of patients who took empagliflozin for three months and the other group of patients who did not receive this treatment. Patient data, including serum creatinine, HBA1C, albuminuria, weight, blood pressure, side effects, were extracted and then the patients' data were collected three and six months after receiving empagliflozin. Data analysis was done with descriptive and analytical statistics.
Results: In this study, 56 (41.2%) were male and 80 (58.8%) were female. Changes in eGFR (P=0.044) and (P=0.003), HbA1C (P=0.014), albuminuria (P=0.001) during 3 months and 6 months, and changes in systolic blood pressure (0.020) during 3 months between the empagliflozin group were significantly different compared to the control group. However, there was no significant difference between the two groups in terms of weight changes during 3 months and 6 months (P=0.97) and changes in systolic blood pressure during 6 months (P=0.13).
Conclusion: Using empagliflozin can improve kidney function and reduce albuminuria.

Background: Diabetic retinopathy is one of the main causes of blindness in the world and one of the causes of disability in diabetic patients. However, no study has been conducted in Iran to Comparison of Quality of Life between Diabetic Patients With and Without Retinopathy.
Methods: This descriptive-analytical study was conducted on 183 diabetic patients referred to the Jahrom Honari Clinic from October to February 2023. The patients were divided into two groups: diabetic patients without retinopathy complications and diabetic patients with retinopathy complications. The data collection tool included two demographic information questionnaires and a quality of life questionnaire (DQOL-BCI). The data of the two groups and subgroups were compared and analyzed using SPSS version 21 software and descriptive statistics (frequency, percentage, mean, and standard deviation) and inferential statistical tests (chi-square, t-test, ANOVA, Pearson correlation coefficient) at a significance level of P<0.05.
Results: The majority of diabetic patients participating in the study in the group with retinopathy (70.3%) and the group without retinopathy (75%) were male. The groups of Diabetic Patients With and Without Retinopathy did not differ significantly from each other in terms of demographic variables and were similar. There was a significant difference between Diabetic Patients With and Without Retinopathy in terms of average quality of life (P>0.001). The mean quality of life in the group of diabetic patients with retinopathy (41.19±7.97) was higher than that of the group of diabetic patients without retinopathy (37.22±7.37). There was no significant difference between the mean quality of life and demographic variables in diabetic patients without retinopathy and diabetic patients with retinopathy (P<0.001).
Conclusion: That patients with retinopathy had a higher quality of life than the group without retinopathy. These results were obtained while none of the demographic variables such as age, gender, marital status, and education level had a significant relationship with the quality of life of these patients.