Tehran University Medical Journal

Background: Nutrition education and introduction of procedures for choosing healthier food have an important role to reduce the rate of non-communicable diseases. It was shown the amount of risk factors of non-communicable diseases such as energy, salt, sugar, fat and trans fatty acid on the traffic light of food labelling. The status of risk is presented through three colors of red, yellow and green that are the signs of risk, precautious and safe use of food. The object of this study was to evaluate the influence of education on the knowledge, attitude and practices of Isfahan University of Medical Sciences students to the traffic light on food labeling.
Methods: This project was an empirical study performed by random sampling of 379 students of nine schools in Isfahan University of Medical Sciences from January 2017 to March 2018. The knowledge, attitude and practices of students toward the traffic light were assessed by self-administered and structured questionnaire. Education was performed face to face with the usage of pamphlet. In the period of three to six months, questionnaires were refilled out by students to determine knowledge, attitude and practice. Descriptive statistics were calculated using SPSS in mean± SD. Paired t-test was performed to assess the influence of education in total score of knowledge, attitudes and practices in test-retest. P value was considered less than 0.05 as statistically significant.
Results: Before education, the average of scores for knowledge, attitude and practice was 1.12±0.84, 14.44±4 and 2.25±2.2, respectively. Afterwards, the scores were increased to 11.72±0.75, 18.67±3.18 and 17.69±4.7 after education. Significant difference was observed in the scores of knowledge, attitude and practice of students before and after education (P<0.05).
Conclusion: Education of traffic light had a significant role in the improvement of knowledge, attitude and to some extent of practice of students in selection of healthier food.

Background: The Multi state Markov models have extensively application with categorization of laboratory marker of CD4 cells for evaluation of HIV disease progression. These models with different states result in different effects of covariates and prediction of HIV disease trend. The main purpose of this study was comparison of four and five states models with the three- state in order to select the model with better prediction ability of occurrence of HIV and finally death in HIV positive people.
Methods: A total of 305 HIV positive people were included in this cohort study in the Iran AIDS center in Imam Khomeini Hospital in Tehran that entered during March 1995 to January 2005 and then fallowed up to October 2014. The three continuous- time Markov models of three-, four- and five- state models were fitted to data to describe the evolution of a HIV disease Trend over different states.
For comparison of models, two criteria of modification of Akaike’s criterion (DRAIC) and likelihood cross-validation criterion (DRLCV) along with their 95% tracking interval was used. For fitting of these models and estimation of transition matrix and the hazard ratio of gender and treatment independent variables, the msm package of R project for statistical computing, version R 3.2.4 (www.r-project.org) was used.
Results: The results showed that the four- state model has more prediction ability than five-state model for evaluation of HIV disease Trend. In the four-state model, the progression hazard ratio to death for people who received highly active antiretroviral therapy (HAART) was 0.64 lower than who didn’t get this therapy. Moreover, the progression hazard ratio for men was 2.33 fold in comparison to women. The disease progression hazard ratio to death was 4.9 fold for men in comparison to women.
Conclusion: The (DRAIC) and (DRLCV) criterions showed that the four-state model has more predictive ability of the progression trend of HIV disease in comparison of five-state model.

Background: Retinal vein occlusions are one of the most common form of retinal vascular disorders and could lead to vision loss due to macular edema, macular ischemia and sequelae from neovascularization. Anti-venous endothelial growth factor (anti-VEGF) treatment is the choice strategy of treatment for patients with macular edema secondary to central retinal vein occlusion (CRVO). There is an evidence of body with the controversies regarding increment of choroidal thickness in CRVO condition. The current study was designed to determine whether baseline subfoveal choroidal thickness may be an indicator for visual and anatomical outcome of bevacizumab in patients with CRVO macular edema.
Methods: This study was a prospective clinical cohort study that enrolled in 23 new cases of treatment-naïve central retinal vein occlusion (CRVO) from February to July 2017 who were visited in Feiz Eye Hospital, Isfahan, Iran. Patients received a single injection of bevacizumab and were followed for 30 days. Ratio of subfoveal choroidal thickness (SFCT) was measured using enhanced depth imaging spectral-domain optical coherence tomography (EDI-OCT). Ratio of SFCT of the CRVO eye to the fellow healthy eye (SFCT1/F) was taken as independent variable. Changes of best-corrected visual acuity (BCVA) in LogMAR (ΔBCVA, functional response) and secondary to baseline central macular thickness ratio (CMT2/1, anatomical response) in the CRVO eyes were taken for comparative and correlative analytics.
Results: A total of 46 eyes from 23 patients with the mean age of 64.60±10.19 years were included in this study. Baseline SFCT was higher in CRVO eyes (251.91±46.09 µm) in comparison to the fellow eye (206.95±26.62, P<0.0001). Also central macular thickness in CRVO eyes were significantly higher in CRVO eyes in comparison with fellow eye (531.04±38.22 vs 303.30±33.59, respectively, P<0.05). SFCT1/F, correlated moderately with anatomical (CMT2/1) and strongly with functional response (ΔBCVA).
Conclusion: Bilateral evaluation of SFCT by EDI-OCT in all newly diagnosed CRVO cases is recommended to determine if there is a relative increase in choroidal thickness. This may help predict short-term response to anti-VEGF therapy.

Background: Acute myeloid leukemia (AML) is blood and bone marrow malignancy. Low-density oxidative lipoprotein (oxLDL) is a pro-inflammatory factor that has free radicals in its structure. OxLDL levels are also rising in diseases such as diabetes, cardiovascular disease, and some cancers. Studies have shown that oxLDL and dyslipidemia are more common in patients with various cancers. This study aimed to evaluate the level of blood lipids and oxLDL in these patients with acute myeloid leukemia.
Methods: In a descriptive study, 36 patients who were diagnosed with acute myeloid leukemia from April 2016 to March 2017 were enrolled. This study was done in Shahid Ghazi Blood Department of Imam Reza Hospital, Tabriz University of Medical Sciences, Iran. Basic information including age, sex, type of disease, cause for referrals of the patients were collected. After obtaining informed consent from patients and 12 hours of fasting, 5 cc blood samples were sent to the Central Laboratory of Shahid Ghazi Hospital to measure the level of blood lipids including cholesterol, triglyceride, low density lipoprotein, high density lipoprotein (HDL), and oxLDL levels. Blood lipid and oxLDL levels were measured by automatic analyzer (Abbott Laboratories, Abbott Park, IL, USA) (ELISA method).
Results: 23 patients (54.8%) were male and 19 (45.2%) were female. The mean age of the patients was 44.06±14.48 years. The lowest age was 25 and the highest was 80 years. In the study, the mean serum cholesterol level was 147.64±42.28 mg/dl, the blood triglyceride was 183.28±79.34 mg/dl, the LDL was 84.89±26.35, and the HDL 29±14.51, the mean oxLDL was 1482.5±6031.85 ng/ml.
Conclusion: The results of this study indicate that dyslipidemia in patients with acute myeloid leukemia has not been evident. Concerning oxLDL, an oxidative stress factor involved in acute myeloid leukemia requires further investigation and studies.

Background: Rotator cuff injuries are the most common causes of shoulder pain and supraspinatus muscle is usually involved. Clinical tests are available and inexpensive tools for assessment of shoulder dysfunctions. The empty can (EC) and full can (FC) tests are considered as shoulder gold standard tests. Recently, hug up (HU) test has been developed to assess the supraspinatus. So far, no ultrasonographic study has compared supraspinatus muscle thickness in these testing positions. The present study aimed to compare the supraspinatus muscle thickness in the hug up testing position with the full can and empty can testing positions in young and healthy women.
Methods: Forty healthy women (mean age 21.62±2.4 years) participated in this cross-sectional-comparative study from April to June 2018 in the Biomechanic Laboratory of Rehabilitation School, Shahid Beheshti University of Medical Sciences in Tehran, Iran. The supraspinatus muscle thickness was scanned during rest and contracted states with a 0.5 Kg weight cuff. For contracted states, (A) EC testing position: the arm was at 90º abduction in the scaption plane with the thumb-down, (B) FC testing position: the arm was maintained at 90º abduction in the scaption plane with the thumb-up, (C) HU testing position: the palm of hand was placed on the opposite shoulder with the elbow flexed.
Results: The Bonferroni test showed significant differences (P<0.001) between the muscle thickness in the rest and the testing positions. The muscle thickness in the empty can testing position was significantly less than the full can testing position (P=0.001), no significant difference was found between the muscle thickness in the hug up testing position compared to the full can and empty can testing positions.
Conclusion: All of the empty can, full can and hug up testing positions demonstrated increased mean muscle thickness when compared to the rest position and the greatest muscle thickness was in the full can testing position. It seems that supraspinatus muscle thickness in hug up testing position is similar with empty can and full can testing positions.

Background: Infant mortality is important as a standard indicator for the development of health, educational and social health systems in each country. Considering the fact that in different studies of the country there are different statistics on the prevalence of infant mortality in the intensive care unit and the general statistics on the prevalence of mortality in neonates in the country are unclear and unclear, the aim of this study was systematic review and meta-analysis for determine the prevalence of mortality in infants admitted to the intensive care unit (ICU) of hospitals in Iran.
Methods: A meta-analysis was performed for relevant articles in scientific databases including scientific information database (SID) and Magiran, ScienceDirect, Scopus, Medline (PubMed) and Google Scholar. Entrance criteria included cross-sectional studies between March 2000 to September 2018. The search process in these databases was performed using keywords: Neonatal, Intensive Care Unit, Mortality, and Iran. Non-relevant articles included review articles, interventions, cohorts and case-control studies, excluded from the study list. Heterogeneity of study was checked using I2 index and the possibility of publication bias by funnel plot and Egger test. Data were analyzed using the comprehensive meta-analysis software, version 3 (Biostat, Englewood, NJ, USA).
Results: The overall prevalence of infant mortality in ICU hospitals was 21.8% (95% CI 14.4-31.6%), the highest prevalence of infant mortality in Isfahan was 64.4% percentage (95% CI 57.5-70.9%) and the lowest mortality rate in babies in Babol's intensive care unit with 5.1% (95% CI 3.8-6.7%). The results of the study showed that the prevalence of infant mortality was significantly reduced with increasing sample size (P<0.05). Also, with an increase in years of research, the frequency of infant mortality in the intensive care unit increases, which is also statistically significant respectively (P<0.05).
Conclusion: Considering the high prevalence of infant mortality in ICU hospitals in Iran, health policy makers need to take effective measures to raise awareness of parents as well as effective measures to reduce infant mortality.

Background: Aphanizomenon flos-aquae (AFA) is a type of blue-green algae and contains a source of biological compounds. These microalgae have many beneficial health effects. Recently, fucoidan, known sulfated polysaccharide component of AFA algae, has been claimed to stimulate stem-cell mobilization in animal models. Stem cells play an essential role in tissue repair process. In this study, we use excisional full thickness wound model to investigate the effectiveness of trademark AFA extract on skin wound repair process.
Methods: In this experimental study, 21 adult male Wistar rats (weighing 200-250 g) were used and under general anesthesia (intraperitoneally with a ketamine/xylazine solution), two round excisional wounds were created under sterile conditions by a 6 mm punch on the dorsum (paravertebral area) of all rats. Animals were randomly assigned into 3 groups. In groups 1 and 2 (SE-200, SE-400), StemEnhance© (StemTech Health Sciences Inc. British Columbia, Canada) were given respectively 200 or 400 mg/kg by oral gavage once daily and in group 3 (Sham), distilled water (DW) was given to all subjects. Post-wounding gavage of StemEnhance or DW started from 1st day and continued to 7th day. The wound surface area was monitored daily by digital camera and assessed by Image Tool™ software, version 3.5 (UTHSCSA, San Antonio, TX, USA). At 9th day post-wounding animals were sacrificed and repaired tissues were harvested by and assessed by a 8 mm punch. Repaired skin areas were processed for hematoxylin and eosin (H&E). Histopathological parameters of healing including inflammatory cell infiltration, angiogenesis, and fibroblast count were assessed by pathologist. Our study was conducted in the Physiology Department of Medical School, Bushehr University of Medical Sciences, Iran, from October 2016 to March 2016.
Results: Macroscopic imaging of wound area revealed that there was statistically significant difference in wound area reduction between SE-200 group and sham group on day 6 post wounding (P=0.032). Moreover, histological findings showed that the number of neutrophils, macrophages, fibroblasts, and microvessel density decreased in both StemEnhace-treated groups. There were no significant differences between two treatment groups.
Conclusion: According to the obtained results it seems that the extract of Aphanizomenon flos-aquae algae positively affects wound healing process by ameliorating inflammatory response in early healing phases.

Background: Today, due to changes in human lifestyle and consumer demand incidence of foodborne diseases is on the rise. The aim of this study was to investigate the mortality rate of foodborne diseases and their related factors.
Methods: In this cross-sectional study, data on deaths registered according to the International Classification of Diseases (ICD-10th revision) were extracted from death registration and classification of causes system in the Ministry of Health and Medical Education of Iran from 2011 to 2018. Data on deaths from food and water borne diseases including Salmonella, Shigella, Escherichia coli O157:H7, Staphylococcus aureus, Clostridium botulinum, and other foodborne diseases were extracted from database of death registration and classification of causes system. The demographic variables of dead people considered in this study include age (under 5 years, 5-20 years, 20-40, 40-60s and over 60 old), gender, nationality, and the location where people died (urban, rural and unknown).
Results: The majority of deaths cases occurred at the age of 60 years and in older age groups (P<0.001). The results show that across all the age groups mortality rate from foodborne diseases was higher among men than among women (P=0.110). Most of foodborne diseases were reported by people living in urban areas (P<0.0001). The results of this study showed that most of the deaths from these diseases occur in the warm seasons. In this study, the crude death rate was 10 cases per one million inhabitants.
Conclusion: The results of this study showed that there was a significant difference between the mortality rate due to different bacterial agents. This study suggests that demographic variables are important predictors of mortality from foodborne illness and should be further investigated.

Background: Color vision has an important role in daily activities and also learning special talents in different jobs, especially in the field of medicine. However, they are many people all over the world that has no insight into their color blindness and choose the study fields that are completely dependent on vision. Due to the importance of color vision in the field of medicine, we conducted this study to evaluate the prevalence of color blindness in Mashhad medical school, Mashhad, Iran.
Methods: A total number of 200 male medical students from June to September 2016 were enrolled in this study by a simple sampling method. Ishihara test was applied for the evaluation of color vision. Required data were written down in questionnaire sheets, which were designed for this study. A T-test was used to compare the mean value of quantitative data. Chi-square test and Fisher exact test were used to compare the qualitative data in different groups.

Background: One of the most important duties of a family physician is primary health care. The family doctor plan is one of the developmental measures to provide easy and low-cost access for patients to health care centers. The family doctor and her team are fully responsible for the health of the individuals and families covered. Therefore, this study was conducted to assess the satisfaction of rural areas of Rafsanjan city with the family physician plan.
Methods: This study is a descriptive-analytical study that was conducted in rural areas of Rafsanjan from October to December 2018. The study population consisted of twelve randomly selected villages in Rafsanjan. The required sample size was examined according to the size of the statistical population of 480 people. In this study, to collect the required data, a researcher-made checklist was used, which was prepared by reviewing the texts of the questions. The sampling method was cluster random. To check the validity of the checklist, the opinions of 10 health education experts were used. To check the reliability, the checklist was provided to 20 villagers and the reliability was determined using Cronbach's alpha method of 82%. The mean was used to describe the data and inferential statistics t-test and ANOVA were used to analyze the data and analyzed by SPSS.

Background: Posturography is a method in which the postural stability of adults is evaluated by measuring the center of pressure sway. This study aims to evaluate the reproducibility of measuring the center of pressure oscillation in standing position with internal perturbation in healthy young women with and without hyperkyphosis.
Methods: Ten women with dorsal hyperkyphosis with the mean age of 23.5±2.65 years and 10 healthy women with the mean age of 21.9±1.3 years (October 2018 to February 2019) were recruited for the study. Subjects were asked to perform rapid bilateral arm elevation while standing on a force plate. Standard deviation of the amplitude and The standard deviation of the velocity of the center of pressure sway in anterior-posterior, Medio-lateral directions and the area of sway were used for statistical analysis. Measurements were carried out by one examiner with a 1-day interval in The Biomechanics laboratory of The School of Rehabilitation Sciences, Shahid Beheshti University of Medical Sciences. The relative reproducibility of the measurements was calculated by Intra-class Correlation Coefficient (ICC), standard error of measurement (SEM) and minimal detectable changes (MDC).

Background: The preparedness and safety of hospitals in disasters are essential to maintain the health and survival of the community. Numerous studies have shown that the level of preparedness of Iranian hospitals is moderate and low. Lack of comprehensive hospital standards for disaster preparedness is one of the reasons. This study aimed to develop hospital accreditation standards for hospital disaster risk management.
Methods: This comparative study was conducted between April and September 2016. Hospital disaster risk management accreditation standards were extracted from the hospital accreditation standards of 11 countries including the United States, Canada, Australia, Malaysia, India, Thailand, Egypt, Turkey, Saudi Arabia, Denmark and Iran. Overall, 27 hospital disaster risk management accreditation standards were introduced. The opinions of 22 disaster risk management experts were used to assess the content validity of the proposed disaster risk management accreditation standards.
Results: Differences were observed in the quality and quantity of those countries’ disaster risk management standards. The national accreditation standards of the United States, Australia, and Canada had comprehensive standards and covered all aspects of the disaster risk management cycle. Finally, 27 standards were proposed for developing Iranian hospitals’ disaster risk management accreditation standards. The CVI & CVR validity of the proposed standards were acceptable.
There were significant differences in the quantity and quality of hospital disaster risk management accreditation standards in selected countries. The most comprehensive standards belonged to the US National Standards (12 standards and 113 sub-standards), followed by the Australian and Canadian accreditation standards. The accreditation standards of the developing countries and Iran were not comprehensive and did not meet the international goals of disaster risk management. The proposed hospital disaster risk management accreditation standards had high content validity.
Conclusion: Disaster risk management accreditation standards in Iran and developing countries need to be revised and upgraded. Comprehensive standards based on international experiences and expert opinions were introduced in this study that can be used to develop hospital accreditation standards in Iran and other countries.

Background: The clinical field has vast sick data that has not been analyzed. Discovering a way to analyze this raw data and turn it into an information treasure can save many lives. Using data mining methods is an efficient way to analyze this large amount of raw data. It can predict the future with accurate knowledge of the past, providing new insights into disease diagnosis and prevention. Several data mining methods exist but finding a suitable one is very important. Today, coronavirus disease (COVID-19) has become one of the causing deadly diseases in the world. The early diagnosis of pandemic coronavirus disease has a significant impact in preventing death. This study aims to extract the key indications of the disease and find the best data mining methods that enhance the accuracy of coronavirus disease diagnosis.
Methods: In this study, to obtain high accuracy in diagnosing COVID-19 disease, a complete and effective workflow over data mining methods was proposed, which includes these steps: data pre-analyzing, indication selection, model creation, the measure of performance, and display of results. Data and related indications of patients with COVID-19 were collected from Kerman Afzalipour Hospital and Rafsanjan, Ali Ebn Abi Taleb Hospital. Prediction structures were made and tested via different combinations of the disease indications and seven data mining methods. To discover the best key indications, three criteria including accuracy, validation and F-value were applied and to discover the best data mining methods, accuracy and validation criteria were considered. For each data mining method, the criteria were measured independently and all results were reported for analysis. Finally, the best key indications and data mining methods that can diagnose COVID-19 disease with high accuracy were extracted.

Results: Out of 98 subjects, 24 (24.5%) had positive rectovaginal culture. Individuals treated with antibiotics based on positive culture results did not show a significant difference in terms of observed pregnancy outcomes compared with the control group. Conclusion: The prevalence of GBS colonization was significantly higher in patients with a history of vaginal discharge than in those without a history. Due to the small number of studies conducted in Iran, it is recommended to conduct studies with a larger sample size in order to explain a more appropriate protocol in terms of effectiveness and economics.

Background: Information on the coronavirus infection 2019 (COVID-19) which can clinically range from asymptomatic infection to severe pneumonia, in transplant recipients is still low. Infections are a major cause of death in kidney transplant recipients, and kidney transplant recipients, like other organ recipients, appear to be more vulnerable to a variety of infections due to comorbidities and immunosuppressive drugs that predispose them to infection.
Case presentation: In this study, we reviewed 10 transplant recipients with a mean age of 50.3±11.25 years who were admitted to Ayatollah Rouhani Hospital in Babol due to COVID-19 From April 2019 to September 2019. Four patients were female and six ones were male. Fever (100%) and cough (60%) were the most common symptoms in patients. All patients used standard immunosuppressive drugs (tacrolimus, corticosteroids, mycophenolate, and cyclosporine). The mean level of oxygen saturation at the time of admission in these patients was 87.9±11.3 and in two patients with death outcomes of 57% and 95%, it was at the beginning of hospitalization. The mean leukocytes of patients at the beginning of hospitalization was10470±5784.08 per ml and the mean lymphocytes of these patients were 1081.5±516.05. In the studied patients, the mean of previous years of transplantation was 8/05±7.13 and two patients died 20 years and 5 years after their kidney transplantation. Two patients (20%), aged 57 and 50 years, died from progressive respiratory symptoms and the other eight patients recovered and were discharged from the hospital.
We reported COVID-19 infection in ten kidney transplant recipients with different clinical outcomes and periods, which may be a reference for the management of COVID-19 in such patients.
Conclusion: It seems that more information is needed to better understand the effect of anti-transplant immunosuppressive therapy on the outcome of COVID-19 infection in kidney transplant recipients. Long-term follow-up studies and more cases are needed to clarify the diagnosis, outcome, and treatment options for COVID-19 in these patients.

Background: Mendelian randomization (MR) is a new generation in the statistical method that uses genetic variants as instrumental variables in data from non-experimental studies to evaluate and estimate the causal effects of risk factors.
Methods: The weakness of observational studies to detect causality, the difficulties of conducting clinical trials, the dramatic advancement of Genome-Wide Association Studies (GWAS) have led to the emergence of a new type of study called MR. It is increasingly being used to determine causality MR is an approach based on meta-analysis methods. The main idea of the MR is based on using the instrument variable (IV) to find the causality between exposure and outcome. This variable does not need to adjust the confounding effects found in observational studies.

Results: Data for this study were collected from the beginning of January 2003 to October 2020 in PubMed. Our results showed that MR has an increasing trend. The data used in MR includes summarized statistical data, individual-level data, and meta-analysis. Choosing the suitable IV is essential to successfully conduct an MR. For an unbiased estimate, three main hypotheses should be considered: 1) The IV has a strong relationship with the desired exposure (i.e., potential risk factor), 2) The IV is not related to the confounding variable, and 3) The IV is not directly related to the outcome and should only relate to the outcome through exposure. If these conditions are not met, one solution is to use robust methods. Besides, this research introduced the study designs, estimation methods, limitations, software packages, and some applications of MR in medical research. Conclusion: When we seek to find a causal relationship, but it is not possible to use a clinical trial as a standard method, the MR design can be used in observational studies. Therefore, it is possible to obtain causal relationships between exposure and outcome using the MR.

Background: Most people often complain of abdominal bloating. The present study was designed and conducted with the purpose of examining the effect of sequential treatment of Metronidazole and Probiotics, and Probiotics alone in reducing the severity of symptoms of functional bloating.
Methods: The present study was a randomized clinical trial that was carried out from March 2022 until June 2023 in Isfahan and Khurshid Hospital. The studied population were suffering from flatulence and were diagnosed with functional bloating by a gastroenterologist based on Rome III criteria. Then they entered one of the two study groups in a double-blind manner. The first group was treated with Metronidazole for two weeks and then with Probiotic for two weeks. The second group was treated with Probiotic for four weeks. The severity of patients' bloating was measured by a 4-question questionnaire in five stages: before the start of the study, two weeks after, four weeks after, six weeks after, eight weeks after and 12 weeks after the start of the study.  Finally, the obtained information was entered into SPSS software version 24 Repeated measures ANOVA was used to investigate the relationship between variables.

Results: After collecting the data, 43 patients in the first group and 44 patients in the second group were examined. 72.1% of the first group were women and 27.9% were men. In group two, this ratio was 72.7% for women and 27.3% for men. In this intervention, it was seen that in the 1st group, the average severity of bloating decreased until the end of the eighth week and after the second week of drug treatment, and then increased. In the second group, the average intensity of bloating decreased until the end of the fourth week and at the same time as the end of drug treatment, and then increased. Conclusion: It was shown that in the study, the effect of this combined treatment had a greater effect in reducing the severity of functional bloating among patients with functional bloating.

Background: Screening is a cost-effective method for prevention, early detection of the disease and reducing the burden of the third deadliest cancer in the world, i.e. colorectal cancer. This study aimed to analyze the cost-effectiveness of colonoscopy screening compared to sigmoidoscopy for colorectal cancer in high-risk individuals in Iran.
Methods: This economic evaluation study was conducted using the cost-effectiveness method between July 2016 and February 2017. Evaluation of the effectiveness of screening methods was done using a systematic review. Cost evaluation was also done using the costs obtained from the tariff approved by the Iranian Ministry of Health in 2015 for colonoscopy and sigmoidoscopy. Finally, the combined model of decision tree and Markov was used to evaluate the cost effectiveness. Incremental Cost Effectiveness Ratio (ICER) formula was used for cost effectiveness analysis considering the final outcome of 5-year survival of high-risk individuals. Excel and TreeAge software were used for data analysis.

Results: The effectiveness of sigmoidoscopy and colonoscopy in increasing 5-year survival is 11 and 15.7%, respectively, and colonoscopy screening is 4.7% more than sigmoidoscopy. The cost of colonoscopy and sigmoidoscopy screening was calculated as 1000 and 19920 billion Rials, respectively. Based on cost-effectiveness analysis, the cost of treating patients in the case of screening with colonoscopy and sigmoidoscopy is lower than without screening. The ICER ratio of colonoscopy and sigmoidoscopy compared to no screening was -4/441/389/160 and -4/757/954/940 Rials respectively, and colonoscopy compared to sigmoidoscopy was -3/699/785/880 Rials, respectively. Finally, the use of colonoscopy leads to spending 3/699/785/880 Rials less in exchange for obtaining 4722 additional survivals with the prevention of colorectal cancer compared to sigmoidoscopy. Conclusion: Screening by colonoscopy and sigmoidoscopy methods are effective in reducing the incidence and death of colorectal cancer compared to no screening. Screening by colonoscopy is a dominant option for the high-risk population in Iran. Colonoscopy screening is more cost effective compared to sigmoidoscopy. However, decisions about colorectal cancer screening and screening methods depend on local resources and personal preferences.

Results: Staphylococcus aureus diagnostic tests including gram staining on colonies, catalase, coagulase, DNase tests were performed and it was found that all strains were Staphylococcus aureus. In the next step, all samples were resistant to Cloxacillin by disc diffusion method, and the presence of mec A gene in them was confirmed by PCR method, thus the presence of MRSA strains was confirmed from the genotypic point of view. Of the 43 Staphylococcus aureus strains, 26 samples were identified as having the nor A gene by PCR and electrophoresis. Conclusion: The results of the present research have shown that the prevalence of Staphylococcus aureus bacteria in hospital samples is significant and resistance to methicillin and ciprofloxacin has increased in the strains of this bacteria.