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Using decision tree to predict serum ferritin level in women with anemia
Parisa Safaee , Rassoul Noorossana , Kamran Heidari , Parya Soleimani ,
Volume 74, Issue 1 (April 2016)
Abstract

Background: Data mining is known as a process of discovering and analysing large amounts of data in order to find meaningful rules and trends. In healthcare, data mining offers numerous opportunities to study the unknown patterns in a data set. These patterns can be used to diagnosis, prognosis and treatment of patients by physicians. The main objective of this study was to predict the level of serum ferritin in women with anemia and to specify the basic predictive factors of iron deficiency anemia using data mining techniques.

Methods: In this research 690 patients and 22 variables have been studied in women population with anemia. These data include 11 laboratories and 11 clinical variables of patients related to the patients who have referred to the laboratory of Imam Hossein and Shohada-E- Haft Tir hospitals from April 2013 to April 2014. Decision tree technique has been used to build the model.

Results: The accuracy of the decision tree with all the variables is 75%. Different combinations of variables were examined in order to determine the best model to predict. Regarding the optimum obtained model of the decision tree, the RBC, MCH, MCHC, gastrointestinal cancer and gastrointestinal ulcer were identified as the most important predictive factors. The results indicate if the values of MCV, MCHC and MCH variables are normal and the value of RBC variable is lower than normal limitation, it is diagnosed that the patient is likely 90% iron deficiency anemia.

Conclusion: Regarding the simplicity and the low cost of the complete blood count examination, the model of decision tree was taken into consideration to diagnose iron deficiency anemia in patients. Also the impact of new factors such as gastrointestinal hemorrhoids, gastrointestinal surgeries, different gastrointestinal diseases and gastrointestinal ulcers are considered in this paper while the previous studies have been limited only to assess laboratory variables. The rules of the decision tree model can improve the process of diagnosing and treatment of the patients with iron deficiency anemia and reduce their costs.


Clustering of patients with anemia by data mining approach
Khadijeh Dolatshah , Rassoul Noorossana , Kamran Heidari , Parya Soleimani , Roohallah Ghasempour ,
Volume 74, Issue 2 (May 2016)
Abstract

Background: Anemia disease is the most common hematological disorder which most often occurs in women. Knowledge discovery from large volumes of data associated with records of the disease can improve medical services quality by data mining The goal of this study was to determining and evaluating the status of anemia using data mining algorithms.

Methods: In this applied study, laboratory and clinical data of the patients with anemia were studied in the population of women. The data have been gathered during a year in the laboratory of Imam Hossein and Shohada-ye Haft-e Tir Hospitals which contains 690 records and 15 laboratory and clinical features of anemia. To discover hidden relationships and structures using k-medoids algorithm the patients were clustered. The Silhouette index was used to determine clustering quality.

Results: The features of red blood cell (RBC), mean corpuscular hemoglobin (MCH), ferritin, gastrointestinal cancer (GI cancer), gastrointestinal surgery (GI surgery) and gastrointestinal infection (GI infection) by clustering have been determined as the most important patients’ features. These patients according to their features have been seg-mented to three clusters. First, the patients were clustered according to all features. The results showed that clustering with all features is not suitable because of weak structure of clustering. Then, each time the clustering was performed with different number of features. The silhouette index average is 80 percent that shows clustering quality. Therefore clustering is acceptable and has a strong structure.

Conclusion: The results showed that clustering with all features is not suitable because of weak structure. Then, each time the clustering was performed with different number of features. The first cluster contains mild iron deficiency anemia, the second cluster contains severe iron deficiency anemia patients and the third cluster contains patients with other anemia cause.


Profile of neonatal mortality in Iran in 1391
Mohammad Ali Heidarnia , Alireza Abadi , Mohamad Fsmaeil Motlagh, Mohammad Heidarzadeh , Abbas Habibelahi , Farima Raji ,
Volume 74, Issue 7 (October 2016)
Abstract

Background: The first duty of any government is to ensure the health of its children and neonates. Today's countries are classified as declining mortality in this group. To increase neonatal survival rate, classified causes of newborn mortality are the core strategy and policies. This study was aimed to determine the classification of causes of neonatal death in Iran.

Methods: Neonatal mortality refers to deaths of young children. It is measured by the neonatal mortality rate (NMR), which is the number of deaths of neonates per 1000 live births. This study was used data from 11693 neonatal deaths (from 22 weeks gestational age to neonatal death less than 30 days), in Iran's hospitals in 2012 that registered in the perinatal mortality surveillance system (hospital-based system). Demographic characteristics and other factors associated with neonatal death were investigated. To aid in cause of death analysis, burden of disease analysis, and comparative risk assessment we classified the causes of death according to international statistical classification of diseases version 10 (ICD 10), divided into three cause mortality strata.

Results: Results showed the most common cause of neonatal mortality was "certain conditions originating in the perinatal period" (77.92%) with the highest incidence of "disorders related to length of gestation and fetal growth" (37.7%) in this group. Also it shows that 20.82% of deaths caused by "congenital malformations, deformations and chromosomal abnormalities" and 1.26% cases had occurred as a result of "accidents and injuries". The greatest cause of death in the neonates with weight over one thousand grams was "certain conditions originating in the perinatal period" (71.29%), with the highest percentage in the disorders related to "length of gestation and fetal growth" (29.65%).

Conclusion: According to this study the "certain conditions originating in the perinatal period" special "disorders related to length of gestation and fetal growth" was the main cause of neonatal mortality. Also "congenital malformations, deformations and chromosomal abnormalities" was the second cause of neonatal mortality.


Drug susceptibility pattern of candida species isolated from skin of neonates to fluconazole, amphotericin B and caspofungin
Soraya Ghorbani , Roshanak Daie Ghazvini , Seyyed Jamal Hashemi , Parivash Kordbacheh , Ensieh Zibafar , Zahra Kamali Sarwestani, Heidar Bakhshi , Pegah Ardi ,
Volume 75, Issue 4 (July 2017)
Abstract
Background: Candida species are opportunistic yeasts that are capable of causing different infections and diseases among immunocompromised patients. Since Candida infections are major causes and frequent of septicemia in Neonatal Intensive Care Units (NICU), and they are associated with high morbidity and mortality rates, so obtaining adequate treatment seems necessary. Low birth weight preterm infants are especially vulnerable to these devastating infections. The aim of this study was to evaluate the drug susceptibility of Candida species colonized on the skin and mucous membrane of neonates to fluconazole, amphotericin B and caspofungin.
Methods: This study was carried out in the laboratory of medical mycology and serology, School of Public Health, Tehran University of Medical Sciences for the period of 7 months from June 2016 to December 2016. In this descriptive cross-sectional study, 23 isolates of Candida species including Candida parapsilosis, Candida albicans, Candida tropicalis, Candida guilliermondii and Candida krusei were studied. These under study isolates were previously isolated from skin and mucous membranes of neonates in NICU of Imam Khomeini Hospital and Children's Medical Center were identified by PCR-RFLP (Polymerase chain reaction-restriction fragment length polymorphism). Evaluation of antifungal drug susceptibility including fluconazole, amphotericin B and caspofungin was carried out. Antifungal susceptibility test was done according to the standard protocol Clinical and Laboratory Standards Institute (CLSI M27-A3) that is specific to the yeast fungi. Statistical analysis was done by using T-test in SPSS version 22 (IBM, Armonk, NY, USA) and P<0.05 was considered statistically significant.
Results: In this study, C. parapsilosis, C. albicans and C. tropicalis had the most sensitivity to fluconazole. Clinical Isolates of C. guilliermondii were also sensitive to fluconazole, but in C. krusei sensitivity was dose-dependent. All isolated species were sensitive to amphotericin B and caspofungin.
Conclusion: According to the results, all isolated Candida species were more sensitive to amphotericin B and caspofungin than other antifungal drugs. In final conclusion, Finally, it is emphasized that antifungal susceptibility testing is necessary to prevent treatment failure or recurrence of disease.

Diagnosis of fungal keratitis in patients with corneal lesions at Amiralmomenin hospital in Rasht, Iran
Rhoghaye Tighnavard Bejarbane , Roshanak Daie Ghazvini , Shahram Mahmoudi , Reza Soltani Moghaddam, Mahin Safara, Heidar Bakhshi , Parivash Kordbacheh ,
Volume 75, Issue 5 (August 2017)
Abstract
Background: Keratomycosis is a fungal infection of the cornea which could be sight-threatening and even causes eye loss. Considering the high humidity and the dominance of agriculture as important predisposing factors of keratomycosis in north of Iran, this study was carried out for diagnosis of fungal keratitis in patients with corneal lesions in Rasht, Gilan province, Iran. 
Methods: This descriptive cross-sectional study was conducted from July 2015 to November 2016 on 56 patients with corneal lesion suspected to keratomycosis and referred to eye emergency ward of Amiralmomenin hospital, Rasht, Iran. Corneal scraping was performed in all cases and specimens were subjected to direct examination and culture. Only colonies grown in sites of corneal scraping inoculation were considered significant. Fungal isolates were identified according to their macroscopic features of colonies and microscopic characteristics in slide cultures. Data were analyzed in SPSS software, version 21 (IBM SPSS, Armonk, NY, USA) and P<0.05 was considered significant.
Results: The patients included 42 (75%) men and 14 (25%) women with the mean age of 49.5 years (9 to 90 years). Positive culture was observed in 9 cases but, only in one of these patients direct examination was positive and fungal elements were seen in 10% KOH preparation. Though, fungal keratitis was confirmed in 9 (16%) patients including seven (77.8%) men and two (22.2%) women. The majority of cases (88.9%) had a history of corneal trauma with plants and they were mainly farmer. According to statistical analysis, there was a significant association between corneal trauma and keratomycosis (P=0.007). The most common etiologic agents were Fusarium spp. (n: 4, 44.4%), followed by Aspergillus flavus (n: 2, 22.2%), Penicillium sp. (n: 1, 11.1%), Acremonium sp. (n: 1, 11.1%), and Cladosporium sp. (n: 1, 11.1%) respectively.
Conclusion: In the presence of sufficient predisposing factors such as corneal injuries caused by plants, keratomycosis could be caused by a variety of fungi. Furthermore, low sensitivity of direct examination in this study, revealed the necessity of culture in diagnosis of keratomycosis.

Study on synergistic effect of 2-phenylethanol and clotrimazole on candida species isolated from patients with chronic vulvovaginal candidiasis
Niloufar Majdabadi, Mehraban Falahati , Fariba Heidarie-Kohan , Shirin Farahyar , Parvaneh Rahimi-Moghaddam, Mahtab Ashrafi-Khozani ,
Volume 75, Issue 11 (February 2018)
Abstract
Background: 2-phenylethanol is a colorless and aromatic compound with antimicrobial effects which is used extensively in perfumes and cosmetics, as well as in the food industry. Chronic vulvovaginal candidiasis is a vulvovaginal inflammation which is caused by Candida spp. Resistance to clotrimazole which is one of the most common drugs in the treatment of this disease was reported in many patients. In order to improve the treatment, the effect of 2-phenyl ethanol was investigated in combination with clotrimazole on Candida species isolated from chronic vulvovaginal candidiasis.
Methods: This interventional study was performed in Iran University of Medical Sciences from February, 2016 until December, 2016 on Candida species isolated from women with chronic candidial vulvovaginitis who had been referred to Lolagar Hospital of Tehran. All specimens were examined by direct microscopy, culturing on Candida CHROMagar medium (to primary identification), sabouraud dextrose agar medium) to preservation the isolates) and determining the internal transcribed spacer (ITS) sequence (in order to final determination of Candida species). Then clotrimazole and 2-phenyl ethanol alone and in combination, was examined on isolated species, according to Clinical and Laboratory Standards Institute (CLSI) M27-A3 protocol (micro-broth dilution method). Finally, findings were analyzed.
Results: From 40 detected strains of Candida species in this study, 95% were Candida albicans and 5% were Candida africana. The mean minimum inhibitory concentration (MIC) and minimum fungicidal concentration (MFC) of clotrimazole were 24.73±28.87 µg/ml and 30.18±33.004 µg/ml, respectively and the mean MIC and MFC of 2-phenylethanol were 2580±932.38 µg/ml and 3200±1403.29 µg/ml, respectively. The MIC50 and MIC90 of clotrimazole were 16 and 64 µg/ml, respectively. The MIC50 and MIC90 of 2-phenylethanol were both 3200 µg/ml. Most of the isolates were resistant to clotrimazole (82.5%). In combination test, the mean MIC of 2-phenylethanol and clotrimazole alone were 3200±0 µg/ml and 56±40.16 µg/ml, respectively. The fractional inhibitory concentration index (FICI) range was 0.14-0.37. Also, there was a significant difference between clotrimazole MIC values alone and in combination (P= 0.021).
Conclusion: The synergistic effect was observed in combination of clotrimazole and 2-phenylethanol.

Identification of Candida species by molecular and mycological methods in pregnant women with vulvovaginal candidiasis
Nahid Arefi Lisar , Parivash Kordbacheh , Sasan Rezaie , Mahin Safara , Roshanak Daie Ghazvini , Heidar Bakhshi , Zahra Omidvar Jalali ,
Volume 75, Issue 12 (March 2018)
Abstract
Background: Vaginal candidiasis is common in during pregnancy. It may lead to complications like abortions, premature birth, low birth weight, chorioamnionitis and fungal systemic neonatal infection. The aim of present study was identification of Candida species by mycological and molecular methods in pregnant women with vaginal candidiasis.
Methods: This cross-sectional study was performed on 80 pregnant women with or without clinical symptoms of vulvovaginal candidiasis referred to Shahid Noorani Talesh Hospital, Gilan University of Medical Sciences, Iran, from April to December 2015 (8 months). All specimens were examined by direct microscopy and culture on CHROMagar Candida medium for isolation and differentiation of major clinical-significant Candida species (spp.). Cultured media were incubated at 35 °C for 48 hours and evaluated based on color and number of grown colonies. If no growth was observed, the media were incubated for several additional days. Subcultures were done on Sabouraud dextrose agar (Merck, Germany) and Corn meal agar with Tween 80 media (Micromedia, Hungary) for further study. Identification of Candida spp. carried out by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method.
Results: In this study, vulvovaginal candidiasis was observed in 20 (25%) patients. Twenty-two isolates were obtained from culture of specimens on CHROMagar Candida medium (Paris, France). The most common isolated species was Candida albicans 16 (72.8%) and followed by Candida glabrata 5 (22.7%), Candida tropicalis 3 (13.6%) and Candida krusei 1 (4.5%) cases. Two patients had mixed infection with 2 different Candida species (C. albicans and C. glabrata) While using PCR-RFLP method, the Candida species were identified as 13 (59.1%) Candida albicans, 5 (22.7%) Candida glabra, 3 (13.6%) Candida tropicalis and 1 (4.5%) Candida krusei cases, respectively. In direct examination were seen yeast budding cells and pseudohyphae in 8 culture positive specimens. In the present study, results of conventional mycological method in differentiation of Candida spp. were consistent with molecular results in 80% of cases. There was also significant correlation between vulvovaginal candidiasis with clinical symptoms (P<0.0001), including diabetes mellitus (P<0.014), and taking antibacterial drugs (P<0.003) in pregnant women.
Conclusion: PCR-RFLP was able to identify correctly the Candida spp. as a complementary method.

Practice of oral and maxillofacial surgeons in bisphosphonates users in Tehran: brief report
Mohadeseh Heidari, Avideh Maboudi, Sepideh Motevali , Farhad Sobouti, Mahmood Moosazadeh,
Volume 76, Issue 11 (February 2019)
Abstract
Background: Although the treatment of bisphosphonate-related osteonecrosis of the jaw (BRONJ) is very difficult, it can be prevented. The aim of this study was to investigate the knowledge and practice of oral and maxillofacial surgeons in the treatment of bisphosphonates user patients.
Methods: This was a cross-sectional study carried out by census sampling of oral and maxillofacial surgeons in Tehran, Iran from March to June 2016. The employed instrument was a questionnaire including 4 sections. The first section was to collect the demographic information of the participants. In the second part including 7 questions, the knowledge of the participants was measured. The third section with 6 questions was to assess the participants’ practice in the treatment of patients using bisphosphates. Finally, the last sections contained 4 questions. The content validity of the questionnaire was evaluated by 5 specialists in the field (two oral and maxillofacial surgeons, two periodontists, and one endodontist). To assess the reliability of the questionnaire, it was given twice with a 10-day interval to 10 of target group members. The calculation of Spearman-Brown formula revealed a correlation coefficient of 0.79.
Results: In the treatment of BRONJ, most subjects responded to risk, 1 and 2 stages patient education and symptom relief. Treatment with antibiotics and debridement surgery was chosen for patients with higher stages. From 123 oral and maxillofacial surgeons, 102 answered the questionnaires. 77.2% of the surgeons answered correctly to questions about implant insertion. This percentage was higher than other therapeutic procedures.
Conclusion: The knowledge of oral and maxillofacial surgeons as final line of referral and treatment of patients using bisphosphonates should be increased.

Dosimetric comparison of treatment of left breast cancer using two different dose schedules Dosimetric comparison of treatment of left breast cancer using two different dose schedules
Arezoo Kazemzadeh, Iraj Abedi, Alireza Amouheidari, Atefeh Shirvany,
Volume 78, Issue 9 (December 2020)
Abstract
Background: To date, different kinds of treatment methods have been proposed for radiotherapy of cancer patients. Choosing the kind of treatment method affects the quality of the patient's treatment. This study aims to investigate the effect of the number of radiation treatment sessions on the dose received by the patient and the distribution of tumor dose and dose received by organs at risk in breast cancer radiation therapy. These results help us to select the appropriate treatment schedules for the treatment of left breast patients.
Methods: This prospective cross-sectional study was performed on the treatment plans of 35 patients with left breast cancer who referred to Isfahan Milad Hospital between July 2019 and April 2020. They were candidates for left breast radiation therapy. Also, these patients had no history of surgery or chemotherapy, and no supraclavicular or axillary lymph nodes were involved. Patients were treated with a conventional fraction regimen (CF) or hypofractionated (HF) treatment schedule. Different dosimetry parameters for the target and organ at risks such as conformity index, homogeneity index and mean dose were obtained from the dose-volume histogram plot. Finally, the results of both plans were compared with each other.
Results: The data obtained from this study indicate a decrease in the average dose of all organs in the hypo fractionated regimens compared to conventional plans. The differences between two plans were statistically significant for tumor, lung, and skin (P=0.0). Moreover, the maximum dose for the skin was also reduced when hypofractionated regimens were used. However, the values of the homogeneity index and conformity index of tumor in the two methods did not show a significant difference (P were 0.99 and 0.86, respectively).
Conclusion: In general, the results of the current study indicate that the hypofractionated regimen leads to a reduction in dosimetric factors compared to conventional fraction plans. It seems that this method can be used as an alternative treatment plan for breast cancer radiation therapy due to the reduced duration of the treatment period.
 
Predictive factors of deep vein thrombosis in patients admitted to intensive care unit
Hossein Mahjobipoor, Mojtaba Rahimi-Varposhti , Hamidreza Shetabi , Soheila Heidari,
Volume 78, Issue 12 (March 2021)
Abstract
Background: Because deep vein thrombosis (DVT) is one of the most common problems in the intensive care unit, it may lead to complecating the patient's general condition. This study aimed to investigate the predictive factors of DVT in patients admitted to the intensive care unit (ICU) of Amin hospital in Isfahan.
Methods: In this retrospective study, all the records of patients admitted to the ICU ward of Amin Hospital located in Esfahan, from April 2015 to March 2018, were investigated and from all patients with DVT, 20 records were extracted and 40 cases of patients without DVT were also randomly selected. Information such as age, sex, Wells score, Apache score, nutritional status, clinical parameters, cause of hospitalization, length of stay, ICU induced disease and treatment were extracted from these records and compared between both groups with and without DVT.
Results: From 2000 patients admitted to the ICU ward, 20 cases were developed DVT. The age of patients in the DVT group was significantly higher (P=0.008). Factors such as increased Wells score, increased length of stay in the ICU, having ICU induced internal diseases and pneumonia increased the chance of DVT incidence as 18.75, 1.92 and 2.75 and 2.28 times, respectively and the increase of potassium level and use of heparin bandage for treatment reduced the chance of DVT by 2.31 and 2.55 times, respectively (P<0.05).
Conclusion: In the general intensive care unit, the incidence of deep vein thrombosis was higher in internal ward patients. Pneumonia was the most common disease associated with deep vein thrombosis and the risk of deep vein thrombosis was higher in the anemic patient. Patients with upper limited normal levels of potassium were less likely to develop deep vein thrombosis. It seems that potassium in the upper limit of normal reference can play a protective role against deep vein thrombosis. Further studies with larger sample sizes are suggested.

Pivotal exigencies of dental services and related professions, in COVID-19 pandemic: a systematic literature review
Ghasem Janbabai, Amir Hashem Shahidi Bonjar , Abtin Heidarzadeh, Mahdi Shadnoush , Ghasem Sadeghi, Mohsen Dalband, Amir Reza Rokn, Hamid Samadzadeh, Ali Tajernia, Said Sai, Reza Masaeli, Gholamreza Heydari, Ali Yazdani , Behzad Houshmand ,
Volume 79, Issue 2 (May 2021)
Abstract
Background: The advent of Severe Acute Respiratory Syndrome Coronavirus 2 (so-called SARS-CoV-2) causing Coronavirus Disease 2019 (so-called COVID-19) occurred in Dec. 2019 in Wuhan, China. Having an inconceivable worldwide contagion, the outbreak was labeled a pandemic by the WHO. Dental services and related professions (including dentists, dental assistants, dental hygienists and the personnel of cleansing, remedial, triage, dental laboratories, radiographic laboratories and other related paraclinicals), facing galore aerosol and droplets, are in the topmost risk groups exposed to the queer virus. This study was fulfilled to round up evidence-based data to break a link at any part of the virus transmission chain in dental services and related professions.
Methods: Relevant online databases, as PubMed, MEDLINE, Embase, Scopus, Google Scholar and TripDatabase were searched meticulously and evaluated for relevant published original research papers. Subsequently, to fulfill the investigation, ADA, CDC and WHO websites were reviewed to gain relevant guidelines and protocols. Consequently, 476 resources were included considering the canonical inclusion criteria. For the sake of quality assessment of the resources, an authentic checklist was exploited to score the resources from 1 to 15, wherein the admissible score was 10. After deliberation of resources, 366 of them were excluded and finally, 110 resources were selected and overhauled to attain a comprehensive perception on the subject of the investigation.
Results: Transmission of SARS-CoV-2 includes direct transmission (via droplet and aerosol inhalation) and indirect transmission (via surface and instrument contamination), which can amply occur in dental services and related professions. Therefore, an all-inclusive evidence-based miscellany was rallied on several exigent topics, containing genuine esteem in reputable scientific authorities, to present a consummate report for the dental clinicians and related practitioners, working in the course of the running pandemic.
Conclusion: Contemplating the ongoing crisis, undertaking a set of miscellany elected guidelines and protocols, is indispensable in this vital interval of history to bridle the current pandemic, which has been abridged via this systematic perusal.

Comparison of the effect of two drug combinations of Labetalol-hydralazine and labetalol-trinitroglycerin on hemodynamic factors and bleeding volume during dacryocystorhinostomy
Seyed Morteza Heidari, Hamid Reza Shatabi, Elnaz Marzabani,
Volume 79, Issue 3 (june 2021)
Abstract
Background: Control of bleeding during dacryocystorhinostomy (DCR) surgery is of particular importance and controlling the body's hemodynamic responses to stress effectively reduces the amount of bleeding during surgery and improves the surgical area. Therefore, in this study, we aimed to investigate the effect of two-drug combinations Labetalol-Hydralazine and Labetalol-Trinitroglycerin on hemodynamic factors during dacryocystorhinostomy surgery.
Methods: The present study is a double-blind randomized clinical trial that was performed on 71 patients who were candidates for dacryocystorhinostomy (DCR) surgery. Patients enrolled in the study using computerized randomization software (Random allocation software).they were divided into two groups. The study was conducted from September 2016 to September 2017 in Isfahan. The amount of bleeding, the cardiovascular response of patients during and after surgery, the degree of satisfaction of the surgeon and the patient, the severity of pain, and the occurrence of nausea and vomiting were assessed, collected and analyzed.
Results: Between the two groups in terms of demographic characteristics there was no significant difference. There was no significant difference between the two groups in terms of mean arterial blood pressure (MAP), heart rate (HR) during surgery and the time of staying in the recovery room (P>0.05). There was no significant difference between the two groups in terms of bleeding volume, surgeon and patient satisfaction (P=0.73), frequency of vomiting, length of stay in recovery (P=0.57), the severity of nausea (P=0.38), pain (P=0.33) and rebleeding in recovery (P=0/75).
Conclusion: The results of the present study show that the use of labetalol with hydralazine in comparison with labetalol with trinitroglycerin has similar results in terms of hemodynamic factors as well as bleeding volume and surgeon and patient satisfaction criteria. Therefore, both of these compounds can be used to reduce bleeding and control vital signs during and after dacryocystorhinostomy surgery.

Relationship between some indices of cardiovascular functions and pulse pressure as a predictor index for heart diseases: a case-control study
Salman Daliri, Mohammad Khanbeigi, Reza Heidary Moghadam , Parisa Asadollahi, Khairollah Asadollahi,
Volume 79, Issue 8 (November 2021)
Abstract
Background: Pulse pressure has recently been considered as a predictor of coronary heart disease. The difference between systolic and diastolic blood pressure is called pulse pressure. Various factors including increased age, vascular stiffness, stenosis, and hypertension are associated with pulse pressure. The present study, therefore, aimed to investigate the relationship between some cardiovascular function indicators such as vascular stenosis, blood pressure and cardiac output with pulse pressure as a predictor of cardiovascular diseases.
Methods: This case-control study was performed on 544 patients who were referred to Imam Ali Hospital in Kermanshah, Iran, from March 2015 to February 2016. In this study, according to the angiographic findings, individuals with artery stenosis were considered as the case group (n=272) and those without artery stenosis were considered as the control group (n=272). Statistical analysis was performed using descriptive statistics, Chi-square and odds ratio estimation by SPSS22 software.
Results: According to the findings of this study, ages over 50 (OR: 3.3, 95% CI: 2.1-5.2), high systolic blood pressure (OR: 8, 95% CI: 4.3-15.2), high diastolic blood pressure (OR: 4.9, 95% CI: 2.0-11.7), cardiac output less than 50% (OR: 1.8%, 95% CI: 1.3-2.7) and vascular stenosis (OR: 3.5, 95% CI: 2.4-5.1) were associated with high pulse pressure. The male gender had a preventive role in increasing of pulse pressure (OR: 0.7, 95% CI: 0.5-0.9). A significant relationship was demonstrated between systolic blood pressure and pulse pressure (P<0.0001).
Conclusion: Based on the findings of the present study, the chances of having high pulse pressure are high among individuals over 50 years of age, female gender, those with elevated systolic and diastolic blood pressure, and individuals with high coronary artery stenosis. This chance is associated with decreased cardiac output and coronary stenosis. Increased pulse pressure is a predictive indicator of cardiovascular disease and it is recommended that pulse pressure measurements of all referrals, especially those who are being referred to cardiology clinics, are taken into account by medical professionals to prevent adverse clinical outcomes.

Study of knee range of motion after soft tissue repair in both flexion and extension during total knee arthroplasty: a randomized clinical trial
Kiavash Hushmandi, Mohsen Heidari , Seyedeh Omolbanin Seyed Rezaei, Alireza Bahonar, Mehdi Motififard, Hamed Gholizadeh, Mehdi Raei,
Volume 79, Issue 11 (February 2022)
Abstract
Background: The patient's position during the recovery time after arthroplasty surgery can be a factor in reducing complications and improving patients’ condition. Therefore, this study was performed to compare the knee range of motion after soft tissue repair in both flexion and extension positions of total knee arthroplasty.
Methods: This study is a double-blind clinical trial. The study population was all candidates for total knee arthroplasty surgery in Al-Zahra and Kashani hospitals in Isfahan from July 2011 to September 2012. The sample size was selected using the statistical formula of 88 patients and randomly divided into two groups of flexion and extension. In the first group during the knee soft tissue repair, the knee was in flexion and in the second group it was in extension and then it was repaired. Information such as age, sex, body mass index and surgical position were recorded in the checklist. The knee range of motion was measured at the end of the first, second, fourth, eighth and twelfth weeks and recorded in a checklist. In order to compare the pattern of changes in mean knee range of motion over time in the two groups, mixed linear models and conventional marginal models to generalized estimator equations were used by STATA software.
Results: The results showed that there was no significant difference between the flexion and extension groups in knee range of motion. In both groups, the mean knee range of motion increased with time (P<0.001). The mean scores of knee function after the end of the twelfth week in the flexion and extension groups were 141.04±23.19 and 143.09±22.34, respectively, and this difference was not significant.
Conclusion: Soft tissue repair in a particular position is not so effective on the outcome that we want to institutionalize it by spending a considerable amount of budget for training surgeons.

A systematic review on risk factors and protective factors related to Parkinson's disease
Negar Heidari , Paria Heidari, Nader Salari, Hakimeh Akbari, Masoud Mohammadi,
Volume 79, Issue 12 (March 2022)
Abstract
                                                                        
 
 
 
 
 
 
 
Background: Parkinson's disease is one of the chronic neurological diseases. It is the second most common neurodegenerative disease after Alzheimer's, affecting 7.5 million people worldwide and its rate is expected to increase by 20% by 2020. three symptoms of tremor, muscle stiffness and movement disorders are among the main diagnostic symptoms of the disease. The prevalence of Parkinson's worldwide varies between 18 and 418 cases per 100,000 people per year. It is generally estimated that the prevalence of this disease in the general population is 0.3%. A systematic review study was performed to determine the factors associated with Parkinson's disease.
Methods: This study was a systematic review that was conducted by searching national and international databases until February 2020. Initially, all articles which had mentioned Parkinson-related factors were collected and accepted by researchers based on studies. Entry and exit criteria were met. Exclusion criteria included irrelevant items, duplication of studies, unclear procedure, and lack of access to the full text of the study. To reduce bias, articles were evaluated independently by two researchers, and the quality of articles was assessed using the STROBE checklist. All final articles submitted to the systematic review process were prepared by a template checklist. Checklists included article title, first author’s name, year of publication, place of study, risk factors, protective factors, and ineffective factors or the ones which their effects have not yet been determined, and the average age.
Results: In these studies, the following risk factors were reported: family history, agricultural occupation, literacy, stress, well water consumption, aging, environmental factors, genetic factors, pesticide exposure, and alcohol abuse. On the other hand, factors such as smoking and oilseeds, high levels of B-complex vitamins, female estrogen hormones, and selenium have been reported to protect against Parkinson's disease.
Conclusion: Considering the results of the present study and although there is no definitive treatment for this disease, protective factors and risk factors should be seriously considered by health policymakers for preventive measures.
 

Automatic segmentation of glioma tumors from BraTS 2018 challenge dataset using a 2D U-Net network
Zahra Papi , Iraj Abedi, Fatemeh Dalvand, Alireza Amouheidari,
Volume 80, Issue 4 (July 2022)
Abstract
Background: Glioma is the most common primary brain tumor, and early detection of tumors is important in the treatment planning for the patient. The precise segmentation of the tumor and intratumoral areas on the MRI by a radiologist is the first step in the diagnosis, which, in addition to the consuming time, can also receive different diagnoses from different physicians. The aim of this study was to provide an automated method for segmenting the tumor and intratumoral areas.
Methods: This is a fundamental-applied study that was conducted from May 2020 to September 2021 using multimodal MRI images of 285 patients with glioma tumors from the BraTS 2018 Database. This database was collected from 19 different MRI imaging centers, including multimodal MRI images of 210 HGG patients, and 75 LGG patients. In this study, a 2D U-Net architecture was designed with a patch-based method for training, which comprises an encoding path for feature extraction and a symmetrical decoding path. The training of this network was performed in three separate stages, using data from high-grade gliomas (HGG), and low-grade gliomas (LGG), and combining two groups of 210, 75, and 220 patients, respectively.
Results: The proposed model estimated the Dice Similarity Coefficient (DSC) results in HGG datasets 0.85, 0.85, 0.77, LGG datasets 0.80, 0.66, 0.51, and the combination of the two groups 0.88, 0.79, 0.77 for regions the whole tumor, tumor core, and enhancing region in the training dataset, respectively. The results related to Hussdorf Distance (HD) for HGG datasets were 8.24, 9.92, 4.43, LGG datasets 11.5, 11.31, 2.23, and the combination of the two groups 7.20, 8.82, 4.43 for regions the whole tumor, tumor core, and enhancing region in the training dataset, respectively.
Conclusion: Using the U-Net network can help physicians in the accurate segmentation of the tumor and its various areas, as well as increase the survival rate of these patients and improve their quality of life through accurate diagnosis and early treatment.

Surgical competence in general surgery assistance: a brief report
Leila Sadati, Peigham Heidarpoor, Babak Sabet , Shahram Yazdani ,
Volume 80, Issue 5 (August 2022)
Abstract
Background: The training and education of competent and qualified surgeons have been one of the challenges of the surgical profession. The concept of surgical competence has been affected widely due to a series of developments in the new disease emergence, various surgical techniques and the introduction of advanced tools and equipment into the operating. The development of surgical competence and achieving this goal requires accurate identification and analysis of the dimensions of competence. This study was done to explain the concept of surgical competence using the 8-step Walker and Avant approach.
Methods: This study is a qualitative study that was conducted from May- October 2016 at Shahid Beheshti University of Medical Sciences. The present study is a qualitative and conceptual analysis study, which is done with Walker&Avant's eight-step approach to determine the defining characteristics of the concept of surgical competence. A systematic search was conducted between 1990 and 2020 by keywords search such as surgery, surgical, operation OR laparoscopy AND competence competency development competency proficient, proficiency, expertise, clinical, in the database like Google Scholar, PubMed, SID, Magiran, Scopus, Web of Science. Twenty articles were included in the study based on inclusion and exclusion criteria. Moreover, the defining features of the concept were extracted from it.
Results: Based on the results of this study, the concept of surgical competence was defined and the four dimensions of elements, goals, components and the process of developing surgical competence were identified. Then, by clarifying the characteristics of surgical competence, a model of surgical competence development was drawn. Surgical competence development depends on the acquisition of specialized knowledge and numerous skills that are acquired through experience and deliberated practice under the supervision of others in the surgical community of practice and over time.
Conclusion: Surgical competence is a set of observable and measurable skills that allows a surgeon to manage the surgical process independently pbt while maintaining the patient's safety. It includes specialized knowledge, communication skills, cognitive and technical skills, and basic surgical skills.

Preventable risk factors of hospital readmission in stroke patients: an integrative review
Mohammad Rajabpour, Abbas Heidary , Kavian Ghandehari , Amir Mirhaghi,
Volume 81, Issue 10 (January 2024)
Abstract
Background: Despite advances in medical treatments, readmission of stroke patients remains high and has been reported between 31% and 56.1% during the first year after discharge. The difference between the risk factors of readmission and the risk factors of stroke is not clear. The purpose of this study is: 1) to determine the preventable risk factors associated with stroke readmission and 2) to provide a conceptual model for preventable factors that effective in the readmission of stroke patients.
Methods: This integrated review was performed according to Whittemore and Knafl (2005) method in five stages including problem identification, literature search, data evaluation, data analysis, and presentation. In order to find relevant articles, PubMed, Web of Science, CINAHL, Scopus databases and Google Scholar search engine were searched. The search was conducted using the keywords "stroke," "readmission," "recurrence," "re-hospitalization," "review," and "systematic review," for the period between January 2023 and September 2023, following the PRISMA guidelines. In addition to providing a qualitative synthesis of readmission factors categorized into categories, a conceptual model of these factors was also presented.
Results: Out of a total of 3785 article titles, 38 articles were included in the study for the final analysis after screening and removing duplicates. The most important risk factors for readmission in four categories: (1) knowledge deficit about the comorbidities (such as hypertension, atrial fibrillation, diabetes), (2) unhealthy diet and medicine, (3) high-risk behaviors (smoking, alcohol consumption, and tobacco use disorder), and (4) psychological distress (depression and worry about the future). In addition, the conceptual model showed that the most important preventable factor in readmission of stroke patients is of knowledge deficit about comorbidities (especially hypertension). 
Conclusion: The most important preventable risk factors that are effective in the readmission of stroke patients are knowledge deficit regarding clinical risk factors, especially high blood pressure, high-risk behaviors and unhealthy diet and medicine. Therefore, more detailed care and follow-up programs should be designed for stroke patients after discharge.

Investigation of epidemiological and histopathological features of central nervous system tumors in the samples referred to the pathology department of a referral hospital in the east of iran in a 10-year period
Yasser Hasanzadeh, Zahra Sagheb Movafagh , Atena Sahrabeygi , Hamid Heidarian Miri , Masoumeh Gharib ,
Volume 81, Issue 10 (January 2024)
Abstract
Background: Identifying the epidemiological aspects of central nervous system (CNS) tumors is the first step in implementing management protocols to control the condition of these tumors. We aimed to examine the epidemiology and histopathology of both benign and malignant tumors of the CNS in one of the referral and university centers in the east of Iran.
Methods: This cross-sectional study was conducted on all files of patients admitted to Qaem Hospital in Mashhad City, Iran, in a period of 10 years from March 2009 to February 2018 with a definitive diagnosis of benign or malignant tumors of the CNS, including tumors of the brain, cerebellum, spinal cord, or meningeal membranes. Information sources included the patients' physical files and the hospital information system (HIS). The statistical software SPSS version 28.0 for Windows (IBM SPSS, Armonk, New York, USA) was used for the statistical analysis.
Results: In total, 775 patients with benign and 771 patients with malignant CNS tumors were included in the study. Regarding epidemiological aspects of benign tumors, the incidence rate of women was almost twice that of men (68.47% versus 31.53%), with an overall average age of 45.31±19.81 years. The most common benign tumors were meningioma (72.77%), followed by schwannoma (13.67%). Regarding malignant brain tumors, the mean age of affected patients was 36.64±19.67 years, with males accounting for 53.04% of cases and females for 46.96%. The most frequent type of tumor was glioblastoma (32.68%), followed by diffuse astrocytoma (16.47%). Both benign and malignant CNS tumors were associated with significant hospital mortality; in-hospital mortality rates for benign and malignant tumors were 10.1% and 17.5%, respectively. Tumor type and its grade were the main determinants of early death in malignant CNS tumors.
Conclusion: The epidemiological characteristics of benign and malignant tumors in our study community were similar to the reports presented in other communities. Knowledge of these characteristics provides the possibility of managing patients and reducing morbidity and mortality related to these tumors.

Mobile applications as a new way to health: a systematic review
Negar Heidari , Fatemeh Rajati , Mojgan Rajati, Paria Heidari,
Volume 81, Issue 11 (February 2024)
Abstract

                                                                  
Background: Management of chronic diseases, such as hypertension and diabetes, requires a comprehensive long-term care plan. Adherence to self-management behaviours is crucial in improving health outcomes and quality of life for individuals living with these conditions. The research highlighted in this review study aimed to explore the potential of mobile health technology in enhancing primary and secondary prevention of chronic diseases. By providing personalized interventions, mobile applications can play a significant role in supporting individuals in the self-management of their hypertension and diabetes, ultimately leading to better disease control and improved overall well-being.
Methods: The present study is a systematic review of research examining the impact of mobile application interventions on the self-management of hypertension and diabetes. The review analyzes studies published between July 2013 to March 2023, retrieved from the PubMed and Scopus international databases using keywords such as Mobile Health, mHealth, adherence, Hypertension, High Blood Pressure, and Diabetes.
Results: A total of 1398 abstracts were found, of which 12 articles met the inclusion and exclusion criteria for this study. The research indicates that mobile health (mHealth) applications have significant potential to optimize healthcare processes and facilitate improved access to health information. These digital tools can combine various treatment methods with attractive, user-friendly solutions that allow patients to actively monitor a range of health indicators, such as diet, body weight, blood pressure, mood, and sleep patterns. By enabling this type of continuous self-monitoring, mHealth apps can empower individuals to take a more active role in managing their well-being. Additionally, these applications can facilitate greater collaboration between healthcare providers, patients, and their families, thereby enhancing the overall coordination and accessibility of care. As such, mHealth technologies can be effectively leveraged in conjunction with traditional medical services to improve health outcomes and expand access to critical health information.
Conclusion: The present study found a significant increase in mobile health app usage. To understand the real, long-term impact of this technology on health, further longitudinal studies are needed. Comprehensive research is crucial to guide the development of effective digital health interventions that can improve individual and population outcomes over time.


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