Vol 49 No 6 (2020)

Published: 2020-06-08

Review Article(s)

  • XML | PDF | downloads: 315 | views: 284 | pages: 1022-1032

    Background: We aimed to characterize the pelvic floor muscle training (PFMT) programs for non-pregnant women used in the experimental studies with surface electromyography, based on the four training components: the frequency, intensity, time and type of exercises. Then, to characterize the study groups in which the PFMT programs were applied and the effectiveness of these programs.

    Methods: This is a review of 29 papers published in the years 1986-2019, available in PubMed, MEDLINE and SPORTDiscus with Full Text databases. We used keywords: "pelvic floor", "muscle training" and "EMG or electromyography".

    Results: Only in six articles all training components were characterized. The frequency was given in 17 papers, and on average it was 4 ± 2 (M ± SD) times a week. The intensity was described in nine reports, most often the maximal contraction of the pelvic floor muscles was recommended. Researchers conducted their interventions on average for 10 ± 5 weeks. The exercise sessions lasted 25’ ± 10.49’. Type of exercises was specified in eleven papers and most often quick flicks were performed. In 90% of the studies the training programs were applied in women with pelvic floor muscle dysfunctions. In most works positive effects of PFMT were observed. No adverse outcomes of the use of electromyography were reported.

    Conclusion: The full training description should be presented in any scientific work, providing information on applied intensity, frequency, volume and type of pelvic floor muscle exercises to enable their replication and comparability between various interventions. It is important to pay more attention to preventive approach and the implementation of PFMT programs in healthy women. It is justified to use surface electromyography to support PFMT, regardless of health condition.

  • XML | PDF | downloads: 138 | views: 143 | pages: 1033-1044

    Background: Visceral leishmaniasis (VL) is a zoonotic disease that currently occurs in some parts of Europe, Asia, Africa, and America. This study aimed to determine the distribution of the canine visceral leishmaniasis in dogs (Canis lupus familiaris) in northwestern Iran.

    Methods: The data were collected from 1994 to 2018 in Ardabil Province from electronic databases. An extensive literature search was conducted in different international and national databases, including Cochrane, MEDLINE/PubMed, Scopus, Web of Science, and Iran Medex to find articles with the words “visceral leishmaniasis in Ardabil” in their titles, and “canine visceral leishmaniasis in Ardabil” or “accidental reservoir hosts of visceral leishmaniasis in Ardabil” in their subtitles, irrespective of the type and duration of study. The GIS software and MaxEnt model were used to determine the ecologically suitable niches for the disease.

    Results: In total, 9088 dogs were examined, and the overall prevalence rate of CVL in dogs was estimated to be 14.56%. The most ecologically suitable areas of CVL occurrence were identified in four hotspots in Meshkinshahr, Germi, and two spots in Parsabad counties. The results of jackknife test showed that the environmental and climate variables with the highest gain, when used in isolation, were Isothermality, Bio3, Bio13, and Bio 4.

    Conclusion: A widely epidemic CVL has emerged among dogs, making a lot of risks on inhabitants of this area and increasing the probability of an outbreak of VL in humans.

  • XML | PDF | downloads: 133 | views: 176 | pages: 1045-1052

    Background: The information content of medical tourism websites could influence the decisions patients and their families make regarding medical centers. This study aimed to investigate the information content of medical tourism websites.

    Methods: This systematic review was carried out in 2017. Key terms used for searching consisted of, but not restricted to, medical tourism, information content, information needs, and medical tourism website. The terms were searched on PubMed, Science Direct, Web of Science, Embase, ProQuest and Cochrane. One hundred and ninety-two articles out of 1185 retrieved were duplicated and removed from the study. Titles and abstracts of the remaining identified studies were scanned considering the aim of the study. Finally, 31 relevant studies were included in the study.

    Results: The information content of medical tourism websites can be grouped into three main categories including general information (with six subgroups), medical information (with eight subgroups) and tourism information (with one subgroup). The subgroups include information about medical centers, target country, costs and insurance, contact details, website information, photo galleries, the quality of services, trustworthiness, the quality of supportive services, risks, patient rights, physicians and their specialties, and patient instructions for receiving medical and tourism services.

    Conclusion: The medical tourism websites should provide a wide range of information. Considering the important role of medical tourism websites in meeting patients’ information needs, the relevant bodies should improve the information content of medical tourism websites to help patients to make their decisions reliably.

  • XML | PDF | downloads: 179 | views: 246 | pages: 1053-1059

    COVID-19, a respiratory infection caused by the virus SARS-CoV-2, causes a variety of symptoms in infected people. We have recently addressed our concerns over unintentional “Directed Accelerated Evolution” of the SARS-CoV-2 and introduced a modified treatment method for ARDS associated with COVID-19. COVID-19 outbreak could last for a long time in communities. Due to growing requests for medical equipment such as ventilators and ICU beds, “flattening the epidemic curve” has been considered as an effective strategy to adjust the level of health care demand to potential capacity of the system. In this paper, we compare possible outcomes of “Without Precaution” and “With Precaution” epidemic models. When there are no precautions, a higher number of people would be infected. RNA viruses such as SARS-CoV-2 have extremely high mutation rates. Accordingly, the combination of a higher number of infected people and any effort for inactivation of the viruses is expected to exert a strong selective pressure on SARS-CoV-2 that can lead to more mutations. These mutations can be either pathogenicity attenuating mutations (PAMs) or pathogenicity promoting mutations (PPMs). On the other hand, when flattening strategy is used, the number of infected people will be lower than the previous model, but both type of mutations may occur, although with lower frequency. Although the occurrence of PAMs helps the development of herd immunity, possible occurrence of PPMs needs serious tracking, especially in patients with severe COVID-19, to prevent new endemic with more virulent mutant viruses.

  • XML | PDF | downloads: 179 | views: 415 | pages: 1060-1068

    Background: One of the serious health concerns is rape to adolescents. It is caused by unwanted behaviors through threats, force and physical pressure. The purpose of this study was to review rape in adolescents and methods for its prevention.

    Methods: This systematic review study was conducted from 2000 to 2017 in the databases of PubMed, Google Scholar, Web of Science, and Scopus. The CONSORT was used to assess interventional studies. The evaluation of observational studies was performed using the STROBE tool by two researchers independently. Inclusion criteria were studies published from 2000 to 2017, in English languages, and on the samples of 10-20 yr old. Overall, 202 articles published from 2000 to 2017 in English languages were retrieved.  Of them, 154 articles were excluded due to lack of inclusion criteria and 38 articles were deleted due to lack of quality And non-relevance. Finally, 10 articles were selected.

    Results: In the review of interventional studies, the prevalence of sexual harassment and sexual assault by the means of adolescents’ empowerment and education of self-defense techniques was significantly lower in the intervention group than the control group. In other non-interventional studies, there was a statistically significant relationship between the high level of knowledge and attitude of adolescents and the reduction of risk factors and sexual assault.

    Conclusion: Promotion of awareness and attitudes through evidence-based interventions can prevent sexual abuse in adolescents. Appropriate education programs in schools and adolescent centers to adolescent students and their caregivers can promote healthy relationships and prevent sexual harassment.

Original Article(s)

  • XML | PDF | downloads: 199 | views: 185 | pages: 1069-1078

    Background: To evaluate the changes of mortality among children aged 1–14 yr due to road traffic injury and related demographic and economic factors in an ecological study undertaken in 33 European countries.

    Methods: Information about mortality due to road traffic injury among children aged 1–14 yr in European countries was obtained from the WHO database. Changes in the mortality for the years 2000–2009 were estimated as linear regression. These deaths were correlated with demographic and economic factors.

    Results: The greatest burden of child mortality due to road traffic accidents was observed in Baltic States, three times lower mortality levels than that in Northern States. Between 2000 and 2009, there was a significant reduction (P<0.05) in mortality among children aged 1–14 yr in Southern-West countries and Western countries, 1–4 yr in Central and Eastern countries, and 5–14 yr in Northern countries. Mortality due to road traffic injury among boys was strongly associated with the level of urbanization. Both sexes showed strong negative correlations with the economic level and strong positive correlations with income inequality.

    Conclusion: Although in European countries the mortality of children due to traffic injury was considerably reduced, efforts should be made to educate and design a safe environment.

  • XML | PDF | downloads: 106 | views: 132 | pages: 1079-1086

    Background: Newborn infants who are risk for severe hyperbilirubinemia and cared at home should be monitored for progression of jaundice. We aimed to verify if a smart phone application (BiliScan Inc), which uses automated imaging for bilirubin (AIB), can be used to estimate total serum bilirubin (TSB) levels at home.

    Methods: A convenience sample of 1038 “healthy” infants in China were prospectively enrolled to a single-center study in 2016. Correlations between AIB and TcB measurements were correlated to TB measurements. Bias and imprecision of AIB measurements were determined using Bland-Altman analysis. The diagnostic value of AIB was compared by the area-under-curve (AUC) values of receiver operator characteristic (ROC) curves.

    Results: The best correlation and AUC for AIB were at the sternum, both with values of 0.76. We truncated performances to 369 TB values >5 and <15 mg/dL, and sternal AIB showed the best correlation to TB (r =0.5, P<0.0001). The AUC for this range was 0.54. However, from a subset of 200 AIB values >13.5 mg/dL (n=369 babies), the sensitivity and negative predictive value (NPV) were 100% with a specificity of 50%. Furthermore, Bland-Altman analyses showed a bias and imprecision of AIB and TcB when TB was >13.5 and <15 mg/dL.

    Conclusion: The use of AIB may be a potentially useful screening device for neonatal jaundice. Its performance requires additional improvements for accurate measurements across wider ranges of TB levels.

  • XML | PDF | downloads: 115 | views: 184 | pages: 1087-1096

    Background: After the Japanese nuclear power plant disaster in 2011, many residents became concerned about health effects of radiation. We aimed to evaluate the effectiveness of a training program for public health and school health nurses to improve their skills and expertise for better support to residents and students.

    Methods: This was a quasi-experimental study using single-group and pre-post comparison in 2016 in Hiroshima, Kagoshima and Hyogo prefectures of Japan. The educational evaluation was conducted through each sub-item of Bloom’s attainment goals. The evaluation of effectiveness was surveyed among 61 participants before and immediately after the workshop, and at 1-week and 1-month later. The analysis compared initial scores obtained before the workshop with subsequent responses. Where a significant difference was observed among three-group or more in the Friedman test, the Wilcoxon signed-rank test was used for two-group comparisons across the time periods. The significance level was set at P<0.05.

    Results: Data of 54 participants were analyzed. The knowledge based on Bloom’s taxonomy was increased as the number of correct responses increased significantly after the workshop (P<0.001). Cognitive domain was significantly increased after 1-week and 1-month (P<0.001). Affective and psychomotor performances were also increased compared with prior. Participants increased vocabulary related to radiation and developed confidence in radiation disaster recovery measures.

    Conclusion: Each sub-item of the Bloom’s attainment (goal, cognitive, affective, psychomotor) has almost been reached and the effect was maintained even after 1-month. By learning concrete words, they could explain accurately. Participants improved their confidence after receiving the training to respond and clarify the radiation anxieties to the community people.

  • XML | PDF | downloads: 164 | views: 172 | pages: 1097-1105

    Background: With increasing demands for medical treatment and healthcare, private hospitals have enjoyed rapid development, and the quality and satisfaction ratings of their medical services have gradually become hotspot issues. We aimed to investigate the influencing mechanisms of medical service quality, patient perceived value, patient satisfaction, and patient loyalty.

    Methods: On the basis of improved patient perceived value, service satisfaction, and loyalty scales, a questionnaire survey was conducted among 300 patients in 15 private hospitals in China. The action mechanisms of medical service quality, patient perceived value, patient satisfaction, and patient loyalty were verified via SPSS 22.0 and AMOS 20.0 statistical software.

    Conclusion: 1) Improving medical service quality is the main path to acquire patient loyalty for private hospitals. 2) When accepting high-quality medical services, patients will think that the cost paid is reasonable, and their satisfaction with private hospitals will consequently increase. 3) As patient satisfaction with private hospitals is elevated to a certain degree, they become increasingly willing to choose these hospitals again and recommend them to others.

  • XML | PDF | downloads: 102 | views: 167 | pages: 1106-1111

    Background: Air pollution is one of the major threats to human health and well-being. This study aimed to explore the effect of renewable energy consumption and carbon dioxide emissions on tuberculosis (TB) incidences. It further investigates the moderating role of urbanization on the relationship between underlying factors and TB.

    Methods: The data of 183 countries over the period 2000 to 2014 were collected and a two-step system GMM technique was utilized to reduce the endogeneity issue. Additionally, we divided the sample into two sub-panels based on country risk for more robust estimates.

    Results: Carbon dioxide emissions increase the incidences of TB while renewable energy consumption could restrict these cases. On the other hand, urbanization is positively associated with TB in high-risk. System-GMM estimates also indicated that urbanization further strengthens the positive association between CO2 emissions and tuberculosis.

    Conclusion: Climate-friendly energy technologies, surveillance, and adequate city planning can act as effective mechanisms to improve public health.

  • XML | PDF | downloads: 63 | views: 73 | pages: 1112-1119

    Background: To evaluate the diagnostic value of diffusion weighted imaging (DWI) and apparent diffusion coefficient measurement (ADC) in glioma.

    Methods: Thirty two low-grade glioma patients and 31 high-grade glioma patients who were confirmed by pathology in Lanzhou University Second Hospital, Lanzhou, China from February 2016 to January 2019 were selected. The other 30 patients with brain metastases were selected as a control group. DWI imaging data of the three groups were collected, and ADC, relative ADC (rADC) values in tumor parenchyma, peritumor edema area, and contralateral normal white matter area were measured, and the levels of n-acetyl aspartic acid (NAA), choline (Cho), creatine (Cr) of tumor metabolites were analyzed.

    Results: rADC values in the peri-tumor edema areas of the high-grade glioma group were significantly lower than those in the low-grade group and the metastatic group (P=0.011), and the low-grade group was significantly lower than that in the metastatic group (P < 0.05). NAA/Cho and NAA/Cr in parenchymal and peritumor edema areas of patients in the advanced group were significantly lower than those in the metastatic group (P < 0.05), and Cho /Cr was significantly higher than those in the metastatic group (P < 0.05).

    Conclusion: the rADC value, NAA/Cho, NAA/Cr and Cho/Cr in parenchymal and peritumor edema areas of the tumor can help to distinguish high-grade glioma, low-grade glioma and brain metastases.

  • XML | PDF | downloads: 88 | views: 110 | pages: 1120-1128

    Background: Epidemiology of cervical cancer is relatively well studied in developed countries of the world, but little is known about Central Asian states. This study aimed to analyze the changing patterns of cervical cancer incidence and mortality in the Republic of Kazakhstan.

    Methods: The statistical analysis of official data on cervical cancer mortality and morbidity was performed for the whole country. Data on cervical cancer patients were retrieved for the period 2007-2016.

    Results: There was an increase in the incidence of cervical cancer among the population of Kazakhstan from 15.24 per 100,000 in 2007 to 18.83 per 100,000 in 2016. This might be attributed to the introduction of national health program in 2011, which improved early identification. Over the last few years, the decreasing cervical cancer mortality is observed influenced by early diagnosis. The age-standardized incidence rates show that the majority of cervical cancer cases occur in the 40-49 yr age group.

    Conclusion: The incidence of and mortality from cervical cancer in Kazakhstan in 2007-2016 are comparable with those in the neighboring former Soviet Union countries. Significant variations in incidence and mortality rates and one-year cancer-specific survival were observed between country regions.

  • XML | PDF | downloads: 98 | views: 137 | pages: 1129-1137

    Background: Healthcare utilization has progressively increased, especially among Medical Aid (MA) beneficiaries in South Korea. Recently, the focus of MA policy is shifting to long-term inpatient management. We aimed to identify the factors associated with inpatients’ medical service use among MA beneficiaries compared to National Health Insurance (NHI) beneficiaries.

    Methods: This secondary data analysis study used raw data collected from 2012 to 2014 by the Korea Health Panel Study, which is a national health survey conducted annually. Data from 3,869 participants were analyzed: 3,621 NHI beneficiaries and 248 MA beneficiaries. Multiple regression analysis and difference and slope difference tests were performed.

    Results: Age, education level, marital status, living with family, employment, disability, and unmet medical needs significantly influenced the length of hospital stay. Living with family, employment, disability, chronic illness, and unmet medical needs significantly influenced hospitalization costs. MA beneficiaries had longer hospital stay than did NHI beneficiaries (F=5.99, P=0.003); however, there was no difference in hospitalization costs. Among those with low education, longer hospital stay length was more frequent among MA beneficiaries.

    Conclusion: A future intervention model for MA inpatients should consider their service use patterns and characteristics. Most importantly, healthcare education should be provided according to MA patients’ education level to enable patients to make informed health-related decisions. An effort is needed to change the current hospitalization system by encouraging patients to utilize local community care service and by expanding community care and in-home healthcare services.

  • XML | PDF | downloads: 66 | views: 131 | pages: 1138-1147

    Background: qRT-PCR was used to measure the expression of miRNA-26a in pancreatic epithelial cells (HPDE) and human pancreatic cancer cell lines PANC-1 and MIA PaCa-2.

    Methods: PANC-1 and MIA PaCa-2 cell lines were infected with lentiviruses to construct PANC-miR-26a and MIA-miR-26a, and RT-PCR was used to detect the infection efficiency. The cell proliferation ability of PANC-miR-26a and MIA-miR-26a were examined by CCK-8 assay, and apoptosis was detected by flow cytometry. Western blotting was used to detect the expressions of CyclinE2 protein and mitochondria-associated apoptotic proteins. 

    Results: miR-26a was expressed in human normal pancreatic epithelial cells (HPDE), and not detected in PANC-1 and MIA PaCa-2; miR-26a was highly expressed in the cell lines PANC-miR-26a and MIA-miR-26a infected by the virus particles. The absorbance values of PANC-miR-26a and MIA-miR-26a were lower than those of NC1 and PANC-1 in control group. The apoptosis rates of PANC-miR-26a and MIA-miR-26a were substantially higher than those of the control group. The overexpression of miR-26a inhibited the expression of the target protein CyclinE2 in PANC-miR-26a and MIA-miR-26a. The expression of the anti-apoptotic protein Bcl-2 was decreased in PANC-miR-26a and MIA-miR-26a, while the expression of the pro-apoptotic protein Bax was increased. Compared with HPDE, miR-26a was down-regulated in PANC-1 and MIA PaCa-2. After overexpression of miR-26a, the proliferation of PANC-1 and MIA PaCa-2 cell lines was weakened.

    Conclusion: Molecular mechanism is the negative regulation of CyclinE2 by miR-26a as well as the expressions of downstream mitochondrial apoptosis proteins Bcl-2 and Bax.


  • XML | PDF | downloads: 127 | views: 208 | pages: 1148-1156

    Background: We aimed to detect Fasciola specific deoxyribonucleic acid (DNA) by nested-PCR assay on human stool and urine samples and compare the results with the respective ELISA diagnostic assay.

    Methods: Overall, 206 clinically suspected cases of fascioliasis were enrolled in the study. Blood samples were collected from all the patients, and serum samples were isolated. ELISA assay, using Fasciola somatic antigen (SA), was carried out to detect anti Fasciola antibodies for the collected sera. DNA was randomly extracted from 25 stool and 10 urine samples of seropositive individuals and was evaluated by conventional PCR and nested PCR methods. The nested-PCR results were confirmed by sequencing the 430 bp region of ribosomal ITSI gene. Stool and urine samples from patients with different parasitic diseases and 25 stool samples from healthy individuals served as controls. Urine samples were collected from 10 healthy controls as well.

    Results: Fascioliasis was detected by ELISA in 24.8% of the individuals. Of these, 25 seropositive patients were randomly assigned to the study. Fasciola DNA was identified in the stool samples of 96% of seropositive patients by nested PCR but ova of Fasciola was detected by parasitology methods in only 20% of seropositive cases. Fasciola DNA was identified in 90% of the urine samples by nested PCR. No cross-reactions were observed with other parasites.        

    Conclusion: Detection of cfDNA in stool and urine samples has high accuracy and thus can be used for the diagnosis of Fasciola infection in human.


  • XML | PDF | downloads: 96 | views: 140 | pages: 1157-1163

    Background: Intestinal parasitic infections (IPIs) are among the major public health problems, especially in developing countries. Northern Iran is highly endemic area for these infections. This study aimed to investigate the prevalence of IPIs among people referred to the medical centers of the coastal cities in Guilan Province, Northern Iran.

    Methods: In this descriptive cross-sectional survey, 1232 stool samples were collected during 2015-2017. We used a structured questionnaire to obtain socio-demographic characteristics, and stool examination was performed using direct slide smear, formalin-ether concentration, trichrome and modified Ziehl-Neelsen staining techniques. The results were analyzed using SPSS and Chi-square test.

    Results: The overall prevalence of IPs in our study was 17.8% (219/1232). The most common IP was Blastocystis sp. 154/1232 (12.59%), followed by Giardia lamblia 50/1232 (4.1%) and Entamoeba hartmani 45/1232 (3.7%). Out of the 219 positive patients, 82 (55.14%) and 137 (44.85%) were female and males, respectively. Regarding the socio-demographic variables, educational status (P=0.226), contact with domestic animals and soil (P=0.476), age years (P=0.78), Occupation (0.637) and Gender (P=0.417) were not significantly associated to IPIs.

    Conclusion: In the past, parasitic infections were more prevalent in different parts of Iran. However, today it has declined indicating a significant improvement in level of individual hygiene, and environmental standards.


Case Report(s)

  • XML | PDF | downloads: 90 | views: 88 | pages: 1164-1168

    A mild clinical Chronic Mucocutaneous Candidiasis (CMC) phenotype with STAT1 transcription factor mutation has been identified in a Chinese family. It is a rare variant in STAT1 (NM_0073315.3c.1175T>C Met392Thr). Specifically, it is a heterozygous mutation. To date, the pathogenicity of this variant in STAT1 (NM_0073315.3c.1175T>C Met392Thr) for CMC has not been reported in the Human Gene Mutation Database. Thus, this is the first report about STAT1 mutation found in CMC patients from Chinese ethnic group. This study also shows the mutation on the DNA-binding domain of STAT1 for the first time. The findings will broaden the spectrum of STAT1 mutations and facilitate genetic diagnosis by the oral medicine specialists.


Letter to the Editor