The effect of topical olive oil dressing on the healing of grade 1 and 2 diabetic foot ulcers: An assessor-blind randomized controlled trial in type 2 diabetes patients

BACKGROUND AND AIMS

We aimed to compare the effect of topical olive oil dressing plus standard care with standard care alone on the treatment of grade 1 and 2 diabetic foot ulcers (DFUs) in type 2 diabetes mellitus (T2DM) patients.

METHODS

This assessor-blind randomized controlled trial included 60 T2DM patients with DFU referred to the Diabetes Clinic of Shahid Mohammadi Hospital, Bandar Abbas, Iran, from February 21 to August 22, 2017. Patients were randomly assigned to intervention (n = 30) and control (n = 30) groups. The intervention group received standard care, including wound irrigation with normal saline and oral antibiotics plus daily topical olive oil dressing for four weeks, and the control group only received standard care. The wound healing assessment scale (wound degree, color, drainage, and surrounding tissue healing) was recorded weekly and the total wound status was determined at the end of the study.

RESULTS

Treatment with olive oil led to significantly higher scores of ulcer degree, color, drainage, and surrounding tissue healing at weeks one, two, three and four in the olive oil group than in the control group (P < 0.001). Also, the total wound status score was higher in the olive oil group compared to the control group (P < 0.001). The proportions of completely healed, partially healed, and unhealed wounds were 76.6%, 23.3% and 0% in the intervention group, and 0%, 93.3% and 6.7% in the control group, respectively.

CONCLUSIONS

Topical olive oil dressing promoted the healing of DFU and it can be recommended as a safe and effective treatment in this regard.

TRIAL REGISTRATION

Iranian Registry of Clinical Trials (IRCT), IRCT20150607022585N4. Registered 05/12/2018. Retrospectively registered, https://www.irct.ir/trial/19460.

Diagnostic accuracy of sFlt1/PlGF ratio as a marker for preeclampsia

BACKGROUND

Preeclampsia (PE) is a serious complication of pregnancy and one of the main causes of maternal and neonatal mortality and morbidity in the world. Finding a biomarker with high sensitivity and specificity could lead to prediction and early diagnosis of the disease and reduces its complications. In this study, we evaluated diagnostic accuracy of Soluble fms-like tyrosine kinase-1 (sFlt-1) to Placental growth factor (PlGF) ratio for diagnosis of PE.

METHODS

The cases included 23 mild, 15 severe preeclamptic patients, and 20 normal term pregnant women as control referred to GYN ward of the Persian Gulf Hospital in Bandar Abbas from 2014 to 2016. Levels of sFlt-1 and PlGF were measured. Receiver Operating Characteristic (ROC) curve analysis was applied to calculate diagnostic accuracy of sFlt-1/PlGF ratio.

RESULTS

The mean Level of sFlt-1/PlGF in PE patients (91.33 ng/ml) was significantly higher than control women (17.62) (P<0.001). ROC curve analysis showed sFlt-1/PlGF ratio diagnostic accuracy in preeclamptic patients with Area Under Curve (AUC) of 0.90, the best cut-off value of 24.96, sensitivity and specificity of 84.2 and 85.0%, respectively.

CONCLUSIONS

Our data showed sFlt-1/PlGF ratio has higher accuracy for differentiating PE patients from non-PEs in comparison with its power for differentiating severe or early onset forms of the disease.

An overview of diarrheagenic Escherichia coli in Iran: A systematic review and meta-analysis

BACKGROUND

Diarrheagenic Escherichia coli (DEC) is a common enteric pathogen that causes a wide spectrum of gastrointestinal infections, particularly in developing countries. This is a systematic review and meta-analysis to determine the prevalence of DEC in various geographical regions in Iran.

MATERIALS AND METHODS

English (PubMed, Web of Science, Scopus, Embase, Cochrane Library, and Google Scholar) and Persian (IranMedex, SID, Magiran, and Iran Doc) databases were comprehensively searched from January 1990 to April 2017. Study selection and data extraction were performed by two independent reviewers. After assessing heterogeneity among studies, a random effects model was applied to estimate pooled prevalence. Data analyses were done with the Stata software (version 12.0). This meta-analysis was registered with PROSPERO, number CRD42017070411.

RESULTS

A total of 73 studies with 18068 isolates were eligible for inclusion within the meta-analysis. The results of random effects model showed that the most prevalent DEC pathotypes were enterotoxigenic E. coli (ETEC) (16%; 95% confidence interval [CI]: 11%-23%), enteroaggregative E. coli (11%; 95% CI: 8%-15%), atypical enteropathogenic E. coli (EPEC) (11%; 95% CI: 8%-14%), Shiga toxin-producing E. coli (9%; 95% CI: 6%-13%), diffuse adherent E. coli (6%; 95% CI: 6%-12%), enteroinvasive E. coli (4%; 95% CI: 2%-6%), and typical EPEC (3%; 95% CI: 1%-5%).

CONCLUSION

This study showed that DEC infections in the Iranian population have low frequency. Our data suggest that the ETEC pathotype can be regarded as one of the most important etiological agents of diarrhea in this country. However, the prevalence of DEC pathotypes is diverse in different regions of Iran.

The demographic and paraclinical characteristics of patients with hepatitis B presenting to Shahid Mohammadi Hospital and Clinic and other private clinics in Bandar Abbas, Iran

Considering the crucial importance of hepatitis B and its high prevalence in the society, the present study was conducted to examine the demographic and paraclinical characteristics of patients with chronic hepatitis B. This descriptive cross-sectional study examined 180 patients with hepatitis B presenting to Shahid Mohammadi Hospital and Clinic and other private clinics in Bandar Abbas, Iran, in 2016–17. The patients were divided into three main groups: chronic hepatitis, liver cirrhosis, and healthy carriers. Parametric and nonparametric tests were used to analyze the relationship between the quantitative variables in terms of their normal or nonnormal distribution (P < 0.05). About 13.5% of the patients had cirrhosis, 35.4% were healthy carriers, and 51.12% had chronic hepatitis. The number of male patients in the cirrhosis group and the number of female participants in the healthy carrier group were higher. The difference in gender distribution between the three groups was statistically significant. According to the results of this study, male and married people constitute a high percentage of the population of patients with chronic hepatitis B. The clinical symptoms of chronic hepatitis B often do not occur until the patient's progress to advanced stages and cirrhosis, and most of the population is asymptomatic. Contact with a person suspected to have hepatitis B is one of the major risk factors of this disease.

Addressing the Sexual Function of Women During First Six Month After Delivery: Aquasi-Experimental Study

Introduction

Pregnancy and childbirth are important periods of women's life that cause hormonal and bodily changes, and these changes could have significant effects on sexual function.

Aim

The aim of this study was to assess the effectiveness of PLISSIT-based counselling model on the sexual function of women during the first six months after childbirth.

Material and Methods

This was a randomized controlled clinical trial study from June to November, 2015. Ninety lactating women,with at least one sexual problem, were included in this study. Samples were recruited and randomized into two groups (intervention group and control group). Demographic and obstetric information, Edinberg postpartum depression, Larson's sexual satisfaction and female sexual function index questionnaire were used. Data were collected from participants at two points: before consultation and 4weeks after consultation. The statistical analyses were performed using SPSS software and Data were analyzed using the Paired t-test,dependent t-test with parametric data and Chi-square tests.

Results

Ninety women who were the nulliparous and lactating criteria subjects were randomly divided into two groups and all recruited women completed the questionnaires. Mean score of sexual function was 19.35 before consultation and 27.90 after consultation in experimental group. In the control group, mean score of sexual function was 20.55 before consultation and 22.41 after consultation. These differences were statistically significant in pre-counseling stage and 4 weeks after counseling in the two groups (P<0.001 and P=0.002). Four weeks after consultation, there was significant difference in the mean score of sexual function between the control and experimental groups (P<0.001).

Conclusion

Based on the result of this study, sexual problems in lactating women decreased by using the PLISSIT model. The use of the PLISSIT model is recommended in health care setting.

A Survey of Managers' Access to Key Performance Indicators via HIS: The Case of Iranian Teaching Hospitals

BACKGROUND

The challenges of using health information systems in developing countries are different from developed countries for various reasons such as infrastructure and data culture of organizations.

OBJECTIVE

The aim of this study is to assess managers' access to key performance indicators (KPI) via Hospital Information System (HIS) in teaching hospitals of Iran.

METHODS

All managers (Census method) of the four teaching hospitals affiliated to Hormozgan University of Medical Sciences (HUMS) were included in this study. KPIs which are linked to the strategic objectives of organizations were adopted from the strategic plan of HUMS. The questionnaire used in this study included three categories: Financial, Human Resources and clinical. One-sample t-test was used and the significant difference score was calculated for the acceptable level.

RESULTS

We found that HIS cannot facilitate access to KPIs for managers in the main categories, but it was effective in two subcategories of income (p = 0.314) and salary (P = 0.289)).

CONCLUSION

A study of barriers to the use of managers of HIS in hospitals is suggested.

Identification of Carbapenem-Resistant Klebsiella pneumoniae with Emphasis on New Delhi Metallo-Beta-Lactamase-1 (blaNDM-1) in Bandar Abbas, South of Iran

BACKGROUND AND OBJECTIVE

The spread of carbapenem-resistant Klebsiella pneumoniae especially bla_NDM-1-carrying isolates is a great concern worldwide. In this study we describe the molecular basis of carbapenem-resistant K. pneumoniae in three teaching hospitals at Bandar Abbas, south of Iran.

MATERIALS AND METHODS

A total of 170 nonduplicate clinical isolates of K. pneumoniae were investigated. Antimicrobial susceptibility test was performed by disc diffusion method. PCR was carried out for detection of carbapenemase (bla_KPC, bla_IMP, bla_VIM, bla_NDM, bla_SPM, bla_OXA-48, and bla_OXA-181) and extended-spectrum β-lactamase (bla_CTX-M, bla_SHV, bla_TEM, bla_VEB, bla_GES, and bla_PER). Clonal relatedness of bla_NDM-1-positive isolates was evaluated by multilocus sequence typing (MLST).

RESULTS

Tigecycline was the most effective antimicrobial agent with 96.5% susceptibility. In addition, 6.5% of the isolates were carbapenem resistant. Bla_NDM-1 was identified in four isolates (isolate A-D) and all of them were multidrug-resistant. MLST revealed that bla_NDM-1-positive isolates were clonally related and belonged to two distinct clonal complexes, including sequence type (ST) 13 and ST 392. In addition to bla_NDM-1, isolate A coharbored bla_SHV-11, bla_CTX-M-15, and bla_TEM-1, isolate B harbored bla_SHV-11 and bla_CTX-M-15, and isolates C and D contained both bla_SHV-1 and bla_CTX-M-15.

CONCLUSION

Our results indicate that NDM-1-producing K. pneumoniae ST 13 and ST 392 are disseminated in our region. Moreover, one of our major concerns is that these isolates may be more prevalent in the near future. Tracking and urgent intervention is necessary for control and prevention of these resistant isolates.

Factors affecting smartphone adoption for accessing information in medical settings

OBJECTIVES

This study aimed to acquire knowledge about the factors affecting smartphone adoption for accessing information in medical settings in Iranian Hospitals.

METHODS

A qualitative and quantitative approach was used to conduct this study. Semi-structured interviews were conducted with 21 medical residents and interns in 2013 to identify determinant factors for smartphone adoption. Afterwards, nine relationships were hypothesised. We developed a questionnaire to test these hypotheses and to evaluate the importance of each factor. Structural equation modelling was used to analyse the causal relations between model parameters and to accurately identify determinant factors.

RESULTS

Eight factors were identified in the qualitative phase of the study, including perceived usefulness, perceived ease of use, training, internal environment, personal experience, social impacts, observability and job related characteristics. Among the studied factors, perceived usefulness, personal experience and job related characteristics were significantly associated with attitude to use a smartphone which accounted for 64% of the variance in attitude. Perceived usefulness had the strongest impact on attitude to use a smartphone.

CONCLUSION

The factors that emerged from interviews were consistent with the Technology Acceptance Model (TAM) and some previous studies. TAM is a reliable model for understanding the factors of smartphone acceptance in medical settings.

Improving the Accuracy of Early Diagnosis of Thyroid Nodule Type Based on the SCAD Method

Although early diagnosis of thyroid nodule type is very important, the diagnostic accuracy of standard tests is a challenging issue. We here aimed to find an optimal combination of factors to improve diagnostic accuracy for distinguishing malignant from benign thyroid nodules before surgery. In a prospective study from 2008 to 2012, 345 patients referred for thyroidectomy were enrolled. The sample size was split into a training set and testing set as a ratio of 7:3. The former was used for estimation and variable selection and obtaining a linear combination of factors. We utilized smoothly clipped absolute deviation (SCAD) logistic regression to achieve the sparse optimal combination of factors. To evaluate the performance of the estimated model in the testing set, a receiver operating characteristic (ROC) curve was utilized. The mean age of the examined patients (66 male and 279 female) was 40.9 ± 13.4 years (range 15- 90 years). Some 54.8% of the patients (24.3% male and 75.7% female) had benign and 45.2% (14% male and 86% female) malignant thyroid nodules. In addition to maximum diameters of nodules and lobes, their volumes were considered as related factors for malignancy prediction (a total of 16 factors). However, the SCAD method estimated the coefficients of 8 factors to be zero and eliminated them from the model. Hence a sparse model which combined the effects of 8 factors to distinguish malignant from benign thyroid nodules was generated. An optimal cut off point of the ROC curve for our estimated model was obtained (p=0.44) and the area under the curve (AUC) was equal to 77% (95% CI: 68%-85%). Sensitivity, specificity, positive predictive value and negative predictive values for this model were 70%, 72%, 71% and 76%, respectively. An increase of 10 percent and a greater accuracy rate in early diagnosis of thyroid nodule type by statistical methods (SCAD and ANN methods) compared with the results of FNA testing revealed that the statistical modeling methods are helpful in disease diagnosis. In addition, the factor ranking offered by these methods is valuable in the clinical context.

Diagnosis of Malignancy in Thyroid Tumors by Multi-Layer Perceptron Neural Networks With Different Batch Learning Algorithms

To diagnose the malignancy in thyroid tumor, neural network approach is applied and the performances of thirteen batch learning algorithms are investigated on accuracy of the prediction. Therefore, a back propagation feed forward neural networks (BP FNNs) is designed and three different numbers of neuron in hidden layer are compared (5, 10 and 20 neurons). The pathology result after the surgery and clinical findings before surgery of the patients are used as the target outputs and the inputs, respectively. The best algorithm(s) is/are chosen based on mean or maximum accuracy values in the prediction and also area under Receiver Operating Characteristic Curve (ROC curve). The results show superiority of the network with 5 neurons in the hidden layer. In addition, the better performances are occurred for Polak-Ribiere conjugate gradient, BFGS quasi-newton and one step secant algorithms according to their accuracy percentage in prediction (83%) and for Scaled Conjugate Gradient and BFGS quasi-Newton based on their area under the ROC curve (0.905).

Prevalence and pathological lesion of Trichomonas gallinae in pigeons of Iran

This research was conducted to determine the prevalence and pathological lesion of Trichomonas gallinae in pigeons in the northeast part of Iran. Wet mount preparations from the oral cavity/crop of 418 pigeons (Columba livia) captured from various locations in Khorasan province analyzed for T. gallinae by Giemsa's staining between April 2008 and June 2009. A total of 418 pigeons, 37.32% (n = 156) were infected with T. gallinae. Macroscopically, the oropharynx of infected pigeons has white, caseous lesions or stomatitis. Microscopically, there was moderate congestion with infiltration of mononuclear inflammatory cells in the lamina propria of pharynx, hyperplasia of mucous cells in epithelia of trachea with infiltration of mononuclear inflammatory cells, numerous granulomatous foci in the livers with many multinucleated giant cells, tubulointerstitial nephritis with multifocal to diffuse infiltration of mostly mononuclear inflammatory cells in the kidneys. In the present paper we have described for the first time the co-existence of both genotypes of T. gallinae based on pathological lesions in this area.

Faunestic study of ants with emphasis on the health risk of stinging ants in qeshm island, iran

BACKGROUND

Qeshm (26.75N, 55.82E), Iran, is 1500 km² island in the Strait of Hormuz. Qeshm is a free trade zone, acting as an important channel for international commerce, and has been the site of much recent development. There is potential risk of stinging ant attacks for residents and visitors that may occur in the island. The aims of this study were to find out the fauna, dispersion, and some of the biological features of ant species with special attention to those, which can play role on the public health of the island.

METHODS

In this cross-sectional study, we surveyed ants around the island using non-attractive pitfall traps and active collection to evaluate potential threats to humans and other species during 2006-2007. All collected specimens were identified using the morphological ant keys.

RESULTS

ONLY SIX ANT SPECIES WERE FOUND: Pachycondyla sennaarensis (41%), Polyrhachis lacteipennis (23%), Camponotus fellah (16%), Cataglyphis niger (9%), Tapinoma simrothi (7%), and Messor galla (4%).

CONCLUSION

We were surprised not to find any cosmopolitan tramp ants so often associated with commerce and development. Instead, all six species may be native to the Middle Eastern region. The most common species, P. sennaarensis, has a powerful sting and appears to do well around human habitations. This species may prove to be a serious pest on the island.

The first observed complex of 11-crown-3 ether. X-ray crystal structure and NMR study of (benzo-11-crown-3)2·LiNCS

The title complex crystallizes in the monoclinic P21/c space group, with a = 7.7397(8), b = 18.287(2), c = 17.4726(19) Å, β = 94.008(2)°, and Z = 4. The coordination geometry around the lithium cation is pseudooctahedral. The effects of lithium complexation on the 1H and 13C solution NMR spectra are discussed. In the solid-state 13C NMR spectrum at 300 K, very long aliphatic proton spin lattice relaxation times are observed along with broadening of the aliphatic carbon resonances. These results are attributed to the dipolar washout phenomenon, where the presence of a low amplitude motion of the same frequency as the 1H decoupler, leads to less effective removal of the 1H–13C dipolar coupling. At 330 K, there is some sharpening of the aliphatic resonances since there is less interference between the motion and the decoupling frequency.Key words: crown ether analog, lithium complex.