Use of complementary and alternative medicine in pregnant women: A cross-sectional survey in the south of Iran / 中西医结合学报

OBJECTIVE@#The use of traditional medicine and complementary alternative medicine (TM/CAM) derived from herbal remedies or natural supplements is increasing worldwide, but there are limited data on the use of TM/CAM during pregnancy. Iran has various ethnic populations, and the usage of TM/CAM by the different ethnic groups has not been researched. The aim of this study is to understand the use of TM/CAM modalities in pregnant women of different ethnic groups in southern Iran.@*METHODS@#This study was conducted in primary health care centers in Khuzestan Province, Iran, from May to August, 2016. A semi-structured valid questionnaire was used to gather information in pregnant women (n = 170).@*RESULTS@#About 46.5% of women in this study used TM/CAM during previous pregnancies. The majority (67%) of study participants were Arab. The Arab population showed increased use of TM/CAM during pregnancy (P = 0.014). Women with complications in former pregnancies had significantly higher incidence rate of TM/CAM use (65.8%) compared to the other group (39.6%) (P = 0.001).@*CONCLUSION@#Understanding TM/CAM use and the associated factors in different ethnic groups of pregnant women will benefit the evaluation of the proper health policies and mother-infant health programs. This study contributes to the growing literature on TM/CAM, ethnic diversity and pregnant women.

Quality of life and its influencing factors of couples referred to an infertility center in Shiraz, Iran

Background: Infertility adversely affects quality of life [QoL]. The present study aims to evaluate QoL and its associated factors among infertile couples

Materials and Methods: In this cross-sectional study, the Fertility QoL [Ferti QoL] instrument was used to measure QoL among 501 volunteer couples who attended the Infertility Clinic at the Mother and Child Hospital, Shiraz, Iran. We used an additional questionnaire to assess participants' demographic and clinical characteristics. The relationship between the scores of QoL to the sociodemographic and treatment data was analysed

Results: The subjects with lower income levels had lower relational, mind/body, emotional, and total core scores. Fe- male participants without academic education had lower scores in the emotional subscale, while the male participants showed lower scores in emotional, mind/body, relational, social, and total QoL domains. Subjects who had undergone any type of treatment, including pharmacological treatment, intrauterine insemination [IUI], intra-cytoplasmic sperm injection [ICSI], and in vitro fertilization [IVF] showed significantly lower scores in the environmental domain. Participants with lower infertility duration obtained significantly greater QoL scores. Finally, tolerability, emotional, and environmental domains were significantly more desirable when the infertility problem was related to a male factor

Conclusion: Infertile couples with shorter duration of infertility and male etiology have higher QoL. Lower academic education, lower income levels, or prior unsuccessful treatments are associated with lower QoL

Prevalence of chronic constipation and its associated factors in pars cohort study: a study of 9000 adults in Southern Iran

Background: Chronic constipation is one of the most common gastrointestinal disorders. It has negative effects on the patients' quality of life, and their productivity, and results in a high economic burden on the healthcare services. The aim of the present study was to estimate the prevalence of chronic constipation and its associated factors in pars cohort study [PCS]

Methods: A cross-sectional study was conducted on the baseline data of the PCS. Data gathering was done by structured questionnaire and physical examination. A total of 9264 subjects aged between 40 and 75 years were enrolled in the PCS. Diagnosis of chronic constipation was done using Rome IV criteria. Multivariable binary logistic regression was applied for data analysis

Results: A total of 752 [8.1%] participants were diagnosed as having chronic constipation [9.3% of female and 6.7% of male participants]. Older age [OR: 1.55, 95% CI:1.31-1.83], physical activity [OR: 0.56, 95% CI: 0.46-0.68], opium consumption [OR: 2.06, 95% CI: 1.63-2.60] , anxiety [OR: 1.38, 95% CI: 1.15-1.65], depression [OR: 1.22, 95% CI: 1.01-1.48], back pain or arthralgia [OR: 1.38, 95% CI: 1.14-1.67], insomnia [OR: 1.62, 95% CI: 1.36-1.93] and gastroesophageal reflux disease [OR: 1.51, 95% CI :1.28-1.78] were associated with the prevalence of constipation in the multivariable analysis

Conclusion: Chronic constipation was a common problem in the PCS population. Decreasing modifiable risk factors associated with constipation such as opium consumption and physical inactivity can reduce its prevalence and decrease burden of the disease.

Prevalence and correlates of gastroesophageal reflux disease in Southern Iran: pars cohort study

Background: Prevalence of gastroesophageal reflux disease [GERD] is increasing worldwide. We aimed to estimate the prevalence of GERD in Pars Cohort Study [PCS] and to find its correlates

Methods: We used the baseline data from PCS. PCS was conducted in the district of Valashahr in Fars province in southern Iran from 2012 to 2014. 9264 inhabitants who were 40-75 years old, and agreed to participate were enrolled. Data were collected by a structured questionnaire and simple physical examination of all participants

Results: Generally, 58.50% [95% CI 57.49 - 59.51] of the participants had GERD and 25.10% [95% CI 24.22 - 25.99] experienced it at least weekly. Approximately, 32.0%, 52.0%, and 24.4% of the participants reported heart burn sensation, regurgitation, and both symptoms, respectively. Being female [OR: 1.45, 95% CI 1.27 - 1.65], being older [OR: 1.20, 95% CI 1.06 - 1.36], being divorced/ widowed/separated [OR: 1.38, 95% CI 1.01 - 1.91], and lower education [OR: 1.43, 95% CI 1.02 - 2.03] were associated with frequent GERD

Conclusion: GERD is common in PCS and its prevalence is close to that in western countries. Being female, higher age, being divorced/widowed/separated, lower education, history of hypertension, anxiety, insomnia, and non-cigarette tobacco smoking were associated with frequent GERD. We are going to investigate the causal relationship between these risk factors and GERD in the next stages of PCS

Social well-being and related factors in students of school of nursing and midwifery

Background: According to the World Health Organization viewpoint, social well-being is an important dimension of health along with physical and mental aspects. Evaluation of social wellbeing is necessary in students, especially in medical sciences students due to future responsibility as health care professionals. The present study attempted to investigate the level of social well-being, five domains of it [like actualization, integration, contribution], and some related factors in the school of nursing and midwifery students

Methods: This cross-sectional study was carried out between Julys to December 2015 and comprised 346 students in the school of nursing and midwifery in Shiraz University of Medical Sciences, Shiraz, Iran. Social well-being, socio-demographic status and physical activity were measured by valid questionnaires. Univariate linear regression analysis, multiple imputation method, ANOVA and independent sample t-test were used as different statistical methods. The P values less than 0.05 were considered as statistically significant

Results: The mean score of social well-being was 50. The minimum and maximum scores of social well-being were 20 to 100. Married students had higher social well-being than single students in univariate linear regression [Beta: 2.111, 95% CI: [0.387 to 3.738], P=0.017]. Also, social integration had higher scores in married students [P=0.015]. Social actualization was higher in male students [P=0.015]; on the other hand, social contribution was higher in female students [P=0.026]

Conclusion: The results of our study showed that social well-being status of students in this research was not satisfactory. Designing and conducting programs for promotion of social well-being, for example preparing facilities for marriage of students, can be helpful. Evaluation of social well-being in students of other schools with multicenter studies seems to be useful

comparative study of potassium hydroxide versus CO[2] laser vaporization in the treatment of female genital warts: a controlled clinical trial

Background: genital warts are the most common viral sexually transmitted disease affecting 1% of the population. A prospective, open-label controlled trial was performed to compare topical 5% potassium hydroxide [KOH] solution with CO[2] laser in the treatment of female genital warts

Methods: seventy patients were enrolled in the study after convenience sampling. Right-sided lesions of the patients were treated by CO[2] laser every 3 weeks. The left-sided lesions of the same patients were treated by topical 5% KOH solution twice a day using a toothpick with cotton wrap on the tip. The patients were visited at 3, 6, and 9 weeks after initiation of the treatment and followed up for 6 months after the last visit

Results: out of seventy patients, sixty three completed the study and were analyzed. A total of 56 KOH treated-patients [88.9%] showed complete response. On the other hand, 56 laser-treated patients [88.9%] presented complete clearing of the lesion. There was not any difference in response to both modalities of treatment. Complications of KOH solution and CO[2] laser were 24% and 19% respectively [P>0.05], but serious adverse events were not observed. The patients under KOH treatment displayed a recurrence rate of 11.1% [7 cases], while the same patients with CO[2] laser therapy demonstrated a recurrence rate of 7.9% [5 cases] [P=0.54]

Conclusion: topical 5% KOH solution was as effective as CO[2] laser in the treatment of female genital warts. There was not any serious complication in the application of KOH solution. This could be used as a new treatment for genital warts

Designing and conducting MD/MPH dual degree program in the Medical School of Shiraz University of Medical Sciences

Introduction: Many studies have focused on the need of health systems to educated physicians in the clinical prevention, research methodology, epidemiology and health care management and emphasize the important role of this training in the public health promotion. On this basis, Shiraz University of Medical Sciences [SUMS] has established MD/MPH dual degree program since the year 2012

Methods: In the current study, Delphi technique was used. Both qualitative and quantitative methods were applied in the Delphi process. The Delphi team members including experts with extensive experience in teaching, research and administration in the field of educational management and health/medical education reached consensus in almost 86% of the questionnaire items through three Delphi rounds. MD/MPH program for SUMS was designed based on the items agreed and thematic analysis used in these rounds

Results: The goals, values, mission and program requirements including the period, the entrance condition, and the number of units, and certification were determined. Accordingly, the courses of the program are presented in parallel with the MD education period. MPH courses consist of 35 units including 16 obligatory and 15 voluntary ones

Conclusion: Designing MD/MPH program in SUMS based on the existent models in the universities in different countries, compatible with educational program of this university and needs of national health system in Iran, can be a beneficial measure towards promoting the students' knowledge and theoretical/practical skills in both individual and social level. Performing some additional research to assess the MD/MPH program and some cohort studies to evaluate the effect of this program on the students' future professional life is recommended

Early acute kidney injury based on serum creatinine or cystatin C in intensive care unit after major trauma

Background: Acute kidney injury [AKI] is a common problem in critically ill patients and is independently associated with increased morbidity and mortality. Recently, serum cystatin C has been shown to be superior to creatinine in early detection of renal function impairment. We compared estimated GFR based on serum cystatin C with estimated GFR based on serum creatinine for early detection of renal dysfunction according to the RIFLE criteria

Methods: During 9months, three hundred post trauma patients that were referred to the intensive care unit of a referral trauma hospital were recruited. Serum creatinine and serum cystatin C were measured and the estimated GFR within 24 hours of ICU admission was calculated. The primary outcome was the incidence of AKI according to the RIFLE criteria within 2[nd] to 7[th] day of admission

Results: During the first week of ICU admission, 21% of patients experienced AKI. After adjusting for major confounders, only the patients with first day's serum cystatin level higher than 0.78mg/l were at higher risk of first week AKI [OR=6.14, 95% CI: 2.5-14.7, P<0.001]. First day's serum cystatin C and injury severity score were the major risk factors for ICU mortality [OR=3.54, 95% CI: 1.7-7.4, P=0.001] and [OR=4.6, 95% CI: 1.5-14, P=0.007], respectively

Conclusion: Within 24 hours after admission in ICU due to multiple trauma, high serum cystatin C level may have prognostic value in predicting early AKI and mortality during ICU admission. However, such correlation was not seen neither with creatinine nor cystatin C based GFR

Comparison of abnormal cervical cytology from HIV positive women, female sex workers and general population

Sex workers and HIV seropositive women are at high risk of abnormal cervical cytology. The objective of this study was to compare the cervical cytology among three groups of women: active sex workers, HIV-infected women, and general population in Iran. This was a cross-sectional study performed in Hazrat Zeinab, Lavan clinics and drop in center [DIC] in Shiraz, Iran. This study was performed from October 2009 to October 2011. A total of 266 patients were assigned into three groups: sex-workers [85], HIV positive patients [100], and general population [81]. Pap smear was performed for all participants from the exocervix and endocervix, using a plastic Ayres's spatula and cytobrush. The samples were sent to a pathology center, using a liquid-based media. The risk of cervical infection in sex workers and HIV positive women was greater than the general population [OR=5.47, 95% confidence interval [CI]:2.24, 13.40], [OR=3.71, 95% CI:1.52, 9.09], respectively. The frequency of abnormal cervical cytology in the HIV positive and sex worker groups was higher than the general population [OR=6. 76, 95% CI:2.25, 20.32], [OR=3. 80, 95% CI:1.19, 12.07], respectively. Low-grade squamous intraepithelial lesion [LSIL] and high-grade squamous intraepithelial lesion [HSIL] were associated with CD4 cell count<200I106/L, P=0.021 and P<0.001, respectively. Vaginal infections were seen more often in the sex worker group, and abnormal cervical cytology was greater in the HIV positive group

Chiropractic: is it efficient in treatment of diseases? review of systematic reviews

Chiropractic is a complementary medicine that has been growing increasingly in different countries over recent decades. It addresses the prevention, diagnosis and treatment of the neuromusculoskeletal system disorders and their effects on the whole body health. This study aims to evaluate the effectiveness of chiropractic in the treatment of different diseases. To gather data, scientific electronic databases, such as Cochrane, Medline, Google Scholar, and Scirus were searched and all systematic reviews in the field of chiropractic were obtained. Reviews were included if they were specifically concerned with the effectiveness of chiropractic treatment, included evidence from at least one clinical trial, included randomized studies and focused on a specific disease. The research data including the article's first author's name, type of disease, intervention type, number and types of research used, meta-analysis, number of participants, and overall results of the study, were extracted, studied and analyzed. Totally, 23 chiropractic systematic reviews were found, and 11 articles met the defined criteria. The results showed the influence of chiropractic on improvement of neck pain, shoulder and neck trigger points, and sport injuries. In the cases of asthma, infant colic, autism spectrum disorder, gastrointestinal problems, fibromyalgia, back pain and carpal tunnel syndrome, there was no conclusive scientific evidence. There is heterogeneity in some of the studies and also limited number of clinical trials in the assessed systematic reviews. Thus, conducting comprehensive studies based on more reliable study designs are highly recommended

Cucurbita pepo oil as a drug microemulsion formulation: study of phase Diagram

Investigation of phase diagram of various drug formulations is effective to predict different phase region of drugs to detect final formula. The purpose of this research was to develop the ternary phase diagrams for a drug microemulsion system consisting of Cucurbita pepo [pumpkin] oil, surfactant [Tween 80] and deionized water. An electrical conductivity was used to study the properties of system. Particle size analysis of microemulsion system was performed by dynamic light scattering. The electrical conductivity of the microemulsions increases with increasing of aqueous phase content. Structural transitions from the oil-in-water to a bi-continuous phase then inversion to water-in-oil occured in the system. Diameter of particles was calculated 70 nm [for 75 percent of particles] and 35 nm [for 25 percent of particles]. Solubility results showed that microemulsion system of Cucurbita pepo oil can increase its solubility in aqueous medium due to droplet size reduction into nanometer size. Microemulsion technique can be used as a successful method in preparation of Cucurbita pepo oil drug formulation

symptom profile analysis of depression in a sample of Iranian patients

Background: In some cultures, including ours, direct explanation of inner psychic world is inhibited and stigmatized, therefore finding alternative modes of expression. The aim of this crosssectional study was to assess the frequency of somatization in the depressed patients

Methods: The present study comprised 500 patients referred to the outpatient clinic of Shiraz University of Medical Sciences, and diagnosed with major depressive disorders based on DSMIV- TR. The presenting complaints of these patients were assessed through psychiatric interview. The presenting symptoms were divided into three main categories including mental symptoms, pain, and physical symptoms without pain. Statistical analysis [chi-square and logistic regression] were performed to determine the relationship between presenting symptoms and some demographic variables such as age, gender, marital status, educational level and cultural background [urban or rural]

Results: Physical symptoms other than pain, mental symptoms, and pain were found in 193 [38.6%], 186 [37.2%], and in 121 [24.2%] patients respectively. Pain and physical complaints were more common in patients with rural cultural background, lower education, women and the married individuals. Headache [15.2%], irritability [10.6%] and pain in different parts of the body [10.4%] were the most frequent chief complaints of the patients. Hypochondriasis, suicidal idea, crying, irritability and insomnia were significant symptoms associated with the complaint of somatization

Conclusion: Somatic symptoms, especially pain, have a significant weight in the chief complaints of depressed patients. Physicians need to pay particular attention to this important issue in order to better understand these patients