Aloe vera supplementation improves cardiovascular risk factors in hemodialysis patients: A randomized, double-blind, placebo-controlled trial.

Objective: This study assessed the effects of Aloe vera supplementation on serum inflammatory factors, blood sugar and lipid profiles in hemodialysis patients. Materials and Methods: Totally, 50 hemodialysis patients were allocated randomly to either Aloe vera or placebo groups. The Aloe vera group received 2 Aloe vera capsules daily for 8 weeks (500 mg/day). Serum C-reactive protein (hs- CRP), Fasting blood glucose (FBS), and lipid profiles levels were evaluated at the baseline and the end of the eighth week. Results: Aloe vera supplementation for 8 weeks was associated with a significant reduction of serum hs- CRP (p=0.004), total cholesterol (p=0.01), low density lipoprotein (LDL) (p=0.02) leves and increased high density lipoprotein (HDL) (p=0.002) concentration in the hemodialysis patients. Conclusion: Aloe vera supplementation is beneficial in improvement of cardiovascular risk factors in hemodialysis patients.

Fear of the unknown, anxiety, and social isolation in Iranian patients with Covid-19, the grounded theory.

BACKGROUND: Coronavirus 2019 (COVID-19) pandemic has incurred a health challenge. Patients suffer from many physical and mental disorders. To accurately identify the experience of patients with Covid-19 in the Iranian society. MATERIALS AND METHODS: This qualitative research was conducted using the grounded theory. The data of this grounded theory study were collected using 32 semi-structured interviews with participants and field notes including the patients with Covid-19, nurses, physicians, and the patients' families. Data analysis was performed using Corbin and Strauss (2008) approach for concepts, context, process, and categories' integration. RESULTS: Qualitative analysis of data led to the extraction of 54 sub-categories and 7 final categories. "Isolation, fear of death, and fear of infection of relatives and family members" were identified as the main issue. The context to this concern was the "unfamiliarity with the virus due to its ambiguous nature that was obtained with a wide range of symptoms." Facing this issue, the patients used the strategy of "adherence to health protocol in the coronavirus infection process" that was recognized as the central variable. CONCLUSION: The ambiguous and complex nature of the emerging virus, the appearance of different symptoms in different people, and the fear of infecting others, death and anxiety due to unknown complications of the disease make patients go through the most difficult experience of their lives. That requires ongoing training on up-to-date prevention and treatment protocols, along with the emergence of mutated viruses and new symptoms.

Synbiotic supplement for treatment of iron deficiency anaemia in haemodialysis patients: A randomized controlled trial.

BACKGROUND: There is evidence that probiotics can increase the availability of iron. The aim of current study was to determine the effects of synbiotic supplementation on the haematological parameters and anaemia in haemodialysis patients. METHODS: This study was a randomized, double-blind, placebo-controlled trial. Fifty patients were randomly selected from the haemodialysis section of Vaseii Hospital, Sabzevar, Iran. Subjects in the symbiotic and control groups received 2 capsules of synbiotic supplement or placebo, respectively, once a day for 8 weeks. Blood samples were divided into two test tubes in equal volumes. Blood haemoglobin, haematocrit, transferrin saturation, red blood cells (RBCs), and total iron binding capacity (TIBC) were measured with auto-analyser. Ferritin was determined using Sandwich enzyme-linked immunosorbent assay (ELISA). RESULTS: Twenty tree patients in each group completed the study. Significant results were recorded in synbiotic groups regarding the concentration of blood haemoglobin, haematocrit, transferrin saturation, the number of RBCs, and serum ferritin compare to placebo group (P < .05). At the end of week 8, TIBC significantly decreased in synbiotic than placebo group (P < .05). CONCLUSION: Synbiotic supplementation could be a safe and promising candidate in improving anaemia in CKD patients.

Investigation of radiation dose around C-arm fluoroscopy and relevant cancer risk to operating room staff.

This study aimed to evaluate the ambient dose equivalent around a C-arm device during spinal surgeries and determine the optimum locations for the surgeon and staff to keep radiation exposure as low as reasonably achievable. Furthermore, cancer risk incidence was estimated using the excess relative risk (ERR) concept of the biologic effects of ionizing radiation VII report for operating room (OR) staff. A lateral projection of the C-arm setup was considered in the current study. The ambient dose equivalent rate was measured using an electronic dosimeter in 30° steps all around for 1, and 1.6-m heights as well as 1, and 2-m distances away from a water tank (scattering medium). By assuming a typical workload, the annual ambient dose and a maximum number of permissible operations were determined. For a worst-case scenario, the dose was used to estimate the ERR for various organs including prostate, ovary, breast, lung, thyroid, and colon for attained ages of 35, 40, and 50 years. The maximum ambient dose equivalent rate was seen at 330° and 30° (about 600 µSv/h at 1 m height and a distance of 1 m from the scattering medium). The corresponding permissible workload for an OR staff was about 30,660 operations. Based on the obtained results, 60° next to the image intensifier was the optimum position for the surgeon, while 30° next to the tube was the worst position because of backscattered radiation. The ERR results showed that the lung and colon have the highest cancer risk incidence among the considered organs for both males and females, respectively.

Quality of life and asthma control in pregnant women with asthma.

BACKGROUND: Asthma is the most commonly occurring respiratory illness during pregnancy. Associations with complications of pregnancy and adverse perinatal outcome have been established. However, little is known about quality of life (QoL) in pregnant women with asthma and how it relates to asthma control particularly for Iran. OBJECTIVE: To determine the relationship between asthma related QoL and asthma control and severity. METHODS: We conducted a prospective study in pregnant women with asthma. We used the Asthma Control Questionnaire and the Asthma Quality of Life Questionnaire (AQLQ) and the guidelines of the Global Initiative for Asthma for assessment of asthma severity. RESULTS: Among 1603 pregnant women, 34 were diagnosed with asthma. Of these 13 had intermittent, 10 mild, 8 moderate and 3 severe persistent asthma. There was a significant decrease of QoL with poorer asthma control (p = 0.014). This decline could be due to limitations of activity in those with poorer asthma control, which is underlined by the significant decline of QoL with increasing asthma severity (p = 0.024). CONCLUSION: Although the majority of pregnant women with asthma had a favorable score in AQLQ, reduced QoL was related to increased asthma severity and poor asthma control. This underlines the importance of controlling asthma during pregnancy not only for the prevention of adverse pregnancy outcomes but also for the preservation of QoL.

Designing a comprehensive clinical competency test for operating room technology student: Using Delphi technique and CIPP model evaluation.

BACKGROUND: The ultimate goal in educating medical students is to train skilled workforce who by obtaining the required knowledge of the discipline, personal and professional skills, and attitudes to enter the national health-care system. This study was conducted with the goal of designing a comprehensive clinical competency test of operating room technology student using the Delphi technique, and then, the clinical skills of the operating room technology students of the paramedical school were assessed using the CIPP evaluation model. MATERIALS AND METHODS: The present study was conducted in the University of Medical Sciences to evaluate clinical skills with Delphi technique and CIPP evaluation model. This was a mixed methods study. Purposive sampling method was employed in the qualitative stage, and a census was conducted in the quantitative part. A comprehensive clinical competency test was designed in this research using the Delphi technique and was conducted with 18 students. Then, clinical skills evaluation was performed by descriptive-analytical statistical tests and evaluator's observation using the CIPP model. RESULTS: The comprehensive clinical competencies test of the surgical technology students was designed in four sections: content, evaluation method, test conditions, and the criteria for passing the comprehensive test. The results in the implementation stage showed that the operating room technology students had a range of excellent to weak performances in exhibiting basic skills at different levels. CONCLUSIONS: The results of the present study showed that the comprehensive test, designed based on the Delphi technique of experts, and using the CIPP model can be a good criterion for the evaluation of the operating room technology students before entering the clerkship.

Environmental tobacco smoke exposure during pregnancy affects complications and birth outcomes in women with and without asthma.

BACKGROUND: It is known that environmental tobacco smoke (ETS) has adverse effects on pregnancy and birth outcomes. We aimed to assess the impact of ETS in pregnant women with and without asthma. METHODS: A cohort study was conducted from August 2014 to June 2015 enrolling 1603 pregnant women during their 2nd trimester. Data on tobacco exposure were collected at first visit and women were followed through pregnancy till postpartum. RESULTS: Of the 1603 women, 231 reported passive smoking, 223 non-asthmatics and 8 asthmatics. Women exposed to ETS during pregnancy were more likely to have an infant admitted to the pediatric ward (10.8% vs. 6.5%, p = 0.026) and to have low one- and five-minute Apgar scores (1 min: 6.1% vs. 2.6%, p = 0.011; 5 min: 2.2% vs. 0.7%, p = 0.039). Complications of pregnancy were also elevated in women exposed to ETS (53.7% vs. 42.3%, p = 0.002). Asthma had no additional effect beyond the impact of ETS except for cesarean sections that were more frequent in women with asthma exposed to ETS. CONCLUSIONS: Due to the small number of women with asthma exposed to ETS, combined effects of asthma and ETS were only found for cesarean sections. Still counseling of pregnant women about adverse effects of ETS should consider women's asthma as an additional reason to avoid ETS.

Prioritizing the health education needs based on community participation: AHP method.

INTRODUCTION: The identification of health education needs through the community results in targeted services and health promotion. Prioritizing these needs, in addition to identifying the desired health system based on the needs of the community, is required for the optimal allocation of resources. Therefore, this study was conducted with the aim prioritizing the health educational needs of Sabzevar-Iran community. MATERIALS AND METHODS: This study was a two-step mix study. In the first stage, the qualitative method of the main themes of health educational needs of Sabzevar society was determined. Then, the questionnaire was prepared by a paired scale (36 questions) and quantitative method was used to prioritize the main themes with Analytic Hierarchy Process (AHP) software. The random sampling method was used in this study and data analysis was performed using Expert Choice software using AHP method. RESULTS: Social problems with 0.206, contagious diseases with 0.205, nutrition with 0.161, and public health with 0.132 were in the first to fourth grades of health educational needs in Sabzevar city and environmental health, health management, noncontagion diseases, elderly, and occupational health were in the fifth to ninth grades. The consistency index in this study was 0.08, although the adjustment index is <0.1 good and acceptable. CONCLUSION: Social problems are the first priority of Sabzevar society, which require appropriate training.

Correction to: Prospective cohort study of pregnancy complications and birth outcomes in women with asthma.

In the original publication, the university name of the authors in the affiliations was published as University of Medical Sciences, Sabzevar, Iran. The correct university name should read as Sabzevar University of Medical Sciences, Sabzevar, Iran.

Prospective cohort study of pregnancy complications and birth outcomes in women with asthma.

BACKGROUND: Asthma is the most common potentially serious medical complication in pregnancy. The purpose of this study was to determine the association between maternal asthma and a spectrum of adverse neonatal and maternal outcomes. METHODS: Events during pregnancy and birth outcome were evaluated in 34 asthmatic as well as 1569 non-asthmatic pregnant women who were enrolled in a prospective cohort study undertaken at the antenatal clinics of Mobini Hospital in Iran. The women were interviewed and classified according to clinical severity and asthma control as per GINA guidelines. Information on asthma symptoms was collected by a questionnaire as well as by spirometry and physical examination. All subjects were followed until delivery, and postpartum charts were reviewed to assess neonatal and maternal outcomes. Eosinophil cells counts were obtained and total IgE was measured by ELISA. Results were assessed by multivariate logistic regression adjusting for maternal age and parity, and for birth outcomes, for gestational diabetes, and hypertension/pre-eclampsia. RESULTS: The well-known relationship between family history of asthma and asthma in pregnancy was again supported (p < 0.001). Women with asthma had more bleeding events 3 weeks or more before delivery (OR 3.30, 95% CI 1.41-7.26), more often placenta problems (OR 6.86, 95% CI 1.42-33.02), and gestational diabetes mellitus (OR 3.82, 95% CI 1.06-13.75). No significant differences between asthmatic and non-asthmatic mothers regarding duration of gestation, birthweight, low Apgar scores, or neonatal respiratory difficulties were found. Total IgE antibody levels and eosinophil counts did not differ by asthma control and severity. CONCLUSIONS: Asthma in pregnancy poses some risk for pregnancy complications and adverse perinatal outcomes. Managing asthma effectively throughout pregnancy could benefit women and their babies and help to reduce the health burden associated with asthma during pregnancy.

Status of antioxidant and homocysteine-lowering vitamins related to cardiovascular diseases in hemodialysis patients.

BACKGROUND AND AIM: Cardiovascular disease is the major cause of mortality in hemodialysis patients. Oxidative stress and hyperhomocysteinemia may contribute to an increased risk of CVD. Therefore, we assessed the status of antioxidant and homocysteine-lowering vitamins related to cardiovascular disease in hemodialysis patients at Vasei hospital in Sabzevar. METHODS: In this cross-sectional study, we enrolled 75 hemodialysis patients by using census method at Vasei Hospital in Sabzevar (Iran) in 2014. After measuring height and body weight, food intake was assessed by a 24-hour dietary recall questionnaire for at least two days (a non-dialysis and dialysis day), and food frequency was recorded with Nutritionist IV software. Data were analyzed by SPSS version 16, using descriptive statistical tests, one sample t-test and independent samples t-test and p<0.05 was considered statistically significant. RESULTS: This study was carried out on 75 patients. Mean age and BMI of patients were 49.95±17.22 years and 20.04±3.38 kg/m2, respectively. Intake of all vitamins with the exception of vitamin B12 in hemodialysis patients studied, were less than the recommended dietary allowance (RDA) (p<0.05). CONCLUSION: According to the survey, consumption of antioxidants and B-vitamins related to cardiovascular disease was less than RDA in hemodialysis patients.

Study of fruit and vegetable intake in breast cancer patients in the city of Sabzevar.

INTRODUCTION: Diet is one of the most important modifiable risk factors for prevention and control of chronic diseases, including breast cancer. This study aimed to determine the fruit and vegetable intake in women with cancer breast in Sabzevar. METHODS: This cross-sectional study was conducted on 125 women with breast cancer in Sabzevar in 2011. Census sampling was done on volunteers in a visiting home and suspected women referred to the mammography, ultrasound, and radiology clinic in the Sabzevar center for breast cancer. Demographic and semi quantitative food questionnaires of 160 foods were completed for each of the patients by trained interviewers. Data were analyzed using the software Nutritionist IV. Descriptive statistics, one-sample t-test, and Chi-square test were used, employing the SPSS version 16. RESULTS: In this study, 125 women were assessed with breast cancer. The highest risk with breast cancer was 35.5% in women 40 to 49 years old. The results of this study showed that patients with breast cancer had minimum daily recommended intake (3.06 ± 2.3 serving of fruits and 2.09 ± 1.81 serving of vegetables in days). One sample t-test showed that the mean intake of fruits and vegetables was not a significant deference with daily recommended intake (p>0.05). The chi-square test showed that patients with minimum daily recommended intake of fruits and vegetables were at high risk for breast cancer in comparison with those who received the highest amount (p=0.001). CONCLUSION: This study supports evidence that high vegetable and fruit intake is associated with lower breast cancer risk.

Multicomponent one-pot reactions: synthesis of some new 6-oxopyrano [2,3-c]isochromenes by condensation of homophthalic anhydride, dialkyl acetylenedicarboxylate, and isocyanides.

A novel three-component, one-pot condensation of the zwitterion generated from dialkyl acetylenedicarboxylate and isocyanides with homophthalic anhydride is described. The reaction affords new 6-oxopyrano[2,3-c]isochromenes in good yield. Isochromenes have been reported to possess diverse biological activities such as antibacterial, antifungal, antiinflammatory, and antiangiogenic effects. Moreover, Theses important compounds are found in various natural products.