Researcher Bulletin of Medical Sciences

Objective: Considering the necessity of creating, maintaining and promoting the health of employees as the main organizational capital, this study was conducted with the aim of comprehensive and complete observation of the health status of employees in individual, occupational and organizational dimensions in order to achieve a comprehensive occupational health management model.

Materials and Methods: This study is an applied, qualitative and survey research in terms of objective, and is a qualitative study of survey and observational studies in terms of method, conducted during the years 2016 to 2018 in 300 workstations in 5 government buildings with sampling and snowball methods and data were collected with field method using technical apparatus and designed forms finalized by focus group discussions.

Results: Creating a health management model resulted in creating a database on the individual health status of employees and their workplace health and creating a management dashboard for instant monitoring of organizational health status. Using this model, it was possible to evaluate and monitor the personal and occupational health of employees at any time.

Conclusion: A managerial approach was achieved while classifying media related jobs by designing this occupational health model that, at each moment a clear, realistic and complete picture of the health status of the community was created and, strategies regarding the health status of the staff in accordance with the health status of the staff were adjusted, implemented and communicated

The optimal surgical treatment of isolated tibial avulsion fractures of the Posterior Cruciate Ligament remains controversial. The purpose of this study was to evaluate the results of an arthroscopic technique using two ordinary portals and an incision to stabilize an avulsed fragment. Five patients were treated and followed up for 4 years. The mean score measured by KT-2000 was 9.2 mm preoperatively, 4.6 mm a year (P<0.042) and 3.8 mm 4 years postoperatively (p<0.041). This study showed that fixing the PCL avulsion fractures by a cannulated screw could improve knee function and stability.

Objective: Doping is known as an important public health problem. Prominent sports events can be blemished due to doping. The role of general practitioners as an important part of the health system in the prevention of doping is obvious. Previous studies have shown they have been presumed themselves ill-prepared in dealing with this topic. This study set out to investigate the amount of knowledge and attitude among medical interns toward doping.

Materials and Methods: This cross-sectional study was conducted on 100 medical interns in Taleghani hospital, Tehran, Iran Subjects were asked to complete a 35-item questionnaire. The questionnaire consisted of four parts: demographic data, status of physical activity, knowledge, and attitude. Knowledge was measured by questions regarding identifying prohibited drugs, adverse effects of banned drugs, WADA as an original source of published list of prohibited drugs, and regulations related to anti-doping rules violation. The attitude was measured based on a 5-point Likert scale. The more negative attitude toward doping was shown by higher scores.

Results: The mean age was 25.39+/-1.43. Only 8% of students were familiar with WADA as an original source of doping. Approximately 90% of students were not aware of sanctions of anti-doping rules infraction. 65%, 33% and 2% of our subjects had poor, good and very good knowledge respectively. The mean score of attitude was 19.68+/-2.88.

Conclusion: Our findings revealed, the senior medical students had negative attitudes toward doping and also their level of knowledge was poor in this regard.

Objective: Blood pressure-related diseases are the most influenced by psychological factors. The present study was done with the aim of investigating the effectiveness of emotional regulation techniques along with drug therapy on blood pressure reduction, anxiety symptoms, depression and hostility in patients with hypertension compared to drug therapy alone.

Materials and Methods: The present study is a quasi-experimental study with pre-test design, post-test design and control group. The population of this study was men and women between the age of 20 to 70 years with hypertension and resident in Tehran province in 2019. Among patients with hypertension referred to Ayatollah Taleghani Training Center Clinic, 30 persons were selected accessibly and were randomly assigned to experimental and control groups. The intervention program of cognitive emotion regulation techniques training was done during 8 sessions in the experimental group. The instruments used in this research were Hospital Anxiety and Depression Scale (HADS) and Spielberger's State-Trait Anger Expression inventory (STAXI).

Results: Analysis of covariance showed that there was a significant difference between the experimental and control groups after the intervention in the level of blood pressure, anxiety, depression and total anger expression index at p <0.05 level. Effect size was 0.39, 0.26, 0.21, and 0.21 in depression, anxiety, blood pressure, and total anger expression index, respectively.

Conclusion: Specialists in cardiovascular diseases and health psychology area can employ cognitive emotion regulation techniques to improve the physical and psychological problems of individuals with hypertension including blood pressure, anxiety, depression and anger

Introduction: The purpose of this study was to design and evaluate the effectiveness of an intervention package on the attitude toward infidelity and marital intimacy among the infidel women.

Materials and Methods: The present research uses the pseudo experimental pretest-posttest-follow up methodology with a control group to investigate the effectiveness of the formulated intervention package. Population of the research includes all married infidel women who had referred to Entekhab No Psychology Clinic during 2019, with the statistical sample being made up of 30 married infidel women who had referred to Entekhab No Psychology Clinic. Following the introduction of the research objectives to obtain an informed consent from the participants, they were organized into experimental and control groups by observing the inclusion criteria. The standardized questionnaire on marital infidelity and the marital intimacy questionnaire presented by Vandon-Brouck and Bertommen (1995) were used in the pretest, posttest, and follow up stages. Mixed analysis of variance with repeated measures in SPSS v.24 was adopted to investigate the effectiveness of the formulated intervention package.

Results: The results implied that provision of training courses based on phenomenological description of the marital infidelity provides the infidel women with sustainably increased average levels of the sexual intimacy, negative attitude toward infidelity, religious encountering, problem-solving skill, and infidelity avoidance. The findings further indicated that such training material might lead to stably enhanced levels of intimacy, affection/amour, agreement and adherence to marital intimacy commitments among the infidel women.

Discussion: Based on the findings of this study, it can be argued that designing an intervention package based on the ecological status of the community under study can effectively improve the components of marital commitment and thus if used by therapists. It can be extremely helpful in preventing marital breakdowns in society.

Introduction: Tension type headache is the most common type of headache that is associated with myofascial pain syndrome and trigger points. The aim of this study was to evaluate the efficacy of deep dry needling into trigger points of temporalis, sternocleidomastoid and upper trapezius muscles of females with episodic tension type headache.

Materials and Methods: The study was a clinical randomized, single-blind, parallel-group trial in which 24 participants were allocated into two groups. The first group received dry needling with passive stretching treatment and the second group (control group) received only passive stretching. Subjects were asked to record headache indices (headache intensity and frequency) for 4 weeks before treatment. Headache intensity and frequency and quality of life (SF-36) were measured at baseline and 4 weeks after the intervention.

Results: In the dry needling group, the intensity and frequency of headache and physical functioning scores of quality of life questionnaire were significantly improved after treatment (p <0.05).

Conclusion: Due to the positive effects of deep dry needling and passive stretching in females with episodic tension type headache, the use of deep dry needling into trigger points of head and neck musculature is recommended in the presence of episodic tension type headache.

Background: Simultaneous with other countries, utilization of laboratory tests has increased in Iran. Since understanding the requesting behavior of doctors is a crucial matter, this study conducted in a university reference laboratory center, aiming to assess the process of requesting clinical tests.

Materials and Methods: This study was a descriptive cross-sectional study conducted using the census method on 231277 patients of a main referral polyclinic in Kerman. The data regarding the performed tests, the frequency of requesting laboratory tests, and the demographic information about the patients between 2008 and 2012 extracted from the information system of the laboratory. To analyze the data, SPSS 20 and descriptive statistics methods used.

Result:  Most of the patients were women 16 to 50 years old, and had gone to the clinic only once. Most prescriptions had 50 to 100 tests. General physicians and internists had the highest share of orders and prescription costs. In accordance with rising medical expenses, the prices of laboratory services increased in each year.

Conclusion: This study showed that the 80/20 rule applies to prescriptions, since more than 80% of prescriptions made by only 20% of doctors. To change the behavior of requesting laboratory tests, we need to define accurate and tangible criteria for assessing the appropriateness of requesting in clinical guidelines.

Background: Diabetes mellitus (DM) and its related complications such as diabetic retinopathy (DR) are among considerably growing global concerns. Many efforts have been done toward a better understanding of the modifiable risk factors of DR, to stop progression as well as prevention of this complication. Physical activity (PA) is a known modifiable risk factor of DM but its effect on the severity of DR is not clearly understood. In this study, we aimed to evaluate the association between PA and severity of DR.

Materials and Methods: A case-control study was done comprising 232 patients with DM (type 1 or 2), 58 of whom were in control group with no sign of DR, while the others were divided into three subgroups each contained 58 individuals, according to the severity of DR. PA of patients was assessed by the International Physical Activity Questionnaire (IPAQ) short-version and total scores of PA were compared among different groups.

Result:  Total PA scores in (metabolic equivalent [MET]-hour/week) in control group, in patients with mild to moderate non-proliferative diabetic retinopathy (NPDR), severe to very severe NPDR, and proliferative diabetic retinopathy were 24.6 ±28.3, 23.7 ±30.6, 17.1 ± 27.0, and 7.1 ±10.2, respectively. The lower the score of PA, the higher the stage of DR (r=-0.284, p<0.001). Low PA levels came with higher stages of DR (odds ratio [OR]=2.7, P=0.023) than moderate PA (OR=2.1, P=0.114). When adjusted for age, sex, duration of DM, and type of medication regimen, the association of DR severity with PA level was still statistically significant in mild PA group (P=0.049) and statistically insignificant in moderate PA group (P=0.132). Adjusting for hemoglobin A1c (HbA1c) and body mass index (BMI) showed no significant correlation between PA level and DR severity (OR=1.1 and P=0.794 in low PA group, OR=1.2 and P=0.670 in moderate PA group).

Conclusion: Low PA level can be identified as a risk factor for DR, but not a completely independent one. It is more likely that PA lowers the risk of DR progression through lowering BMI and achieving better glycemic control (HbA1c).

Since researches have shown that maladaptive cognition plays a role in the beginning and maintenance Borderline Personality Disorder (BPD), this research aims to evaluate the relationship between cognitive flexibility and cognitive fusion with borderline personality disorder symptoms. 356 students of Mazandaran University of Medical Sciences who studied in the academic year of 2017-2018 were selected using cluster sampling method and they completed Cognitive Flexibility inventory (CFI), Cognitive Fusion Questionnaire (CFQ) and Schizotypal Trait Questionnaires (STB). There was a positive and significant relationship between cognitive fusion and borderline personality disorder (BPD) (p<0.01). The correlation between cognitive flexibility and borderline personality disorder and subscales was significant and negative (p<0.01, p<0.05). Cognitive flexibility and cognitive fusion and their subscales can predict the BPD factors. It is suggested that psychological interventions, especially cognitive-behavior therapy (CBT) and Acceptance and Commitment Therapy (ACT), are used to increase the cognitive flexibility and reduce cognitive fusion of students with borderline personality symptoms

Background: Epilepsy is accompanied by a series of clinical manifestations of frequent and abnormal discharges of brain neurons. Early onset of epilepsy can normally cause severe cognitive, emotional and social impairments. Therefore, the purpose of the present study is to compare the recognition of facial emotions in patients with early- and late-onset temporal lobe epilepsy.

Materials and Methods: In a causal-comparative study, after definitive diagnosis of temporal lobe epilepsy, 80 patients with temporal lobe epilepsy included 40 early- and 40 late-onset are recruited in the study by using purposive convenience sampling. The research instruments were by Ekman test of facial emotion recognition and clinical psychiatric interview based on DSM-V. SPSS 19 analyzed data using multivariate analysis of variance.

Results: The results showed significant differences in response accuracy and reaction time of facial emotion recognition between the two groups of early- and late-onset temporal lobe epilepsy (p<0.01). These differences were significant in the response accuracy for recognition of sadness, as well significant differences represented in the reaction time for all six basic emotions (happy, sadness, fear, disgust, anger and surprise).

Conclusion: Patients with early-onset temporal lobe epilepsy performed poorly in recognizing sadness. Furthermore, these patients had a longer reaction time in recognizing facial emotions such as; fear, sadness, anger, disgust, happiness and surprise than patients with late-onset temporal lobe epilepsy.

Proximal humeral fracture is a common injury particularly in elderly. A proper management of these fractures is very challenging, based on the various characteristics of patient, fracture anatomy, equipment and the surgeon experience. Bilateral PHF is a rare condition, which almost always caused by seizure, electric shock and trauma, respectively. An appropriate treatment of these patients needs especial attention to obtain a good clinical outcome.

We report a 29-year-old patient who suffered from bilateral proximal humeral fracture with posterior dislocation and splitted humeral head due to the combined mechanism of injury including severe trauma after high voltage electric shock. We did not find similar case(s) reported before in the literature. The patient treated with bilateral open reduction and internal fixation (ORIF). He was able to do his daily activities after 6 months

The genus Brucella is a worldwide distributed intracellular bacteria, which infects animals and human. Currently, this zoonosis has been diagnosed by microbiological and serological laboratory tests. Different PCR protocols with various primer pairs and different target genes have been published for the detection of Brucella, but only a few of these primers have been used in human samples. This study aimed to evaluate and compare the sensitivity and specificity of three primer pairs in the PCR technique, each of which separately amplifies three different regions in the Brucella genome, to determine which are more comfortable for the detecting of Brucella DNA in human clinical samples.

49 clinical serum samples were isolated from suspected patients in different cities in Iran from October 2017 to July 2018. The suspected patients with brucellosis-compatible symptoms were checked. These primers amplified 3 distinctive fragments in BCSP 31 gene (B4/B5), Designed IS711 primers, and a sequence of 16SrRNA of Brucella melitensis.

The results showed that the B4/B5 primer pair had the highest sensitivity and specificity for the detection of both positive and negative samples (100%). The designed IS711 primer pair detected 94% of samples, whereas the 16SrRNA primer pair was the least sensitivity, being able to detect only 30.64% of samples.

The specificity of 3 techniques was 100%. The B4/B5 primers were able to detect the smallest number of bacteria 0.05 CFU/reaction whereas IS711 was able to detect 2 CFU/reaction and 16SrRNA was able to detect 2×10⁵ CFU/reaction.

Objective: The effectiveness of acceptance and commitment therapy (ACT) in quality of life and death anxiety in women suffering from breast cancer.

Materials and Methods: This study was a quasi-experimental research with a non-equivalent control group design. All women suffering from breast cancer and being treated at Imam Khomeini Hospital in year 2019. The sample was randomly selected. Thirty people were selected 15 of whom were randomly assigned to the experimental group and 15 were randomly assigned to the control group. During eight 90-minute sessions, the experimental group received the ACT intervention. Both groups were evaluated before and after the intervention with quality of life questionnaires and death anxiety, and multivariate analysis of covariance and variance was used to analyze the data. Data analysis was performed with SPSS24.

Results: The findings suggested that the quality of life and death anxiety in the experimental group were significantly different from the control group.

Conclusion: The training program based on ACT had an impact on the quality of life and death anxiety of women suffering from breast cancer.

Objective: Congenital hypothyroidism (CH) refers to a condition in which there is a low level of thyroid hormone in an infant’s blood. It can result in serious problems in physical and mental development of patients. This study aimed to compare growth indices in patients with and without CH.

Materials and Methods: Historical cohort study, 96 patients with CH in different counties of Kurdistan province were considered as exposed cases. The non-exposed group included children of the same age, sex and geographical area as much as possible. Independent t-test was used to compare growth indices in the two groups. Moreover, repeated measurement was used to compare the two groups in terms of trend of changes in growth.

Results: There was a significant difference between the two groups of neonates in terms of weight and head circumference measured at third and ninth months of ages (p<0.05) respectively. Moreover, no statistically significant difference was observed between the two groups in terms of the trend of changes in growth percentiles (head circumference, height, and weight) (p>0.05).

Conclusion: The quality of care provided for CH patients in Kurdistan province is at a desirable level.

In the inguinal region at normal anatomical situation the artery is positioned lateral to vein and by this figure artery and vein get out under inguinal ligament and entrance to this region. Every surgeon (general surgeon, vascular surgeon or orthopaedic) that works at this region should know anatomical anomaly and variation of these vessels in inguinal region. Dissection at this region without knowing these variations could damage the vessels especially femoral artery. Some times this variations could induce compression on the vein and induce deep vein thrombosis. In this case while exploring femoral artery for transfemoral thrombectomy, femoral vein was found in the arteries anatomical position and complete transposition of artery and vein was founded. In conclusion, knowing normal variations and anomalies while dissecting this area helps us for lowering iatrogenic vascular trauma and complications.

Rabies is one of the most common viral and fetal diseases between humans and animals known as a zoonotic disease. Approximately 99% human rabies deaths occur in developing countries. Health care and follow up programs conducted for all the rabies cases are one of the important priorities for health care system in Iran to prevent the rabies incidence. The purpose of this study is to describe the cow rabies status and the health care programs conducted to the successful elimination of this deadly disease in one of the largest cowsheds in Mallard city in Iran during 2014.

After founding the rabies incidence in one of the largest cowsheds in Mallard city in Iran, the crisis committee was held immediately and control measures including isolation, complete quarantine, vaccination of residents, and other sanitation measures were achieved in cooperation with the responsible organizations. During this incidence, 23 calves, cows and heifers were died.

By conducting an integrated program and method, the numerous stakeholders contributed to the successful elimination of this fatal disease. In order to control the rabies, it is essential to educate the public on the prevention of the disease, especially in areas where the disease is more prevalence. Therefore, cooperation between the institutions involved in the disease control and planning for emergency disease eradication are essential to prevent the rabies infection among pets, especially livestock

Objective: In this research, the scientific and practical question, whether or not people with sublingual varices were more exposed to dental prosthesis than those who did not have sublingual varices, was answered.

Materials and Methods: The case-control study was done by referring to the Kahrizak Alborz charity sanatorium. A list of seniors over 60 years were prepared and referred to each of them after justifying the plan and obtaining their consent were analyzed, sampled. The case group was those who suffered from sublingual varices and the control group were those who did not have sublingual varices and in terms of age, sex, smoking, high blood pressure and leg varice were similar to those of the case. Varices detection was evaluated by clinical examination and according to the standard method. Sublingual varices were examined and recorded based on age, sex, dental prosthesis, smoking, leg varices, blood pressure, literacy level. Exposure level of two groups with denture prosthetics were Judged by the statistics with chi-square test, Fisher exact, and odds ratio.

Results: A total of 141 patients with sublingual varices and 141 controls were studied. The subjects were two groups. Exposure to denture in the control group was 65 (46%) and in the case group 100 (71%).

Conclusion: It seems that having removable denture prosthesis increases the chance of developing sublingual varices.

Objective: The issue of the philosophy of religious orders is a popular topic and the first book written in this regard is ‘Elal-o-Sharaye’ by Sheikh Sadough. The present study attempts to explain the effect religious texts have attributed to observing religious orders related to slaughter, which is referred to as ‘halal’ or healthy food in religious experts’ words. Of course, there is a relationship between being halal and food health, which is not within the scope of the present study.

Materials and Methods: The method used in the present study was descriptive-analytical. Accordingly, interpretations and statements were used as sources based on the key words ‘physical health, Islamic slaughter, food health, halal, health from the perspective of Shari’a, the logic behind the divine decrees were investigated. In addition to describing the existing facts and collecting the required data based on the research questions, how and why slaughter is done in Islam and its different dimensions related to food health were explained from the perspective of Shari’a (in terms of being halal).

Results: Scientific effects scientists attribute to Islamic slaughter have to do with theoretical reason. Definitely, theoretical reason cannot understand the criteria and the reasons behind religious orders independently of Shari’a in all cases, in the same was as considered by the holy Shari’a. Therefore, as long as there is no clear logic as the absolute or compelling reason for the effects of Islamic slaughter, all these issues are taken into account in the framework of the benefits of religious orders and they will not be more important than the effect attributed to Islamic slaughter in religious texts (becoming halal).

Conclusion: The effect of Islamic slaughter, from the perspective of the religious expert, is certainly for the food to become halal and the meat to become healthy. Undoubtedly, the scientific effects of slaughter should be referred to as the logic behind religious decrees.

Aims: Diabetes and intermittent periods of fluctuations in blood sugar levels are associated with stress and negative emotions. Due to the fact that these patients are prone to emotional problems, the aim of this study was to evaluate the effectiveness of autogenic training and affect regulation training on anxiety sensitivity in women with type-2 diabetes.

Materials and Methods: This was a quasi-experimental study with pre-test and post-test design and control group. The statistical population included all women with type-2 diabetes in Tehran who referred to diabetes control centers in 2020. Among them, 45 people were selected by available sampling and replaced in two experimental and one control groups. All three groups completed anxiety sensitivity questionnaire. Autogenic training and affect regulation training were performed on the experimental groups. Data were analyzed using SPSS software version 24 and multivariate analysis of variance.

Results: The analysis of the results showed that both autogenic training and affect regulation training reduced anxiety sensitivity in women with type 1 diabetes (p<0.00), but the effectiveness of autogenic training was not significantly different from affect regulation training (p >0.001).

Conclusion: Therefore, it can be said that affect regulation training by accepting and expressing the negative emotions, reduced anxiety sensitivity in women with type-2 diabetes. Also, people with high anxiety sensitivity are incapable of moment-to-moment awareness without judgment. Thus, through autogenic training, the skill of processing thoughts and observing emotion as objective events in the mind is strengthened.

Aims: We decided to investigate the role of non-pharmacological method of breastfeeding and maternal nutrition in the treatment of infantile colic in order to reduce the role of pharmacological method.

Materials and Methods: This study was a double-blinded clinical trial study on 62 infants less than 4 months of age referred to Emergency ward of Mofid Hospital in 2014. The infants were randomly divided into two groups that one group received routine colic treatment without any intervention (as the control group) and the other group received hypoallergenic lactation and also were trained on how to breastfeed appropriately. On the second and tenth days, all mothers were contacted and the duration of crying and restlessness of the infant was assessed.

Results: The severity of colic significantly lower in intervention group as compared to control group on the second and tenth days of intervention. In this regard, the mean change in severity of colic at the end of assessment was 2.4 ± 2.2 in intervention group and 0.7 ± 1.5 in control group (p < 0.001). The mean change in colic intensity in subgroups with complete, partial and low adherence was 4.1 ± 2.4, 2.5 ± 1.6, and 0.2 ± 1.6 respectively indicating a significant difference (p < 0.001). 

Conclusion: Comprehensive mothers' training on how to breastfeed and determine the best breastfeeding position along with the change in nutritional habit can significantly reduce colic severity. 

Carbon monoxide poisoning is common, challenging and serious poisoning with wide range of non-specific flu-like clinical manifestations that leads to misdiagnosis. This cross-sectional descriptive controlled study conducted in Loghman Hakim Hospital on 3-14 year-old patients presenting with non-specific Flu-like (headache, dizziness, nausea, vomiting, malaise) symptoms from November 2018 to May2019. In all subjects carboxyhemoglobin level measured via noninvasive pulse CO-oximetry (Massimo Company, USA). Demographic data, cigarette, shisha, opium smoke exposure, type of home heater, carboxyhemoglobin level were collected and statistically analyzed via SPSS v16.0. A total of 93 children 3-14 year-old were enrolled the study. Their mean age was 4.6+4.3 years, 46% were male and54% female. Mean carboxyhemoglobin level was 27.8+9.7 %( range 2.7% to 44%). The most frequently encountered symptoms were nausea &vomiting (44%), dizziness (36%), headache (32%) and myalgia (23%). We obtained the COHb levels using noninvasive pulse oximeter for all study patients and their mother, and the levels > 5% for non-smokers were considered as CO poisoning. Of the 93 study patients, 49%had normal carboxyhemoglobin levels (CoHb level< 5%). Of the remaining 51% study patients, 47 patients had CoHb levels between 5% and 10%, and seven patients > 10%. Closer attention to early and nonspecific signs and symptoms of Carbon Monoxide poisoning and higher clinical suspicion could reduce the rate of misdiagnosis and therefore minimize complications in this serious poisoning.

The social security system in any country is a mirror of the development and the level of welfare of that society, and sustainable development in any country has a direct relationship with the quantity and quality of social security services. Given the initial establishment of the social security system in almost all countries, as well as Iran, the main challenge in this area can be considered the development of quality, quantity and services in a way that is able to meet the needs of society. (Khaleghparast, Rasekh, Naimi, 2017). Therefore, this study intends to identify the gaps between the current situation and the desired situation, by presenting applications in the form of a proposed model, to design the desired social security system according to the characteristics and conditions prevailing in society and its final destination to determine the development process of the country. This study is a descriptive-comparative study and has been done in several stages. The findings indicate that there is a significant gap between the management, governance and establishment of the social security system in Iran and the sample countries, especially Denmark. In countries that have succeeded in establishing the social security system, they have paid special attention to the three indicators of development and empowerment (risk management and realization of prevention levels), macro-planning and how to provide services, and by recreating the position of government in the security system, as well as following the recommendations and patterns of communication by international organizations and institutions, which are always considered as policy theories, the reference of policy makers in this field, have achieved good success in creating social welfare and public satisfaction. In this regard, according to the information obtained, it seems that the Social Security Organization, in following the patterns, models and global systems in the field of social security, should undertake serious reforms in the field of macro planning, development and improvement of employees, as well as improving and developing service delivery, take effective steps towards achieving sustainable development of the country

Background: The start of oral nutrition after colorectal surgery has always been an issue of debate. There is a long-standing practice of beginning oral feeding 4-5 days after surgery. However, in recent years a number of surgeons have questioned this method and in fact, have begun ordering immediate oral nutrition for their postoperative patients. The current article presents the findings of a clinical trial study, which compared the early and delayed start of oral feeding after colorectal surgery.

Materials and Methods: The present clinical trial recruited 52 patients undergoing colorectal anastomosis and divided these subjects into two groups. In the control group, oral feeding started 4-5 days after the operation. In contrast, the study group commenced oral nutrition soon after surgery.  The outcomes for both groups were measured in terms of demographic data, anastomotic leakage rate, nausea and vomiting, the start of bowel movements, and complications.

Results:  The two patient groups did not differ in their rates of ileus and diet intolerance (p=1). As for the factors of nausea and vomiting, there were no observed statistically significant differences between the study and control groups (p=0.1). The most critical outcome of the early and late start feeding groups was anastomotic leakage, for which there was no significant difference to report. The length of hospital stay was significantly shorter in the early feeding study group (3.56 days) than in the delayed feeding control group (7.36 days) (p<0.001). Defecation among patients receiving early oral nutrition was 2.8 days on the average, but 4.91 days among the control group patients, a statistically important difference (p<0.004).

Conclusion: While the early start of oral nutrition after colorectal surgery resection and anastomosis does not raise postoperative risks and mortality; it does reduce postoperative complications, the length of hospital stay, and final health care costs. As a result, early feeding after surgery can be considered as a viable alternative to delayed feeding.

Following economic, social, political and cultural changes and the spread of social phenomena such as poverty, unemployment, increasing population of the elderly and disabled, governments have taken on new responsibilities towards their citizens and their scope of operation has expanded. (Ghaffari, 2017). In this direction, due to the mentioned changes, several challenges have been faced on social security in relation to the efficient establishment of the social security system. Therefore, the present study, in response to the question of what are the most important challenges of social security in the implementation of sustainable development programs, intends to provide appropriate solutions in this area by analyzing and analyzing the causes of challenges facing the Social Security Organization. This research is a descriptive-comparative type and in addition to interviews with experts, professors and individuals who have researched in the field of social security, as well as a number of managers and experts in the field of social security, using the library method. The statistical population includes existing documents in the field of social security at the domestic and international levels, which have been dictated by reference organizations such as the International Social Security Association (ISSA), International Labour Organization (ILO) and the World Bank in this field. Content analysis method has been used for data analysis. The challenges have been enumerated by adapting the current state of social security to its desired state based on global guidelines, models, and systems. Then, the obtained information was tested using the questionnaire with a reliability coefficient of 0.7 to examine and comment on the experts Delphi test and was analyzed using SPSS software. Findings indicate that social security in Iran is far from global standards and models and is struggling with micro and macro challenges. Evidence and research results showed that the most important reasons for the existing challenges should be pursued in policies, regulations and also in the field of implementation. It also seems that explaining the role of the government in the field of social security is a missing link that ignoring it will jeopardize any orientation in the field of social security and it is necessary to pay attention to macro-planning in this area.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of coronavirus disease 2019 (COVID-19), was first detected in Wuhan, China and has since spread across continents. Although the globe grapples with the COVID-19 pandemic, neither a vaccine nor a drug has been proven to be effective for prevention and treatment of the disease. With millions of individuals are at high risk of contracting the disease, there is undoubtedly a need for finding a solution to control the spread of SARS-CoV-2 (1).

Probiotics are living microorganisms, which exert health-beneficial attributes when consumed in sufficient amounts (2). Based on mechanism of immune regulation, probiotics can be categorized into two distinct groups, namely immunostimulatory and immunoregulatory probiotics. The former induces production of Interleukin-12 (IL-12), which stimulates interferon gamma (IFN-γ) in natural killer cells and promotes the development of T helper 1 (Th1) responses, whereas the latter is able to suppress pro-inflammatory responses through induction of IL-10 production and activation of regulatory T cells (Tregs) (3). Some probiotics can also enhance production of secretory Immunoglobulin A (sIgA) in lung tissues (4). Furthermore, probiotics are capable of interacting with intruding pathogens in several ways. For instance, they can bind to viral particles or saturate their host receptors, resulting in blockade of viral attachment (4).

The genera Lactobacillus and Bifidobacterium are among the most frequently used probiotics in the management of various gastrointestinal disorders. For example, supernatants of Lactobacillus plantarum Probio-38 and Lactobacillus salivarius Probio-37 have been observed to impede in vitro infectivity of transmissible gastroenteritis virus (5), a coronavirus infecting enteric and respiratory tissues of newborn piglets with a mortality rate of almost 100%. This finding suggests that probiotics can ameliorate the severity of gastrointestinal symptoms caused by coronaviruses.

Accumulating evidence also abounds on the prophylaxis and therapeutic effects of probiotics against respiratory tract viral infections (RTVIs). In this respect, pre-treatment of human laryngeal epithelial cell line HEp-2 and mouse lung epithelial cell line MLE12 with Lactobacillus gasseri SBT2055 (LG2055) suspension significantly protected the cells from respiratory syncytial virus (RSV) infection (6). In BALB/cCrSlc mice, daily oral administration of LG2055 for 21 days resulted in a perceptible decrement of RSV titers and pro-inflammatory cytokine production as well as up-regulating gene expression of type I and type II interferon in lung tissues (6).

Figure 1: Possible anti-viral properties of probiotics against SARS-CoV-2 infection

In a randomized, double-blind, placebo-controlled trial, preterm infants receiving oral probiotics (Lactobacillus rhamnosus GG, ATCC 53103) exhibited a substantially lower incidence of RTVIs compared to those receiving placebo (7). One study showed that oral administration of L. rhamnosus GG is useful for achieving a reduction of antibiotics prescribed for hospitalized patients with ventilator-associated pneumonia (VAP) (2). In consistent with these findings, another randomized controlled multicenter trial demonstrated that consumption of Bacillus subtilis and Enterococcus faecalis prevents VAP as well as gastric colonization of potentially pathogenic microorganisms in critically ill patients (8).

A pilot study demonstrated that nasal spray administration of Streptococcus salivarius 24SMBc for 3 days was well tolerated by all 20 healthy adult volunteers, of whom 95% were colonized by the probiotic in rhinopharynx tissues at least in the first 4 h after administration (9). According to these results, colonization of upper respiratory tract with probiotics may confer protection from viruses causing pulmonary infections, in particular rhinovirus, coronavirus, influenza virus, and RSV.

Based on above-mentioned studies, we hypothesize that oral administration or even inhalation of aerosolized probiotics employing various formulations (in the form of live or heat-inactivated microorganisms) not only acts as prophylaxis, but also has the potential for adjunct therapy against SARS-CoV-2 infection. Possible beneficial roles of probiotics in COVID-19 therapy are depicted in Fig. 1. Nevertheless, clinical trials are needed to evaluate anti-viral effects of specific probiotic strains for treatment of SARS-CoV-2 infection.