Original Article


Background: Recent studies have indicated the high prevalence of burnout among nursing staff. Shift work is one of the characteristics of the nursing job; therefore, this study aimed to investigate the relationship between shift work and burnout among intensive care unit (ICU) nursing staff in hospitals of Shahid Beheshti University of Medical Sciences. Materials and Methods: This descriptive-analytic study of cross-sectional type was carried out the period of 2017-2018. The research population was of all nursing staff in the intensive care unit (ICU) in 7 public hospitals and 5 private hospitals. The sample size was 320 nursing staff that was surveyed by census method. To collect data, Maslach burnout inventory (with 78% and reliability and internal validity ranges from 71% to 92 %) and demographic profile questionnaire were used. All statistical analyses analyzed by SPSS software. Results: There was a significant relationship between emotional exhaustion and rotational shift work. There was no significant relationship between emotional exhaustion and night shift. There was a significant relationship between depersonalization and morning shifts in public hospitals. The shift component was only significant in the work shift of the evening and night of public hospitals with personal accomplishment as well. Conclusion: The shift work was considered as an effective factor in the burnout of nursing staff in ICU. By utilizing the results of the study, we can reduce the effects of shift work and make an appropriate intervention plan for promoting staff health.

Designing a Comprehensive Evaluation Model for Health System Reform Plan in Iran: An Approach to Extended Balanced Scorecard

Shahriar Janbazi, Mohammad Reza Rabiee Mandejin, Alireza Eslambulchi, Ayad Bahadori monfared

Novelty in Biomedicine, Vol. 7 No. 4 (2019), , Page 187-200

Background: Health and striving to maintain and promote it has always been an important priority in governments, communities, and public policies. To implement health objectives through the Fifth Five-Year National Development Plan of Iran, the health system reform plan with three approaches to the financial protection of the public, creating equity in access to health services, and improving the quality of services has been on the government's agenda since 05.05.2014. Investigations revealed that the lack of a comprehensive and scientific model for evaluating this national program is evident. This study aimed to design a comprehensive model of health reform plan evaluation in Iran. What distinguishes this study from previous studies is the simultaneous attention to the challenges of performance evaluation, social responsibility, and examining them in a comprehensive and coherent model.

Materials and Methods: The present study considered as descriptive-survey research in terms of strategy. The research method was a combination that conducted from 2018 to 2019. The sample size of the qualitative part of the research consisted of 17 academic and executive health experts selected by purposive non-random sampling. In the quantitative part of the study, 400 health service providers selected by stratified random sampling. In this study, content analysis and Delphi technique, and Expert choice v24, SPSS V22 and AMOSV14 software were used to collect, classify, deduce and exploit data, and questionnaires.

Results: The findings of this study resulted in the design of a 900-scorecard model of the comprehensive evaluation of the health system reform plan in Iran based on 5 dimensions (finance, social responsibility, growth and learning, clients and internal processes), 17 components and 70 indicators.

Conclusion: The findings of the quantitative section of the study showed that the indicators, dimensions and levels of the comprehensive evaluation model for health system reform plan in Iran (CEHSRP-IR) qualified for evaluation of the effectiveness of this national program at different organizational levels and executing units of health system reform plan in Iran.

The Assessment of Acupuncture and Exercise Therapy in Patients with Carpal Tunnel Syndrome: Randomized Clinical Trial

Shahin Salehi, Omid Hessami, Amir Rashed, Mohammad Hassabi, Mehrshad PourSaeid Esfehani, Amirhosein Abedi Yakta, Hamid Mahdavi Mohtasham, Shahrzad Khosravi, Shahram Mohaghegh, Mohammad Reza Sohrabi

Novelty in Biomedicine, Vol. 7 No. 4 (2019), , Page 201-209

Background: The efficacy of acupuncture and exercise therapy in the treatment of carpal tunnel syndrome (CTS) has been investigated in limited studies with controversial results. The purpose of this study was to compare the short-term efficacy of acupuncture and exercise therapy in patients with mild to moderate CTS.

Materials and Methods: This study was a randomized controlled clinical trial study conducted on 60 patients (55 women) with mild to moderate CTS referring to Imam Hossein Hospital in Tehran in 2017. The patients were randomly divided in to 3 equal groups; groupa1: only night splint was used for 6 weeks (control), group2: splint with tendon and nerve gliding exercises (2 times a day for 6 weeks) were applied, group3: splint and electroacupuncture was performed for 12 sessions (2 sessions/week). The score on the Boston Carpal Tunnel Questionnaire (BCTQ) for Functional Status and Symptom Severity (BCTQ FUNCT and SYMPT) and visual analog scale (VAS) score were evaluated at baseline and after the treatment.

Results: At the final follow up, significant improvements in all parameters of quality of life and VAS were found in third groups (p<0.05). Acupuncture affected the score on the BCTQ FUNCT and SYMPT, the VAS score more than exercise therapy. In addition, the efficacy of splint alone was less than intervention groups in all parameters.

Conclusion: Acupuncture with splint has a high effect on reducing pain and improving the quality of life in patients with mild to moderate CTS and could be adopted in the management of these patients.


Background: Due to the limitations of more common treatments of osteoarthritis, pharmaceutical research has been increasingly conducted during the past two decades with the aim of determining the rate of recovery of the disease' symptoms and making the process of disease progression slow. The purpose of this study was to compare the effect of intra-articular injection of autologous interleukin-1 Receptor Antagonist and hyaluronic acid in pain control of knee osteoarthritis.

Materials and Methods: A total of 60 patients with knee osteoarthritis were allocated to two groups of 30 in this randomized double-blind clinical trial. In the intervention group, injection of 2 milliliter of interleukin-1 receptor antagonist (Orthokine) into the knee joint was performed three times at intervals of one week (base time, seventh day and fourteenth day). In the control group, three injections of two milliliters of hyaluronic acid solution into the knee joint were performed at intervals of one week. Pain, symptoms, daily activities, sport-recreational performance, and knee-related quality of life were five outcomes investigated by completing two questionnaires, the knee injury and osteoarthritis outcome score (KOOS), Western Ontario, and McMaster Universities Arthritis Index (WOMAC) by the patients on two occasions before the start of treatment and six months after the last injection. Repeated measure and t-test were statistical tests used in this study.

Results: The mean score of pain in the first month (p=0.005) and the sixth (p=0.049) in the intervention group was less than the control group. Based on the scores of the KOOS questionnaire, the mean score of symptoms (p=0.006), daily activities (p=0.001) and sport-recreational performance (p=0.037) in the Orthokine group were higher than the hyaluronic acid group after six months. Also, the results of the questionnaire WOMAC show that while before the start of treatment, the mean of physical performance in the Orthokine group is greater than the control group, there is no difference in any of the indicators of pain, dryness of the joint, physical performance, and total score (p=0.319) in the sixth month.

Conclusion: According to the findings of this study, it seems that Orthokine has beneficial biological effects in patients with knee osteoarthritis. Intra-articular injection of Orthokine is a low invasive, safe and effective method, which can be considered as an appropriate choice in patients with chronic knee pain.

Effect of ankle sprain on postural control and electrical activity of selected muscles after single-leg jump landing task

Behnaz Maleki, Zahed Mantashloo, Shahin Salehi, Amir hosein Abedi yekta

Novelty in Biomedicine, Vol. 7 No. 4 (2019), , Page 218-224

Background: Ankle joint plays an important role in restoring the balance of individuals. Ankle sprain injury effects on balance of affected individuals. The changes in the postural control and activity of the ankle muscle, because of ankle sprain, can put the patients at reinjure risk and lower extremity injuries, especially during dynamic activities. The aim of this study was to investigate the electrical activity of ankle joint stabilizer muscles and postural stability after single-leg jump landing in individuals with ankle sprain.

Materials and Methods: In this cross-sectional study, 30 non-athletic students were participated. They were divided in two groups of 15 people, in the form of accessible and purposeful. Subjects was asked to land on a force plate with Single-leg, by at least 80% of their maximum jump. The com-cop changes assessment was used as an indicator for postural control evaluation. After jump landing, muscles activity was recorded on the ankle joint by surface electromyography (EMG) device. MATLAB software was used to analyze data, and MANOVA test was performed to compare two groups.

Results: The results showed a significant reduction in EMG of soleus, gastrocnemius, and peroneus longus muscles (p=0.03, p=0.01 and p=0.006 respectively). Tibialis anterior activity significantly increased (p=0.001) in patient group than to healthy group. Postural control was significantly lower in patient group than healthy group, in all directions (p=0.00 and p=0.00 respectively).

Conclusion: Decreased postural control indicates changes in EMG of the stabilizer muscles of this joint in people with ankle sprain injury.

The explanation and effectiveness of intellectual and behavioral components in satisfying the lives of married women

Akram Ghashghayi, Kiomarth Farahbaksh, Asieh Shariatmadar, Abdollah Moatamedi

Novelty in Biomedicine, Vol. 7 No. 4 (2019), , Page 225-231

Background: The aim of this study was to determine the components of the educational model of intellectual and behavioral principles in healthy interpersonal relationships based on the Holy Quran and its effectiveness on marital satisfaction of married women. Research was arranged in two sections.

Materials and Methods: The research method was qualitative in the first part and was quantitative in the second part. In the qualitative section, after researching and searching in the sources of the Quran, which was carried out by a qualitative method in the form of thematic analysis, ultimately the intellectual and practical principles in the healthy interpersonal relations based on the Holy Quran were determined and explained. The method of the second part of the research is quantitative and of type Semi-experimental, with pre-test-posttest design with control group and random selection. For this purpose, 30 married women with children from Tehran selected in a sample of 30-97 years old and randomly assigned to two groups of 15 subjects. The instrument of this research was a survival satisfaction questionnaire (SWIS). The experimental group was placed under the training of the principles of intellectual and behavioral training in healthy interpersonal relationships based on the Holy Qur'an for two months.

Results: The results of the hypothesis test showed that the components of the educational model of intellectual and behavioral principles in healthy interpersonal relationships based on the Holy Quran On the other hand, life satisfaction variable (83.36, F=0.001) had a significant effect. This power is 100%. In other words, there was a significant difference between the experimental group and the control group in terms of the variables.

Conclusion: In explaining this finding, it could be said that the sacred religion of Islam in various aspects of family life has provided useful commands and teachings. In Islamic religion, marriage and family are declared the most beloved and dearest human institution to God, and the adoption of these orders can affect the satisfaction of couple’s life.

Cytotoxic Activity of Rosa Damascene Mill, Allium sativum, Allium Hirtifolium Boiss, and Prosopis Farcta Extracts on Human Cervical Carcinoma Cell Line

Ebrahim Khadem, Ebrahim Faghihloo, Talat Mokhtari-Azad, Mohammad Kamalinejad, Kobra Pasha Pashabeyg razavi, Mehdi Norouzi

Novelty in Biomedicine, Vol. 7 No. 4 (2019), , Page 232-236

Background: Cervical cancer is one of the major reasons of cancer-related mortality. Human papillomavirus is the most common sexually transmitted viral infection, which can lead to cervical cancer. There is no powerful chemotherapeutic agent for HPV infection and cervical cancer. Some plants have the proper potential to be used for treatment of cervical cancer caused by HPV type 18.

Materials and Methods: In this study, cytotoxic effect of extract of four indigenous Iranian plants including Rosa damascene millAllium sativumAllium hirtifolium boiss and Prosopis farcta were investigated on the HeLa cell line. HeLa cells were incubated with different concentrations of extracts and then the cell viability was measured by MTT assay.

Results: The viable cell numbers were decreased by increase of the extracts concentration. The Allium sativum showed the higher cytotoxicity in all concentrations than the other ones. Afterwards, Allium hirtifolium BoissRosa damascene mill, and Prosopis farcta showed maximum efficiency to decrease cell viability, respectively.

Conclusion: The above four mentioned plants might be used for death of HeLa cell harboring HPV type 18. Therefore, they could be employed as a chemotherapeutic agent in the cervical cancer treatment in future.

Background: Beta interferon is one of the important drugs for multiple sclerosis. Its common side effects are flu-like symptoms caused by drug injection. The purpose of this study was to evaluate the possibility of predicting the response rate of this drug based on the flu-like drug reaction.

Materials and Methods: This case-control study performed in Loghman Hakim hospital in Tehran in 2017 and 110 patients with multiple sclerosis under beta interferon treatment studied. Patients were divided into two groups with and without flu-like drug reaction. A neurology resident according to the patient’s history and patient records filled in the questionnaires. The results of the two groups were compared by SPSS 16 software.

Results: A total of 110 patients including 31 patients with flu-like drug reaction and 79 non-complicated patients were evaluated. These patients included 32 males and 78 females with an average age of 35.55 years. The mean duration of beta interferon use was 4.33 years in the case group and 4.34 years in the control group. Finally, a significant correlation between the flu-like drug reaction and the optimal response in the first year treatment was found (p=0.026). In addition, cause of drug discontinuation had significant correlation with presence of flu like drug reaction (p=0.028). There was no significant correlation between the disease annual attacks rate and flu like drug reaction.

Conclusion: Flu-like drug reaction is a common complication of interferon beta drugs, which has a therapeutic difference in patients with and without this drug reaction.

Up-Regulation of Tmevpg1 and Rmrp LncRNA Levels in Splenocytes and Brain of Mouse with Experimental Autoimmune Encephalomyelitis

E Farahani, F Sotoodehnejadnematalahi, S Mami, A Fathollahi, M Hajimolahoseini, R Pouriran, Farshid Yeganeh

Novelty in Biomedicine, Vol. 7 No. 4 (2019), , Page 246-253

Background: Two long noncoding (lnc) RNAs, which have been recognized as Tmevpg1/Ifng-AS1/NeST and Rmrp play indispensable roles in the differentiation of TH1 and TH17, respectively. The aim of the present scientific study was to analyze the expression levels of the aforementioned lncRNAs in experimental autoimmune encephalomyelitis (EAE) as an animal model for multiple sclerosis (MS).

Materials and Methods: Initially, EAE was induced in C57BL/6 mice via immunization by using MOG peptide. The leukocyte infiltration rate and demyelination of neuronal axons were determined. Secondly, the expression levels of Tmevpg1, Rmrp, Tbx21, and Rorc were analyzed in the cultured splenocytes and brain lysates, by using Real-Time PCR assay; eventually, the levels of interferon-gamma and interleukin-17 evaluated by ELISA.

Results: Gene expression analysis revealed that Rorc expression in the splenocytes of EAE mice in comparison to the controls was elevated; however, Tbx21 expression did not show any significant difference. Tmevpg1 and Rmrp levels increased in the splenocytes of EAE mice (4.48 times and 39.70 times, respectively, p = 0.0001). Besides, in the brain lysate, the entire genes that have been mentioned were higher than the controls (Tmevpg1: 3.35 times p = 0.02 and Rmrp 11.21 times, p = 0.0001).

Conclusion: The marked up-regulation in Tmevpg1 and Rmrp transcripts suggested the essential roles of lncRNAs in the pathogenesis of EAE and multiple sclerosis indeed. Further investigations are necessary to evaluate the values of these lncRNAs as the target for the therapy or molecular marker for disease monitoring.

Short Communication

Cause-Specific Mortality among HIV-Infected Persons in One Medical Center, Tehran, Iran

Zahra Arab-Mazar, Fahimeh Hadavand, Payam Tabarsi, Fatemeh Abbasi

Novelty in Biomedicine, Vol. 7 No. 4 (2019), , Page 254-259

Background: Human immunodeficiency virus (HIV) is one of the major infectious agents, which has important role in the public health challenges, which have affected the world's economic and social situation recent decades. During the last decades, millions of people died due to HIV infection worldwide. However, data remain limited on the causes of death among HIV-infected in Iranian population. The aim of the present study was to assess the cause specific death among HIV positive inpatient persons in Iran.

Materials and Methods: This surveillance was conducted on inpatient HIV positive admissions at Masih Daneshvari Hospital, Tehran, Iran during October 2016 and April 2017.All patient’s data were collected via abstraction form, which were ascertained, from medical records and from written logbooks that were kept by the nursing staff on the ward. The data of each admission was recorded from the medical reports at the time of admission and upon discharge. All laboratory data were collected and recorded separately.

Results: Fifty persons were diagnosed as HIV-infected patients, of which 58% of them were classified as AIDS patients. Our findings indicated that the cause of hospitalization were pulmonary 54%, neurological 20%, gastrointestinal 16%, and dermal 10% complications. Overall, 21 patients (42%) were diagnosed with pulmonary tuberculosis, of which one patient died from tuberculosis complications. Four patients died during the study period.

Conclusion: In conclusion, early treatment and/or early use of ART can be improved outcomes. Therefore, early HIV testing and early ART use play important role in mortality reduction among eligible persons.