---

Background and purpose: Propofol produces anesthesia with rapid recovery. However, it causes pain or discomfort during injection. The effect of remifentanil in prevention of propofol-induced injection pain was demonstrated in earlier studies. Sufentanil, an opioid analgesic, has not been studied for managing pain on injection of propofol. We have compared the efficacy of remifentanil and sufentanil for the prevention of propofol induced pain.
Materials and Methods: One hundred twenty American Society of Anesthesiologists (ASA) class I-II adults undergoing elective surgery were randomly assigned into four groups of 20 each. Patients received 2 mL (10 mg) sufentanil, 2 mL of remifentanil (10 mg), 2 mL of remifentanil (20 mg), or 2 mL of saline 60 seconds prior to administering 5 mL of propofol 1%. Patients were asked whether they had pain due to propofol injection.Their pain scores were evaluated with the use of the four-point scale of Ambesh.
Results: The remifentanil and sufentanil groups significantly showed lower frequency of pain than that in the saline group (p < 0.05). Median pain intensity scores were significantly lower in the group receiving remifentanil 20 mg compared with the sufentanil groups (P < 0.05). The median intensity of propofol-induced pain was statistically similar between the groups receiving sufentanil or remifentanil 10 mg and the placebo groups.
Conclusion: Remifentanil 20 mg over 1 min before propofol administration is more effective than sufentanil 10 mg 1 min prior to propofol in reducing the incidence and intensity of injection pain.

---

Background and purpose: Propofol causes pain and hypotension when it was injected. Magnesium (Mg) and ketamine are antagonists of the N-methyl-d-aspartate (NMDA) receptor ion channel and cause analgesia. In view of the analgesic activity of Mg and ketamine, we tested the effect of intravenous administration of magnesium sulfate in reducing pain induced by propofol.
Materials and Methods:Two hundred ASA I-II adults patients undergoing elective ophthalmic surgery were randomly assigned into four groups of 50 subjects in each groups. Group M received magnesium sulfate 2.48 mmol, Group K received ketamine 10 mg, Group L received lidocaine 1% (30 mg) and Group C received normal saline, all in a volume of 5 mL followed by 5 mL of 1% propofol 30 s later. Pain was assessed on a four-point scale: 0 = no pain, 1 = mild pain, 2 = moderate pain, and 3 = severe pain at the time of pretreatment and propofol injection.
Results:Eighty-eight percent of patients in the control group had pain during iv propofol as compared to 34%, 28%, and 18% in the magnesium, ketamine, and lidocaine groups respectively (P<0.01). Incidence of mild, moderate, and sever pain were significantly lower in groups K, L, and M compared to group C (P<0.05). Ketamine, lidocaine, and magnesium pretreatments were same effect in attenuating pain during the propofol injection (P>0.05).
Conclusion:Intravenous pretreatment of magnesium, ketamine, and lidocaine are same effect in attenuating propofol-induced pain.

---

Background and purpose: The aim of this study was to determine the incidence and presence of a relationship between predictors of body mass index (BMI) or C-reactive protein (CRP) and duration of mechanical ventilation, in trauma patients who were admitted to the intensive care unite (ICU). Furthermore, we compared their prognostic significance, with known indicators such as, the Sequential Organ Failure Assessment (SOFA) score.
Materials and Methods:This prospective observational study was preformed on 72 admitted critically ill trauma patients in a general ICU setting, in Alzahra Medical Center of Isfahan University. Patients were categorized by duration of mechanical ventilation to the group A (≤ 7 days) and group B (> 7 days). The severity of illness was assessed by the Revised Trauma Score (RTS) calculated on the first admission to the ICU unit. The biological status of the patients was assessed by the serial measurement of CRP on admission to ICU (T1), at 48, 72 hours subsequently, and on the beginning day (T2) or discontinuation (T3) from mechanical ventilation. Data on BMI, serum albumin, and the SOFA score, were also collected on T2 and T3.
Results:There was no significant difference between two groups in demographic characteristic or RTS.On T3, the SOFA score, BMI, albumin, and CRP were significantly higher within group B patients, as compared with group A (P < 0.01). The incidence of low BMI (≤ 20 kg/m²) or high CRP (> 10 mg/L) on T2 was 72.2% (52/72) and 81.9% (59/72) respectively. The incidences of low BMI or high CRP in group B patients were significantly higher on T2 or T3, as compared with group A (P < 0.05). CRP or BMI on T3 had high specificity for predicting more than seven days of MV. On T3, the SOFA score, serum albumin, CRP, and BMI provided significantly good discrimination (area under curve > 0.5) in descending order. Mean serum CRP level within 72 hours after admission to the ICU or on T3 was significantly more in group B patients, as compared with group A (P < 0.01). The most significant predictor more than seven days of mechanical ventilation was CRP followed by BMI on T3.
Conclusion:Both the BMI and CRP comparables with the SOFA score can be used in estimating the risk of prolonged mechanical ventilation. It is also concluded that maintaining the level of BMI or CRP in normal range, could shorten the duration of mechanical ventilation.

---

Background and purpose: Brucellosis is a zoonotic disease with worldwide distribution that is endemic in Iran. Worldwide, brucellosis remains a major cause of morbidity in humans and domesticated animals. The disease has a wide spectrum of clinical manifestation and can affect a variety of organs and systems. This study focused on blood culture of serologic diagnosed brucellosis and antimicrobial susceptibility test.
Materials and methods: In this cross sectional study, microbiologic survey was done on a total of 30 serum samples with STA titer of 1:160 or greater and 2ME titer of 1:40 or greater, which were presumptive for brucellosis. Blood cultures were done by lysis centrifugation and antimicrobial susceptibility test, against 9 antimicrobial agents by disk method. The data was analyzed by stata V8.0 software.
Results: At the end this study, the blood culture isolation rate was 23.3 %( 7 cases out of 30 patients) and all of the isolates were brucella melitensis. Antimicrobial susceptibility tests showed high in vitro activity of ofloxacin, ciprofloxacin and doxycycline and also, low in vitro activity of streptomycin and cotrimoxazole.
Conclusion: Brucellosis is endemic in Iran. Brucella melitensis was the most common strain of brucella in our patients. Except cotrimoxazole and streptomycin, high in vitro activity was found with other antibrucella agents, especially with ofloxacin, ciprofloxacin and doxycycline.

---

Background and purpose: Leptospirosis is a common zoonosis throughout the world and common in the flat area of Guilan, Iran, with seasonal incidence, especially in rice farmers. Clinical diagnosis of leptospirosis is difficult, because its symptoms are similar to several acute infective diseases. Serological assays are important in diagnosis of the disease and microscopic agglutination test (MAT) is a gold standard, however, it is not a routine test in diagnostic laboratories. Thus, a simple and reliable test is a necessity. In this study, we evaluated a latex agglutination test using native strains of leptospires.
Materials and methods: A number of 98 positive cases and 54 negative cases which were screened by MAT, along with 30 sera of other diseases as control samples, were examined by latex agglutination test, using an antigenic suspension (whole antigen), which was extracted from 4 common native strains.
Results: False positive and false negative rate were 15 and 12 consequently. Sensivity, specificity, positive predictive value, negative predictive value, and accuracy were 89.0%, 84.5%, 86.7%, 87.2%, and 87.0% respectively.
Conclusion: Regarding the considerable rate of sensivity and specificity of the test which is compatible to other performed studies, in addition to the simple performance test, does not need a complex laboratory facility, which may also be carried out in rural regions, therefore, this test is valuable for primary screening.

---

Background and purpose: This study investigates variables such as illness perception, depression, anxiety, stress coping strategies and perceived social support as predictors of treatment adherence and health related quality of life in hemodialysis patients in city of Isfahan. Materials and methods: In the cross-sectional study, 200 end stage renal disease patients selected by convenience sampling. Brief-Illness Perception Questionnaire, Hospital Anxiety and Depression Scale, Multidimensional Scale for Perceived Social Support, Coping Inventory for Stressful Situations were used to collect the data. Objective and subjective assessments were used to evaluate treatment compliance. Also, canonical correlation analysis was applied to interpret the data. Results: Findings from canonical correlation analysis showed that a linear combination of adherence and quality of life for renal patients is predictable by linear combination of psychological factors. So a pattern of high scores treatment adherence (subjective index) and quality of life is correlated with a pattern of low scores on the perceived consequences of illness, anxiety, emotional representations, nature of the illness, depression, anxiety and emotion-focused coping style and also with a pattern of high scores on social support and problem-focused coping style. Conclusion: Results of this study showed that psychological variables in hemodialysis patients can predict adherence and especially health related quality of life. Also, they determine considerable variance of survival index.

---

Background and purpose: Bacteremia is one of the most common infective diseases. Rapid diagnosis of bacteremia might have great effect on the treatment of the disease and could result in a successful treatment by selecting effective antibiotics. Bacteremia due to Enterococcus faecalis is more common in hospitals and resistant strains are the main causes. Routine method using for diagnosis of bacteremia is a time consuming test so more rapid assays are preferred. The aim of this study was evaluating a PCR assay for rapid diagnosis of bacteremia in rat model which is similar to human bacteremia. Materials and methods: To establish experimental bacteremia we used a standard strain to prepare a suspensions with 10 8 cfu/ml bacteria for inoculating into 10 rats. Blood samples were taken from all rats after 24, 48, and 72 hours. PCR and routine assay was performed for all rats’ specimens. Ten blood samples of healthy rats were used as control cases. Results: Culture was positive for all specimens. Two specimens were found positive in PCR in the first day, seven samples in second day, and eight specimens in third day after inoculation. Culture and PCR assays were negative for all control samples. Sensitivity and specificity of PCR were 69.8% and 100%, respectively. Conclusion: PCR is a more rapid assay than routine method for diagnosis of bacteremia and could be very effective in successful treatment. Therefore, it could be considered as an alternative method for culture but for increasing sensitivity of the test, we recommend using a more efficient DNA extraction method.

---

Background and purpose: Nosocomial outbreaks of legionnaires’ diseases are usually related to contamination of water sources. This survey investigated the frequency of mip gene in cold and warm water taps and water containers of infant incubators containing legionella pneumophila in hospitals of Guilan province, Iran. Materials and methods: This cross-sectional study used 140 samples. They were collected directly from sterile containers and were concentrated by centrifuge, then transferred to buffered charcoal yeast extract including both L-cyctein, Fe2+ ,glycin, and vancomycin and were incubated for 2-4 days. DNA was extracted using boiling method and PCR was performed to investigate legionella, mip gene and bacterial contamination using different primers. Results: About 8.5% of the samples contained legionella pneumophila that 11.1% were isolated from infant incubators and 5.8% were found in hot and cold tap waters. Mip gene was found in 2.8% of the samples. One third of incubator’s legionella pneumophila and half of the legionella pneumophila in hot water taps contained mip gene while the samples from cold taps were not found with mip gene. About 87.2% of negative samples showed bacterial contamination. Conclusion: Today sterile water is used in incubators, however, legionella and bacterial contaminations are considerably high. This may be due to long-term storage of water in incubator container that is a predisposing factor for biofilm formation. In this study high temperature of hot water system and high rate of free residual chlorine in tap water system were the main causes of low rate legionella contamination which did not influence the contamination rate with other bacteria.

---

Background and purpose: Primary cytomegalovirus (CMV) infection occurs in 0.15-2.0% of all pregnancies and might causes abortion. Actually CMV infections are most common in females and rate of infection increases with age. In pregnant women it usually occurs in ages below 30 years old. Aim of the present study was investigating on the seropositivity rate of CMV in pregnant women to determine the rates of infections (primary, reinfection, and reactivated) in them and to find the rates of abortion due to these infections Material & methods: The present study 360 pregnant women were screened for CMV-IgG ELISA to reveal seroprevalence rate in them. Type of CMV infection (primary, reinfection, reactivated and incidious infection) were investigated in them by using CMV-IgM, CMV-IgG, and CMV-IgG Avidity tests. All cases were followed to the end of pregnancy. Results: CMV-IgG seroprevalence in studied women was 77.3% and high rate seropositivity was 50.4%. Frequency of primary, reinfection and reactivated infections was 0.8%, 0.6%, and 21.1% respectively. Insidious infection rate was 54.7%. About 22.8% of studied women had not exposured with CMV before screening. Abortion occurred in about 66.7% of primary infections and 100.0% of reinfections and these two factors presented significant relationship with spontaneous abortion. Conclusion: Results of the present study showed seropositivity for CMV-IgG is not a valuable measure for CMV active infection even with high titers, so screening with CMV-IgG in pregnancy in not valuable without CMV-IgG avidity test but regarding to significant relationship of primary and reinfection with abortion, It seems that follow up of pregnant women for these infections with IgM-CMV ELISA might be more worthy.

---

Background and purpose: Prosocial behavior can offer clinical, psychological, and biological applications to improve the health of patients. The purpose of this study was to investigate the effect of religious attitude on prosocial behavior considering the mediating roles of empathy and altruism in nursing and medical students.
Materials and methods: A descriptive-correlational study was performed in 2018-2019 academic year. The research population included all nursing and medical students in Ahvaz Jundishapur University of Medical Sciences. Participants were 361 students selected via convenient sampling. The Prosocial Tendencies Measure, Allport religious orientation, Self-Report Altruism Scale (SRA), and Interpersonal Reactivity Index (IRI) were administered. Data analysis was done using Pearson Correlation Coefficient and structural equation modeling in AMOS.
Results: According to the findings, religious orientation, altruism and empathy were significantly correlated with prosocial behavior (P<0.01). Also, the final model has a good fitness. Religious orientation was found to have direct positive effect on prosocial behavior, altruism and empathy. Empathy and altruism had a mediating role between religious orientation and prosocial behavior.
Conclusion: Based on the role of religious orientation, altruism and empathy in predicting prosocial behavior, this model can be used in interventions to promote prosocial behavior in nurses and doctors.
 

---

Correction to: Relationship between Religious Attitude and Prosocial Behavior Considering the Mediating Role of Empathy and Altruism in Nursing and Medical Students
 
Abdolzahra Naami¹,
Mahnaz Mehrabizadeh Honarmand¹,
Soodabeh Bassak Nejad²,
Mahdi Hassanvand Amouzadeh³,
Auob Asadi⁴
Nematollah Sanaeenasab⁴,
 
¹ Professor, Department of Psychology, Faculty of Education and Psychology, Shahid Chamran University of Ahvaz, Ahvaz, Iran
² Associate Professor, Department of Psychology, Faculty of Education and Psychology, Shahid Chamran University of Ahvaz, Ahvaz, Iran
³ Psychology Instructor, Department of Psychology, Faculty of Psychology and Education, Payame Noor University, Tehran, Iran
⁴ PhD Student in Psychology, Department of Psychology, Shahid Chamran University of Ahvaz, Ahvaz, Iran
 
   
 

In the article published in volume 29, issue 182, 2020, the order of authors was not correct which is now corrected.

---

 Background and purpose: Identifying the nature of social anxiety through its causative factors can provide valuable information for the health system. The purpose of this study was to evaluate a structural model for creating and maintaining factors causing social anxiety disorder in students in a medical sciences university.
Materials and methods: A descriptive-correlational study was performed in all students at Ahvaz Jundishapur University of Medical Sciences. Online questionnaires were completed (n= 670), including social phobia inventory (SPIN), Young Schema Questionnaire-Short Form (YSQ-3), Behavioral Activation/Inhibition Systems (BAS/BIS), Older Adult Social-Evaluative Situations Questionnaire (OASES), Social Phobia Safety Behaviors Scale (SPSBS), Emotion Regulation Questionnaire (ERQ), Mini-Social Thoughts and Beliefs Scale (Mini-STABS), and Self-Beliefs Related to Social Anxiety Scale (SBSA). Data were analyzed by structural equation modeling and Bootstrap method using AMOS software.
Results: Fit indices showed that hypothetical research model has a good fit with the data. In the present model, positive significant relationships were found between social anxiety and the paths associated with behavioral inhibition, trust-abuse, defectiveness/shame, social isolation, unrelenting standards via mediators of social-evaluative situations, safety behaviors, emotion regulation, social thoughts and beliefs, and self-beliefs to social anxiety (P<0.0001). But, we observed no significant relationship between social anxiety and emotion regulation mediator path (P<0.0001).
Conclusion: Considering the role of etiology and maintenance factors in current model, it can be used in designing treatments for social anxiety and promoting the health of medical students.

---

Background and purpose: Postoperative nausea and vomiting is a common complication of anesthesia. The aim of this study was to compare the effect of midazolam, ondansetron and their combination in prevention of nausea and vomiting after strabismus surgery.
Materials and methods: In this randomized double-blind clinical trial, 140 patients undergoing strabismus surgery were divided into four groups (n=35 per group). The patients received midazolam 0.75 mg/kg (M), ondansetron 4 mg (O), midazolam 0.75 mg/kg + ondansetron 4 mg (MO), and saline 0.9% iv. (S) before anesthesia. Follow-up was done in the first 24 hours after surgery and incidence and severity of nausea and vomiting and other postoperative complications were compared between the four groups.
Results: In this study, 10 patients (37%) in group S, 6 (19.4%) in group O, 8 (28.6%) in group M, and 2 (6.3%) in group MO developed nausea indicating significant differences between the four groups (P=0.019). The study showed no significant differences between the groups in incidence of vomiting (P= 0.18); 6 patients (22.2%) in group S, 5 (16.1%) in group O, 4 (14.3%) in group M, and 1 patient (3.1%) in group MO had vomiting. The severity of postoperative nausea and vomiting was significantly different between the four groups and group MO was found to have less severe nausea and vomiting two hours (P= 0.009) and 24 hours after surgery (P< 0.001).
Conclusion: Combination of midazolam and ondansetron reduces the incidence of postoperative nausea and vomiting compared to midazolam or ondansetron alone and leads to greater patient satisfaction. According to the higher effect of MO and lack of adverse effects on hemodynamic parameters it is recommended in patients undergoing strabismus surgery.

(Clinical Trials Registry Number: IRCT20180416039326N8)