https://www.ircmj.org/index.php/IRCMJ/issue/feed Iranian Red Crescent Medical Journal 2022-06-16T01:53:20+0430 Ahmad Soltani MD, PhD publisher@ircmj.org Open Journal Systems <p>The Iranian Red Crescent Medical Journal (IR<span style="color: #ff0000;">C</span>MJ) is an international, open access, peer-reviewed, monthly, and ISI- Journal, affiliated to&nbsp;<strong>Iranian Hospital- Dubai</strong>, publishes original scientific studies in English that have direct clinical significance on&nbsp;<span style="color: #0033ff;">Basic Science, Clinical Medicine, Humanitarian Assistance, Trauma, and Disaster Management</span>.&nbsp;The journal strives to strengthen connections between research and practice, so enhancing professional development and improving practice within the field of medicine. Original papers submitted to this journal which do not adhere to the Instructions for Authors will be returned for appropriate revision to be in line with the Instructions for Authors. They may then be re-submitted.</p> https://www.ircmj.org/index.php/IRCMJ/article/view/1543 The effects of nursing care based on the therapeutic communication helping model on patient and family satisfaction in coronary care units 2022-01-28T21:22:28+0330 Mitra Payami mitra_payami@yahoo.com Zeinab Ghahremani ghahremanizeinab@gmail.com Parisa Jahangiri Parisajahangiri66@gmail.com <p><strong>Background: </strong>Patient and family satisfaction can affect treatment adherence, outcomes and patient recovery.</p> <p><strong>Objective: </strong>Evaluate the effects of nursing care based on the Therapeutic Communication Helping Model (TCHM) on patient and family satisfaction in coronary care unit (CCU).</p> <p><strong>Methods</strong>: This quasi-experimental posttest-only design study was conducted between June and October 2017 in educational and treatment center of Mousavi in Zanjan-Iran. 58 patients and 58 family members from CCU were included in each of the control and intervention groups. Data were collected using Patient Satisfaction Instrument, and the Family Members Satisfaction Questionnaire for adult patients.Initially, the satisfaction of control groups who received traditional nursing care were determined at the time of discharge. Then a 4-hours work shop was held for nurses working in CCU. Trained nurses provided holistic nursing care based on TCHM for patients (n=58) and their family members (n=58). Satisfaction rate of intervention groups were assessed at the time of discharge. Data were analyzed using Chi-square, independent-t test, and paired- <em>t</em>tests through the SPSS version 22 software at the level of 0.05.</p> <p><strong>Results:</strong>The mean scores of patient and family satisfaction were respectively 3.47(0.84) and 3.91(0.67) in the intervention group. In control group these values was 3.14(0.5)and 3.20(0.78). The mean scores of patient and family satisfaction and their subscales in the intervention group were significantly greater than the control group (P &lt; 0.05).</p> <p> </p> <p><strong>Conclusions</strong>: The TCHM significantly improves patient and family satisfaction. Nursing managers are recommended to integrate this model into nursing care delivery programs.</p> 2022-06-16T00:00:00+0430 Copyright (c) 2022 Iranian Red Crescent Medical Journal https://www.ircmj.org/index.php/IRCMJ/article/view/1838 Strengths and Weaknesses of Asynchronous E-learning in Nursing Education Throughout the COVID-19 Crisis: A Qualitative Study 2022-02-03T20:59:57+0330 Yaser Moradi yasermoradi1045@yahoo.com Rahim Baghae baghaei.r@umsu.ac.ir Aram Feizi aramfeizi@yahoo.com Reza Hajialibeigloo Rezahajialibeigloo@gmail.com <p><strong>Background: </strong>Despite the introduction of e-learning in recent years, it has not been utilized as a major educational method in numerous universities, especially in the area of medical and health sciences, until the crisis of the COVID-19 pandemic.</p> <p><strong>Objectives: </strong>This study aimed at explaining the strengths and weaknesses of asynchronous e-learning in nursing education throughout the COVID-19 crisis.</p> <p><strong>Methods:</strong> In this qualitative descriptive study, a total of 14 nursing faculty members were selected using the purposive sampling method. The interviews were conducted face-to-face with semi-structured questions. The researcher recorded all interviews with the participants' consent. Data analysis was conducted in four phases using the content analysis approach (Graneheim and Lundman).</p> <p><strong>Results:</strong> Nursing faculty members cited "low quality of educational content", "cold and soulless education", "low efficiency in clinical education", and "insufficiency in educational assessment process" as the weaknesses and "maintenance of safe education during the COVID-19 crisis" as the strength of asynchronous e-learning in nursing education during the COVID-19 crisis.</p> <p><strong>Conclusion:</strong> Asynchronous e-learning was shown to have various weaknesses in nursing theoretical and clinical education. However, the most striking strengths of this method in the COVID-19 pandemic were found to be the protection of the safety and health of individuals, followed by the maintenance of academic activities and education. Therefore, it is worthwhile for all nurse researchers, academic education policy-makers, and faculties to put conscious effort into developing standard protocols for the preparation of educational content, empowering lecturers in the area of online education, and using other methods to promote dynamic interactions.</p> 2022-06-16T00:00:00+0430 Copyright (c) 2022 Iranian Red Crescent Medical Journal https://www.ircmj.org/index.php/IRCMJ/article/view/1801 Experiences of Experts with Communication and Information Exchange in Response to Disasters 2022-04-01T21:41:59+0430 Fayegh Abdolahzadeh faz_helal@yahoo.com Mahmud Reza Peirovi tavakoli@mng.mui.ac.ir Pir Hossein Koolivand tavakoli@mng.mui.ac.ir Hossein Bagherian tavakoli@mng.mui.ac.ir Nahid Tavakoli tavakoli@mng.mui.ac.ir <p><strong>Introduction:</strong> Effective communication and timely information exchange during disasters and emergencies can help responsive organizations prepare better and react fast and effectively in order to mitigate losses and casualties.</p> <p><strong>Objectives: </strong>This study summarizes the experiences of experts at Iran’s Relief and Rescue Organization and Emergency Organization with regard to how communication and information exchange contributed in response to past disasters.</p> <p><strong>Methods::</strong> The content analysis approach was used in this qualitative study. The statistical population included the operational managers and employees of Iran’s Relief and Rescue Organization and Emergency Organization from different provinces with various in managerial and field work's experiences at supreme, middle, and operational levels as well as experiences with local, provincial, regional, national, and international disasters. The purposive sampling method was then employed to collect data through semi-structured interviews from 24 participants. Data analysis was performed in MAXQDA 12.</p> <p><strong>Findings:</strong> The results of analyzing the interviews included a main theme of communication and information exchange with two categories. The first category was identified as intra-organizational communication and information exchange with seven subcategories called organizational individuals and departments, communication channels, communication model, message content, purpose of communication, standards and instructions, and challenges. The second category was identified as inter-organizational communication and information exchange with six subcategories called organizational individuals and departments, communication channels, communication model, message content, purpose of communication, and challenges.</p> <p><strong>Conclusion:</strong> The participants believed that there were limited horizontal communications and information exchange between Iran’s Relief and Rescue Organization and Iran’s Emergency Organization at the same level via fixed phones, mobile phones, and wireless radios in response to disasters. Therefore, disturbance to accurate timely communication and information exchange between organizations, especially in the first 24 hours of a disaster and lack of inter-organizational agreements and communication infrastructure result in the further vulnerability of victims, Red Crescent rescuer, and emergency technicians.</p> 2022-06-16T00:00:00+0430 Copyright (c) 2022 Iranian Red Crescent Medical Journal https://www.ircmj.org/index.php/IRCMJ/article/view/1377 Effects Of Thyroid Gland Weight And Volume To Surgical Approach And Characteristics Of Anesthesia Management In Retrosternal Goiter 2022-02-24T21:01:33+0330 Mehmet Kadir Bartin surgeon65@hotmail.com Arzu Esen Tekeli esentekeli190807@hotmail.com Gokalp Okut gokalp.okut@gmail.com Esra Eker dresoseker@hotmail.com Muzaffer Onder Oner zkudrooner@gmail.com <p><strong>Background: </strong>Retrosternal goiter surgery is technically difficult procedure. The surgical approach to be chosen is very important in preventing surgical and anesthesia complications.</p> <p><strong>Objective:</strong> The purpose of this retrospective clinical study was to investigate the role of thyroid volume and weight in the development of retrosternal goitre and the importance of special anesthesia management of patients with retrosternal goiter, which is a potential difficult airway candidate.</p> <p><strong>Methods:</strong> Retrosternal goiter was detected in 125 patients on ultrasonography. Patients were divided in to two groups; cervical surgery (CA) and sternotomy (ECA). Volumetric measurements were performed ultrasonographically. Patients' demographics, preoperative thyroid ultrasonography features, ASA classifications, Mallampati classifications, intubation characteristics, perioperative and postoperative patient datas and postoperative thyroid specimen weights were recorded.</p> <p><strong>Results:</strong> A total of 106 patients (32 male-74 female) were operated for bilateral total thyroidectomy. Total thyroidectomy was performed with CA in 98 (92.5%) patients and with ECA in 8 (7.5%) patients. Malignancy was detected in 4 (3%) of 106 operated cases. All of the malignant cases were seen in patients with cervical approach. When the volumetric measurements of both groups were compared, the volume values were significantly higher in the ECA group (<em>p</em>&lt;0.032).</p> <p>ASA I 67 patients, ASA II 39 patients, Mallampati I 64 patients, Mallampati II 36 patients, Mallampati III 6 patients were identified. Intubation was performed on the third attempt for 5 patients with Mallampati I and 8 patients with Mallampati II. The rate of difficult intubation was statistically significant in ECA group (<em>p</em>=0.019).</p> <p><strong>Conclusion:</strong> Predicting ECA requirement in the preoperative period is closely related to the preoperative volumetric analysis of the thyroid gland with 3D ultrasonography. In addition, since anesthesia management is difficult in patients who need ECA, volumetric analysis has become even more important.</p> 2022-06-16T00:00:00+0430 Copyright (c) 2022 Iranian Red Crescent Medical Journal https://www.ircmj.org/index.php/IRCMJ/article/view/1803 Effectiveness of an Educational Program through Mobile Health Application on Knowledge and Adherence to a Healthy Lifestyle in Cardiac Syndrome X Patients 2022-04-22T19:42:43+0430 Soraya Malekzadeh soraya.maleky68@gmail.com Mei Chan Chong mcchong@um.edu.my Li Yoong Tang lytang@ummc.edu.my Negar Omidi Negar.omidi@gmail.com Mahmoud Danaee mdanaee@um.edu.my <p><strong>Background: </strong>Cardiac syndrome X (CSX) is a form of ischemic heart disease with functional coronary microvascular abnormalities. The symptoms are often debilitating and sufferers have a poor quality of life, with costly demand for healthcare services. Therefore, an educational intervention contributes to the increase of knowledge about CSX risk factors and adherence to a healthy lifestyle.</p> <p><strong>Objectives: </strong>This study aimed to investigate the effectiveness of educational interventions on knowledge and adherence to a healthy lifestyle in CSX Patients.</p> <p><strong>Methods:</strong> A simple, two-arm, parallel, randomized control trial was conducted in the Heart Clinic on 100 CSX outpatients who were selected through randomized sampling and divided into experimental (n=50) and control (n=50) groups. This study assessed an educational program that has been provided through the Mobile Health application (mHealth app) to the experimental group. The data were collected using the Heart Disease Fact Questionnaire (HDFQ) and Adherence to a Healthy lifestyle questionnaire (AHLQ).</p> <p><strong>Results:</strong> In the intervention group, the difference between the pre-test and post-test mean scores of knowledge on CSX risk factors was statistically significant (SD=1.77; P&lt;0.05). However, there was no significant difference between pre-test and post-test means scores in the control group (SD=3.12; P&gt;0.05).</p> <p><strong>Conclusion:</strong> Patients with CSX have high morbidity and health care expenditure; therefore, the provision of an educational program through the mHealth app as well as lifestyle modification can be considered a highly effective and low-cost intervention contributing to an increase of knowledge about CSX risk factors in patients and adoption of a healthy lifestyle.</p> 2022-06-16T00:00:00+0430 Copyright (c) 2022 Iranian Red Crescent Medical Journal https://www.ircmj.org/index.php/IRCMJ/article/view/1907 New solutions to subside the spread of Omicron variants and sixth wave: Based on past experiences to overcome different COVID-19 variants in Iran 2022-02-03T00:08:48+0330 Alireza Mohammadzadeh Shabestari Majidtaati1367@gmail.com Majid Taati Moghadam majidtaati1367@gmail.com 2022-06-16T00:00:00+0430 Copyright (c) 2022 Iranian Red Crescent Medical Journal https://www.ircmj.org/index.php/IRCMJ/article/view/2004 Warning of the COVID-19 Novel Variant: Is the COVID-19 Omicron Variant a Real Danger for Cancer Patients or Not? 2022-03-06T22:56:14+0330 AmirAli Moodi Ghalibaf amiralimoodi1998@gmail.com Mina AkbariRad akbariradm@mums.ac.ir Mehdi Ataee Karizmeh atayee.mahdi@yahoo.com <p>In late December 2019, the novel coronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first presented in the Hubei province of China as pneumonia of unknown cause, which has caused millions of deaths up to now (<a href="#r1">1</a>). Studies indicated the most common signs and symptoms of the conventional COVID-19 variants as fever, cough, dyspnea, and fatigue. In advanced stages, this mysterious viral disease leads to acute respiratory distress syndrome, acute cardiac damage, as well as gastrointestinal manifestations (<a href="#r2">2</a>).</p> <p> In late 2021, the emergence of the new COVID-19 variant, called the Omicron variant, started a new global pandemic wave and was stated as a “version of concern (VOC)” by the World Health Organization (<a href="#r3">3</a>). Despite our little knowledge about the COVID-19 Omicron variant, some evidence presented the milder manifestation of this new variant than the previous variants, probably due to the global vaccination effects. However, few new theories and studies indicated the life-threatening aspects of the Omicron variant (<a href="#r3">3</a>).</p> <p> As indicated in our previous study, cancer patients are in danger of COVID-19 (<a href="#r4">4</a>); however, seemingly, the Omicron variant has made a novel situation for these patients. Therefore, in the present study, the authors briefly investigated whether the COVID-19 Omicron variant is threatening cancer patients or not?</p> <p> </p> <p><strong> </strong></p> <p><strong>Cancer Patients in the COVID-19 Era</strong></p> <p><strong> </strong></p> <p>Most cancer patients are at an exceptionally high risk of infection with the SARS-CoV-2 with probably higher morbidity and mortality rates, prompting special attention to this populace. Molecular links between most cancers and the COVID-19 have been observed to be related to Angiotensin-Converting Enzyme 2, Transmembrane Protease Serine 2, pro-inflammatory cytokines, and blood coagulation (<a href="#r5">5</a>). Some anticancer agents are being investigated as a possible treatment for the COVID-19. Based on these findings, new therapeutic options are designed for the treatment of both cancer and the COVID-19. They can manage the extreme outcomes of the COVID-19 and have therapeutic effects on many active cancers (<a href="#r2">2</a>,<a href="#r5">5</a>). On the other hand, some investigations have proposed the theory of the COVID-19 associated cancer incidence (<a href="#r4">4</a>,<a href="#r5">5</a>). Therefore, according to what is stated and considering the immune-suppressed situation of cancer patients, it is highly advised that clinicians who encounter SARS-CoV-2 infected cancer patients pay special attention to their treatment and follow-up.</p> <p><strong>Omicron Variant: Danger for Cancer Patients or Not?</strong></p> <p> The latest findings of the COVID-19 Omicron variant determined its new immune-escape properties, which can potentially enable the virus to infect vaccinated individuals or re-infect anyone (<a href="#r6">6</a>). Furthermore, these investigations indicated that this VOC has higher transmissibility among people than the Delta and Beta variants. Additionally, its doubling time is approximately one-third of the two other mentioned variants (<a href="#r6">6</a>). Therefore, due to increased infections, transmissibility, and immune escape, this new VOC has made an alert for healthcare workers and clinicians to severely take care of cancer patients, as an in-danger group. In detail, some of the major reasons and recommendations are as follows (Figure 1):</p> <p><strong>1- Cancer Patients Vaccination:</strong> Based on molecular and serological studies, the serum anti-SARS-CoV-2 S (anti-S) titer has a lower median after two doses of vaccination in cancer patients, compared to the general healthy population. Previous research findings proposed that all cancer patients should receive the third dose of the vaccine three to four months after the second one (<a href="#r7">7</a>). While receiving the third dose of the COVID-19 vaccine is necessary for all cancer patients, there are controversies about the fourth dose for these patients. Although administrating dose four is probably not highly efficient in cancer patients due to their anti-CD20 treatment, some scientific tips state that the fourth dose can be administrated four months after the last dose in developed countries (<a href="#r7">7</a>,<a href="#r8">8</a>).</p> <p><strong>2- Cancer Patients’ Relatives Vaccination:</strong> It is highly recommended by scientific studies and societies that relatives of anyone, due to their close contact, could act as a virus transporter. It is advised to administer the third dose for those in contact with cancer patients approximately four months after the second one. Moreover, vaccination of 5-11 years old children, as silent transporters, seems highly important (<a href="#r8">8</a>).</p> <p><strong>3- Behavioral Prophylaxis:</strong> Scientific studies have approved that the COVID-19 is transmitted through air and droplets. Therefore, it is essential that immune-suppressed people, especially patients with active malignancy, do not gather in populated communities and events. Furthermore, wearing highly protective masks is highly crucial not only for cancer patients but also for everyone else (<a href="#r9">9</a>).</p> <p><strong>4- Monoclonal Antibody Prophylaxis:</strong> Monoclonal antibody prophylaxis and treatment is not approved for COVID-19 medication. However, some <em>in vitro</em> documents indicated its efficacy on the Delta variant, while this neutralization effect is lower on the Omicron variant. Nevertheless, there is a high controversy about applying monoclonal antibodies for COVID-19 prophylaxis even in cancer patients (<a href="#r10">10</a>).</p> <p> In conclusion, although cancer patients have been in danger of COVID-19 infection and its complication, the new Omicron variant needs more attention and protection. It is highly advised that clinicians and cancer patients take the Omicron variant seriously. Complete vaccination, the administration of the third and even the fourth dose, as well as behavioral prophylaxis, are major routes to being safe beyond the other ways to be protected in the COVID-19 Omicron era.</p> 2022-06-18T00:00:00+0430 Copyright (c) 2022 Iranian Red Crescent Medical Journal https://www.ircmj.org/index.php/IRCMJ/article/view/2074 Factors Influencing Stress Perception among Hemodialysis Patients: A Systematic Review 2022-06-05T14:58:53+0430 Thalwaththe Gedara Nadeeka Shayamalie Gunarathne mva180022@siswa.um.edu.my Khatijah L Abdullah katlim@um.edu.my Tang Li Yoong liliantang@um.edu.my Nishantha Nanayakkara nishantha4313@gmail.com Lim Soo Kun limsk@ummc.edu.my Samira Mohajer s_mohajer99@yahoo.com <p><strong>Background: </strong>Stress is a common comorbid disorders among hemodialysis patients and diverse factors contributed for stress perception among hemodialysis patients. Although, many findings have been consistent across the literature, there has been a surprising lack of consensus in which factor is most influence the stress perception.</p> <p><strong>Objectives</strong>: This systematic review aimed to provide executive review on factors contribute for stress perception among hemodialysis patients</p> <p><strong>Methods: </strong>Systematic review was conducted in Cumulative Index to Nursing and Allied Health Literature (CINHAL), PubMed, EBESCOhost, Google scholar, Medline and Web of Science (WOS) databases. Rigorous search narrowed to 16 observational studies (Total N=3567) on factors determine for stress perception among hemodialysis patients. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guideline were inco-operated. Selected 16 articles were used in the qualitative synthesis.</p> <p><strong>Results: </strong>Stressors were clustered as Biological, Psychological/Behavioral, or Social/Environmental factors. Effect of socio-demographic factors on stress perception was scarce and inconsistent; whilst fatigue and itching were distressing biological factors. Limitations on time and place on vacation, limitation of food and fluid, decrease in social life with substantial economic burden were enlightened as psychological and social stressors respectively.</p> <p><strong>Conclusion: </strong>Multidisciplinary factors were inspired for stress perception among hemodialysis patients. Nursing care plans should addressed holistic nature of stress with appropriate nursing interventions. Although this review adopted the strict selection criteria, it remains difficult to conclude determinants due to methodological drawbacks. Thus, future research in this scope is highly appreciated with prospective longitudinal nature to produce solid clinical conclusions.</p> 2022-06-16T00:00:00+0430 Copyright (c) 2022 Iranian Red Crescent Medical Journal https://www.ircmj.org/index.php/IRCMJ/article/view/1945 Colonic and Rectum Infarction in the Covid19 Pandemic: A Case Series from an Uncommon Event 2022-04-28T12:00:55+0430 Maryam Sarkardeh SarkardehM@mums.ac.ir Amin Dalili Dalilia@mums.ac.ir Poorya Etesamyzade pooryaetesamyzadeh1998@yahoo.com Ali Shamshirian Shamshiriana951@mums.ac.ir Zahra Sadrzadeh zsadrzadeh71@gmail.com Javad Kooshki j.medkoushki@yahoo.com Maryam Khoshdast maryamkhoshdast98@gmail.com Alireza Rezapanah rezapanaha1@mums.ac.ir <p><strong>Background:</strong> By the end of May 2021, 170 million cases and 3.54 million death from Covid-19 infection have been reported. The high affinity of virus particles to ACE-2 receptors in different body organs can cause varied clinical manifestations and complications. Ischemic colitis and necrosis are some of the rare complications of Covid-19 infection with high morbidity and mortality resulting from colonic hypoperfusion. Different underlying mechanisms have been described for ischemic colitis in Covid-19 patients including hypercoagulable state, inflammatory responses, microthrombosis, and non-occlusive intestinal ischemia due to shock, hypoxemia, and low cardiac output.</p> <p><strong>Case presentation:</strong> here we presented three patients with ischemic colitis and one rectal necrosis as a rare presentation of gastrointestinal complication of SARS-CoV-2 infection. all of our patients presented with abdominal pain and tenderness and all of them received a standard regimen of antibiotics, anticoagulation, and ventilation support.</p> <p><strong>Conclusion:</strong> Ischemic colitis is one of these rare but with high mortality manifestations, which presents with non-specific signs and symptoms. Hence, in patients with Covid-19 infection and abdominal pain, ischemic colitis should be kept in mind which necessitates further evaluations</p> 2022-06-16T00:00:00+0430 Copyright (c) 2022 Iranian Red Crescent Medical Journal https://www.ircmj.org/index.php/IRCMJ/article/view/1879 Statistical methods used in Iranian Red Crescent Medical Journal articles and relation with acceptance period: A review from 2014-2021 2022-02-18T11:23:27+0330 Sajjad Bahariniya sajjadbahari98@gmail.com Farzan Madadizadeh f.madadizadeh@ssu.ac.ir <p><strong>Background &amp; Objectives:</strong> Statistical methods as an adjunct to biomedical research have an important role in the design, management, analysis and interpretation of scientific data. The main purpose of this review was to determine the statistical methods, acceptance period and related factors in Iranian Red Crescent Medical Journal (IRCMJ) articles.</p> <p><strong>Methods:</strong> Original articles in the period 2014 to 2021 from volumes 16 to 23 and issues 1 to 12 were reviewed (1300 articles). Each article was reviewed by a 2-member team consisting of a statistician and an expert researcher in the field of medical research. statistical methods, sample size, sampling method, statistical population, study design and software were extracted. Frequency, Percentage, Median, Inter quartile range and Multiple response analysis (MRA), the Kruskal–Wallis test and Spearman correlation coefficient were used to discription and analysis, respectively . All analyzes were performed in SPSS26 software with a significance level of 5%.</p> <p><strong>Results:</strong> The statistical population of most published articles was related to patients (41.2% and 547 articles). Most studies (43.5% and 565 articles) had a sample size between 100 and 500 people. Most of them were analytical intervention (41.2% and 535 articles). Median (IQR) of acceptance period were 94 (95.57) days. The results of MRA showed that both among the total tests and among the articles, the highest rate of use of statistical methods was related to T-test, Chi square test and descriptive statistics. There were no statistically significant factor influencing acceptance period (p&gt;0.05), and no significant correlation between acceptance period and sample size of published articles (r=-0.04, p=0.625).</p> <p><strong>Conclusion:</strong> Given that acceptance period is a key factor for researchers to choose a journal, it seems to be effective if it is reduced. Contrary to some novice researchers' beliefs, the acceptance period of the article was not affected by the design, statistical methods, and sample size etc. of the study.</p> 2022-06-16T00:00:00+0430 Copyright (c) 2022 Iranian Red Crescent Medical Journal