Shiraz E-Medical Journal Shiraz E-Medical Journal Shiraz E-Med J http://www.emedicalj.portal.tools 1735-1391 10.5812/semj. en jalali 2019 6 20 gregorian 2019 6 20 18 4
en 10.5812/semj.39745 Evaluation of 30-Day Unplanned Hospital Readmission in a Large Teaching Hospital in Shiraz, Iran Evaluation of 30-Day Unplanned Hospital Readmission in a Large Teaching Hospital in Shiraz, Iran research-article research-article Conclusions

It is necessary to consider the patients with internal history, surgical procedure, and more paraclinical requirement. In addition, physicians should be educated to give more consideration to these groups.

Results

Results showed that 66 patients were readmitted during this time. In addition, having history of chronic non-communicable diseases such as hypertension (HTN), diabetes mellitus (DM), chronic kidney disease (CKD) (here called internal problem) (P = 0.04), surgical procedure (P = 0.03), and rate of paraclinical requests (P = 0.04) associated with readmission.

Background

The information about lower 30-day readmission in Iran is very limited. The current study aimed at evaluating the causes of readmission in an educational hospital based on LACE index.

Methods

It was a case-control study evaluating the causes of readmission of the patients from February 2014 till February 2015 (12 months) in a large teaching hospital in Shiraz, Iran. Data were extracted from health information system (HIS) and after removing the planed readmission, the rest of data were examined according to 4 variables of LACE index; in addition to the season of admission, rate of preclinical requests, and patients’ living area. Data were transferred into Stata software version 11.0, according to the conditional regression analysis.

Conclusions

It is necessary to consider the patients with internal history, surgical procedure, and more paraclinical requirement. In addition, physicians should be educated to give more consideration to these groups.

Results

Results showed that 66 patients were readmitted during this time. In addition, having history of chronic non-communicable diseases such as hypertension (HTN), diabetes mellitus (DM), chronic kidney disease (CKD) (here called internal problem) (P = 0.04), surgical procedure (P = 0.03), and rate of paraclinical requests (P = 0.04) associated with readmission.

Background

The information about lower 30-day readmission in Iran is very limited. The current study aimed at evaluating the causes of readmission in an educational hospital based on LACE index.

Methods

It was a case-control study evaluating the causes of readmission of the patients from February 2014 till February 2015 (12 months) in a large teaching hospital in Shiraz, Iran. Data were extracted from health information system (HIS) and after removing the planed readmission, the rest of data were examined according to 4 variables of LACE index; in addition to the season of admission, rate of preclinical requests, and patients’ living area. Data were transferred into Stata software version 11.0, according to the conditional regression analysis.

30-Day Readmission;Internal Medicine;Surgical 30-Day Readmission;Internal Medicine;Surgical http://www.emedicalj.portal.tools/index.php?page=article&article_id=39745 Ahmad Kalateh Sadati Ahmad Kalateh Sadati Department of Sociology, Yazd University, Yazd, Iran Department of Sociology, Yazd University, Yazd, Iran Kamran Bagheri Lankarani Kamran Bagheri Lankarani Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Health Policy Research Center (HPRC), Shiraz University of Medical Science, Building No 2, Eighth Floor, School of Medicine, Zand Avenue, 71348-53185, Shiraz, Iran. Tel/Fax: +98-71132309615 Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Health Policy Research Center (HPRC), Shiraz University of Medical Science, Building No 2, Eighth Floor, School of Medicine, Zand Avenue, 71348-53185, Shiraz, Iran. Tel/Fax: +98-71132309615 Reza Tabrizi Reza Tabrizi Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran Farnaz Rahnavard Farnaz Rahnavard Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran Somaye Zakerabasali Somaye Zakerabasali Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
en 10.5812/semj.46398 The Shiraz Adult Respiratory Disease Study, a Population-Based Survey: Rationale, Design and Methods The Shiraz Adult Respiratory Disease Study, a Population-Based Survey: Rationale, Design and Methods methods-article methods-article Conclusions

We anticipate that future reports from the Shiraz adult respiratory disease study would estimate the prevalence of CORDs and their related determinants in the community. Moreover, it will identify patients who should be targeted by respiratory disease prevention programs.

Results

In this protocol study, we shared our standard protocol considering perfect selection of the study samples and precise examination procedure with effective quality assurance strategies.

Background

Despite preventable and curable nature of chronic obstructive respiratory diseases (CORDs), these are still remains as a growing problem, both in developed and developing countries. One of the major reasons for this ignorance is lacking of precise information on the prevalence of CORDs and their major determinants.

Objectives

This protocol study aimed at providing a population-based data for the prevalence of CORDs and exploring its socioeconomic determinants in adult population of Shiraz, Iran.

Methods

This adult respiratory disease study was designed as a cross sectional survey among urban and suburban population of Shiraz, Iran, during August to December 2015. The local ethics committee of Shiraz University of Medical Sciences authorized the protocol, which adhered to the tenets of the declaration of Helsinki (1975). The study included more than 6,000 noninstitutionalized inhabitants older than 20 years, from the 9 municipal districts of Shiraz city. The sample consisted of 0.5% of the 1,219,237 total inhabitants in the survey area. The sample selection was based on the stratified random sampling method proportionate to the number of municipal districts and strata. After obtaining official permissions, trained interviewers visited the selected homes and completed the data collection form and main questionnaire. Following the completion of recruitment and an initial analysis process, we called and invited the participants with the COPD diagnosis score more than 19.5 to pass the spirometry test in the clinic. The main questionnaire that covered respiratory symptoms was developed from prior validated questionnaires that had been used in several studies. Data were analyzed using the SPSS software version 15.0 (SPSS Inc, Chicago, Illinois, USA). A P-value of less than 0.05 was considered as statistically significant.

Conclusions

We anticipate that future reports from the Shiraz adult respiratory disease study would estimate the prevalence of CORDs and their related determinants in the community. Moreover, it will identify patients who should be targeted by respiratory disease prevention programs.

Results

In this protocol study, we shared our standard protocol considering perfect selection of the study samples and precise examination procedure with effective quality assurance strategies.

Background

Despite preventable and curable nature of chronic obstructive respiratory diseases (CORDs), these are still remains as a growing problem, both in developed and developing countries. One of the major reasons for this ignorance is lacking of precise information on the prevalence of CORDs and their major determinants.

Objectives

This protocol study aimed at providing a population-based data for the prevalence of CORDs and exploring its socioeconomic determinants in adult population of Shiraz, Iran.

Methods

This adult respiratory disease study was designed as a cross sectional survey among urban and suburban population of Shiraz, Iran, during August to December 2015. The local ethics committee of Shiraz University of Medical Sciences authorized the protocol, which adhered to the tenets of the declaration of Helsinki (1975). The study included more than 6,000 noninstitutionalized inhabitants older than 20 years, from the 9 municipal districts of Shiraz city. The sample consisted of 0.5% of the 1,219,237 total inhabitants in the survey area. The sample selection was based on the stratified random sampling method proportionate to the number of municipal districts and strata. After obtaining official permissions, trained interviewers visited the selected homes and completed the data collection form and main questionnaire. Following the completion of recruitment and an initial analysis process, we called and invited the participants with the COPD diagnosis score more than 19.5 to pass the spirometry test in the clinic. The main questionnaire that covered respiratory symptoms was developed from prior validated questionnaires that had been used in several studies. Data were analyzed using the SPSS software version 15.0 (SPSS Inc, Chicago, Illinois, USA). A P-value of less than 0.05 was considered as statistically significant.

Asthma;Adult;Chronic Obstructive Pulmonary Disease;Design;Prevalence;Respiratory Disease Asthma;Adult;Chronic Obstructive Pulmonary Disease;Design;Prevalence;Respiratory Disease http://www.emedicalj.portal.tools/index.php?page=article&article_id=46398 Seyed Masoom Masoompour Seyed Masoom Masoompour MD Associate Professor of Internal Medicine, Pulmonologist,Non Communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran MD Associate Professor of Internal Medicine, Pulmonologist,Non Communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran Hamideh Mahdaviazad Hamideh Mahdaviazad MD, Assistant Professor of Community Medicine, Poostchi Ophtalmology research center, Shiraz University of Medical Sciences, Shiraz, IR Iran; Assistant professor of Community and Preventive Medicine, Shiraz University of Medical Sciences, P.O. Box: 7193634154, Shiraz, IR Iran. Tel: +98-7136234504, Fax: +98-7136234504 MD, Assistant Professor of Community Medicine, Poostchi Ophtalmology research center, Shiraz University of Medical Sciences, Shiraz, IR Iran; Assistant professor of Community and Preventive Medicine, Shiraz University of Medical Sciences, P.O. Box: 7193634154, Shiraz, IR Iran. Tel: +98-7136234504, Fax: +98-7136234504 Seiyed Mohammad Ali Ghayumi Seiyed Mohammad Ali Ghayumi MD, Professor of Internal Medicine, Pulmonologist, Department of Internal Medicine, Shiraz University of Medical Sciences, Shiraz, IR Iran MD, Professor of Internal Medicine, Pulmonologist, Department of Internal Medicine, Shiraz University of Medical Sciences, Shiraz, IR Iran Mehrab Sayadi Mehrab Sayadi PhD Student, Student Research Committee, Medicine School, Department of Biostatistics, Shiraz University of Medical Sciences, Shiraz, IR Iran PhD Student, Student Research Committee, Medicine School, Department of Biostatistics, Shiraz University of Medical Sciences, Shiraz, IR Iran
en 10.5812/semj.46170 Selection and Evaluation of Human Recombinant Antibodies against ErbB2 Antigen for Breast Cancer Immunotherapy Selection and Evaluation of Human Recombinant Antibodies against ErbB2 Antigen for Breast Cancer Immunotherapy research-article research-article Conclusions

Targeted cancer therapy, which acts on a specific molecule in cancer cells, minimizes the side effects of immunotherapy. Due to the unique properties of scFvs, these antibodies have been used in targeted therapy of several cancers. In this study, 2 specific scFvs were selected against 2 ErbB2 epitopes, which contained trastuzumab and pertuzumab binding sites. The results of the panning process demonstrated the selection of 2 specific scFvs (with frequencies of 40% and 45%, respectively), which significantly reacted with the corresponding epitopes in phage ELISA assay. These small, high-affinity, human antibodies, which were selected against regions containing the binding sites of 2 food and drug administration (FDA)-approved monoclonal antibodies for breast cancer immunotherapy, have the potential to be considered for breast cancer targeted therapy. However, in vitro and in vivo tests should be performed to evaluate the antitumor effects of these scFvs.

Background

Breast cancer is the most common cause of cancer-related death in women worldwide. ErBb2/HER2 breast cancer accounts for 25% - 30% of all cases of breast cancer. Approved anti-ErbB2 monoclonal antibodies, trastuzumab and pertuzumab, are currently used for the treatment of ErbB-positive breast cancer, although their clinical use is limited due to their immunogenicity. Human recombinant single-chain antibodies, which are produced by antibody engineering technologies, are new and effective antibodies in cancer immunotherapy.

Results

Single-chain antibodies, scFvI and scFvII, which are ErbB2-specific with 40% and 45% frequencies, were selected against epitopes I and II, respectively. The results of phage ELISA demonstrated a significant difference in the optical density (OD) of scFvs in reaction with the related peptides and non-peptide wells. ODs of 0.65 and 0.71 were obtained for scFvI and scFvII reactions with the corresponding peptides, whereas the ODs of non-peptide wells were 0.1 and 0.13, respectively.

Methods

Escherichia coli bacteria, containing a phagemid with a scFv insert segment, were used to select specific high-affinity scFvs against 2 ErbB2 epitopes, using the panning process. Polymerase chain reaction (PCR) and DNA fingerprinting were performed on the obtained clones to select the positive ones and isolate the common patterns. The selected clones were evaluated via phage Elisa in terms of reactivity and specificity to epitopes.

Objectives

To select specific single-chain variable fragments (scFvs) against 2 immunodominant ErbB2 epitopes, including trastuzumab and pertuzumab binding sites, and to evaluate their reactivity and specificity against ErbB2 epitopes.

Conclusions

Targeted cancer therapy, which acts on a specific molecule in cancer cells, minimizes the side effects of immunotherapy. Due to the unique properties of scFvs, these antibodies have been used in targeted therapy of several cancers. In this study, 2 specific scFvs were selected against 2 ErbB2 epitopes, which contained trastuzumab and pertuzumab binding sites. The results of the panning process demonstrated the selection of 2 specific scFvs (with frequencies of 40% and 45%, respectively), which significantly reacted with the corresponding epitopes in phage ELISA assay. These small, high-affinity, human antibodies, which were selected against regions containing the binding sites of 2 food and drug administration (FDA)-approved monoclonal antibodies for breast cancer immunotherapy, have the potential to be considered for breast cancer targeted therapy. However, in vitro and in vivo tests should be performed to evaluate the antitumor effects of these scFvs.

Background

Breast cancer is the most common cause of cancer-related death in women worldwide. ErBb2/HER2 breast cancer accounts for 25% - 30% of all cases of breast cancer. Approved anti-ErbB2 monoclonal antibodies, trastuzumab and pertuzumab, are currently used for the treatment of ErbB-positive breast cancer, although their clinical use is limited due to their immunogenicity. Human recombinant single-chain antibodies, which are produced by antibody engineering technologies, are new and effective antibodies in cancer immunotherapy.

Results

Single-chain antibodies, scFvI and scFvII, which are ErbB2-specific with 40% and 45% frequencies, were selected against epitopes I and II, respectively. The results of phage ELISA demonstrated a significant difference in the optical density (OD) of scFvs in reaction with the related peptides and non-peptide wells. ODs of 0.65 and 0.71 were obtained for scFvI and scFvII reactions with the corresponding peptides, whereas the ODs of non-peptide wells were 0.1 and 0.13, respectively.

Methods

Escherichia coli bacteria, containing a phagemid with a scFv insert segment, were used to select specific high-affinity scFvs against 2 ErbB2 epitopes, using the panning process. Polymerase chain reaction (PCR) and DNA fingerprinting were performed on the obtained clones to select the positive ones and isolate the common patterns. The selected clones were evaluated via phage Elisa in terms of reactivity and specificity to epitopes.

Objectives

To select specific single-chain variable fragments (scFvs) against 2 immunodominant ErbB2 epitopes, including trastuzumab and pertuzumab binding sites, and to evaluate their reactivity and specificity against ErbB2 epitopes.

Breast Cancer;ErbB2;ScFv Antibodies;Targeted Therapy Breast Cancer;ErbB2;ScFv Antibodies;Targeted Therapy http://www.emedicalj.portal.tools/index.php?page=article&article_id=46170 Elham Nadimi Elham Nadimi Recombinant Antibody Laboratory, Department of Immunology, Shiraz University of Medical Sciences, Shiraz, IR Iran Recombinant Antibody Laboratory, Department of Immunology, Shiraz University of Medical Sciences, Shiraz, IR Iran Foroogh Nejatollahi Foroogh Nejatollahi Recombinant Antibody Laboratory, Department of Immunology, Shiraz University of Medical Sciences, Shiraz, IR Iran; Shiraz HIV/AIDS Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, IR Iran; Shiraz HIV/AIDS Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, IR Iran Recombinant Antibody Laboratory, Department of Immunology, Shiraz University of Medical Sciences, Shiraz, IR Iran; Shiraz HIV/AIDS Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, IR Iran; Shiraz HIV/AIDS Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, IR Iran
en 10.5812/semj.44968 Patients’ Satisfaction with Medical Residents’Communication Skills at the Largest Teaching and Treatment Center in North West Iran in 2016 Patients’ Satisfaction with Medical Residents’Communication Skills at the Largest Teaching and Treatment Center in North West Iran in 2016 brief-report brief-report Conclusions

In this study, patients’ overall satisfaction with medical residents’ patient-physician communication skills was moderate. It is recommended that training as well as evaluation of communication skills should be a pivotal part of residents’ formal curriculum.

Results

The mean of patients’normalized overall satisfaction score with medical residents’ communication skills was 48.8 ± 18 (out of 100). Patients’ satisfaction with 6 of the 10 considered to assess skills was less than the median score of the statistical population. The relationship between patients’ overall satisfaction score with their educational, income, and socio-economic level unlike with their gender and residential area was statistically significant.

Background

Given that the capability to build an effective relationship with patients has been reported as a strong predictor of physicians’ professional achievements, this study was intended to assess patients’ satisfaction with medical residents’ communication skills at the largest teaching and treatment center in North West Iran in 2016.

Methods

This cross-sectional study was conducted in 2016. Using the valid and reliable Persian version of the patient satisfaction questionnaire, 488 patients assessed communication skills of 198 medical residents, using a seven-point Likert scale, from “poor to fair” to “outstanding”. Data were analyzed using STATA, V 13 for descriptive, co relational, one way ANOVA and regression analyses.

Conclusions

In this study, patients’ overall satisfaction with medical residents’ patient-physician communication skills was moderate. It is recommended that training as well as evaluation of communication skills should be a pivotal part of residents’ formal curriculum.

Results

The mean of patients’normalized overall satisfaction score with medical residents’ communication skills was 48.8 ± 18 (out of 100). Patients’ satisfaction with 6 of the 10 considered to assess skills was less than the median score of the statistical population. The relationship between patients’ overall satisfaction score with their educational, income, and socio-economic level unlike with their gender and residential area was statistically significant.

Background

Given that the capability to build an effective relationship with patients has been reported as a strong predictor of physicians’ professional achievements, this study was intended to assess patients’ satisfaction with medical residents’ communication skills at the largest teaching and treatment center in North West Iran in 2016.

Methods

This cross-sectional study was conducted in 2016. Using the valid and reliable Persian version of the patient satisfaction questionnaire, 488 patients assessed communication skills of 198 medical residents, using a seven-point Likert scale, from “poor to fair” to “outstanding”. Data were analyzed using STATA, V 13 for descriptive, co relational, one way ANOVA and regression analyses.

Patient Satisfaction;Communication Skills;Residents Patient Satisfaction;Communication Skills;Residents http://www.emedicalj.portal.tools/index.php?page=article&article_id=44968 Mahdi Nouri Mahdi Nouri MSc Student of Medical Education, Medical Education Department, Education Development Center, Tabriz University of Medical Sciences, Tabriz, Iran MSc Student of Medical Education, Medical Education Department, Education Development Center, Tabriz University of Medical Sciences, Tabriz, Iran Saeideh Ghaffarifar Saeideh Ghaffarifar Assistant Professor, Medical Education Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; Medical Education Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. Tel: +98-9128120191, Fax: +98-4133362700 Assistant Professor, Medical Education Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; Medical Education Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. Tel: +98-9128120191, Fax: +98-4133362700 Homayoun Sadeghi Bazargani Homayoun Sadeghi Bazargani Assistant Professor, Department of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran Assistant Professor, Department of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran Reza Ghaffari Reza Ghaffari Assistant Professor, Medical Education Department, Education Development Center, Tabriz University of Medical Sciences, Tabriz, Iran Assistant Professor, Medical Education Department, Education Development Center, Tabriz University of Medical Sciences, Tabriz, Iran
en 10.5812/semj.43920 Contamination of Senior Medical Students’ Cell Phones by Nosocomial Infections: A Survey in a University-Affiliated Hospital in Tehran Contamination of Senior Medical Students’ Cell Phones by Nosocomial Infections: A Survey in a University-Affiliated Hospital in Tehran research-article research-article Conclusions

Mobile phones can act as potential carriers of nosocomial infections which are significantly higher in male students’ phones and in smartphones. So, some restrictions should be applied to their use in sensitive areas of hospitals. Also, due to the significant impact of cleaning mobile phones in reducing the frequency of bacterial contamination, attention to their regular cleaning should be considered.

Background and Purpose

Nosocomial infections are a growing problem in many health centers. Cell phones used by the medical staff can act as a vector for nosocomial transmission of microorganisms. This study aimed to investigate the role of cell phones of senior medical students in the spread of nosocomial bacterial infections in Amir-al-Momenin general hospital in Tehran in September 2015.

Methods

Thirty medical students were enrolled using convenience sampling method. Demographic data, perspectives, attitudes, phone type, and frequency of cleaning of mobile phones were collected by questionnaires. Samples were taken from the phones using a sterile swab moistened with a nutritive medium in order to assess the possibility of bacterial growth.

Results

A total of 53.3 percent of mobile phones were infected. Isolated bacteria were: Staphylococcus epidermidis (26.7%), Non-albicans Candida (16.7%), Bacillus PSP (13.3%), Micrococcus PSP (10%), non-hemolytic Streptococcus and Enterococcus (each 6.7%), and Klebsiella and Staphylococcus aureus (each 3.3%).

Conclusions

Mobile phones can act as potential carriers of nosocomial infections which are significantly higher in male students’ phones and in smartphones. So, some restrictions should be applied to their use in sensitive areas of hospitals. Also, due to the significant impact of cleaning mobile phones in reducing the frequency of bacterial contamination, attention to their regular cleaning should be considered.

Background and Purpose

Nosocomial infections are a growing problem in many health centers. Cell phones used by the medical staff can act as a vector for nosocomial transmission of microorganisms. This study aimed to investigate the role of cell phones of senior medical students in the spread of nosocomial bacterial infections in Amir-al-Momenin general hospital in Tehran in September 2015.

Methods

Thirty medical students were enrolled using convenience sampling method. Demographic data, perspectives, attitudes, phone type, and frequency of cleaning of mobile phones were collected by questionnaires. Samples were taken from the phones using a sterile swab moistened with a nutritive medium in order to assess the possibility of bacterial growth.

Results

A total of 53.3 percent of mobile phones were infected. Isolated bacteria were: Staphylococcus epidermidis (26.7%), Non-albicans Candida (16.7%), Bacillus PSP (13.3%), Micrococcus PSP (10%), non-hemolytic Streptococcus and Enterococcus (each 6.7%), and Klebsiella and Staphylococcus aureus (each 3.3%).

Cell Phone;Medical Students;Nosocomial Bacterial Infections Cell Phone;Medical Students;Nosocomial Bacterial Infections http://www.emedicalj.portal.tools/index.php?page=article&article_id=43920 Sana Jalalmanesh Sana Jalalmanesh Medical Student at Tehran Medical Branch of Islamic Azad University, Tehran, IR Iran Medical Student at Tehran Medical Branch of Islamic Azad University, Tehran, IR Iran Mohammad Darvishi Mohammad Darvishi Infectious Diseases and Tropical Medicine Research Center (IDTMRC), AJA University of Medical Sciences, Tehran, IR Iran; Infectious Diseases and Tropical Medicine Research Center (IDTMRC), AJA University of Medical Sciences, Tehran, IR Iran Infectious Diseases and Tropical Medicine Research Center (IDTMRC), AJA University of Medical Sciences, Tehran, IR Iran; Infectious Diseases and Tropical Medicine Research Center (IDTMRC), AJA University of Medical Sciences, Tehran, IR Iran Mohammadkarim Rahimi Mohammadkarim Rahimi Department of Medicine, Tehran Medical Branch of Islamic Azad University, Tehran, IR Iran Department of Medicine, Tehran Medical Branch of Islamic Azad University, Tehran, IR Iran Meisam Akhlaghdoust Meisam Akhlaghdoust Pars Advanced and Minimally Invasive Manners Research Center, Pars Hospital, Iran University of Medical Sciences, Tehran, IR Iran; Pars Advanced and Minimally Invasive Manners Research Center, Pars Hospital, Iran University of Medical Sciences, Tehran, IR Iran Pars Advanced and Minimally Invasive Manners Research Center, Pars Hospital, Iran University of Medical Sciences, Tehran, IR Iran; Pars Advanced and Minimally Invasive Manners Research Center, Pars Hospital, Iran University of Medical Sciences, Tehran, IR Iran