Razi Journal of Medical Sciences

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Mccune Albright syndrome is a polyosteotic fibrous dysplasia which manifests itself with disturbance of endocrine function and pigmented patch in skin at birth. The prevalence of polyosteotic is between two and three per million. The upper end of femur is the frequent site of involvement in polyosteotic form with multi endocrinopathy and limb deformity and multiple fractures. The present study is the case report of a 19-year-old girl who referred for left lower limb shortening and deformity of thigh following conservative management. In follow-up, and at the age of 19 due to recurrence of deformity and lower limb shortening(10 cm) the patient underwent derotational subtrochantric valgus osteotomy and bone graft, fixation with plate and concomitant distal femural supracondylar close wedge osteotomy. After operation limb deformity and discrepancy were corrected.

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This study was conducted to investigate the role of cell immunity in adults suffering from chronic sinusitis who referred to Rasoul-e-Akram Hospital for endoscopic sinus surgery. CD3, CD4, CD8 & CD4/CD8 ratio in sinus mucosa of serum IgE level were all measured in the patients. The three studied groups were: chronic sinusitis with high serum IgE(28 cases), chronic sinusitis with normal range serum IgE(45 cases) and a control group with no sinusitis and normal serum IgE(10 cases). It was found out that chronic sinusitis occurred more often in persons with high serum IgE than normal range serum IgE(P=0.012). Females with serum IgE more than 100IU/ml, had a higher risk for chronic sinusitis compared to males(P=0.05, OR=2.8). CD3, CD4, CD8 counts and CD4/CD8 ratio had no correlation with age and serum IgE. CD4 to CD8 ratio in different anatomical regions of mucosa showed that CD4/CD8 in nasal cavity was greater than ethmoid sinus(2.6vs 1.9) and it was greater in ethmoid sinus than in maxillary sinus(1.9vs 0.9). Also, more CD8 lymphocytes were seen in maxillary sinus mucosa than ethmoid sinus mucosa and nasal cavity, but statistically there were no significant differences between these anatomical regions. CD3 cells in nasal cavity and CD4 cells in ethmoid sinus were greater than other regions. Number of CD4 cells were significantly higher in patients with nasal polyp than in others(P=0.002). Due to several affecting factors in cellular immunity in sinus mucosa, it is necessary to perform more detailed studies in this regard.

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    Background & Aim: Diabetes mellitus is one of the commonest chronic diseases in community which induces immunodeficiency and infection through multiple mechanisms. In addition, infections can also bring about hyperglycemia and ketoacidosis. In this study, we have tried to evaluate the frequency of diabetes and the factors related to its outcome in patients with sepsis. Patients & Method: This is a descriptive cross-sectional study which involves 300 randomly sampled cases who had been admitted to Rasoul-e-Akram Hospital and diagnosed with sepsis between 2001 and 2003. The data was analyzed by SPSS version 11.5. Results: The mean age of the patients was 52.7 years(SD=28.4). 158(52.7%) out of 300 patients had diabetes. The most common sites of infection were respiratory tract and then urinary tract. Evaluation of the outcome of the patients in two diabetic and non-diabetic groups demonstrated a statistical difference(P.value=0.001). Mortality rate increased with aging and delay in beginning the treatment(P.value=0.001). With respect to 4 signs of SIRS, 88 cases revealed 2, 156 had 3, and 56 presented with all signs at the time of admission. 16(18.2%) of the first group, 116(74.4%) of the second group, and 47(84%) of the third group expired, though(P.value=0.001). Of 158 patients with diabetes, 67 cases of whom 97% expired had average blood glucose more than 250mg/dl, 55 ones of whom 84% expired had average blood glucose between 180-250 mg/dl, and 36 patients of whom 42% expired had average blood glucose less than 180 mg/dl. These 3 groups, however, demonstrated statistical differences(P.value=0.001). Conclusion: This study demonstrates that aging can increase the rate of sepsis and its mortality in both diabetic and non-diabetic groups. Also, mortality of sepsis in diabetics is more than non-diabetics and quick treatment of it can decrease this mortality. In addition, mortality increases with an increase in the severity of the disease, i.e. more SIRS criteria, and strict control of blood glucose can result in a better prognosis.

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  Background & Aim: The stressful environment of the emergency department exposes the staff to the hazards posed by physical and verbal violence.This can affect not only the job security and satisfaction among the personnel but also the service and care offered to the patients. This study has been designed to determine the incidence rate of physical and verbal violence inflicted by patients and their companions on the emergency department personnel of Hazrate-e-Rasoul Hospital in the fourth trimester of the year 1385.

  Patients and Method: In this cross-sectional descriptive study, all the emergency department staff of Hazrat-e-Rasoul Hospital were asked to fill in a questionnaire about experiencing physical and verbal violence in the last trimester of the year 1385. 166 respondents included 17 attending physicians, 33 residents, 15 interns, 32 nurses, 15 ancillary staff, 20 laboratory technicians, 10 radiology technicians, 18 security guards and 6 orderlies. Data were collected and analyzed using SPSS software version 15 , t-test and Chi-square.

  Results: The mean age of the staff was 32.20‌±7.67 years. 39% of the subjects were female and 61% were male. 77.5% had experienced verbal or physical violence at least once.The mean rate of verbal violence in the fourth trimester of the year 1385 was 31.1 times. 74% of verbal assaults were committed by men and 26% by women. 15.93% of the emergency department staff had experiences of physical violence in this trimester, and in 78% of the cases the violent person was a man and in 22% of the cases a woman. 13% of the emergency staff felt a high degree of security during their shift work, 52% felt a moderate degree of security, 27% felt a low grade of security and 8% felt no security during their shift work. 96.15% of the staff had received no education in this regard, and 87.4% reported that they think security measures provided to decrease violence in emergency department are insufficient.

  Conclusion: This study shows that the incidence of violence in emergency department is high and this is a concern for the emergency department staff. Most of the violent behaviors which were displayed by patients’ companions can be controled by considering a good waiting area for them and avoiding their crowding in the ward.

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  Background & Aim:By early detection of high-risk patients presenting in emergency departments with primary unstable angina and performing the required diagnostic and therapeutic interventions, we can decrease the mortality and morbidity of cardiovascular diseases. The aim of the present study is the evaluation of the role of White Blood Cell count as a tool in determining the short-term prognosis of patients with primary unstable angina.

  Patients and Method: In this descriptive-analytic, prospective study, White Blood Cell count was performed on every patient diagnosed with primary unstable angina and admitted to the emergency department of Hazrat-e-Rasoul Hospital in a 3-month period.Then its relation with age, sex, underlying diseases, duration of chest pain (more or less than 30 minutes), pain response to sublingual TriNitroGlycerni(TNG), and short-term prognosis ( from admission time until 2 months after discharge) was evaluated using t-test and SPSS v.11 software.

  Results: There was no statistically significant relationship between WBC count and age(P value=0.47), sex (P value=0.57), hypertension (P value=0.76), and duration of pain (P value=0.62). However,there was a statistically significant relationship between WBC count and response to sublingual TNG (P value=0.025), remaining asymptomatic (P value=0.035), admission into CCU(P value=0.035), and death from cardiovascular accidents (P value=0.035).

  Conclusion: WBC count is a simple, inexpensive, easily available and effective tool in predicting the short-term prognosis of patients presenting in emergency departments with unstable angina.

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Background: Cancer is primarily a genetic disease and Myeloid dysplasia refers to a group of syndromes thathave a close relationship with each other and through the proliferation of arbitrary one or more types of bone marrow cells, are identified. One of the most prevalent psychiatric symptoms in patients with cancer, transplantand anxiety, is death anxiety. This type of anxiety can be viewed as one of the important psychological diagnosis in patients with suspected cancer. This study aimed to investigate the effect of hypnosis ondeath anxiety in patients with acute myeloid leukemia treated with chemotherapy.

Methods: The research method was quasi-experimental with pre-test and post-test in experimental and control groups. Twenty-fourpatients with acute myeloid leukemia on chemotherapy with medical records and flow cytometry test were selected and randomly divided in experimental (n = 13) and control group (13 case). Death Anxiety Inventory Collet-Lesterinwas used to collect data from two group before and after trial. Six sessions of hypnotherapywas conducted for the experimental group in six weeks. SPSS₂₂ was used for statistical analysis of data

Results: The results showed that hypnotherapysignificantly reduces the anxiety duedeath,  dead people, see people dying and death anxiety in general, which has been statistically significant (p<0.001).

Conclusion: As a result, it can be said that hypnosis is an effective intervention on the anxiety of death in patients with acute myeloid leukemia underchemotherapy and can be used as a non-invasive method

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Background: Shin splints is the most common cause of overload-related musculoskeletal injuries. The aim of this study was to comparing the lower limb joint angles during the step parade return and flexibility in soldiers with and without shin splints.
Methods: In this study, 30 soldiers of the border guard Training Center of Khorasan Razavi with range of 18 to 30 years, were selected as volunteers and based on the presence or absence of symptoms of shin splints during parade were divided into two groups. Measurement of kinematic parameters of angles of the hip, knee and ankle using a system of markers, percutaneous, digital imaging (camcorder, with a resolution of 4 megapixels) and Auto CAD software was used. The flexibility of the subjects was measured using sit and rich test. Shapiro-Wilk test was used to determine the normal distribution of data. Descriptive statistics and Levene's test was used to evaluate the homogeneity data, then data were analyzed by independent-samples t-test at a significance levels of p<0.05.
Results: The results showed the significant differences in the results of lower extremity joint angles (ankle: p= 0.001; t= -6.176, knee: p= 0.001; t= 14.824, Hip: p= 0.001; t= 14.231) and sit and rich test soldiers with shin splints compared to the soldiers without shin splints (p=0.001; t= 8.164).
Conclusion: The results of the study showed that shin splints changes the lower limb joint angles and the lower back and hamstring flexibility.
 

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Background: Seizure is a transient occurrence of signs or symptoms due to abnormal excessive or synchronous neuronal activity in the brain. Seizures are described as sudden abnormal neuronal discharges that are clinically manifested by behavioral, autonomic, motor, and sensory disturbances. Seizure is the most common neurologic problem in children. On the other hands, the most common nutritional problem in developing countries is iron deficiency. Due to the high incidence of seizures in children and its role in causing mortality and morbidity in this age group, recognizing and controlling the factors affecting seizures can have a significant impact on reducing mortality and morbidity. After the first seizure of unknown origin in children the risk of recurrence is about 50% and after the second seizure of unknown origin, the risk of recurrence is 80% epilepsy may be diagnosed only after a child has had two or more seizures of unknown origin over a period of more than 24 hours. The term of unknown origin implies that there was no close association between seizures and disease, electrolyte disturbances, fever, or acute brain injury. On the other hand, the most common microelement deficiency is iron deficiency, which affects at least 1.3 percent of the world's population. The most common clinical manifestation of iron deficiency is anemia, but other organs may also be affected. The possibility of lowering the seizure threshold and increasing the risk of seizures by anemia has been investigated in many studies in patients with febrile seizures, but A few studies has pointed to association between iron deficiency and the first unprovoked seizure without fever. Also the results of these studies are controversial. The effects of iron deficiency in an evolving brain include: changes in the evolutionary mechanism of hippocampal neurons, impaired energy metabolism, delayed myelin maturation, decreased visual and auditory stimulus potentials, and changes in synaptic neurotransmitter systems including norepinephrine, dopamine , Glutamate, GABA (gamma aminobutyric acid) and serotonin, which can cause iron deficiency symptoms. The results of some studies have shown that iron deficiency may increase the seizure threshold because iron lipid peroxidation by the brain can lead to seizures. In addition, the uptake and release of dopamine, gamma-aminobutyric acid, and other neurotransmitters by cell membranes can be affected by iron. Therefore, the seizure threshold increases following iron deficiency. Iron deficiency anemia reduces the activity of excitatory neurotransmitters such as monoamine oxidase and aldehyde oxidase, resulting in neuronal stimulation and a lower risk of seizures. Research on the relationship between iron deficiency and seizures has shown conflicting results regarding iron status in children with febrile seizures and non-febrile seizures due to the high prevalence of iron deficiency anemia and Due to the effects of anemia and the possibility of its effect on the occurrence of seizures in children this study was carried out to determine the relation of iron deficiency anemia with first unprovoked seizure
Methods: This study is a case-control study. The study population included 172 children aged 3 months to 16 years old who referred to the neurology clinic of Hazrat Ali Asghar (AS) Children's Educational and Medical Center in Tehran Sciences due to their first afebrile seizure during 2017-2019. Samples were divided into case and control groups based on the reason of hospitalization Control group included of 86 children (3month-16years old) referring for other causes to this center from 2017-2019. Non-febrile seizures based on clinical manifestations in the form of cyanosis, rotation of the head or eyes, clonic movements of the seizure in the face or limbs, a sensory disturbance such as paraesthesia or localized pain in a specific area, increased tone or stiffness, loose or decreased movements, stiffness and Rhythmic muscle relaxation is defined as a disorder or lack of consciousness without fever before and after a seizure. All selected cases were infants and children with non-febrile seizures for the first time in which there were no underlying problems.The children with fever or any type of chronic systemic disease (cardiac, renal, metabolic, confectious) and the children with the history of using drugs or blood iron transfusion for treatment of anemia were excluded. Cell blood count (CBC), Serum ferritin, iron and total iron binding capacity (TIBC) were measured in all of children. Iron deficiency anemia was diagnosed by the values of CBC, ferritin, serum iron and TIBC based on the Nelson text book of pediatrics.To analyze the data, descriptive analysis including statistical indices of frequency, frequency percentage, mean and standard deviation was used. Also for analytical analysis, demographic findings and mean hemoglobin and ferritin were compared between the control and case groups. Data were analyzed by chi-square and independent T-test and SPSS 22 software and the significance level was considered less than 0.05.
Results: From 172 participants, 73 (%42 ) were girls and 99 (%57) were boys, the average age in case  group was 6.4±3.75 years old, and in control group was 5.79 ±3.65 years old. From 86 patients with seizure 34 (%0.39) were girls and 52 (%0.60) were boys. In case group serum iron average was 55.1±28.4 µg/dl. Hb in 24 persons (%27.9) and ferritin in 14 persons (%16.3) was in the lower limits of normal. In the control group serum iron average was 51.8±25.79 µg/dl. Ferritin in 20 persons (%23.3) and Hb in persons (%27.9) was in the lower limits of normal. In the case group14 persons (%16.3) and in the control group 20 persons (%23.3) had iron deficiency anemia .the difference statistically was meaningless. (P value >0.05)
Conclusion: In this study, the prevalence of iron deficiency anemia in the group with the first febrile seizures of unknown origin was not higher than the group referring to other causes.There was no statistically significant differences between the first unprovoked seizure without fever and iron deficiency anemia in our study. However the more comprehensive studies should be done in this regard.

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Background & Aims: Considering the epidemic irreversible effects of the corona virus disease and the lack of any definitive treatment resulting in the prevalence of the stress and great worry in the community. There seem to be psychological factors that affect people's anxiety. These factors can be individual or social. Individual factors are like the beliefs and schemas of individuals, and social factors are like the support that individuals receive from family, friends, and important people in their lives. Research shows that these variables are associated with anxiety Therefore, the present study aims to Determining the role of maladaptive schemas of abandonment, vulnerability to harm and disease, and perceived social support in coronary disease anxiety.
Methods: The descriptive and correlational methods were applied in this study. The study society composed of Health Network Personnel of Darab in 1399 in which 200 individuals were selected via available sampling method. The Perceived social Support Questionnaire (Zimet et al. 1998), Young's Early Maladaptive Schemas (2003), and Corona Disease Anxiety Scale (Alipour et al.2019) were applied to collect data. Criteria for inclusion in this study included: 1) having at least 20 years, 2) employee of Darab health network, 3) conscious consent and voluntary to answer the questions of the questionnaire; Exclusion criteria included: Deficiency in answering the questions of the questionnaire. Data was analyzed via Enter and Stepwise regression method in SPSS 22.
Results: Findings showed that there was a significant relationship between predictor variables including vulnerability to harm and disease schema, maladaptive abandonment schema and perception of support of others with corona disease anxiety (P>0.001). On the other hand, the relationship between perceived support of family and friends with corona disease anxiety was not significant. Enter regression results showed that approximately 31% of the variance related to the corona anxiety variable is explained by the predictor variable. Also, among the predictor variables, vulnerability schema to harm and disease and abandonment maladaptive schema are the best predictors for teachers' corona disease anxiety, respectively (P<0.001).
Conclusion: This study showed that there is a significant relationship between predictors of vulnerability to harm and disease schema and coronary disease anxiety. This results is in line with the research of Kalvete and Cardenoso (4) and Arefinia (6) et al. The prevalence of coronary disease and the media coverage of injuries associated with the disease cause people to experience anxiety, wich is primarily triggered by coronary heart disease but is rooted in the beliefs and schemas of the anxious person; Research has also shown that the vulnerability to harm and disease schema plays an important role in disease anxiety; These people think that it is possible for them or their loved ones to get coronary disease and they can have no control over this condition. In fact, distorted interpretations of coronary disease, its magnification and catastrophe, become a stimulus for the activation of anxiety and fear of the disease. Therefore, vulnerability to harm and disease schema may play a role in the development of coronary disease anxiety. Another finding of this study was that there was a significant relationship between the predictor variables of maladaptive abandonment schema and coronary disease anxiety. This finding is in line with the research of Kalvete and Cardenoso (4) research, Which showed that schema of fear of abandonment are major predictor variables in anxiety symptoms. Because of outbreak of the disease, people usually try to protect themselves by creating a home quarantine, and as a result, people's relationships with each other weaken, so this situation is a stimulus to activate the abandonment schema of people, which follows, Anxiety occurs, an anxiety that is triggered by illness and the fear of abandonment. Also, the results of the present study on the non-significance of the family and friends dimension of perceived social support with coronary disease anxiety are in line with the results of Ghasemi, Ganjeh, Saqezi et al. (22). Perceived social support theorists state that not all relationships one has with others are social support. In other words, social communication is not a source of social support, unless one assesses it as an accessible and appropriate source to meet one's needs (23). Another finding of the study was a positive and significant relationship of important another dimension in the scale of perceived social support of coronary disease anxiety, which is in line with the research of Rashedi et al. (33). Another important dimension has an adaptive function and is negatively correlated with the psychological disorders of people at risk (35). Therefore, having social support, especially from important people in life, leads a person to physical health, psychological and ultimately mental well-being, and leads to better adaptation to difficult and critical situations associated with illness (36). Therefore, in examining the effective factors in corona disease anxiety of clients, it is recommended to pay attention to the schemas of vulnerability to harm and disease and the abandonment schema to counselors and psychologists. Also, considering the research results and the special importance of the important role in mental and physical health, it is suggested to prioritize educational and treatment programs to improve these relationships in counseling and education.
 

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Background & Aims: The main goal of athletes and coaches is to reach the peak of athletic performance. Optimal and optimal performance of sports skills is the result of the complex interaction of physiological, genetic, biomotor, anthropometric factors and finally the selection of a desirable method for recovery (1). Taekwondo, like any other sport, requires proper recovery principles to reduce injuries and achieve optimal performance. One of the most important concerns of Taekwondo coaches and athletes is the limited distance between activities and sports competitions for physiological recovery and return to the pre-activity state)2).
Exercise-induced muscle damage is characterized by decreased isometric muscle strength, changes in joint range of motion, changes in muscle diameter, and leakage of certain enzymes into the bloodstream [6). During muscle injury, creatine kinase (CK) and lactate dehydrogenase (LDH) leave the skeletal muscle and enter the bloodstream; Therefore, they are known as physiological indicators of muscle damage (7). Also, due to the role of AST and ALT enzymes in causing muscle damage after strenuous activity, these enzymes are considered as indicators of muscle damage (10).
Injury to active skeletal muscle reduces energy resources, accumulation of metabolic products due to exercise, fatigue, and decreased performance (11). In these circumstances, the ground is prepared for the need for a proper recovery. Recovery in sports is an essential and important component of the overall training pattern (12). Cold water immersion is a popular recovery method used by coaches and athletes to accelerate the process of improving performance after exercise and competition. The potential benefits of the cold-water immersion method depend on the reduction in muscle tissue temperature associated with the effects of hydrostatic pressure (14). The two most important variables in the immersion method are water temperature and immersion time. Immersion temperature and time can vary depending on the type of exercise and the variable being measured (15). Mardnik et al. (2017) showed that immersion in cold water after strenuous exercise is effective in reducing the CK and LDH in the recovery process and improving the performance of the athlete (17). However, Farajnia et al. (2017) in the study of the effect of immersion in cold water and repetition of rapid activity on antioxidant indices in trained men showed that immersion in cold water has an effect on the return to the state. Primary did not have these factors (19).
As can be seen, the contradictions observed in the research are due to different methods of immersion as well as differences in the research method in this field. Since Taekwondo athletes must participate in their competitions on a regular basis and do not have enough time to recover, this study, assuming the positive effect of immersion in cold water on the indicators of muscle damage, as well as this that no research has been done in this field, Therefore, the aim of this study was to investigate the effect of immersion in cold water on muscle injury indices during and after repetitive sessions of simulated competition.
Methods: In this quasi-experimental study, 12 male taekwondo practitioners of Karaj city (mean height 1.76 ± 0.06 cm, weight 59 ± 4.6 kg and body mass index 19.2 ± 2.18 kg/m2) were selected in an accessible and purposeful manner and randomly divided into two Cold water immersion and control group (inactive recovery). Subjects performed three simulated taekwondo competitions at one-hour intervals. Immersion in cold water was performed as local immersion of feet in cold water at 11 ° C for 11 minutes. Data were analyzed using analysis of variance with repeated measures, dependent t-test and Bonferroni post hoc test at P<0.05.
Results: The results showed that the simulated competition led to a significant increase in AST, ALT, CK and LDH indices in the cold-water immersion group compared to the control group. Also, the mean AST, ALT, CK and LDH indices of the cold-water immersion group in all stages of the research were significantly lower than the control group (P<0.001).
Conclusion: The results of the present study show that the mean indices of AST, ALT, CK and LDH of the cold-water immersion group in all stages of the research were significantly lower than the control group and in the continuation of the study, the difference between the two groups increased. These findings indicate that cold water immersion is more effective than inactive recovery after several consecutive races. The findings of this study were consistent with the results of Previous research (24-26). Both muscle fatigue and muscle damage have been reported to have specific mechanisms (impaired glycogen storage, sarcomere destruction, increased muscle protein breakdown, and inflammatory responses) that reduce muscle strength and capacity. Also, muscle dysfunction in response to muscle injury and fatigue mechanisms, depending on the intensity of the exercise, may last from a few hours to seven days (31).  Vaile et al. (2008) suggested that immersion in cold water immediately reduces muscle metabolism immediately after the shuttle run test (32). The mechanisms associated with reduced enzyme release due to immersion in cold water after exercise are generally unknown. However, some studies have suggested that immersion in cold water may reduce the release of intramuscular proteins into the lymphatic system or the extent of post-exercise injury (26). In addition, changes in CK are associated with pain sensation, which can be reduced by immersion in cold water. `Also, water Physiological changes due to immersion in cold water may include parasympathetic reactivation, reduction of cutaneous blood flow, change in the direction of intracellular fluid movement into the arteries, decrease in muscle swelling, and increase in cardiac output. These factors can increase blood flow and increase waste transport (37). On the other hand, we must consider that a combination of physiological and psychological factors can play an important role in the perception and awareness of participants in the study, which in turn potentially enhances recovery (38). In particular, there may be a psychological benefit (reducing the feeling of tiredness when immersed in cold water) for athletes. Differences in body composition, such as body fat and body mass, should also be considered in the individual effects of cold-water immersion protocols (39). There were some limitations in the present study, such as the lack of measurement of other indicators of muscle damage. It can also be noted that the subjects did not have complete control over their mental state during the research. To make the most of the benefits of therapies (methods that are low-cost and require the least equipment) to recover from muscle fatigue, it is recommended that other indicators of muscle damage be examined in a similar study. Overall, the findings of the present study showed that immersion in cold water is more effective than inactive recovery after several consecutive Taekwondo competitions; Therefore, it seems that immersion in cold water can be used to minimize the period of muscle injury and contusion, as well as to have a better recovery in short periods of time.

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Background & Aims: Today, cancer is a growing phenomenon that is recognized as one of the major problems for contemporary human health. Breast cancer is still the most common cancer among women in the world. Living with breast cancer presents women with significant challenges that interfere with their physical, social, psychological, economic and spiritual life of patients. These challenges are major factors that reduce the quality of life of women with breast cancer. One of the psychological components that plays a key role in the lives of these patients and their families is hope. Hope is a vital factor in predicting the adaptation of cancer patients to the nature of the disease and its treatment, especially when faced with the prospect of chronic pain. Low or no hope can threaten the patient's physical and mental health. Another important psychological component in coping with the disease is the perception of the disease. Perception of disease means the belief or image that patients have of their disease, which affects their adaptation to the disease and their psychological state. Understanding the causes of breast cancer can affect patients' ability to seek medical treatment; Because misconceptions may lead to search for alternative health care from unapproved sources. Another psychological factor related to life expectancy in patients is the availability and perception of social support. The availability of social support is considered a important source of coping that can help the patient to cope with life with cancer. Evidence from the research literature shows that social support from family, friends, and other important individuals is associated with reduced mental health problems such as depression, anxiety, and suicidal behaviors, and improved quality of life in women with breast cancer. Another important psychological component that people use when facing problems is coping styles. These styles that developed to reduce stress are important both in acute periods of stress (such as natural disasters) and in patients suffering from chronic illnesses such as depression, breast cancer, and HIV / AIDS. One of the most common styles for managing a challenging situation is trying to deal with and change the stressful stimulus; This strategy is called problem-oriented coping. Most research shows that people who use this style are more adaptable. On the other hand, research shows that people who use emotion-oriented and avoidance strategies experience higher stress and lower quality of life. Thus, the aim of this study was to determine the role of perception of disease, perceived social support and coping style in the life expectancy in women with breast cancer.
Methods: The method of the present study is descriptive-correlational. The statistical population is all patients with breast cancer in Ahvaz in 1398 that 60 patients volunteered to participate in the study by available sampling method. Inclusion criteria include 1- ability to read and write, 2- being between 31 to 70 years old, 3- having 2 to 3 years of illness, 4- undergoing chemotherapy without or before mastectomy, 5- Not having a history of psychiatric illness and being hospitalized in psychiatric wards and 6- Willingness to participate in research. In order to conduct the research, after obtaining the necessary permits and coordination with the relevant authorities from the two public hospitals of Baqaei and Golestan in an available method, 70 patients who met the research criteria were asked to complete the research tools. Due to the decrease in patients staying in the hospital during corona disease and the lack of cooperation of patients, the sample of this study was reduced from 70 volunteers to 60 patients. The tools used in this study included questionnaires of disease perception (Bradbent, 2006), multidimensional perceived social support (Zimt et al., 1998), coping styles in special situations (Billings & Moss, 1981) and  life expectancy (Schneider, 1991). In this study, multivariate regression was used to analyze the data.
Results: The results showed that there is a negative and significant relationship between perception of disease and life expectancy (-0.78). Also, there is a significant relationship between predictor variables including social support, problem-oriented coping styles and emotion-oriented coping style with participants' life expectancy (0.80, 0.47 and -0.52, respectively). On the other hand, the relationship between avoidant coping style and participants' life expectancy was not significant (0.06 and 0.06, respectively). Also, the results of stepwise regression analysis indicate that the variables of social support and disease perception are the best predictors of life expectancy in patients with breast cancer, respectively.
Conclusion: The findings of this study showed that there is a positive and significant relationship between social support and life expectancy of breast cancer patients. Sun et al. Also found in their research that people who benefit from the social support of their relatives when faced with problems are more satisfied with life. Perceived social support affects patients' life expectancy in two ways. First, it can vaccinate a person before experiencing stress, thus reducing the harmful effects of stress. Second, it acts as a shield against the stress of the disease and makes the patient more satisfied with his life and hopes for positive consequences such as health and reducing the risk of disease. Also, this study showed that there is a significant positive relationship between problem-oriented coping style and life expectancy of breast cancer patients. When people believe that they have the ability to cope with stressful events such as illness, their anxiety is reduced and they can choose more effective coping strategies. Also, this study showed that the perception of the disease has a negative and significant relationship with life expectancy of women with breast cancer. Therefore, when patients have negative beliefs and perceptions of their disease and its various aspects, they experience physical and mental problems that can increase the burden of the disease for them and reduce their quality of life. Considering the importance of hope in the life and treatment of cancer patients, it is recommended that medical staff and psychologists pay attention to the role of life expectancy in their interventions and treatment protocol, especially in breast cancer patients.
 

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Background & Aims: Separation anxiety is known as one of the most fundamental and fundamental fears in human beings that separation anxiety does not disappear with growth and maturity; Rather, it is less visible in adulthood than other psychological problems and often appears alongside other pathologies or some of them. Separation anxiety is predictable in children entering school for the first time, but the diagnosis of this disorder is made when excessive anxiety is disproportionate to the level of development and when separating from the attached person. Separation anxiety disorder is a mental disorder in which a person becomes very anxious due to being away from home or from people with whom they have a lot of emotional attachment. This disorder can cause severe disorders in various aspects of life (such as academic or social performance). Other research has also shown that fostering a healthy parent-child relationship can promote a child's psychological development and prevent psychological damage during his or her lifetime. The type of parental relationship and their interaction with children can have a significant impact on how anxiety disorders develop in children. In most theories of child and adolescent development, the importance of mothers' behavior has been considered. Among mental disorders, anxiety and depression were the most studied disorders in the area of mother-child relationships. Therefore, parental management training is a type of psychological intervention for clinical problems in the field of child and adolescent psychotherapy with the aim of training parental management in reducing the problems of children and adolescents. This program has caused cognitive-emotional change of parents and mutual change of child behavior and has led to increasing parents' awareness of how to deal with children, the skill of controlling emotions against children's behavior and setting appropriate rules and regulations at home. The purpose of this research was to determine the Effectiveness of training differentiation, mother's empathy and child- Parent relationship on separation anxiety disorder students.
Methods: The research method was applied research and was a kind of pre-posttest Quasi-experimental design with control group. The statistical population of the study consisted of the Mothers with daughters with separation anxiety disorder syndrome whose child / children in one of the preschool centers in Kermanshah. 60 of them were randomly assigned into two groups of 30 experimental and control groups. Differentiation, empathy, child- Parent relationship was conducted on the experimental group in 8 sessions of 80 minutes. The research data were collected through separation anxiety disorder Hahn, Hajinlian, Eisen, Winder & Pincus (2003) questionnaire. Then the hypotheses were tested using spss software.
Results: According to According to the obtained results, it can be said that the training differentiation, mother's empathy and child- Parent relationship can provide the basis for reducing separation anxiety disorder students.
Conclusion: Separation anxiety is known as one of the most fundamental and fundamental fears in human beings that separation anxiety does not disappear with growth and maturity; Rather, it is less visible in adulthood than other psychological problems and often appears alongside or part of other pathologies. Separation anxiety is predictable in children entering school for the first time, but the diagnosis of this disorder is made when excessive and disproportionate anxiety occurs when separating from the attached person. Separation anxiety disorder is a mental disorder in which a person becomes very anxious due to being away from home or from people with whom they have a lot of emotional attachment. This disorder can cause severe disorders in various aspects of life (such as academic or social performance). The fourth revised text, Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) classifies separation anxiety as a disorder that is first diagnosed in infancy, childhood, or adolescence. Disproportionate anxiety disorder in the DSM-5 is divided into two types: the first type, separation anxiety disorder, starting in the DSM-5, has been reported as disproportionate in dealing with being away from home or being separated from those on whom the child is dependent. Adult (ASAD) and another type starting in childhood (CSAD), researchers have confirmed the importance of parental factors in trying to identify the factors affecting child separation anxiety (Khorshidvand, Rahimian Booger and Talepsan 2015 and Pirzadi 2018). In this regard, Ingelberg and Ssuberg (2005) showed that positive parental behavior reduces child anxiety. Arab, Al-Kashki, and Hadwin (2015) showed that childhood separation anxiety disorder is a definite factor in predicting ADHD in adulthood. And the findings of Kern, Renault, Kendall, Wood, and Stork (2017) suggest that when a parent fails to recognize and respond appropriately to a child's emotions, the child, because of his or her role modeling, is able to recognize and manage his or her emotions. Loses and easily becomes anxious.
 

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Background & Aims: Diabetes is a metabolic disease characterized by chronic hyperglycemia and impaired metabolism of carbohydrates, lipids and proteins. This disease is caused by defects in insulin secretion, insulin function, or both (1, 2). This chronic disease can have serious short-term and long-term consequences that affect the health and quality of life (QOL) of patients (3). Type 2 diabetes accounts for approximately 90% of all cases of diabetes and is associated with a variety of immutable and modifiable risk factors (4). QOL refers to a person's individual perception of physical, emotional, and social status (5, 6). Patients with type 2 diabetes have a lot of stress to treat and their QOL is lower than healthy people (7, 8). Also, for chronic diabetics, complete cure cannot be achieved and clinical interventions can provide a good estimate of disease control, but the ultimate goal of diabetes care is to prevent the patient's QOL from worsening (3). It is important to understand the predictors and identify risk factors for QOL, and these factors may be targeted for prevention (5). Since the improvement of QOL is one of the important goals of treatment of diabetic patients (3, 10) and studies have shown that diabetes can have negative effects on physical function, development of complications, mental and psychological and personal, family and social relationships (15, 16); Therefore, understanding the factors related to QOL is of particular importance in the treatment programs of these patients (5). Cardiorespiratory endurance is one of the health-related physical fitness factors (2). Cardiorespiratory endurance is defined as the ability of the circulatory and respiratory systems to supply oxygen during physical activity and is usually defined as the maximum oxygen consumption (VO₂max) during submaximal or maximal tests. The main determinants of VO₂max are cardiovascular function, cardiac output, pulmonary diffusion capacity, oxygen carrying capacity, liver function, and other environmental constraints such as muscle diffusion capacity, mitochondrial enzymes, and capillary density, all of which are examples of determinants. Are VO₂max (2, 21). VO₂max is associated with functional capacity and human function and has been shown to be a strong and independent predictor of mortality from all specific causes and diseases (22). Physical activity and the resulting cardiorespiratory fitness are associated with several health benefits, including reduced risk of diabetes, cardiovascular complications, and mortality (23). In view of the above, cardiorespiratory fitness is a variable related to mortality prediction and as a health-related variable in diabetic patients (23); Therefore, cardiorespiratory fitness can be considered in determining the strategies of primary and secondary prevention programs of cardiovascular diseases in patients with type 2 diabetes; Considering the importance of factors related to the prediction and identification of risk factors for QOL (5); It is necessary to measure the relationship between cardiorespiratory fitness as a health-related physical fitness variable with QOL in patients with type 2 diabetes. In view of the above, the aim of this study was to investigate the relationship between QOL and cardiorespiratory endurance in patients with type 2 diabetes.
Methods: In this cross-sectional correlational study, 150 patients with type 2 diabetes mellitus were randomly selected from patients that had referred to health centers in Zabol city, which included 75 women and 75 men. QOL, demographic characteristics and history of diabetes in patients were measured using a questionnaire. Blood variables were measured on an empty stomach. Cardiorespiratory fitness was also measured using the Tecumseh step test. Pearson correlation coefficient was used for statistical analysis.
Results: There was a positive and significant relationship between cardiorespiratory endurance and QOL in patients with type 2 diabetes. There was also a significant negative relationship between cardiorespiratory endurance with glycemic control, age and history of type 2 diabetes.
Conclusion: In the study of the relationship between cardiorespiratory endurance and QOL, the results showed that there was a positive and significant relationship between cardiorespiratory endurance and QOL in patients with type 2 diabetes. In a study of patients with type 2 diabetes, Leite et al. (2009) reported that a decrease in VO₂max is associated with impaired insulin sensitivity, and that the most common abnormality in the population is at risk for insulin resistance and type 2 diabetes, and a decrease in VO₂max is one. Is an important risk factor for disease progression (28). Low resting heart rate and VO₂max are associated with a reduction in cardiovascular events (29). Cardiorespiratory disorders are more common in diabetic patients and may partly explain the morbidity and mortality in these patients. There are several potential causes for dysfunction in diabetics: hyperglycemia, insulin resistance, endothelial dysfunction, inflammation, microvascular dysfunction, myocardial dysfunction, and skeletal muscle changes. These changes are somewhat reversible, and improvement in each of these components may increase functional capacity in diabetic patients (30). Interventional studies indicate an increase in VO2max in adaptation to exercise in patients with type 2 diabetes (2, 31, 32). It can be said that with increasing cardio-respiratory endurance, the level of health increases and with increasing health, patient satisfaction with treatment and satisfaction with QOL improve (27). Also, The results of the present study showed that there was a significant negative relationship between aerobic fitness and HbA1c levels in patients with type 2 diabetes. Jekal et al. (2010) in a study that examined aerobic fitness and HbA1c levels, stated that people with higher cardiorespiratory fitness had better weight and lower HbA1c levels than people with lower endurance (25), which It was consistent with the results of the present study. Abushamat et al. (2020) also stated in their research that diabetes leads to decreased cardiorespiratory function, which is associated with poor glycemic control and its complications (35). Physical activity is effective in controlling blood glucose in diabetics; because it increases insulin sensitivity and glucose tolerance and decreases the level of hyperglycemia in these patients (36). Adaptations in insulin signaling as well as insulin receptors can lead to better blood glucose uptake by muscles. Increasing the number of GLUT4 carriers and increasing muscle mass, which plays a major role in blood glucose uptake, increases the body's response to insulin (38). The results of the present study also showed that there was a significant negative relationship between aerobic fitness and history of diabetes in patients with type 2 diabetes. Hadipoor et al. (2014) also introduced the years of diabetes as one of the factors affecting the physical dimension and QOL of these patients (45). Due to the fact that type 2 diabetes is associated with aging (46) and also the complications of diabetes, including cardiovascular complications with a history of diabetes and poor glycemic control are increased (47); with an increased history of diabetes, it reduces cardiorespiratory endurance in these people. On the other hand, due to having an active lifestyle and higher level of physical fitness, in addition to controlling blood sugar, the potential benefits of physical activity on reducing the complications of diabetes can be enjoyed (44, 50), which can improve QOL in patients with Type 2 diabetes is effective (50, 51). Overall, the results of our study showed that cardiorespiratory fitness was associated with improved QOL in patients with type 2 diabetes, which was negatively associated with age, duration of diabetes, and HbA1c levels.
 

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Background & Aims: One of the methods that coaches use to simulate a real game is training or small sided games, and now the study of small sided games is one of the topics that has received the most attention of researchers active in soccer (3). Small sided games are defined as a smaller version of the official game, in which the trainers divide the playground into several small sided according to the training objectives (2). small sided games allow for increased individual participation and short-term physiological and immunological responses (4,5). However, little information is available on the effects of this type of training methods on physiological characteristics, including the immune responses of soccer players (6,7).
One of the cytokines involved in immunity is interleukin-15 (IL-15). Interleukin 15 is involved in the interaction and cooperation between adipose-muscle tissue and increases the metabolism of adipose tissue triglycerides and provides the resulting fatty acid to muscle fibers for consumption. On the other hand, this cytokine precipitates free fatty acid deposition, reduces adipose tissue and thus has potential role in weight control (10). On the other hand, some interleukins can increase the motility of neutrophils at the site of inflammation (14, 15). Neutrophils are among the axes of the innate human immune system, which according to available reports, their function is easily affected by the quality and quantity of physical activity (16).
small sided games are one of the training methods that can simulate the needs of racing (2). The importance of this type of training method is such that many coaches in the world often use it to simulate the physical, technical and tactical needs of a real soccer match (18), however, the impact of this type of training on the immune system and aspects Its physiological properties have received less attention. Examining the effects of this type of exercise on the immune system and especially the functional components of this system, including cytokines, can provide very effective information. There are contradictions in the research on the effect of exercise on IL-15, some of which have confirmed the acute effects of resistance training on this cytokine (11) and in another study, the lack of effect of endurance training on IL-15 has been reported (19). Therefore, in order to answer the ambiguities in this field, it is necessary to conduct various researches based on different variables such as the type, intensity and duration of training. On the other hand, a study that examines the effect of training in the field Small on IL-15 and neutrophils were not found. Therefore, the present study intends to compare the effect two modes of small sided games on the interleukin-15 and neutrophil levels in soccer players.
Methods: In this semi-experimental study, 24 youth soccer players of Tehran Province Premier League (15 to 18 years old) were selected and randomly divided into three groups include; control, 2 vs. 2 and 4 vs. 4. small sided game 2 vs. 2 consisted of eight two-minute activities with a minute of rest between each two minutes of play on a field measuring 20 by 25 meters. Also, the small sided game 4-on-4 included four four-minute activities with two minutes of rest after every four minutes on a field measuring 28 by 35 meters. Plasma levels of interleukin-15 and blood neutrophil counts were measured. Data were analyzed by t-test, One-way ANOVA and Tukey post hoc test at the P <0.05.
Results: The results showed that IL-15 levels increased significantly only after small sided game 2 vs. 2 compared to before training (p=0.043). The number of neutrophils in both experimental groups increased significantly compared to before exercise (p=0.001). There was no significant difference in the number of neutrophils between the two experimental groups (p=1.000).
Conclusion:  The results of the present study showed that immediately after 2 vs. 2 in the small sided games, IL-15 levels increased significantly, although increase in IL-15 levels was also seen in exercise 4 vs. 4, but this increase, from the comment was not statistically significant. The findings of this study were consistent with the results of some Previous research showed that exercise leads to significant increase in IL-15 levels (11,20). Due to the fact that exercise training is performed in different intensities and will have different effects, according to the above, it can be suggested that one of the reasons for the difference between the effect of exercise 2 vs. 2 compared to 4 vs. 4 in contrast to IL-15, the intensity of exercise is high, which increases the response of interleukin-15 to exercise. No change or increase in IL-15 has been observed following exercise. These changes probably depend more than anything on the age and training status of the subjects. In any case, more research is needed and with only one research cannot be concluded with confidence. also, it has been suggested by Ajuwon and Spurlock (2004) that IL-15 may be produced by organs in response to immune stress in muscle protein stability and fat oxidation to produce energy (26). Therefore, the action of interleukin-15 on muscle mass and fat can be important for exercise. In the present study, small sided game 20-25 compared to small sided game 28-35 led to a further increase in interleukin-15 levels. In this regard, it has been shown that in a training session, there is strong inverse relationship between the reaction of interleukin-15 circulating to the intensity and duration of training, so that longer and less intense muscle activity can reduce the secretion of this myokine (11).  As mentioned, the intensity of training on small sided can be adjusted by changing or manipulating several factors, including the number of players involved in training, the size and shape of the small sided. Research has shown that training in small sided with fewer players increases heart rate more than training in small sided with more players (2).
Also, the results of the present study showed that exercise 2 vs. 2 and 4 vs. 4 increased the number of neutrophils, which is in line with the results of previous research (29,30). It is possible that the increase in neutrophil count is mainly due to exercise-induced muscle injury, but this increase has been seen following exercise that does not cause muscle damage (32). Also, some studies have shown that regular exercise reduces the number of neutrophils in active people (33). Because exercise can be considered a stress, and stress (both physical and mental) causes messages to be released from the brain and affect the functioning of the human immune system, the main neuroendocrine pathways against stress activated on the hypothalamic-pituitary-adrenal (HPA) axis, the human immune system controls the release of glucocorticoids (such as cortisol) and catecholamines. Thus, the primary increase in neutrophils is rooted in the release of catecholamines and the secondary increase is rooted in plasma cortisol activity (34). Overall, it seems that high intensity training on smaller pitches (Exercise 2 vs. 2 on 20-25m field) increased the IL-15 response. As mentioned, IL-15 is secreted by organs in response to immune stress in muscle protein stability and fat oxidation to produce energy. Therefore, the action of IL-15 on muscle mass and fat can be important for exercise. Therefore, it is recommended to use the game on smaller fields in order to have its benefits.