Background: Regarding to the importance of self-efficacy and its impact on health-related behaviors, chronic disease management and quality of life, and limited studies in this field, present study tried to investigated the relationship between self-efficacy and quality of life in breast cancer patients undergoing chemotherapy in the Seyed-o-shohda hospital (Isfahan/ Iran). Methods: This descriptive- correlational study was done in Isfahan Seyed-o-shohada hospital in 2014. Statistical population included all women who had received chemical therapy because of their breast cancer (N=130). 100 participants were selected through Cochran formula and systematic sampling. Data gathering instruments included Sherer's standard questionnaire of self-efficacy and W.H.O questionnaire of quality of life (WHOQOL-BREF). The data were analyzed with use of the descriptive statistics and Kolmogorov–Smirnov test, one-way ANOVA and Pearson Correlation in SPSS 18. Results: The average and Standard Deviation of both self-efficacy (11.00 ± 55.78) and quality of life (15.28 ± 75.91) were estimated on the average level. There was a direct meaningful relation between self-efficacy and quality of life efficiency. The results also showed that there is meaningful relation between self-efficacy and quality of life’s dimensions including physical health, mental health, social relations and satisfaction with the environment. Conclusion: Based on the significant positive relation found between self-efficacy and quality of life it’s recommended to hold some training courses for these patients, have a physiologist in chemotherapy department, and prepare more palliative care to raise the breast cancer patients’ self-efficacy which finally leads to a better quality of life.

Background: The present research work was aimed to study whether application of 10% extract of wudani leaf (Quisqualis indica Linn) may decrease the potential of becoming embryos of eggs of Fasciola gigantica and Paramphistomum sp. worms under in-vitro evaluation. Methods: It was used three doses of the extract; those were 0.5 ml/40 ml of physiological NaCl, 1.0 ml/40 ml NaCl and 2.0 ml/40 ml of NaCl and with 5 repetitions for each dose. Assessments of the ovicidal effect of extract that is reducing the potential of eggs to become embryo were conducted at day-10 and day-30 at the Parasitology Laboratory of The Faculty of Veterinary Medicine, Udayana University, Bali. Results: Results showed that assessment at day-10, the ovicidal ability of the extract at 0.5 ml/40 ml NaCl for Fasciola gigantica eggs was 23.8% and was significantly lower (P < 0.05) than that of the dose of 1 ml/40 ml (33.1%) and of the dose of 2 ml/40 ml (35.9%). However, it was significantly higher than that of  the control (10.4%). Moreover, the ovicidal ability of dose of 1 ml/40 ml and 2 ml/40 ml did not differ significantly (P > 0.05). At Day-30, the ovicidal ability of 1 ml/40 and 2 ml/40 ml was very high, that was 88.8% and 88.5%, respectively. Furthermore, for eggs of Paramphistomum sp., assessment at day-10 showed that the ovicidal ability of the dose of 2 ml/40 ml was the highest (23.3%) and significantly higher (P < 0.05) than that of the dose of 1 ml/40 ml (21.6%), 0.5 ml/40 ml (11.6%) and of the control (9.4%). On the other hand, there were no significant difference were noted between the dose of 1 ml/40 ml, 2 ml/ 40 ml and the control (P > 0.05). Likewise, at day-30 of assessment, the ovicidal ability of 1 ml/40 ml (51.9%) and 2 ml/40 ml (53.4%) was significantly higher (P < 0.01) than that of control. The high ovicidal ability of 10% extract of wudani leaf at the dose of 1 – 2 ml/40 ml NaCl may be related to damage of egg shells caused by active ingredient of the extract. Conclusion:  Since infection of lungworm predominantly occurs in cattle, the present results may reveal the opportunity of applying the wudani leaf extract to control lungworm infection in cattle. Further study is definitely needed.

Background: As an Indonesian traditional medicine, betel leafis often used to stop nosebleed. Effective substances in betel leaves which serves to stop the bleeding is tannin. Objective: The aim of this study was to determine the effectiveness of the betel leaf ethanol extract gel shortened bleeding time after the revocation of deciduous teeth. Method: This research was conducted at the Department of Dental Nursing Clinic, Health Polytechnic Denpasar.This study is pure experimental research design with Completely Randomized Post Test Only Control Group Design. The total sample of 27 respondents were divided into a treatment group and two control groups. Anterior deciduous teeth on the physiological loose grade 3 or 4 is extracted, then the tooth socket is put pure gel for group 1 to group 2, epinephrine gel and gel ethanol extract of betel leaf for group 3. The bleeding time is calculated from the first moment the blood out until there is blood on filter paper that is placed on the tooth socket. Data were statistically analyzed with descriptive test and comparability test with One Way Anova. Result: The results showed bleeding time pure gel groups differ significantly with epinephrine group and the group of ethanol extract of betel leaf gel (p< 0.05). Bleeding time of epinephrine group did not differ significantly with betel leaf ethanol extract group (p>0.05). Conclusion: This means ethanol gel betel leaf extract can shorten bleeding after deciduous tooth extraction and it is suggested that the use of gel ethanol extract of betel leaves to cope with bleeding after tooth extraction.

Background: In postmenopausal women, decreasing estrogen levels is a marker of ovarian dysfunction. Hypoestrogenic state has known increasing the risk of osteoporosis. Objective: To determine the correlation between estradiol serum levels with classification of osteoporosis risk OSTA (Osteoporosis Self-Assessment Tools for Asian) in menopausal women. Methods: This study was case series study which examined estradiol serum in menopausal women by ELISA and assess the osteoporosis risk using osteoporosis risk classification OSTA. Total 47 samples was collected at Dr. H.Adam malik, dr. Pirngadi, and RSU Networking in Medan. This research was conducted from May to December 2016. Data were statistically analyzed, and presented with Spearman test. Results: In this study, we found the mean levels of estradiol in menopausal women was 18.62 ± 16.85 ng / ml with OSTA osteoporosis risk score of 2.09 ± 2.45. There was a significant positive correlation between estradiol and risk of osteoporosis OSTA with correlation coefficient r = 0.825 and p <0.05. Conclusion: There is a strong positive correlation between serum levels of estradiol with OSTA osteoporosis risk assessment in menopausal women.

Background. Iron-deficiency anemia is an anemia that occured due to reduction of total iron content. The high-risk groups are women of reproductive age (WRA), pregnant women, students and adolescences. The aim of this study was to know the prevalence  of  iron deficiency  and its association with  level of education, meat consumption and menstrual pattern.

Methods. Population-base study using  analytic cross sectional was done. Simple random sampling were drawn from list of all WRA population statistical data in Pengeragoan village, Pekutatan subdistrict, Jembrana. WRA between 20-49 years old with their demographic data, meat consumption pattern, menstrual pattern and level of education were taken using questionnaire. Ferritin level < 20 ug/dl is considered iron deficiency state.  All data were examined with significancy level < 0.05.

Results. Out of  790 WRA registered, 80 subjects were recruited. Only 1(1.25%) subject was found having abnormal menstruation pattern and 5 (6.25%) of them having anemia. Low ferritin serum  < 20ug/dL was foun in 11 subjects, so iron deficiency prevalence was 13.75%. Mean ferritin serum was 64.45 ± 3.95 ug/L (range 5.3-150 ug/L). This study found no relationship was noted between meat consumption, level of education and menstrual pattern  and ferritin level in WRA subjects ( p > 0.05).

Conclusion. Iron deficiency was found 13.75% and no association was discovered between level of ferritin serum and meat consumption,level of education , menstrual pattern.

Introduction: Pelvic organ prolapse (POP) can be found in more than half of all women who had given birth. Pelvic organ prolapse can be a burden to the patients, whether it is psychological, social and/or economic. The aim of this study is to investigate the characteristics of patients with POP at the Sanglah Hospital, Denpasar, Indonesia. Method: This is a descriptive retrospective study conducted in the gynecologic outpatient clinic, Sanglah Hospital, Denpasar. All newly diagnosed cases of POP in the clinic from January 2014 to December 2015 were recorded. The diagnosis and severity of prolapse were assessed by using Pelvic Organ Prolapse Quantification (POP-Q) system. Data were obtained both from the outpatient clinic’s registry and from patient’s medical record. Result: In 2 years period (1 January 2014 to 31 December 2015), there were 43 new cases of POP (11.38%) out of 378 gynecologic cases recorded in the clinic’s registry. In 2 years period, there were 475  gynecologic surgeries performed and 41 out of the 43 patients with POP had undergone a surgical procedure. Conclusion: Severe stage POP is most likely to be found in women with high parity, older age (≥60 years old), and who went through menopause already. It is also estimated that the real incidence of POP is higher, due to POP being asymptomatic. It is important for women to be educated about symptoms and treatment of POP because most patients come to seek for a care when they have a more severe symptom.

Background: The prevalence of polycystic ovary syndrome (PCOS) and infertility are rising due to changes in lifestyle. In this study, the polymorphism of insertion and deletion (I/D)in the angiotensin
converting enzyme (ACE) gene in PCOS patients and the possibility of its association with PCOS and plasma level of hormones level as well as body mass index was investigated. Materials and Methods: In this study, three polymorphisms in the ACE gene in Iranian women (Insertion-Insertion (II), Insertion-Deletion (ID), Deletion-Deletion (DD)) at three groups: PCOS, infertile patients and control as well as their relationship with hormones level and Body Mass Index (BMI) were examined. The methods included standard DNA extraction from peripheral blood and polymerase chain reaction (PCR)
using specifc primers for ACE gene. The data were then statistically analyzed. Results: Results showed an higher prevalence of ID polymorphism in PCOS and infertility population with statistically signifcant association (p=0.013). There were also signifcant associations between the polymorphism with BMI, LH and progesterone level. The number of primordial follicles also found to be three times greater in PCOS group compared with normal ones. Conclusion: The results showed signifcant association between
polymorphisms of ACE gene, hormones level and BMI in PCOS which might be considered as possible prognostic marker for infertility of PCOS patients.

Background: Recently, assisted reproductive technology has been widely accepted as a well-established procedure to treat infertility. Unfortunately, the success rate is still below expectations, whereas the rate of infertility has risen steadily. Intrauterine insemination procedure is the highest performed compared to other procedures, but the success rate is still lowest, around 10%. One cause of failure has been thought to occur due to lack of oocytes and embryos protection from cleaning of oxygen radicals. Reactive oxygen species negatively affect the maturation and interaction of gamete, fertilization, as well as acceleration of pathological states of the reproductive tract. On female reproduction, an antioxidant is essential for the maturation and quality of oocyte, implantation, placentation, fetal growth, and development of the organ. Concentrations of antioxidants have an important role in the reproduction, and interventions to reduce the influence of reactive oxygen species can improve the quality of embryos and their implantation.

Objective: To determine the effect of antioxidants (superoxide dismutase [SOD]) in ovarian stimulation response and pregnancy rates in women undergoing intrauterine insemination.

Material: Women undergoing intrauterine insemination procedures and who met the criteria of research were randomly and in double-blind divided into two groups, that is, SOD group and placebo group. During ovarian stimulation, 20 patients randomly selected were administered capsules containing 250 mg SOD (glisodin®, Kalbe Pharmaceutical, tbk.) twice a day, and the remaining 20 patients were given the same dose and color capsules containing placebo. Furthermore, ovarian activity and endometrial thickness were monitored by regular transvaginal ultrasound scans. A dose of 5000 U of hCG (Profasi, Serono Pharmaceuticals Ltd., UK) was administered when the leading cohort of follicles reached a diameter of 18–22 mm. Intrauterine insemination with prepared sperms was then performed 34–36 hours following hCG using Friedman catheter. Biochemical pregnancy is determined at day 15 after insemination with the cut-off point 25I U/mL. The data are compared between two groups and analyzed using SPSS 16 with a 95% confidence interval.

Result: Forty women underwent intrauterine insemination cycles, with 20 cycles administered to each group, SOD and placebo. There were five (12.5%) positives for chemical pregnancies, four (80%) in SOD, and one (20%) in placebo. The pregnancy rates tend to be higher in the SOD group than in the placebo group, even though it was not significantly different (p = 0.151). The ovarian stimulation determined by the number of growing follicles and endometrial thickness showed that more follicles (≥ 6 follicles) were found in SOD group (n = 10, 58.8%) than in placebo (n = 7, 41.2%); however, it was not statistically significant (p = 0.075). Endometrial thickness of 10 mm or more is statistically significant (p = 0.017), which is higher (79.2%) in SOD compared with placebo (20.8%) and yields significantly (p = 0.0251) greater pregnancy rates (n = 4, 80%) than placebo (n = 1, 20%).

Conclusions: SOD provides better stimulation response and increased pregnancy rates in intrauterine insemination program.

Introduction. Obesity is one of the risk factors that cause degenerative diseases such as diabetes mellitus, coronary heart disease, and hypertension. The cause of obesity is an imbalance of energy between consumed calories and expended calories in a long term influenced by environmental and genetic factors. The aim of this study is to see the relationship between calorie intake, physical activity, and dopamine D2 receptor Taq1A (DRD2 Taq1A) gene polymorphism in normal-weight, overweight, and obese students of the Faculty of Medicine of University of Sumatera, Utara.

Research Design and Methods. Data of calorie intake were taken by an interview using 24-hour food recall questionnaire. Body weight and height measurement are taken using digital scales and microtoise. Physical activity is measured using the International Physical Activity Questionnaire. DRD2 gene Taq1A polymorphism was visualized with 3% agarose gel after RFLP was digested with Taq1  restriction enzyme.

Results. Our study included 48 normal-weight, 16 overweight, and 75 obese students. HWE  analysis  yielded a significance of p > 0.05 in normal-weight, overweight, and obese students. There is a relationship between calorie intake, physical activity, and dopamine D2 receptor (DRD2) gene Taq1A polymorphism in normal-weight, overweight, and obese students (p = 0.011, p = 0.032, p = 0.004).

Conclusion. Calorie intake, physical activity, and DRD2 Taq1A gene polymorphism modulate overweight and obesity in students’ of the Faculty of Medicine of University of Sumatera Utara, with equilibrium population from time to time in this subjects

 

 

Background: Cholera is an infectious disease with symptom rice water stool diarrhea caused by Vibrio cholerae. Cholera transmitted by water or contaminated seafood. Ice usually used as a preservative marine products which vulnerable to contamination. Objective: This study aimed to determine the bacterial contamination of V. cholerae carrying the ompW and ctxA genes on ice preservatives marine product in Kedonganan Fish Market, Badung-Bali. Method: This study used 3 samples of ice that has not been used to preserve marine products and 20 samples of ice that has been used to preserve marine products. Samples were examined using bacterial culture methods and followed by dPCR assay to detect ompW and ctxA genes. Result: The results showed all samples of ice that has not been used preservative marine products are not contaminated by V. cholerae, while 16 of 20 (80%) samples of ice that had used contaminated by V. cholerae based on ompW gene and found no samples that carry ctxA gene. Conclusion: Ice agent (EA) was not contaminated by V. cholerae, while use ice sample marine product preservative contaminated with V. cholerae with 80% positive and  none of  isolates carry the gene ctxA.

Background: Diabetes is a chronic metabolic disease characterized by hypergyclemia due to insulin deficiency (type 1 diabetes) or insulin insensitivity/resistance (type 2 diabetes). The significant metabolic changes that occur in diabetes also affect the skeleton and cause bone loss and/or altered bone matrix and strength, thereby increasing the risk of fracture. Hyperglycemia can alter cellular metabolic processes through the formation of advanced glycation end products (AGEs), which caused dysregulation of various cytokines as the underlying mechanism in the decrease of bone density. This study aimed to see the bone loss caused by hyperglycemia in rats, using cortical bone thickness as a parameter. Methods: This study was an analytical experimental study, which was conducted in a laboratory. The sample of this study was Wistar rat (Rattus norvegicus). Diabetes in the rats were induced using streptozotocin. The diabetic rats were then sacrificed 11 days later, and the left femur bone was obtanied. The bone was decalcified for 1 week, then prepared for histological slides. Cortical bone thickness was measured microscopically using Optilab Image Raster software at 10 different axis points, and then averaged. Results: The mean of cortical bone thickness were 32.43 ± 2.65 μm in the control (non diabetic) rats, and 26.64 ± 2.89 μm in streptozotocin-induced diabetic rats (p < 0.001). The diabetic rats had lower mean of cortical bone thickness than control by 5.79 μm. Conclusion: Cortical bone thickness in the diabetic rats were lower by 18% compared to control 11 days after induction of streptozotocin.

Background and Purpose. One of the essential steps after open-heart surgery is extubation of patients. It is necessary to know variables that may influence extubation time in patients to be able to decide on the suitable time for this procedure. This research intended to determine the correlations between extubation time after open-heart surgery and age, gender, and homeodynamic status.

Methodology. This was a descriptive study, and the sample population consisted of patients who had undergone coronary artery bypass surgery in Ahvaz Golestan Hospital. Files of 100 patients qualified to take part in the study were selected by employing the simple sampling method, and the required information was extracted from them using a checklist. The chi-square test and regression analysis were used to analyze the data.  

Findings. 45% of the patients were extubated 6 hours or less and 55% more than 6 hours after surgery. The mean and standard deviation of extubation time for all the patients were 7.19±3.00 with the range of 3-18.25 hours. Only the age of the patients had a significant correlation with extubation time (p<0.05).

Conclusions. Based on our findings, age is one of the variables related to the duration of mechanical ventilation in coronary artery bypass surgery. Therefore, nurses should exercise greater care and caution when deciding on extubation time for old patients.

 

Background: Diabetes mellitus (DM) is one of the most common chronic diseases in the world. There are several therapeutic strategies that are obtainable in the viewpoint of Traditional Persian Medicine (TPM) knowledge ranging from changes in lifestyle to pharmacological remedies. Objective: To evaluate the effect of the TPM based nutritional recommendations on blood glucose and lipid profile in patients with type 2 DM. Materials and Methods: In this randomized controlled clinical trial, we divided 54 participants with type 2 DM into two groups. The intervention group received a three months TPM based nutritional style, and the control group had the routine care from their health care providers. The fasting blood glucose and glycosylated hemoglobin (HbA1c) as primary outcome measures and triglyceride and total cholesterol as secondary outcome measures were determined for this study at the baseline and three months after the intervention in both groups. Results: There was a statistically significant reduction in fasting blood glucose (165.48±30.18 versus 203.92±42.66 p=0.001), HbA1c (7.57±0.51 versus 8.05±0.82 p=0.000), triglyceride (154.91±50.52 versus 197.40±71.87 p=0.000), and total cholesterol (167.79±28.87 versus 184.76±38.36 p=0.006) respectively in the intervention group compared to control group after study. Conclusion: TPM based nutritional recommendations as an affordable free and accessible approach could be introduced as a non-pharmacological strategy for the control of blood glucose and lipid profile in diabetic patients.

 

Background and Objective: Increasing exposure to magnetic and electromagnetic fields is inevitable. This study evaluates effect of MRI on ECG parameters of patients. Methods: This is an analytic study conducted in 2015 in the Gonabad MRI center. Eighty-four patients referred to the MRI center were recruited by convenient sampling. Two-lead ECG was measured before and after MRI. MRI was done by Neusoft machine, made in China, with 0.35 Tesla magnetic fields. Data analysis was done by SPSS, version 14.5, using pairwise t-test and Wilcoxon test (p<0.05). Results: Heart rate was 80.63 ± 10.41 beat/minutes before MRI and 71.58 ± 10.22 beat/minutes after MRI. QT interval was 9.70 ± 1.60 mm/s before MRI and 10.95 ± 0.93 mm/s before MRI (p<0.001). P-wave duration was 2.16 ± 0.47 mm/s before MRI and 2.12 ± 0.38 mm/s after MRI (p=0.45). QRS wave duration was 1.88 ± 0.51 mm/s before MRI and 1.88 ± 0.51 mm/s after MRI (p=0.64). PR interval was 4.33 ± 0.92 mm/s before MRI and 4.33 ± 0.78 mm/s after MRI (p=0.89). Discussion: Findings showed that 0.35-tesla MRI can increase QT interval and reduce heart rate; however, it is ineffective on P-wave duration, QRS and PR interval. To control the limitation, patients referred to MRI center for the second time were selected for the study. Moreover, the patients were kept under similar conditions before MRI to avoid moderate and severe anxiety. Conclusion: This study showed that 0.35 tesla MRI can reduce heart rate and increase QT interval. However, it is ineffective on P-wave duration, QRS and PR interval. Thus, it is suggested to measure these parameters before and after MRI. 

Inflammation in abdominal obesity (Ab-Ob) is associated with insulin resistance condition and hyperinsulinemia. Numerous studies have found that prevalence of prostatic hyperplasia was higher in individuals with central obesity. This study is aimed at testing and verifying whether and to what extent waist circumference (WC), interleukin-6 (IL-6), and insulin resistance (HOMA-IR) increase the risk of benign prostatic hyperplasia (BPH) in Ab-Ob.

The study design was match-paired case-control. Eighty patients were recruited for this study. Data analysis was done with student t-test, multivariate logistic regression analysis, and path analysis. IL-6 was measured with sandwich enzyme immunoassay with Quantikine Immunoassay Kit (R&D System, Inc. USA), hsCRP was measured with the immunometric assay, and fasting insulin level was measured with Chemiluminescence Immunometric method (Immulite ®2000).

From multivariate logistic regression analysis, we found that WC, IL-6, and HOMA-IR increase the risk of BPH significantly with an odds ratio (OR) value of 1.09 (IK = 1.03–1.15), p = 0.005; 1.69 (IK = 1.10–2.58), p = 0.015; and 1.37 (IK = 1.05–1.79), p = 0.021, respectively. Path analysis showed the existence of a significant relationship between WC and BPH (critical ratio [CR] = 2.87, p = 0.004), between WC and IL-6 (CR = 5.9, p < 0.001), and between WC and HOMA-IR (CR = 3.87, p ≤ 0.001). There was a significant correlation between HOMA-IR and BPH (CR = 2.07, p = 0.039), between IL-6 and BPH (CR = 2.19, p = 0.029), and also an indirect relationship between WC and BPH through the increase of IL-6 and HOMA-IR.

We concluded that WC increased the risk of BPH through the increase of IL-6 and HOMA-IR in abdominal obesity patient.

In our work we traced the dependence of erythrocyte microrheological features dynamics on the age of experimentally developed dislipidemia in rats. The investigation was fulfilled with the help of initially healthy rats of Vistar line. The experimental group was composed of 105 male rats (34 rats, aged 12 months; 32 rats, aged 18 months; 39 rats, aged 24 months) which were exposed to dislipidemia development by alimentary way. The control group was composed of 91 male rats, including 30 rats aged 12 months, 32 rats aged 18 months, and 29 rats aged 24 months. We applied biochemical, hematological, and statistical methods of investigation. Experimental dislipidemia development in rats showed decrease of plasma antioxidant protection and increase of lipids' peroxidation, which deepened with aging of animals taken into the experiment. With dislipidemia development in experimental rats, we noticed that during the aging process there was a rapid rise in the number of erythrocytes that both reversibly and irreversibly lost their biconcave form. In the experimental group of animals, we noticed during the aging process an increase in erythrocytes' aggregation. Development of abnormalities in erythrocytes' microrheological features in experimental rats exceeded the aging-related changes in the control group. Changes thus found contributed significantly to aggravation in morbidity and heightened sensitivity of animals to negative impacts of environmental factors. Therefore, during the aging process, it is necessary to control more and more strictly the level of blood lipids in order to avoid the development of dislipidemia which becomes acutely dangerous especially during aging because of worsening hemocirculation and rise in the risk of thrombophilia development.

Background: Breast cancer is the most common cancer found in women worldwide. In 2012, more than 50% of breast cancer patients in Cipto Mangunkusumo Hospital were advanced breast cancer patients. Stage 3 breast cancer patients have five years’ survival rate by 72%, while who’s in stage 4 only by 22% even after receiving adequate treatment. It is said that only CD105, which specifically describes the intratumoral angiogenesis occurrences. Methods: A retrospective cohort analytic data from patient medical records Dharmais Cancer Hospital from 2011-2014 were studied. A simple random sampling and obtained a total of 32 patients. Statistical analysis was performed using univariate and multivariate analysis SPSS version 17.0 and medcalc. Results: The expression between CD105 with the survival rate is: crude HR 1.724 (95% CI 0.693 to 4.288) p=0.241. The median survival of the CD105 positive group is higher than the negative group. The relationship between CD105 groups Luminal A, therapy, and metastasis, the group with negative CD105 expression had a higher survival rate. There was a significant relationship between CD105 and clinicopathologic of breast cancer patients from age and CD105 expression (p=0.034). 71.8% of patients with HER2 negative, has a negative CD105 as well, and 60% of subjects with HER2-positive, suggesting that CD105 expression was also positive. Conclusion: CD105 can not be used as a prognostic factor in patients with advanced stage breast cancer, high CD105 patients have a lower survival compared with low or negative CD105 patients, and CD105 expression correlated with age and PR.

About 20-40% of type 2 diabetic patients may develop diabetic nephropathy (DN) as its complication. The pathogenesis of DN is a complex one. Classically, metabolic and hemodynamic impairment are considered as its pathogenesis. This view has evolved tremendously in recent years. Large number of evidences points that inflammation is a key event in the development and progression of DN. Among several inflammatory molecules, proinflammatory cytokines such as interleukin 1 (IL-1), interleukin 6 (IL-6), and tumor necrosis factor-alpha (TNF-α) are known to be involved. Chronic condition of hyperglycemia responsible for the formation of proinflammatory cytokines via advanced glycation end products (AGE) pathway and protein kinase C (PKC) pathway. These proinflammatory cytokines exert signaling pathway that lead to extracellular matrix (ECM) accumulation, glomerular basement membrant (GBM) thickening, and glomerulosclerosis, ultimately lead to development and progression of diabetic nephropathy. Knowing this mechanism in detail beneficial for future treatment. Intervention in these signaling pathway may benefit to development of novel therapeutic approach.

Purpose: This study aims to systematically review and investigate the benefits and challenges of strategic purchasing implementation in health systems and suggests a basis for improving their performance.

Method: This is a systematic review in which electronic databases and search engines—including PubMed, Springer, OvidSP, ProQuest, Google scholar and Scopus, along with related journals, library, and grey literature—were searched for related articles from 1990 to 2015. Updates were added to the searches if found. Search strategies included the combination of two sets of keywords (“purchasing,” “contracting” OR “commissioning” OR “buying” OR “procurement”) with (“strategic” OR “active” OR “proactive”). Articles in English or Farsi, which discussed benefits and challenges of strategic purchasing in a health context, were eligible to be included in the study. Two researchers independently completed all steps of the research. Quality assessment of all included articles for final review were done using related checklists.

Results: 2049 records identified through searching databases, which were refined to 23 final articles. Based on the result of this study, the benefits of strategic purchasing implementation in health systems were reported as higher quality, higher efficiency, better value for money (VfM), while high administrative costs, issues in priority setting, a need for accurate information and political issues were among the main challenges and disadvantages.