Metabolic indices are the wide range of characteristic factors, which can be changed during several medical conditions such as metabolic syndrome. Nutrition and related behaviors are one of the main aspects of human lifestyle which recent investigations have recognized their roles in the development of metabolic disorders. According to the spread of risky nutritional habits/behaviors due to the changes in lifestyle, and its importance in the prevalence of metabolic disorders, the authors attempted to summarize these evidences in a systematic review. The present study is a systematic review that encompasses those studies investigating the association between metabolic indices and nutritional/dietary behaviors published in two international databases in recent 11 years. Twenty-nine related articles were considered and their data were extracted. The relation between food choices and metabolic indices is more frequent in studies. While, inhibition and abstinent and eating together were two behavioral sets with the smallest share of research. Anthropometric indices have the highest rate in the evaluations. Finding the links between nutritional behavior and metabolic indices will be the key point in selecting the different types of interventions. These results will guide therapists to the accurate recognition of metabolic effects in targeting behavior for their intervention.

A case is presented on a 40-year-old male with chronic lead poisoning with loss of consciousness, rhabdomyolysis, and acute renal failure after occupational exposure. Physical examination revealed generalized atrophy, tenderness, and swelling in the right limb and a decreased proximal muscle strength in the lower limb. A severe acute polyradiculoneuropathy in lower limbs documented by electromyography. All paraclinical tests were normal except increased blood lead level (75 μg/dl) and blue line in gum of the teeth. The patient was treated with penicillamine (500 mg q8 h) and pyridoxine (50 mg daily) for 8 months, only accessible drug in Iran. Force of patient's muscles in the proximal part of the lower limb was improved, and also the blood lead level reached to normal range. This is the first patient with rhabdomyolysis and muscle necrosis induced by lead poisoning.

Background: The results of the former study confirmed the accuracy of magnetic resonance imaging (MRI) in determining the origin and content of ovarian masses. The present study aimed to evaluate the diagnostic value of MRI in differentiating benign and malignant ovarian masses in women. Materials and Methods: This was a cross-sectional study. All candidates for surgery to remove ovarian masses were selected to participate in this study. They underwent MRI with gadolinium before the surgery. MRI images were reviewed by an experienced radiologist who was aware of the ovarian mass found in pelvic ultrasonography (US). A thick-enhancing wall, mural nodules, septations, and internal enhancement within the mass were reviewed by the radiologist. Mass specimens were examined in the laboratory by an experienced pathologist to determine malignancy or benignancy of the masses. Pathological findings were compared with MRI results. Results: there was no significant difference between MRI findings and pathology denoted by benign and malignant (P = 0.06), but results showed a significant difference between US and pathology (P = 0.002). In MRI findings related to a thick-enhancing wall (P = 0.18), internal enhancement (P = 0.18), and pelvic fluid (P = 1.00), no significant difference was seen in benign or malignant masses. However, in findings related to septation, all cases had malignant reports (P = 0.006), and in mural nodule, 80% had malignant reports (P = 0.006). CA-125 blood level in patients with benign masses (1.72 ± 0.97) was significantly less than patients with malignant masses (3.20 ± 0.83) (P < 0.001). Conclusion: We showed that MRI has better results in diagnosing adnexal masses and their characteristics compared to simple ultrasound imaging based on pathological studies.

Background: Although traditional open groin incision repair has been used routinely for decades, the benefit of the minimally invasive surgery has challenged the traditional open method. Nowadays, laparoscopic herniorraphy has evolved to making it more minimally invasive from 3 to 2 and now single port and from intracorporeal to extracorporeal knotting. This study aimed to evaluate a new modification of single port laparoscopic herniorraphy in children with congenital inguinal hernia. Materials and Methods: In this single-institution randomized case–control study 190 children who suffered from congenital inguinal hernia were divided into two groups randomly: Group 1 (N = 73) undergone a single-port modified extracorporeal purse-string sutures (laparoscopic surgery [LS]) and Group 2 (N = 117) undergone open surgery (OS). Results: The mean age of the patients at operation time was 28.79 ± 11.45 months. Overall, three patients (1.57%) had intraoperative retroperitoneal hemorrhage. The duration of anesthesia and operation for those undergoing bilateral operation were significantly shorter in LS group. There was no statistically significant difference in individual postoperative complication rates between the groups. The proportion of overall post-operative complications was 4 (5.4%) in LS and 13 (11.1%) in OS group (P = 0.18). Proportion of trapped cryptorchidism was significantly higher in the OS group. Conclusion: In conclusion for children with inguinal hernia, we had found the benefits of single-port modified extracorporeal purse-string for reduction the operative time, trapped testes and better cosmetics and parents' satisfaction.

Background: There are one-third of children in the world with Vitamin A deficiency. The prevalence of vitamin deficiency in children aged 15–23 months in Iran has increased 18 times and in rural areas. The present article aims to an analysis of related documents to the existing policies on this vitamin in our country. Materials and Methods: This study is a descriptive study using a quantitative content analysis approach to analyze nutritional policy documents. Results: We extracted six themes at the first stage of analysis (based on common policies in the world), which were reduced to two final themes: “Direct interventions” and “Indirect interventions.” There were also six subthemes and eight issues. Conclusions: It seems that policymaking must revise these documents and also making new policy decision with more emphasis on micronutrient.

Background: Diabetes mellitus is one of the major health problems in the world. Stress and mental illnesses adversely affect glycemic control. In most patients, a multidisciplinary approach including physical activity, healthy diet, and stress management is required for glycemic control. Mindfulness-based stress reduction (MBSR) is a structured group program that reduces emotional distress through self-awareness and assuming the responsibility for individual choices, and results in increased effective health behaviors. Here, we aimed to evaluate the effects of mindfulness meditation on glycemic control and mental health in patients with type 2 diabetes. Materials and Methods: This randomized clinical trial study was performed in 2018 in Isfahan city. A total number of 108 patients with diabetes mellitus type 2 were selected and allocated randomly to two groups, intervention (12 weeks MBSR program) and control (routine care). Depression, anxiety, and stress scores regarding to depression, anxiety, and stress Scale - 21 questionnaire and also amounts of fasting blood sugar (FBS) and hemoglobin A1C (HbA1C) were assessed and analyzed using independent t-test, paired t-test, Mann–Whitney U-test, and Chi-square, before and 13 weeks after educational programs. Results: The means of HbA1C, FBS, and depression, anxiety, and stress scores improved significantly after intervention in the MBSR group. Except FBS levels, all outcome variable scores' mean change was significant between the two groups. Conclusions: In general, this study revealed that mindfulness meditation could be helpful in improving the quality of mental health and lowering glycemic control indices in patients with type 2 diabetes mellitus.

Background: Selective serotonin reuptake inhibitors are among the most common agents have been used for the treatment of the premenstrual dysphoric disorder (PMDD); however, due to the diversity in the outcomes and adverse effects, efforts are in progress to find an agent with maximal efficacy and minimal adverse effects. Saffron is an herbal agent consisted of ingredients shown to act as an antidepressant, pain tranquilizer, and antioxidant. In the current study, it is aimed to assess the efficacy of saffron on PMDD treatment. Materials and Methods: In the current randomized controlled trial, 120 females with the diagnosis of PMDD were randomly allocated to three groups of treatment with fluoxetine (20 mg, twice daily), saffron (15 mg, twice daily) or placebo for 2 weeks in the luteal phase of two menstruation cycles. Daily record of severity of problems (DRSP) and Hamilton questionnaires had been filled before the interventions and then following the treatment cessation. The questionnaires' scores and drug-related adverse effects were compared among the studied groups. Results: Post-intervention assessment of three groups revealed significant improvement in all of the treatment approaches in terms of DRSP and Hamilton assessments (P < 0.001). Although DRSP assessments showed remarkable superiority of saffron to placebo (P = 0.027), Hamilton evaluations showed insignificant differences among the three interventions (P > 0.05). Fluoxetine posed a significantly higher rate of adverse effects as compared to the other agents (P = 0.01). Conclusion: Based on the findings of this study, saffron was an efficacious herbal agent for the treatment of PMDD with minimal adverse effects.

Background: Ectopic pregnancy (EP) is the most common cause of death in the first trimester of pregnancy. Methotrexate (MTX) is an acceptable treatment in the cases with the lack of tube rupture or no important one, which has reduced surgical treatment. Despite numerous studies, there is still no consensus about medications. The present study is aimed to evaluate the single- and multiple-dose of MTX among these patients. Materials and Methods: This clinical trial study was done on 108 EP patients who were selected for the systemic MTX treatment and divided into two groups. For the single-dose group, MTX was administered once and β human chorionic gonadotropin (βHCG) levels were measured first and then on days 4 and 7. In the multi-dose group, 1 mg/kg MTX was injected on days 1, 3, 5, and 7. In both groups, MTX was prescribed following these days if βHCG was not reduced. In the two groups, βHCG levels were assessed after 1 week. The success rate of treatment and complications were followed up and recorded up to 6 weeks after treatment. Results: The success rate in the single-dose and multiple-dose MTX group was 47% and 51%. The MTX level in the single dose group decreased from 2532 ± 1154 mIU/mL to 1341 ± 553 mIU/mL and in the multiple dose group from 2671 ± 2685 mIU/mL to 1313 ± 605 mIU/mL (P < 0.05). Although a significant decrease was observed in each of the two groups over time, no significant difference was found between the two groups (P > 0.05). Conclusion: Single and multi-dose regimen did not show a significant difference in terms of the success of treatment. Therefore, given that the lower dose of the drug associated with lower the risk of complications, it is safe to choose the single-dose regimen.

Background: Postmenopausal bleeding might occur due to many benign and malignant underlying diseases. Differentiating between these diseases poses a great importance. This study was designed to compare the diagnostic value of pipelle endometrial sampling and curettage in patients with postmenopausal bleeding. Further, the results were compared with hysterectomy if performed. Materials and Methods: Eighty-seven patients with postmenopausal bleeding were included. Pipelle sampling endometrial biopsy was performed for patients in office, and then, patients were transferred to the operation room for dilatation and curettage. Pathology results of pipelle sampling were compared with curettage method. If hysterectomy was performed due to any reason, it was compared as well. Results: The pipelle sampling biopsy diagnosed 94.1% of malignant tumors, and curettage sampling biopsy diagnosed 100% of malignant tumors. The sensitivity and specificity of pipelle compared to curettage were 94.12% and 100%, respectively, for the diagnosis of malignant tumors. Based on the Kappa test, the agreement between pipelle and curettage sampling biopsy was statistically significant (P < 0.001). Conclusion: The endometrial sampling with pipelle is safe and cost-effective in patients referred with postmenopausal bleeding. This might avoid the need for general anesthesia for the detection of endometrial hyperplasia and endometrial malignancy.

Background: Polycystic ovarian syndrome (PCOS) is an endocrine disorder in fertile women, which seems to be adversely affected by associated thyroid dysfunction. Zinc methionine (ZM) has positive effects on PCOS, but its concerted effects on PCOS and thyroid function have not been investigated. We evaluated the effects of ZM on reproductive and thyroid hormones and the number of follicles in rats with PCOS. Materials and Methods: This study was conducted on 45 female rats, using sesame oil as control; PCOS animals administered with 0, 25, 75, and 175 mg/kg BW of ZM. Serum concentrations of follicle-stimulating hormone (FSH), luteinizing hormone (LH), and thyroid function were investigated. Premature follicles (PMF), primary follicles (PF), preantral follicles (PAF), antral follicles (AF), corpus luteum (CL), and cystic follicles (CF) were assessed. Results: PCOS decreased the concentrations of FSH and free T4, but increased the levels of LH, TSH, and LH/FSH ratio (ALL P < 0.05). ZM at a dose of 75 and 175 mg increased the level of FSH, free T4, and decreased LH, TSH, and LH/FSH ratio (ALL P < 0.05). Induction of PCOS decreased PMF, PF, PAF, AF, and CL, but increased CF (P < 0.05). PCOS treated groups (75 and 175 mg/kg) increased these follicle numbers and decreased CF compared to ZM 25 mg/kg and PCOS groups (Both P < 0.05). Conclusions: Although the induction of PCOS had a negative effect on reproductive and thyroid hormones and follicle numbers, ZM treatment (75 and 175 mg/kg) overcame the negative effects. A high dosage of ZM can alleviate the hormonal and cysts disturbances occurring in PCOS.

Background: Dermatophytosis is mostly caused by dermatophytes species, and the diagnosis of disease is very important for early treatment. The aim of this study was to identify the commonly dermatophytes species isolated directly from the clinical samples, using the polymerase chain reaction (PCR) and evaluate both conventional and molecular methods. Materials and Methods: This study was performed on 115 clinical samples. Dermatophyte isolates were initially identified by conventional method and confirmed by the sequencing molecular method. In this study, the molecular technique is implemented directly on clinical samples. Statistical analysis of the information was performed by the SPSS software, and the results were statistically analyzed. Results: Our findings demonstrated that the most abundant dermatophyte species by PCR-sequencing were Trichophyton mentagrophytes (20%), followed by Trichophyton tonsurans (10%), Trichophyton rubrum (6.7%), T. interdigital (6.7%), Arthroderma otae, and Arthroderma vanbreuseghemii, (3.3%) for each one. Conclusion: For medical laboratories, routine procedures are still preferred because of their lower cost, and the results are almost the same as the molecular methods. The sensitivity and specificity values for PCR under our laboratory condition were 60% and 87%, respectively. This study shows that molecular results performed better in nails than other samples, by culture results.

Background: Liver cirrhosis is associated with cardiac dysfunction in 40%–60% of the patients. Serum NT-ProBNP is a potential additional marker of cirrhotic cardiomyopathy. Materials and Methods: It was a cross-sectional analytical study done in a tertiary care center in South India on 100 patients of cirrhosis of liver. Diastolic function was assessed from mitral inflow parameters as well as tissue Doppler imaging of the left ventricle in 95 patients. Serum NT-ProBNP levels was measured once at the time of inclusion into the study. Cirrhotic cardiomyopathy was diagnosed in those with abnormal echocardiographic parameters and its association with NT-Pro BNP levels was analyzed. Data were analyzed using SPSS version 22. Results: Diastolic dysfunction was found in 40 (42.1%) participants. Twenty-two (23.2%) had Grade I, 16 (16.8%) had Grade II, and 2 (2.1%) had Grade III diastolic dysfunction. The mean NT-Pro-BNP was elevated (107.38 [±66.76] ng/ml) in patients with diastolic dysfunction. NT-ProBNP was higher in Child–Pugh B and C disease when compared to milder disease. NT-ProBNP was not a good screening tool for cardiomyopathy in cirrhotic patients. Area under the curve was 0.517 with 95% confidence interval and the P = 0.77. However, positive correlation was present between the NT-ProBNP value and two echocardiographic parameters of diastolic dysfunction (E/A, E/E'). Conclusion: Increased serum NT-ProBNP levels in cirrhosis of liver have a positive correlation with echocardiographic measures of diastolic dysfunction of the heart but it is not a good tool for screening for cirrhotic cardiomyopathy.

Background: The release of dopamine (DA) in the posterior ventral tegmental area (pVTA) plays an important role in cue-related learning, reward, and relapse. On the other hand, studies have shown that the use of N-methyl-D-aspartate receptor (NMDAR) antagonist (AP5) inhibits the expression of morphine (5 mg/kg, s. c) conditioned place preference (CPP). In this study, we have tried to show the interaction effect of the DA stimulatory agents through D1-like receptor (D1R) agonist (SKF38393) and D2-like receptor (D2R) antagonist (eticlopride; through disinhibition) with NMDAR antagonist into the pVTA on the expression of morphine CPP. Materials and Methods: The SKF38393 and eticlopride, individually and simultaneously (in ineffective doses), were injected into the pVTA with the AP5 in rats, and animals were then placed in a CPP apparatus. Results: Concomitant administration of D1R agonist (4 μg/rat) with NMDAR antagonist (1 μg/rat) induced the expression of morphine CPP, but the administration of D2R antagonist with NMDAR antagonist was unaffected on the expression of morphine CPP. Furthermore, concomitant administration of ineffective doses of D1R agonist and D2R antagonist with NMDAR antagonist had no effect on the expression of morphine CPP. Conclusions: The results showed using higher doses of D1R agonist with NMDAR antagonist could reverse the blocked expression of morphine CPP by NMDAR antagonists, while, the use of D2R antagonist with NMDAR antagonist could not. Therefore, presynaptic receptors such as D1R probably through releasing other stimulatory neurotransmitters can play a vital role in the expression of morphine CPP and cue-related learning.

Background: Watermelon is a fruit with the thirst-quenching effect and especially is consumed in summer. In this study, the effect of consumption of watermelon extract (in drinking water) on thyroid hormone level (TT4), animals' weight, water and food consumption, nerve conduction velocity (NCV), and memory in Wistar rats were investigated. Materials and Methods: Twenty-four male Wistar rats were divided into three groups: control, CT 1500 mg/kg, and CT 3000 mg/kg (n = 8, in each group). Watermelon extract was administered for 42 days. The results measured in this study were analyzed with repeated measures or one-way analysis of variance and compared by the least significant difference post hoc. P < 0.05 was considered as significant difference. Results: The results showed that animals' weight in both the treatment groups decreased compared to the control group (P < 0.05 and P < 0.01, respectively). Water and food consumption and the level of TT4 increased when compared to the control group in both the treated groups (both P < 0.001). NCV in both the treated groups decreased in comparison with the control group (both P < 0.001). Spatial memory did not change significantly, but passive avoidance memory in both the treated groups significantly decreased in comparison to the control group (respectively, with P < 0.05 and P < 0.01). Conclusion: Based on these finding, in spite of increase in food and water consumption in the treated groups, animal weight did not increase significantly. Impairment in memory and decrease in NCV were also occurred, but TT4 level was increased in animals treated with watermelon extract.

Background: Hamstring graft tendon for anterior cruciate ligament (ACL) reconstruction is a common approach worldwide. Tibial side graft fixation to achieve appropriate stability is a serious concern, worldwide. The current study aims to compare the outcomes of mere use of interference screw for fixation of hamstring tendon graft versus the use of interference screw plus supplementary staple. Materials and Methods: This is a randomized clinical trial conducted on 53 patients who underwent ACL reconstruction from 2016 to 2018. The study population was randomly divided into two groups: graft fixation with interference screw only and interference screw plus supplementary staple. Postoperative recovery time, postoperative clinical examinations, and the scale of the International Knee Documentation Committee were assessed for participants and compared between two groups. Results: Comparison of two groups regarding demographic information, including age, gender distribution, postoperative recovery time, and body mass index, showed no statistical difference (P > 0.05). Postoperative Pivot test was insignificantly positive in 4 (16.7%) cases of screw interference with supplementary staple while it was positive in 3 (10.7%) cases with screw interference only approach (P = 0.98). IKCD index was not statistically different between two groups postoperatively (P = 0.72), while IKCD scores changed significantly following the surgical procedure, regardless of the type of the surgical procedure (P < 0.001). Conclusion: Use of supplementary staple beside interference screw was as successful as mere use of interference screw for fixation of hamstring tendon autologous graft of the ACL reconstruction, regarding force withstanding. The comparison of the two approaches revealed no remarkable difference.

Background: Blood pressure (BP) measurement being a part of clinical examination gives a fair idea about the hemodynamic status. The auscultatory method is considered as a gold standard, a simple, noninvasive way to measure BP in patients as well as in the healthy controls. The present study was designed to compare systolic BP (SBP) and diastolic BP (DBP) readings using a newer palpatory method with the standard auscultatory method and further assessing the reliability of the newer palpatory method. Materials and Methods: A cross-sectional study comprising of a total of 400 (240 males and 160 females) individuals in the age range of 20–60 years were included in this study. BP measurement was done by the standard auscultatory method by one observer. Another observer blinded with BP records of the auscultatory method, measured BP using the newer palpatory method on the same individuals. The two methods were compared for the inter-rater reliability using intraclass correlation (ICC) statistics and agreement between two methods using Bland–Altman analysis. Results: The present study observed excellent reliability of the newer palpatory method with the standard auscultatory method with an ICC value of 0.997 and 0.993 for SBP and DBP, respectively. Bland–Altman plot for both SBP and DBP using the auscultatory and newer palpatory method has shown minimum variability and good reliability when both methods are used by independent observers. Conclusions: With practice and experience newer palpatory method can be used to assess BP with accuracy.

Background: Oral candidiasis is a common disease in cancer patients subject to chemotherapy. The aim of this study was to evaluate the risk factors of rising oral candidiasis incidence and to identify the Candida species isolated from oral lesions of cancer patients and their antifungal sensitivity. Materials and Methods: A total of 645 patients with cancer were examined. Several Candida species were isolated from specimens and identified by morphological and molecular methods. The susceptibility of isolates to amphotericin B, fluconazole, and nystatin was also investigated. Results: A total of 74 isolates of Candida were recovered from oral cavity of 61 cancer patients with oral candidiasis. The isolates included Candida albicans (n = 56; 75.5%), Candida glabrata (n = 4; 5.4%), Candida krusei (n = 5; 7%), Candida tropical (n = 7; 9.4%), and Candida kefyr (n = 2; 2.7%). A total (n = 72; 98.65%) of isolates were susceptible to nystatin, (n = 58; 78.4%) of them were susceptible to fluconazole, and (n = 8; 10.8%) of susceptible dose-dependent isolates were specified, (n = 46; 62.16%) of isolates were susceptible to amphotericin B. Conclusion: Finally, in addition to emphasis on topical nystatin application in the first stage of oral candidiasis in these patients, using alternative systemic drugs such as fluconazole and amphotericin B can be considered for the resistant candida isolates to nystatin.

Background: Conjunctivitis is a very common ocular disease, which can be caused by a wide variety of microorganisms. This study was aimed to assess the bacterial etiology and antibiotic susceptibility of conjunctivitis patients' isolates from Central Iran. Materials and Methods: This study was performed in 180 patients referred to the Department of Ophthalmology in Kashan University with symptoms of conjunctivitis from July 2017 to December 2017. To detect of different bacteria, Gram staining, morphological characterization, pigment production, biochemical characteristics, coagulase test, optochin and PYR tests, oxidase test, and culture on specific media were used. Antibiotic susceptibility of the bacteria isolated was done using the Kirby–Bauer method. Methicillin resistance in staphylococci isolated from the patients was identified using polymerase chain reaction technique. Results: Of the 195 bacteria isolated, about 81.5% were Staphylococcus epidermidis and Staphylococcus aureus and the remaining 19.5% included other species. In the present study, Pseudomonas aeruginosa was most resistant to ampicillin. In the case of S. epidermidis and S. aureus, the highest resistance was observed against erythromycin and the least resistance was against rifampicin and linezolid. Conclusion: In this study, S. aureus and S. epidermidis are the most common causes of conjunctivitis in all age groups, however, this condition decreases with age and is also influenced by other factors such as season and weather conditions. The results of this study can be helpful in planning more prudent treatment strategies for patients with conjunctivitis in Kashan.

Background: Chronic alcohol consumption carries a high risk for oral and pharyngeal cancers among persons who have never smoked. Excessive alcohol consumption displays cytogenetic changes in oral mucosa cells. Cytomorphometric analysis of oral mucosal cells helps in the early detection of cytomorphological transformations in alcoholics before and after the onset of carcinoma. Materials and Methods: A prospective, hospital-based, comparative study was done after written informed consent. Smears were obtained from the clinically normal buccal mucosa of 102 randomly selected alcoholic patients attending the medicine outpatient department aged above 25 years who consumed a minimum of 45 ml alcohol per day for at least 10 years and of 102 nonalcoholics as control. The slides were immediately fixed in absolute methanol and stained by the Papanicolaou (Pap) staining technique. PAP-stained smears were examined under the light microscope. Using the image J 1.47 image analysis software, a morphometric analysis of around 50 cells/case was done. Results: A statistically significant increase in mean cytoplasmic area (P < 0.001), mean nuclear area (P < 0.01), and cell-to-nuclear parameter ratio (P < 0.001) was seen in the alcohol group in comparison with the control group. Conclusion: Prolonged consumption of alcohol produces cytomorphometric changes in buccal mucosal cells before the onset of premalignant lesions.

Diffuse idiopathic skeletal hyperostosis (DISH) also known as Forestier disease is a noninflammatory, systemic skeletal disease of unknown etiology. DISH is usually asymptomatic but may compress the posterior wall of the aero digestive tract and lead to dysphagia, globus, hoarseness, stridor, dyspnea, and neurological problems. Although dysphagia is not uncommon among the presenting symptoms of DISH but dysphonia and stridor are rarely reported. We report a 68-year-old man who presented with a history of progressive dysphagia over 1 year and recent dysphonia and stridor secondary to cervical osteophytes. We discuss the symptoms, radiological features, and management of this uncommon case of DISH in conjunction with review of literature.

Anesthesia management has always been challenging in cardiac patients, especially patients with cardiomyopathy. There are a variety of cardiomyopathies such as unclassified cardiomyopathy as a complex type that can occur in many forms like left ventricular noncompaction (LVNC) that is an uncommon primary genetic cardiomyopathy typified by noticeable trabeculation of the left ventricular (LV) wall and intertrabecular recesses. We report anesthesia management in a 53-year-old female patient who admitted to the hospital for the transureteral lithotripsy surgery due to dysuria and urolithiasis with a medical history, and echocardiographic examination indicated the diagnosis of hypertension and unclassified cardiomyopathy (LVNC).

Background: Intrauterine growth factor (IUGR) is one of the most important causes of neonatal mortality. The aim of this study was to evaluate the therapeutic effect of utrogestan on the treatment of IUGR and its complications. Materials and Methods: In this clinical trial, 66 pregnant women with idiopathic IUGR embryos were enrolled. Patients in the intervention group, in addition to receiving routine treatment of control group (high-protein diet, resting), took utrogestan capsules (100 mg) twice daily. The primary and secondary outcomes of the disease were recorded in a checklist. Data were analyzed using SPSS 18 using an independent t-test, Chi-square test, and Fisher's exact test. Results: In the intervention group, mean neonatal weight (P = 0.003), mean neonatal Apgar score (P = 0.001), and mean gestational age at birth (P = 0.001) were significantly higher than those in the control group. There was no neonatal death in the intervention group, whereas in the control group, four cases of neonatal death were observed (P = 0.03). In the majority of subjects in the intervention group, resistance index, and pulsatility index of the umbilical artery decreased (P = 0.002). The difference in abdominal circumference and gestational age in the intervention group decreased (P = 0.01). In the intervention group, the diastolic flow of the umbilical artery increased (P = 0.002). Conclusion: Utrogestan was effective as an inexpensive and effective way to treat IUGR and improve pregnancy outcomes.

Background: The increasing incidence of Group B Streptococcus (GBS) infection among nonpregnant adults has become of growing clinical and public health concern. The current study investigated the distribution of important virulence determinants and antibiotic susceptibility of GBS isolates causing community acquired (CA) and hospital acquired (HA) infections among nonpregnant adults. Materials and Methods: A total of 62 GBS, including 31 CA GBS and 31 HA GBS, were collected from a teaching hospital in Isfahan, Iran. Capsular polysaccharide genotypes (CPS), PI 1, PI 2a, PI 2b, and hypervirulent GBS adhesin (hvgA) virulence genes and antibiotic resistance profiling were determined. Results: There were 19 (30.6%) cases of underlying disease that diabetes mellitus (20.9%) was most common. The rate of multidrug resistant GBS strains was accounted for 29%. Distribution of macrolide resistant phenotypes was as follows: constitutive macrolides, lincosamides, and streptogramin B (MLSB) (15 isolates); inducible resistance to MLSB; and L phenotype (each 5 isolates) and M phenotype (1 isolate). V and Ia serotypes were the most predominant capsular type in HA GBS and CA GBS isolates, respectively. The most frequent pilus types were PI 1, PI 1+PI 2a, PI 1+PI 2b, and PI 2a. PI 1 and PI 1+PI 2a had significantly different distributions between CA and HA GBS isolates. Three CA GBS isolates (9.6%) were positive for hvgA gene that belonged to clonal complex 17/sequence type 17/CPS III/PI 1+PI 2b lineage. Conclusion: There was a significant difference in the distribution of PIs among CA GBS and HA GBS isolates in our region.

Background: Pasteurella multocida is the causative agent of many diseases. Antimicrobial treatment disadvantages highlight the need to find other possible ways such as prophylaxis to manage infections. Current vaccines against this agent include inactivated bacteria, live-attenuated bacteria, and nonpathogenic bacteria, which have disadvantages such as lack of immunogenicity, reactogenicity, or reversion to virulence wild bacteria. Using bioinformatical approaches, potentially immunogenic and protective epitopes identified and merged to design the best epitope fusion form in case of immunogenicity as a vaccine candidate. Materials and Methods: In this study, the fusion protein (PlpE1 + 2 + 3) and full PlpE genes (PlpE-Total) were cloned in pET28a in BL21 (DE3) firstly and later in pBAD/gIII A and expressed in Top10 Escherichia coli. Overlap polymerase chain reaction (PCR) using different primers for 5ˈ and 3ˈ end of each segment produced fusion segment 1 + 2 and (1 + 2) +3 fragments and was used for cloning. Results: Cloning of both PlpE1 + 2 + 3 and PlpE-Total into the pET28a vector and their transform into the BL21 (DE3) E. coli host was successful, as the presence of the cassettes was proved by digestion and colony PCR, however, their expression faced some challenges independent of expression inducer (isopropyl β-d-1-thiogalactopyranoside) concentration. Conclusion: Changing the vector to pBAD/gIII A and consequently changing the host to Top10 E. coli have resulted in sufficient expression, which shows that Top10 E. coli may be a good substitute for such cases. Furthermore, it is concluded that adding 8M urea results in sufficient purification, which hypothesizes that denature purification is better for such cases than native one. Purified proteins headed for further analysis as vaccine candidates.

Suicide with cyanides is relatively rare but highly lethal. The lethal oral dose of cyanide salts is 200 mg, and concentrations >3 mg/L may be potentially lethal. The symptoms of poisoning are predominating in the central nervous system and cardiovascular system. We report the case of a 43-year-old goldsmith man who presented with self-poisoning by cyanide salt ingestion. Patient's symptoms included confusion, cardiac arrhythmias, hyperkalemia, leukocytosis, metabolic acidosis with high anion gap, hypotension, and then hypertension. The cause of the patients poisoning was not initially diagnosed. Intensive supportive treatment was performed. The patient died on the 3^rd day of admission following cardiac arrest. At autopsy, hemorrhagic gastritis and cherry-red discoloration of the chest muscles were observed. Forensic toxicology showed cyanide in the blood and tissues. Cyanide poisoning could appear in different forms, and like our case, the symptoms can last for several days with nonspecific symptoms.

Background: Substance abuse has turned into a great problem in the worldwide. Considering the increased prevalence of addiction in this study, we tried to assess the role of social skills aspects in tendency to addiction among the adolescents. Materials and Methods: This cross-sectional study was conducted on 600 high school students studying in the Isfahan City, Iran, from 2016 to 2018. The studied population was assessed using addiction tendency questionnaire and Matson's social skills questionnaire. Data were analyzed by Statistical Package for the Social Sciences software and independent t-test, Pearson and Spearman correlation, and linear regression test. Results: Social behavior (P = 0.002, r = −0.124), high self-esteem (P < 0.001, r = −0.381), and peer-communication (P < 0.001, r = −0.361) were inversely associated with a tendency to addiction and were independent predictors of it (P < 0.05). Aggression was associated with increased tendency to the addiction (P = 0.01, r = 0.103) but not a predictor. Conclusion: We found that appropriate social behaviors, inappropriate assertiveness, and functional communication were factors associated with less tendency to substance abuse in the adolescent.

Poisoning with any of the colchicine or chloroquine drugs is rare. These drugs exert therapeutic and toxic effects on tissues by different mechanisms. Colchicine is used to treat a number of rheumatologic diseases and heart problems. In addition, chloroquine is used to treat malaria and some inflammatory diseases. There is a small gap between the therapeutic and toxic doses of these drugs. Gastrointestinal symptoms are the initial causes of poisoning with these drugs and then widespread organ failure in later stages can lead to sudden cardiac death. We introduce a case of concurrent poisoning with both drugs, in which the patient presented with a headache, nausea, and vomiting several hours after suicide. On the 1^st day, the patient's status was stable, but on the 2^nd day, the patient suddenly becomes ill and died even though the patient received supportive therapy. Concurrent poisoning with chloroquine and colchicine is extremely lethal, and early aggressive management is recommended even in an apparently stable patient.

Prolactinomas are the most common type of functional pituitary tumors. Dopamine agonists is the most important drugs used in prolactinoma,have antagonistic effect with antipsychotic drugs used in schizophrenia. Conversely, dopamine antagonist drugs increase prolactin in patients with simultaneous schizophrenia. In the present case, we report a 29-year-old single male with schizophrenia who treated for 8 years with risperidone and presented with macroprolactinoma. Iatrogenic hyperprolactinemia is a well-known side effect of dopamine antagonist drugs for treatment in a patient with schizophrenia. On the other hand, it appears these drugs have the other side effects, such as drug- induced prolactinoma or boost growth.

Background: Acute liver failure (ALF) is characterized by severe and sudden liver cell dysfunction. Baseline demographic, clinical, and biochemical factors associated with the survival of ALF patients were identified in a few selected Western studies, but very few studies have been done in India. The aim of the current study is to provide an overview of the factors associated with the survival of ALF patients and to suggest an optimum cutoff value for clinically significant parameters. Materials and Methods: The patients suffering from ALF were reviewed in this study. The factors studied were age, sex, total serum bilirubin, serum creatinine, serum albumin, urea, aspartate aminotransferase, alanine aminotransferase (ALT), and recent hepatitis E virus infection. Results: Total n = 41; Male 73%; median age 43 years. The median survival time of patients in the age group of 18–40 years was 238 days. The median survival time of patients >40 years of age was 129.10 days. Elevated serum urea and serum ALT levels at the time of admission were found to be significant predictors of mortality in patients suffering from ALF in our study. In Receiver Operator Characteristic (ROC) curve analysis, the optimum cutoff value of urea was found to be 42 mg/dL, and ALT was found to be 400 IU/L. Conclusions: Elevated serum urea and serum ALT levels at the time of admission were found to be significant predictors of mortality in patients suffering from ALF in our study. The use of these two parameters, along with King's criteria for the prognosis of ALF, can be more useful in the management of such patients in India.

Gastroenteritis is common among children and is usually caused by bacterial, viral, or parasitic gastrointestinal infections. The occurrence of gastroenteritis as the only symptom of coronavirus disease 2019 (COVID-19) is an uncommon condition. We present a 16-month-old girl that has recently been admitted to our hospital with vomiting, diarrhea, and lethargy, who was ultimately diagnosed with COVID-19. This case shows that the clinical manifestations of COVID-19 can be misleading in children.

The Corona Virus Disease-2019 (COVID-19) pandemic has exposed the weaknesses in the public health care delivery system, and is extremely disheartening that thousands of people are losing their lives to a single disease. A single infectious disease is able to produce so much fear, uncertainty and disastrous impact predominantly because of its novelty and the fact that the many aspects of the disease are still not known. Even though, it has been proposed to strengthen multiple aspects of the disease control, but it is equally important to give immense priority to the research and development domain, as the findings of these results will reorganize the entire approach towards the disease. In conclusion, research and development is an important and integral component of the fight against the COVID-19 pandemic. It is high time that resources are pooled in and research activities are encouraged and accelerated to get answers for the unanswered aspects of this novel viral infection, which will aid all of us to mount an improved public health response against the first pandemic of the 21^st century.

Background: Cyclin-dependent kinases (CDKs) are the key regulators of cell-cycle transitions and characterized by needing a separate subunit, a cyclin, which provides domains essential for enzymatic activity. The activities of cyclin-CDK complexes are controlled by a group of molecules that inhibit CDK activity and CDK inhibitors (CKIs). Cancer often exhibits an aberrant CpG methylation of promoter regions of tumor suppressor genes such as CKIs. Treatment with the DNA demethylating agents, such as 5-aza-2′-deoxycytidine (5-Aza-CdR), can restore and upregulate CKIs. Previously, we reported the effect of 5-Aza-CdR and genistein on DNA methyltransferase (DNMTs) in hepatocellular carcinoma (HCC). The aim of the present study was to evaluate the effect of 5-Aza-CdR on p15INK4, p16INK4, p18INK4, and p19INK4 genes expression, cell growth inhibition, and apoptosis induction in HCC PLC/PRF/5 cell line. Materials and Methods: The effect of 5-Aza-CdR on the cell growth of PLC/PRF/5 cells, genes expression, and apoptosis induction were assessed by 3-[4, 5-dimethyl-2-thiazolyl]-2, 5-diphenyl-2H-tetrazolium bromide assay, real-time quantitative reverse transcription-polymerase chain reaction analysis, and flow cytometry, respectively. Results: 5-Aza-CdR (0, 1, 5, 10, 25, and 50 μM) inhibited PLC/PRF/5 cell growth at different periods significantly. This compound induced apoptosis and reactivated p15INK4, p16INK4, p18INK4, and p19INK4 genes expression at a concentration of 5 μM significantly. Conclusion: 5-Aza-CdR can inhibit cell viability and induce apoptosis by epigenetic reactivation of p15INK4, p16INK4, p18INK4, and p19INK4 genes in HCC PLC/PRF/5.

Background: Women's mental health is a significant health issue for pregnant women during and after pregnancy. Postpartum depression (PPD) is defined as the presence of depression in the 1^st year after delivery. This study reviews the relationship between Vitamin D levels, anxiety and poor sleep quality related to pregnancy. Materials and Methods: A systematic search was conducted on documents presented in PubMed, Scopus, ProQuest, Science Direct, Google Scholar and Web of Science databases until March 2020. Three separate search paths were considered for three different disorders with particular keywords. All observational studies that investigate the relationship between Vitamin D levels and PPD, sleep disorders, and anxiety were selected for inclusion in the study. Results: Search yielded 14 eligible studies. Quality of most included studies was medium to high. Nine studies reported that Vitamin D deficiency was directly associated to the incidence of PPD and sleep disorders. One study reported an indirect association, and three researches did not observe any association between Vitamin D status, sleep disorders and PPD. One study reported a direct association to anxiety but did not have any relation to PPD. Conclusions: PPD and sleep quality during pregnancy associated to Vitamin D deficiency directly. Although studies have several limitations, the importance of sufficient Vitamin D status in pregnant women has been addressed in all studies, especially regarding the prevention of PPD, anxiety, and poor sleep quality during the pregnancy.

Phlegmasia cerulea dolens is a severe form of deep venous thrombosis (DVT) characterized by severe venous outflow obstruction, marked limb swelling, pain, bluish discoloration, and even venous gangrene if the condition is untreated. In our case, 75-year-old woman, with general abdominal pain, which increases with eating and anorexia and 5 days of coldness and swelling of the left leg, was accepted. The patient had a history of Type II diabetes, ischemic heart disease, congestive heart failure, hyperlipidemic (HLP), hypertension, metastatic ovarian cancer, and previous DVT. She has undergone chemotherapy for the past 3 weeks due to ovarian cancers. Anticoagulation with intravenous administration of heparin and fluid resuscitation started immediately. The evidence of color Doppler sonography approved acute DVT in common femoral vein extending to the left external iliac. The patient did not consent for continuing the procedure in the hospital and succumbed to her illness on the 7^th day after discharge.

Background: Candida species are a group of coexistent microorganisms in the oral cavity that opportunistically cause disease in vulnerable people, including addicts. This study is aimed at identifying and determining the frequency of Candida species in the oral cavity of the addicts to inform the epidemiological panel and to warn to prevent the resistance of the species. Materials and Methods: In this study, sampling was done from the oral cavity of 83 addicts who referred to Addiction Treatment Centers in Isfahan, Iran, using moist sterile swab. The presence of yeast on the direct microscope slides of 58 samples was confirmed. To carry out culture and the primary identification, Sabouraud dextrose agar medium with chloramphenicol as well as HiCrome Candida agar medium was used. Isolates were identified by polymerase chain reaction (PCR) restriction fragment length polymorphism (using specific primers ITS1-ITS4 and MSP I enzyme) and Duplex PCR test (using specific primers CDU1-CDU2/CAL1-CAL2). Results: Out of 93 Candida isolates which had been isolated from 58 culture-positive samples of the oral cavity, Candida albicans (41.93%) were the most prevalent species, followed by Candida dubliniensis (24.73%), Candida glabrata (21.50%), Candida kefyr (8.60%), Candida tropicalis (2.15%), and Candida parapsilosis (1.07%), respectively. In 33 cases (56.90%), the presence of more than one Candida species was observed. Conclusion: Compared to the studies conducted on the oral cavity of healthy controls, smoking certain drugs can have a significant effect on the presence and frequency of Candida species, particularly C. dubliniensis and C. glabrata.

Background: Lower extremity genu varum is a common deformity leading to imbalanced weight distribution on the knee joint and eventually significant disabilities due to medial compartment joint osteoarthritis. This study was aimed to assess the efficacy of a novel technique of high tibial open wedge osteotomy plus tubercle osteotomy in a follow-up study. Materials and Methods: This is a prospective census cross-sectional study conducted on 146 patients with the history of genu varus undergone high tibial open-wedge osteotomy and tubercle osteotomy since 2011. The study population was followed within 6 months regarding tibial slope angle and medial proximal tibial angle alterations and operation-related complications, including venous phlebitis, nerve, and arterial injury, deep and superficial infection, mal-, non- and delayed-union. Results: 146 patients with the mean age of 25.66 ± 4.23 years, and predominance of male gender (60.3%) were evaluated. Mean of tibia slope and MPTA before the surgical procedure was 9.38 ± 0.85 and 79.45 ± 2.11 that turned to 7.10 ± 0.84 and 89.74 ± 1.52 postoperatively, respectively (P < 0.001). Arterial and peroneal nerve injury was not detected in any of the cases. Deep-vein phlebitis, superficial infection, and delayed-union, malunion, and nonunion were presented in 2.05%, 1.36%, and 2.05%, respectively. Conclusion: Outcomes of this study showed significant improvement in the tibia slope angle and MPTA postoperatively. Surgical-associated complications were negligible and rehabilitated by performing appropriate medical/surgical approaches. Considering the number of assessed population, HTO plus tubercle osteotomy seems an acceptable approach for genu varum treatment.

Background: In this study, we aimed to evaluate the safety and efficacy of three different doses of atracurium on conditions of laryngeal mask airway (LMA) insertion, first-try success rate, and possible complications. Materials and Methods: A total of 120 patient's ≥18 years old were randomly divided into three groups of 40. The study groups received fentanyl 2 μg/kg thiopental 5 mg/kg and atracurium in doses 0.2 mg/kg, 0.4 mg/kg, and 0.6 mg/kg, respectively, based on the patient group. The conditions of LMA insertion, hemodynamic responses, and complications were evaluated and compared in the groups. Results: In the study groups, the LMA placement was difficult in 15%, 7.5%, and 2.5%, respectively (P = 0.13). There was no statistically significant difference among the groups regarding the success rate in the first attempt to the insertion of LMA. Of the three groups, 5%, 2.5%, and 2.5% had bleeding at the place of mask insertion (P = 0.77). 17.5%, 7.5%, and12.5% had sore throat, respectively (P = 0.4). No patient experienced laryngospasm during the study. Furthermore, changes in blood pressure, heart rate, and oxygen saturation were not significant in the three groups. Conclusion: All three doses of atracurium have similar effects on the condition of LMA insertion. Atracurium 0.4 mg/kg accompanied by higher success on LMA insertion in the first attempt and lower airway complications (bleeding and sore throat), increasing this dose had no significant effect on the success rate of LMA insertion.

Background: Several conducted studies have reported a higher and more frequent Helicobacter pylori infection rate in type 2 diabetes mellitus (T2DM). The aim of this study was to investigate the prevalence and its association between H. pylori infection and T2DM. Materials and Methods: A case and control study was conducted based on 529 T2DM patients and 529 control. H. pylori was assessed by Serum anti-H. pylori immunoglobulin G (IgG) and IgA. Furthermore, patients were investigated for fasting blood glucose (FBG) levels, glycosylated hemoglobin (HbA1c), serum cholesterol, and other biochemistry parameters. Results: The findings showed a positive significantly higher antibody titer for H. pylori infection (IgA > 250) in diabetic patients (50.7%) compared to controls (38.2%) (P < 0.001). Similarly, H. pylori infection for IgG > 300 titer was higher in T2DM patients (73.5%) compared to controls 61.8%) (P < 0.001). Further, the mean values were statistically significant diabetes with H. pylori infection for IgG > 300 titer and IgA > 250 titer, regarding Vitamin D, HbA1C (P < 0.001), FBG, calcium, creatinine, total cholesterol, LHDL, triglyceride levels, uric acid, bilirubin, thyroid-stimulating hormone (TSH), and systolic and diastolic blood pressure. The diabetic patients showed higher prevalence rate of symptoms than controls included: hypertension (14.3%), vomiting (15.5%), muscular symptoms (35.2%), bloating/distension (13.2%), abdominal pain (17%), nausea (9.6%), anemia (17%), kidneys (20.8%), chronic bronchitis (14.7%), gastrointestinal (23.8%), and diarrhea (20.4%). Conclusions: The current study revealed that H. pylori infections were significantly higher in diabetic patients compared to controls. Furthermore, T2DM patients infected with H. pylori positive reported a higher prevalence rate of symptoms than H. pylori negative.

Background: Diabetes mellitus (DM) is a group of metabolic disorders in the body, accompanied with increasing blood sugar levels. Diabetes is classified into three groups: Type 1 DM (T1DM), Type 2 DM (T2DM), and monogenic diabetes. Maturity-onset diabetes of the young (MODY) is a monogenic diabetes that is frequently mistaken for T1D or T2D. The aim of this study was to diagnose MODY and its subtype frequency in a diabetic population in Iran. Materials and Methods: In this study among ten diabetic families that were highly suspected to MODY by nongenetic biomarkers and without any pathogenic mutation in GCK and HNF1A genes, two patients from two unrelated families were examined via whole-exome sequencing (WES) in order to detect the causative gene of diabetes. Co-segregation analysis of the identified variant was performed using Sanger sequencing. Results: In this study, no pathogenic variant was found in GCK and HNF1A genes (MODY2 and MODY3), while these two types of MODY were introduced as the most frequent in other studies. By using WES, a pathogenic variant (p.I488T) was found in one of the patients in CEL gene causing MODY8 that its frequency is very rare in other studied populations. A high-risk variant associated with diabetes was found in another patient. Conclusion: WES was applied in this study to reveal the cause of MODY in 1 family. This pathogenic mutation was previously reported as a disease causing mutation.

Background: The most common sexually transmitted infection is infection by human papilloma virus (HPV). Although the main transmission route of HPV is through sexual intercourse, the contact of the skin with the genital area skin is another known method for transmission. This study aims to examine the awareness and practice of female beauty salon staff about HPV and its transmission in pubic hair removal using wax. Materials and Methods: This cross-sectional study was conducted on 200 female beauty salon staff who do bikini waxing in Shiraz, Iran. Demographic information, awareness, and practice of them were gathered using the researcher-constructed questionnaire. The statistical analysis was performed using the SPSS software version 18. Results: Mean awareness and practice scores of beauty salon staff about HPV and its transmission in bikini waxing were 26.6 ± 12.8 and 5.5 ± 0.8, respectively, and in average range. The results showed that there was a significant relationship between practice and education (P = 0.04), but the relationship between the awareness and education was not seen (P = 0.72). There was no statistically significant relationship between age and work experience with awareness and practice of staff (P > 0.05). Conclusion: The awareness and practice of beauty salon staff about HPV and its transmission in bikini waxing are moderate. Therefore, it seems that the implementation of continuous educational program by the Union of women's beauty salons is necessary to increase and improve the awareness and practice of female beauty salon staff.

In tuberculosis (TB) endemic countries like India, this is a common practice to attribute patient's illness to TB even without microbiological confirmation. Furthermore, a false diagnosis may prove fatal as the underlying disease is left untreated, and the burden is amplified by avoidable potential side effects of antitubercular drugs. We present a case of a 42-year-old female who presented to us with a typical presentation of disseminated TB but found to have metastatic thyroid carcinoma.

Background: Late talkers (LTs) are children under three with poor vocabularies and no developmental problems. Statistical learning (SL) is defined as processing or learning patterns of environmental stimuli, for example, spoken language, music, or motor, that will unfold in time. We hypothesize if some LTs outgrow as developmental language disorder, they might be identified using SL tasks at the onset. We aimed to find any correlation between language measures and SL outcomes in LTs and normal children (NC). Materials and Methods: Sixteen pairs of LTs and NCs were recruited using a convenient sampling method from day-care centers and speech therapy clinics of the Comprehensive Center for Child Development in Isfahan city, Iran. Visual sequences presented using Habit software version 2.2.4. Children's eye movements to visual sequences were monitored, and their reaction times and the number of anticipatory looks were analyzed offline. The language measures were determined in the free-play context. Results: Results indicated no significant correlation between SL and language measures and no difference observed in SL between the groups (P = 0.73). Conclusions: The results may refer to no overt correlation between SL and delayed overall linguistic measures along with inadequate samples, children's fatigue, or insufficiency of the visual task in presenting SL.

Background: The quest for scientific endorsement of new drugs from plants continues due to the rising antibiotic resistance against pathogenic bacteria. Litsea iteodaphne is used in Sri Lanka in the treatment of infectious diseases. Therefore, in vitro antibacterial activity of L. iteodaphne plant extracts were evaluated against selected human pathogenic bacteria. Materials and Methods: Antibacterial activity of 400, 40, and 4 mg/ml concentrations of hexane, ethanol, and aqueous leaf extracts of L. iteodaphne were evaluated against Staphylococcus aureus, Psedomona s aeruginosa, Klebsiella pneumoniae, Escherichia coli, and methicillin-resistant S. aureus (MRSA) clinical isolates using disc diffusion method. Minimum inhibitory concentration (MIC) was identified, and phytochemical screening was carried out. Results: Significant zones of inhibition ranging from 5.7 mm to 8.1 mm, 7.1 mm to 8.0 mm, and 7.6 mm were obtained for ethanol, hexane, and aqueous extracts at 400 mg/ml, respectively, against above four bacteria. For MRSA clinical isolates, zones of inhibition ranging from 6.1 mm to 10.9 mm, 6.7 mm to 10.8 mm, and 6.4 mm to 8.6 mm were obtained for ethanol, hexane, and aqueous extracts at 400 mg/ml, respectively. Ethanol extract of L. iteodaphne showed the lowest MIC value (0.0256 mg/ml). Phytochemical screening revealed the presence of tannins, cardiac glycosides, reducing sugars, phenolic compounds, saponins, and flavonoids. Conclusions: L. iteodaphne crude leaf extracts showed promising antibacterial activity against Gram-positive and Gram-negative bacteria and clinical isolates of MRSA. Further investigations toward fractionation and the identification of an active compound will enhance the antimicrobial potential of L. iteodaphne.

Background: Tuberculous meningitis (TBM) is a highly devastating manifestation of tuberculosis. So far, the major role of the neuroradiology in the management of TBM has been restricted to diagnosis and follow-up of the complications. This study aimed to establish the use of advanced magnetic resonance imaging (MRI) techniques in the early detection of sequelae of TBM like vasculitis and hydrocephalous. Materials and Methods: In this prospective observational study, 30 patients of TBM were recruited during 1 year at a tertiary care health center of northern India and their serial MRI brain was done. Patients were between 18 and 45 years of age. Results: Basal/Sylvian exudates were seen in 90% of patients, hydrocephalus was found in 30% of patients and infarcts were found in 27% of patients. No significant difference was found between the mean, mean diffusivity (MD), and mean fractional anisotropy (FA) in frontal white matter, basal ganglia, thalamus, pons of cases and controls. A significant difference was seen between mean cerebral blood flow (CBF) in the region of basal ganglia of cases and controls (P < 0.05). No significant difference was seen between mean CBF in frontal white matter, thalamus of cases and controls. Diffusion tensor imaging parameters, MD, and FA were abnormal in the region of infarcts (basal ganglia) in three patients in the first scan, the parameters normalized in one patient (late subacute to chronic infarct in the first scan), and they remained abnormal in two patients. Conclusion: Advanced MRI techniques (magnetization transfer imaging) is helpful in visualizing hyperintense thickened meninges in basal cisterns and Sylvian fissures on pre-contrast imaging, and in identifying reduced CBF in the region of basal ganglia.

Background: The incidence of difficult laryngoscopy or tracheal intubation is high, which needs a method to predict the difficulty of tracheal intubation to decrease the rate of complications. Therefore, the aim of this study was to evaluate acromio-axillo-suprasternal notch index (AASI) method for predicting difficult tracheal intubation and difficult laryngoscopy. Materials and Methods: This cross-sectional and diagnostic value study was performed on 108 patients who had indication for endotracheal intubation in the emergency department. Before endotracheal intubation, AASI was evaluated in all patients. The sensitivity, specificity, and total accuracy for predicting the power of AASI for the difficulty of tracheal intubation were measured. Results: Based on Cormack and Lehane grading system, 54 patients had easy endotracheal intubation (33.3% Grade I and 66.6% Grade II) and 52 patients had difficult endotracheal intubation (57.7% Grade III and 32.7% Grade IV). The sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy for AASI in cutoff point 0.515 for predicting difficulty of endotracheal intubation with 0.857 area under the receiver operating characteristic curve were 84.6%, 77.7%, 78.5%, 84%, and 81.13%, respectively. Conclusions: Our results showed that predicting difficulty of endotracheal intubation by AASI is accurate and with high sensitivity and specificity values, therefore, training this method to emergency physicians should be considered in our country or other countries. Further studies are required to confirm our findings.

Background: This study aimed to evaluate the efficacy and safety of long-acting versus short-acting methylphenidate on the symptoms of attention deficit hyperactivity disorder (ADHD) in children and adolescents aged 6–18 years. Materials and Methods: This single-blind, randomized clinical trial was conducted on 150 children and adolescents aged 6–18 years with ADHD based on the Diagnostic and Statistical Manual of Mental Disorder-5 criteria. The patients were randomly assigned to two groups (Matoride or Ritalin). In the first group, Ritalin was prescribed 2/3 times a day, and in the second group, Matoride was prescribed once a day for 3 weeks. The Conner's questionnaire was completed by the parents of the participants for evaluation of the performance and symptoms of ADHD in both groups at the beginning and 3 weeks after treatment. In addition, the incidence of any drug complications at the end of 3-week treatment period was evaluated. Results: There were no statistically significant differences between the two groups before the intervention (P > 0.05) in the dimensions of attention deficit, emotional reaction, behavioral disorder, learning disorder, and impulsivity. At the postinterventional periods, behavioral disorder of the Ritalin group was statistically significantly lower than that of the Matoride group (P = 0.001). This treatment did not have a statistically significant effect on the total score of Conners (P = 0.255). Complications were seen in 58 cases (77.3%) of Matoride group and 49 ones (67.1%) of the Ritalin group. Weight loss in the Ritalin group was higher than that of the Matoride group (P = 0.019). Compared to the Ritalin group, anxiety was higher in the Matoride group (P = 0.022). Conclusion: Given the similar effect of Matoride and Ritalin and no significant difference in drug complications, it seems that Matoride (slow release) can be used as an alternative to Ritalin (short acting).

Background: Alzheimer's disease (AD) is one of the most common neurodegenerative diseases in the older population and characterized by progressive memory and cognitive impairment. Cyperus rotundus, a traditional medicinal herb, has analgesic, sedative, and anti-inflammatory effects and also used to increase memory in Islamic traditional medicine. This study was designed to consider the effects of C. rotundus extract on memory impairment and neurogenesis in the Beta-Amyloid rats' model. Materials and Methods: Forty-two male Wistar rats were randomly divided into six groups (n = 7) for the evaluation of baseline training performance in the Morris water maze test. Then, amyloid-beta (Aβ1-42) was injected in animal hippocampal CA1 bilaterally in four groups. The first probe trial was performed 21 days after Aβ injection. Then, 250, 500, and 750 mg/kg of C. rotundus extract were administered to three Aβ-injected groups for 1 month; after that, the second probe trial was performed, and rats were sacrificed after 28 days of the second probe trial. The neurogenesis was detected in the hippocampus, by immunohistochemical staining. Results: This study showed that spatial memory increased in the behavioral test in AD treated group with C. rotundus extract, compared with the AD group (P = 0.02). Immunohistochemical staining revealed that neuronal differentiation has been occurred in the hippocampus in the AD-treated group with C. rotundus extract compared with the AD group (P = 0.01). Conclusions: This study showed that C. rotundus extract, repaired spatial memory impairment in the Aβ rats, through increased neurogenesis in the hippocampus, which could be related to the flavonoid components in the extract.

Background: Anelloviridae is a viral family which is considered as a constant component of human virome. Given the ubiquitous nature of the virus infection and the long-standing relationship between the virus and the host, in the present study, we aimed at investigating the presence of Anelloviruses in the urine samples of children in a cross-sectional study. Materials and Methods: The urine samples of 50 children who were referred to Hazrat Ali Asghar Children's Hospital, affiliated to Iran University of Medical Sciences, Tehran, Iran, were obtained. Three TaqMan real-time polymerase chain reactions (PCRs) were carried out for Anellovirus detection. A phylogenetic tree was drawn for positive products after PCR amplification, purification, and nucleotide sequencing. SPSS, version 20, was used for statistical analyses. Results: Children's mean age ± standard deviation was 4.30 ± 1.47 years and 56% (28/50) were female. Real-time PCR revealed that Anellovirus was positive in 12% (6/50). Furthermore, PCR-sequencing results showed that torque teno virus was detected in 83.3% (5/6) and SEN virus in 16.6% (1/6) of the Anellovirus positive samples. In addition, 86% (5/6) of the children with positive samples were female. No significant difference was detected between any of the demographic characteristics and Anellovirus positivity (P > 0.05). Conclusion: According to our preliminary study, the presence of Anelloviruses in the urine samples of asymptomatic children in Iran is striking, although limited sample size and age range limitations might have affected the comprehensive results of our study.

Background: This study aims to compare the efficacy and toxicity of povidone-iodine (PI) 5%, polyhexamethylene biguanide (PHMB) 0.02%, and chlorhexidine 0.02% in patients undergoing phacoemulsification cataract surgery. Materials and Methods: This single-center, randomized study was done on 330 patients who referred to Feiz hospital in Isfahan and scheduled for cataract surgery. They were assigned randomly to 1 of 3 groups of 110 eyes who received 1 drop of PI 5% in group 1, 1 drop of PHMB 0.02% in group 2 and 1 drop of chlorhexidine 0.02% in group 3. Pre-operative Cultures samples were obtained without any topical application and it was repeated 5 min after use of antiseptic solutions. Cultures were obtained from the inferior conjunctival fornix, using sterile culture swabs while avoiding contact to the eyelids and lashes. Results: The numbers of colony-forming units (CFUs) did not differ significantly among the three groups (P = 0.149 and P = 0.260, respectively). After the intervention, CFUs numbers in the three groups were decreased with a significant difference in both blood and chocolate agars (P = 0.304 and P = 0.136, respectively). Of the 317 eyes, 108 (34.1%) showed no bacterial growth in the pre-preparation period, which was similar in the three groups. Staphylococcus epidermidis was the most common isolated bacteria. Conjunctival injection was significantly different among studied groups (P = 0.0001), five patients in iodine group had severe conjunctival injection and no one in the other group. SPE was significantly fewer in chlorhexidine group than PHMB and iodine groups (P = 0.0001). Conclusion: Pretreatment with 5% Povidone-Iodine (PVI) for at least 15 min or repeated applications over 10 min is effective in the reduction of conjunctival organisms, and results in less postoperative endophthalmitis.

Background: Calcium-phosphate product is associated with mortality among patients with end-stage kidney disease on dialysis. However, clinical evidence among hospitalized patients is limited. The objective of this study was to investigate the relationship between admission calcium-phosphate product and 1-year mortality in hospitalized patients. Materials and Methods: All adult patients admitted to a tertiary referral hospital in 2009–2013 were studied. Patients who had both available serum calcium and phosphate measurement within 24 h of hospital admission were included. Admission calcium-phosphate product (calcium × phosphate) was stratified based on its distribution into six groups: <21, 21–<27, 27–<33, 33–<39, 39–<45, and ≥45 mg²/dL². Multivariate cox proportional hazard analysis was performed to evaluate the association between admission calcium-phosphate product and 1-year mortality, using the calcium-phosphate product of 33–<39 mg²/dL² as the reference group. Results: A total of 14,772 patients were included in this study. The mean admission calcium-phosphate product was 34.4 ± 11.3 mg²/dL². Of these patients, 3194 (22%) died within 1 year of hospital admission. In adjusted analysis, admission calcium-phosphate product of ≥45 mg²/dL² was significantly associated with increased 1-year mortality with hazard ratio of 1.41 (95% 95% confidence interval 1.25–1.67), whereas lower admission calcium-phosphate product was not significantly associated with 1-year mortality. Conclusion: Elevated calcium-phosphate product was significantly associated with increased 1-year mortality in hospitalized patients.

Background: Several researchers have investigated the clinical outcomes in patients with rotator cuff tear who compared open and arthroscopic surgeries; however, there are limited studies that have compared the outcomes of arthroscopic and open rotator cuff repair. This study was aimed to compare the clinical outcomes of the patients who underwent rotator cuff repair using either arthroscopic or open repair techniques. Materials and Methods: This is a prospective cohort study in which 51 patients who underwent either open or arthroscopic rotator cuff repair were studied. Twenty-six patients underwent open repair, and 25 patients had an arthroscopic repair. Patients were followed for 6–36 months. The outcome of the two groups was evaluated using the Universal California Los Angles (UCLA) score. Results: The mean tear size was 4.93 ± 2.3 cm² in the open surgery group and 4.99 ± 2.3 cm² in the arthroscopic group (P = 0.93). All patients showed significant improvement in their scores for pain, active forward flexion, active abduction, and function at the time of follow-up. Improvement in scores within each group was significant, but the comparison of the two techniques was not statistically significant in pain, active abduction, active forward flexion, and UCLA, but in function, the open surgery group was superior (P < 0.05). Conclusion: This study revealed that short-term outcomes for arthroscopic and open cuff repair are similar, except in function, which was significantly better in the open surgery.

Background: Leishmaniasis is a skin disease caused by Leishmania parasite. Despite being self-limiting, must be treated. Available drugs have side effects and drug resistance has also been seen. Materials and Methods: Maggot debridement therapy (MDT) is using sterile fly larvae (maggots) of blow flies (Lucilia sericata) for the treatment of different types of tissue wounds. Larvae have excreted and secreted substances that have been proved to have antimicrobial effects, in addition to the some other specifications. Results: In this study, the anti-leishmanial effects of extracts and secretions of sterile second- and third-instar larvae of L. sericata on the growth of Leishmania major promastigotes and amastigotes in the J774 macrophages have been evaluated in vitro. Conclusion: The results showed that extracts and secretions had almost the same leishmaniocidal effect on promastigotes and intracellular amastigotes without cytotoxic effect on macrophages.

Background: Human immunodeficiency virus (HIV) transmission pattern in Iran has been changed from injection drug to sexual contact. Lack of accurate assessment of HIV in people with sexually transmitted diseases (STDs) in Iran prompted us to conduct this study to determine the frequency of HIV infection in these patients.Materials and Methods: In this cross-sectional study which conducted in 2016–2017, overall, 190 patients with STDs referring to two hospitals of Hamadan were enrolled in the study. All of the patients were examined for HIV in the first visit by rapid test and then 1 and 4 months later by the 4^th generation ELISA. A questionnaire including demographic data, clinical manifestations, and high-risk behaviors was completed for all of the referring people. The collected data were analyzed using appropriate statistical tests. Results: Of 190 patients, 126 (66.3%) were female with a mean age of 34.1 ± 10.1 years and 64 (33.7%) were male with a mean age of 30.8 ± 7.8 years. One hundred twenty-eight (67.4%) got married, 73 (38.4%) and 76 (40%) had a diploma and postgraduate education, respectively, 32 (16.8%) mentioned the history of unsafe sex, and 23 (12.1%) had used condoms continuously during sexual contacts. The most common STDs were reported genital warts, 107 patients (56.3%), vaginal discharge (28, 14.7%), and genital ulcer (33, 17.4%). Two (1%) patients were positive for HIV at the first visit. Conclusion: Patients with STDs should be considered as an important source of HIV transmission, so clinicians should pay more attention to screening these patients for HIV infection.

Background: There are several scolicidal agents for inactivation of hydatid cyst protoscolices during surgery, but most of them are associated with adverse side effects such as sclerosing cholangitis (SC) and liver necrosis. The present study aimed to evaluate the adverse effects of Eucalyptus essential oil to induce SC in animal models. Materials and Methods: Eighteen rabbits weighting 2000–3500 g were included in three groups for this study. About 0.3 ml of Eucalyptus essential oil (1%), or 5% hypertonic saline, or normal saline was injected for 5 min in the gallbladder. After 4 months, the liver, common bile duct, and duodenum were resected and immediately sent for cholangiography and pathologic studies. Results: According to pathological studies, inflammation is more common in Eucalyptus and hypertonic saline groups. Due to cholangiographic studies, stricture was slightly higher in the hypertonic saline group than the Eucalyptus group. Conclusion: Thus, 1% Eucalyptus essential oil is at least as safe as 5% hypertonic saline, but for clinical uses, it must be confirmed with further studies.

Background: Despite food fortification policies in many countries and recommendations for Vitamin D supplementation of at-risk groups, Vitamin D deficiency (VDD) and infantile rickets remain major public health challenges in many developed and developing countries. Materials and Methods: Ninety-six participants at birth were enrolled and followed up until 9 months of age. Serum 25OHD was estimated in cord blood at birth and at 14 ± 1 weeks of life. Seventy-seven participants were followed up at 9 months for estimation of serum 25OHD, parathyroid hormone (PTH), alkaline phosphatase (ALP), calcium, and phosphorus. VDD was defined as serum 25OHD <15 ng/mL as per USIOM guidelines. Results: Serum 25OHD levels at 9 months of age (15.78 ± 8.97 ng/mL) were significantly increased in comparison to the level of 3 months of age (14.04 ± 7.10 ng/mL) and at birth (8.94 ± 2.24 ng/mL). At birth, all the participants (77) were deficient in 25OHD levels. It was found that 16/94 (17%) and 19/77 (24.7%) participants at 3 and 9 months of age, respectively, became Vitamin D sufficient without any Vitamin D supplementation. There was a significant inverse correlation between serum 25OHD and PTH concentration (r= −0.522,P < 0.001), serum 25OHD and ALP (r= −0.501,P < 0.001). It was found that reduction in serum Vitamin D level to <10.25 ng/mL results in a surge of serum PTH. Conclusion: VDD is common from birth to 9 months of age but incidence decreases spontaneously even without supplementation. Furthermore, a large number of babies may be falsely labeled as Vitamin D deficient with currently followed cutoffs. Hence a new cutoff for VDD needs to be established for neonates and infants.

Background: Nowadays, cartilage tissue engineering is the best candidate for regeneration of cartilage defects. This study evaluates the effect of fibrin/icariin (ICA) nanoparticles (F/I NPs) on chondrogenesis of stem cells. Materials and Methods: F/I NPs were characterized by Dynamic Light Scattering DLS. Poly (lactic-co-glycolic) acid (PLGA)-F/I NP scaffold was fabricated and assessed by scanning electron microscope. Human adipose-derived stem cells (hADSCs) were seeded on scaffold and induced for chondrogenesis. After 14 days, cell viability and gene expression were analyzed by the 3-(4, 5- dimethylthiazol-2yl)-2, 5-diphenyltetrazolium bromide (MTT) assay. MTT assay and real-time polymerase chain reaction (RT-PCR). Results: The size and surface charge of F/I NP were about 28–30 nm and − 17, respectively. The average of pore size of PLGA and PLGA–fibrin/ICA was 230 and 340 μm, respectively. Cell viability of differentiated cells in P/F group was higher than others significantly (P ≤ 0.05). Furthermore, quantitative RT-PCR analysis demonstrated that ICA upregulated cartilaginous-specific gene expression. Furthermore, the results of the expression of type I collagen revealed that ICA downregulated this gene significantly (P < 0.01). Conclusions: The results indicated that F/I NP could be a potential factor for chondrogenesis of stem cells and downregulation of fibrocartilage marker.

Background: Toxoplasma gondii (T. gondii) is a protozoan parasite that infects a wide range of warm-blooded animals and humans. The conventional anti-Toxoplasma treatments cause significant toxicity. Brassicaceae family contains several medicinal plants with anti-inflammatory, chemopreventive, insecticide, antibacterial, antiviral, and antiparasitic effects. In this study, the hydroalcoholic extract of some Brassicaceae species was investigated against T. gondii in vitro. Materials and Methods: Seeds of Alyssum homolocarpum, Lepidium perfoliatum, Lepidium sativum, and aerial parts of Nasturtium officinale and Capsella bursa-pastoris were extracted by maceration method using 80% ethanol. Vero cells were treated with different concentrations (5–600 μg/mL) of the extracts and pyrimethamine (as positive control), and the cellular viability was verified. Next, Vero cells were infected by T. gondii tachyzoites (RH strain), and the viability of the infected cells was measured by a colorimetric 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay. Results: The 50% inhibitory concentration values were 5.1, 14.67, 32.49, 37.31, 71.35, and 2.63 μg/mL, and the selectivity indices were 8.06, 2.59, 0.74, 0.78, 0.65 (P < 0.05 compared with positive control), and 3.03 for L. sativum, L. perfoliatum, N. officinale, A. homolocarpum, C. bursa-pastoris, and pyrimethamine, respectively. Conclusion: The results of this study demonstrated that the hydroalcoholic extracts of L. sativum and L. perfoliatum have the promising anti-Toxoplasma activity by growth inhibition of T. gondii tachyzoites in infected cells.

Background: Dermatomycoses contain superficial fungal infections of keratinized layers of the body such as skin, hair, and nail that affect more than 20%–25% of people and animals worldwide. Some fungi can cause superficial infections in animals after accidental penetration and colonization on injured skin and can be transmitted to humans by exposure. The infection caused mainly by dermatophyte species and may also be caused rarely by yeasts and nondermatophytic molds. Materials and Methods: Eighty-two skin scrapings and hair samples were collected from animals (sheep, cow, cat, camel, calf, goat, horse, and dog) in three specialized pet clinics and three livestock and slaughterhouses. The isolates were identified using direct microscopy, culture, and polymerase chain reaction-sequencing of ITS1-5.8SrDNA-ITS2 region. Results: Thirteen mold strains out of 82 clinical samples (15.8%) were isolated from animal lesions. Acremonium exuviarum (n = 4; 30.7%), Sarocladium implicatum (n = 2; 15.4%), Arthroderma otae (n = 2; 15.4%), Chaetomium iranianum (n = 1; 7.7%), Trichothecium roseum (n = 1; 7.7%), Lichtheimia ramosa (n = 1; 7.7%), Penicillium chrysogenum (n = 1; 7.7%), and Microsporum equinum (n = 1; 7.7%) were isolated from clinical specimens. Conclusion: Since opportunistic fungi are increasing as etiological agents of dermatomycoses, isolation of these molds from wounds can be a warning to veterinarians, and daily cleaning of wounds with a proper disinfectant is recommended for the prevention of fungal colonization.

Background: We conducted a study to evaluate the relationship between aura types and postoperative outcomes in patients with mesial temporal sclerosis (MTS) to predict the prognosis of patients, accordingly. Materials and Methods: In this cross-sectional study, 99 patients with MTS-temporal lobe epilepsy were enrolled based on inclusion and exclusion criteria. The types of aura were evaluated, and the outcomes were categorized according to theEngel scale. Preoperative and postoperative results of patients were compared and analyzed with the Kruskal–Wallis test. Results: About 73.7% of patients had seizure-free after their surgeries. The most of patients (n = 81)were in Class I of Evaluating Engel criteria. About 36.3% had not experienced any aura before their seizures, and among those with aura, the most prevalent aura was abdominal aura in 29 patients (29.3%) followed by other types of aura and affective aura. Most of the patients in Class I, II, III, and IV of Engel scale had an abdominal aura, without aura, effective aura, and abdominal aura, respectively, but this difference was not statistically significant (P = 0.691). Conclusion: According to this study, the type of aura cannot predict postoperative outcomes in MTS patients. More studies are needed to evaluate this relation in better-planned studies with greater sample size.

Background: In most countries, the age of addiction is declining, and the prevalence of adolescent addiction is increasing. Many factors can affect the addiction tendency; one of them can be a sense of responsibility. This study was designed to evaluate the probable relation between addiction tendency and responsibility. Materials and Methods: This cross-sectional study was conducted in Isfahan in 2018. A total of 496 high school students aged from 15 to 18 years were selected by a multistage cluster and systematic random sampling method. Students' responsibility and adolescents' addiction tendency questionnaire were used. The collected data were analyzed by the Statistical Package for the Social Sciences version 20 using Chi-square test, independent t-test, multivariate analysis of variance, and linear regression. Results: The mean age of participants was 16.50 ± 1.12. The results showed that boys' out-of-home activities were more than girls (P < 0.001), but there was no significant difference between girls and boys regarding indoor activities. Furthermore, it was found that girls were more responsible than boys (P = 0.004) and addiction tendency was higher in boys (P = 0.001). Social responsibility and addiction tendency had a significant negative relationship in this research (P < 0.001). In addition, parents' education, the feeling of belonging, and the sense of security had an effect on the addiction tendency (P < 0.001 for all). Conclusion: This study showed that social responsibility could affect the addiction tendency.

Background: The incidence of overweight and obesity in children has increased in recent decades. Physical activity (PA), which is a multidimensional behavior, has an important role in preventing and decreasing obesity. The aim of the study is to evaluate the knowledge, attitude, and exercise habits of middle school students and also explore the differences regarding demographic variables in Isfahan, Iran. Materials and Methods: One thousand seven hundred and forty-one middle school students were studied in this cross-sectional study, in 2015, Isfahan. Knowledge, attitude, and pattern of PA were evaluated by a questionnaire. Data were described using central tendency and dispersion values, as well as t-test, Chi-square, ANOVA, and linear regression tests for further analysis. Results: Students living in Khour and Biabanak and Tiran got the highest and lowest scores in knowledge (mean ± standard deviation: 9 ± 1.32 and 6.7 ± 2.19, respectively). Education of the father is the only variable which was associated with the knowledge about PA after adjusting for other factors. About 62.5% of the students mentioned a good attitude toward PA. About 50% of the students said that they always and often do exercise. The most favorable exercise for all the students was walking. Conclusion: We provide the pattern of PA among middle school students of Isfahan province, which can be used to design evidence-informed policies and interventions that aim to increase PA in students.

Background: The release of dopamine (DA) has certain roles in the induction of conditioned place preference (CPP) and motor learning in the ventral tegmental area (VTA). The aim of this study was to investigate the excitatory effects of DA through DA-D1 agonist (SKF38393) and elimination of the inhibitory effects of DA through DA-D2 antagonist (eticlopride) into the VTA and its synergistic effects with an ineffective dose of morphine in the induction of CPP. Materials and Methods: Morphine (2.5 mg/kg; s. c.) did not induce a significant CPP, without any effect on the locomotor activity during the testing phase. SKF38393 (0.125, 0.5, and 1 μg/side) and eticlopride (0.5, 1, and 2 μg/side) individually or simultaneously were microinjected bilaterally into the VTA. Results: The administration of SKF38393 (1 and 2 μg/rat) with ineffective morphine and also without morphine caused CPP on test day, while eticlopride (2 μg/rat) caused CPP with morphine only. Locomotor activity increased in groups receiving D1 agonist and D2 antagonist that presumed to be caused by the reinforcing effect. In addition, the concurrent administration of ineffective doses of D1 agonist and D2 antagonist into the VTA with ineffective morphine caused CPP but not with saline. Conclusions: This study showed that there was a need for morphine to activate the reward circuit through the D2 receptor in the VTA while the administration of the D1 agonist could independently activate the reward circuit. In addition, there was a probable synergistic effect using ineffective doses of D1 and D2 receptors, in the acquisition of morphine-induced CPP.

Background: Molgramostim, a nonglycosylated version of recombinant granulocyte-macrophage colony-stimulating factor (GM-CSF), can be produced in a high level by Escherichia coli. However, overexpression of GM-CSF in bacterial cells usually leads to formation of inclusion bodies and insoluble protein aggregates which are not biologically active. The aim of the present study was to improve the expression of soluble and biologically active GM-CSF in periplasmic space of E. coli BL21 (DE3). Materials and Methods: The codon-optimized GM-CSF gene was subcloned into pET-22b expression vector, in frame with the pelB secretion signal peptide for periplasmic secretion. Cultivation conditions including as isopropyl β-D-1-thiogalactopyranoside (IPTG) concentration, incubation temperature, and presence of sucrose were optimized to improve periplasmic expression of GM-CSF. The expressed protein was purified using Ni-NTA affinity column. Biological activity of GM-CSF on HL-60 cells was evaluated using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. Results: The amount of soluble protein for periplasmic expression was more when compared with one of the cytoplasmic expressions. The optimum condition for periplasmic expression of GM-CSF was expression at 23°C, using 1 mM IPTG as inducer and in the presence of 0.4 M sucrose. The biological activity of purified GM-CSF on HL-60 cell line was assessed by MTT assay, and the specific activity of produced GM-CSF was determined as 1.2 × 10⁴ IU/μg. Conclusion: The present work suggests that periplasmic expression and optimization of cultivation conditions could improve soluble expression of recombinant proteins by E. coli.

Uveitis and erythema induratum are two uncommon extrapulmonary manifestations of tuberculosis (TB). In most circumstances, we cannot isolate mycobacterium from those sites, so diagnosis is difficult. In the presented case, panuveitis, erythema induratum, and persistent anogenital warts were found concurrently in a 19-year-old girl who had a history of pulmonary TB 10 years ago. Assessment of her immune condition ruled out any immunodeficiency state. Extrapulmonary TB and persistent warts responded dramatically to anti-TB drugs and interferon-gamma, respectively. Our case reveals that a constellation of these clinical manifestations may also occur in immunocompetent individuals.

Background: Fatty liver disease is a common hepatic disorder that remains undiagnosed due to the high number of asymptomatic patients and lack of a proper noninvasive diagnostic tool. Liver biopsy, the gold standard of liver steatosis diagnosis, is an invasive method that can be replaced by fibroscan. Fibroscan can detect liver steatosis with high sensitivity and specificity, but it is not accessible around the world. In this study, we compared ultrasonography (US) as a cheap and accessible device with fibroscan method in detecting patients with liver steatosis. Materials and Methods: We enrolled 77 patients in this study. US and fibroscan were done in each patient at a single day. Liver steatosis stages were recorded using US and fibroscan. The diagnostic performance of US was calculated, using fibroscan as the reference method. Results: The sensitivity and specificity of US in detecting fatty liver disease using fibroscan as a standard method were 73% and 69%, respectively. Conclusion: Based on sensitivity and specificity achieved from US, this study suggests that ultrasound is a suitable method for detecting patients with liver steatosis obviating liver biopsy and fibroscan.

Background: One of the most common problems in the intensive care unit (ICU) is the incidence of pressure ulcer or bedsore. This research was conducted with the aim to compare the effect of henna and olive on pressure ulcer grade one in ICU patients hospitalized in the selected hospitals of Isfahan University of Medical Science in 2016. Materials and Methods: This study conducted on 108 ICU patients with pressure ulcer. Patients were randomly divided into three groups. The two intervention groups were treated with olive oil and henna oil, respectively, and the third group was the control group. Data were collected using a demographic information questionnaire, Braden pressure ulcer risk assessment scale, and a table for daily record of the skin temperature before and within 1 week of the study. Data were analyzed in SPSS 22 using independent t-test, repeated-measures ANOVA, and Fisher's exact test. Results: The results showed a significant difference between the two henna and olive groups in the mean score of pressure ulcer measured through the pressure ulcer scale for healing tool (P < 0.05). The mean area of the ulcer on days 4 and 7 in the henna oil group was lower than that in the olive oil and control groups (P < 0.001). Conclusion: The results of this study showed that both henna and olive oils were effective in healing the pressure ulcer. However, henna oil showed better results in reducing the area of pressure ulcers over time.

Background: Melatonin has anxiolytic and potential analgesic effects. Several studies have indicated the sedative and anti-anxiety effects of melatonin when used as premedication before surgery. Hence, we assessed the efficacy of melatonin premedication in tourniquet-related pain and analgesia in patients receiving intravenous regional anesthesia (IVRA). Materials and Methods: Fifty patients undergoing elective hand surgery under IVRA were randomly divided into two groups (25 patients each) to receive either melatonin 6 mg (melatonin group) or placebo (control group) as oral premedication. IVRA was achieved with lidocaine, 3 mg/kg, diluted with saline to a total volume of 40 mL. Anxiety scores, sensory and motor block onset and recovery times, tourniquet pain, and 24-h analgesic requirements were recorded. Results: The onset of motor and sensory block was statistically significantly shorter in Group M (P < 0.001), and recovery of motor and sensory block was statistically significantly longer in Group M (P < 0.001). The time of starting tourniquet pain was longer in Group M (P < 0.001). The mean anxiety score in the study group was 3 ± 0.81 and in the control group was 4.20 ± 1.04 (P = 0.001). There was a statistically significant difference in the need for opioids between the two groups (P < 0.05). Conclusions: Melatonin is an effective premedication before IVRA because it reduces patient anxiety, decreases tourniquet-related pain, and improves perioperative analgesia.

Background: Diabetes, a major metabolic disorder, seems to affect the fertility rates of women in various ways. Due to the uncertainty of the effects of diabetes along with superovulation treatment on the infertility, we investigate the effects of ovulation induction treatment as therapeutic approach on the expression of leukemia inhibitory factor (LIF) and vascular endothelial growth factor A (VEGFA) as two main factors which are involved in the implantation in the streptozotocin (STZ)-induced type 1 diabetic rats. Materials and Methods: Type 1 diabetes was induced by injections of STZ in Wistar rats. The animals were kept in diabetic conditions for 4 weeks, while some were treated with insulin for treatment. After treatment, the ovulation was induced by human menopausal gonadotropin (hMG) and human chorionic gonadotropin (hCG). The rats were then sacrificed and the expression of LIF and VEGFA was checked by immunohistochemistry staining method, and the relative expression of LIF and VEGFA was measured by quantitative reverse transcription polymerase chain reaction (RT-PCR) and Western blotting methods. Results: It was observed that diabetes and insulin treatment for diabetes altered the expression of Lif and VEGFA in both mRNA and protein levels. However, superovulation treatment seems to ameliorate this alternation for both factors. Conclusion: According to our results, diabetes and insulin therapy could alter the expression of Lif and VEGFA genes and proteins that are effective in endometrial receptivity and implantation process. It seems in diabetic cases, the effect of hCG and hMG therapy by itself could regulate the level of expression and presence of these two genes and proteins.