Background: Prolonged catheter insertion in central veins of hemodialysis patients usually causes central venous stenosis (CVS). These patients present with upper limbs, head and neck, and chest edema or hemodialysis problems. This study was done to determine the clinical success of balloon angioplasty for the treatment of symptomatic CVS/obstruction. Materials and Methods: Sixty-one hemodialysis patients who underwent endovascular treatment for CVS enrolled in this cross-sectional study between January 2017 and July 2018 at our institute. Enrollment included 29 female and 32 male subjects with a mean age of 58.9 ± 9.9 (range: 33–78) years. Results: A total of 61 patients underwent interventions for endovascular treatment of central venous disease. 38 out of 61 patients completed all three phases of the study (the beginning, after 3 and 6 months). The average diameter of central vein in venography at the beginning of the study, 3 and 6 months later were 8.66 mm, 8.03 mm, and 7.66 mm, respectively. The average patency was 45%, and 54% and 51% at the beginning of the study, 3 and 6 months after the treatment, respectively. There was an increase in central vein patency after 3 months of treatment, with significant difference among 3 phases (P < 0.000). Conclusion: Endovascular treatment is effective and safe for patients with central vascular stenosis with less complication rate compared to open surgical treatments, and the rate of venous patency in the treated veins with balloon angioplasty after 3 months is excellent, but this rate after 6 months is significantly reduced.

Leukemia cutis is a rare cutaneous manifestation of chronic lymphocytic leukemia (CLL) which mostly occurs in the late stages of the disease. We reported an unusual case of a patient with leukemia cutis that developed before the diagnosis of CLL and mimicked cutaneous leishmaniasis (CL). A 52-year-old female presented with an ulcerative nodule on the right forearm. The lesion initially was suspected of being cutaneous leishmaniasis; however, the examination of skin lesion biopsy revealed a dense, diffuse, and monomorphous infiltration of lymphocytes in the dermis. Furthermore, immuno-histochemistry analysis of skin lesion biopsy was indicative of small lymphocytic lymphoma (SLL). The result of laboratory tests showed high white blood cell and lymphocyte counts. The results of bone marrow smear, flow cytometric analysis, and computed tomography of the abdomen and pelvis were suggestive of CLL/SLL (stage I). This case has clinical implications for early diagnosis and management of CLL/SLL.

Background: The high prevalence of cervical cancer in developing countries, despite its preventive nature, makes the disease a principal matter of concern for scientific studies. Providing global availability of primary and secondary preventive methods based on the high-risk human papillomavirus (HPV), which is the well-known pathogenesis in most malignant cervical lesions, has become the World Health Organization's (WHO's) critical target for 2030. Considering the demographic diversity and manufacturing of the internal vaccine in Iran, there is need for more study on the cost-effectiveness of these strategies. Materials and Methods: This study intends to assess female HPV prevalence at the time in Iran provinces, especially in the capital province, Khorasan Razavi, in the north to establish a scientific rationale for conducting further studies on arguments for and against national HPV prevention strategies in line with the WHO. In this population-based study, the HPV prevalence was evaluated in 900 cervical samples accumulated between 2012 and 2015. The data were later compared with recently published data in the same province, in the north of Iran. Result: Based on the results of our cross-sectional study, the estimated prevalence of HPV infection in the northern female population was 4.1% in 2015 and significantly increased to 35% in 2021. Conclusion: The hypothesis of the impact of behavioral and cultural changes in addition to population aging on general health indicates the need for national health promotion strategies. Additionally, it emphasizes the critical significance of conducting further investigational studies to obtain the actual and updated prevalence of HPV in Iran.

Background: Coronavirus disease (COVID-19) pandemic around the world has some adverse effects on the human body, and there is limited data about the impacts of this pandemic disease on embolic brain stroke. Materials and Methods: Fifty-two COVID-19 patients with embolic brain stroke were included in this study. The COVID-19 patients were diagnosed according to their clinical findings. The patients underwent diffusion-weighted imaging (DWI) and the apparent diffusion coefficient (ADC) values of different points of their brain were calculated using MRIcro software. Results: The embolic strokes were mostly diagnosed in the medial temporal lobe for both COVID-19 and others. In addition, a combination of COVID-19 with other inflammations and infections was not diagnosed in the studied patients. The mean ADC values of the central region were significantly lower than other regions of the brain stroke for the COVID-19 and other patients. Moreover, the maximum and minimum ADC values of the central region for COVID-19 and other patients were significantly different compared to the other regions. Whereas, the mean and minimum ADC values of the brain's normal regions were not significantly different in the edge regions for both groups, while in the COVID-19 and other patients the maximum ADC value of the edge regions was considerably lower compared to the normal regions. Conclusion: The embolic stroke of COVID-19 patients is likely to occur in the medial temporal lobe of the brain. Moreover, the ADC and relative ADC (rADC) values of embolic brain stroke in COVID-19 patients are not significantly different compared to others.

Diabetes mellitus type 1 is a chronic condition characterized by the loss or dysfunction of β-cells in the pancreas, resulting in insufficient insulin production. This mini-review examines current treatment approaches and explores the potential of gene therapy as interventions for type 1 diabetes mellitus. The discussed strategies include β-cell sensitization, β-cell regeneration from various cell sources, stem cell therapies, and the promotion of β-cell replication. The article emphasizes the importance of understanding the pathways involved in β-cell proliferation and the factors influencing their replication. Stem cell therapies, particularly using embryonic stem cells and induced pluripotent stem cells, hold promise for generating β-cells and replacing damaged or lost cells. Additionally, gene therapy offers a novel approach by manipulating genes involved in insulin production and glucose metabolism. However, ethical considerations, tumorigenic risks, and the translation of these therapies into clinical trials pose challenges. Nonetheless, the ongoing research and advancements in these areas provide hope for improved management and treatment of type 1 diabetes mellitus.

Background: Data gathering and bioinformatics play a significant role in the management and treatment of patients, especially of critically ill patients. This study assesses the feasibility and design of a registration system for nosocomial infections and sepsis in the intensive care unit of Alzahra university hospital in Isfahan. Methods: The members of the registration system consisting of physicians and nurses of the ICU, infectious disease and pulmonary specialists, microbiologists, infection control supervisors, and librarians. The data collection tool was a researcher-made checklist. To design the framework of the tool, researchers investigated various tools and indices in references and databases such as PubMed, Scopus, Web of Science, and national databases regarding ICU infection and disease registration systems. Essential items in this field were selected and a preliminary draft was prepared to record the data of patients with ICU-related infections. After applying experts' opinions, the checklist was reviewed, and the final approval of the checklist was obtained. Results: The final version of the checklist is prepared in three parts consisting of demographic data, principle variables (data required for registration of a patient), and the extended variables including details of the principle variables, and the data used to diagnose and treat. Conclusion: The ICU infection registration system can predict the prevalence of infection, monitor services and treatment of patients, analyze survival, assess clinical care outcomes, and investigate drug-related interventions. Reducing hospitalization costs by stratifying patients, providing a database for research studies, assessing the cost-effectiveness of interventions, are other advantages that resulted from the design of this system.

Background: Spinal cord injury (SCI) is the second cause of complications and disability after brain injury. Although primary prevention is the best strategy, obtaining the necessary knowledge about the patient's condition and follow-up treatment can lead to the use of safety measures and appropriate healthcare planning. This is the basis of this study with the aim of a two-year follow-up of patients with traumatic SCI (TSCI) who underwent surgery. Materials and Methods: This study was a descriptive and analytical type that examined 79 patients with TSCI who had undergone surgery two years ago. The data were collected by a standard questionnaire and analyzed in Statistical Package for the Social Sciences (SPSS) version 24 software. Results: Among the patients in our study, 39.2% of them had the initial C American Spinal Injury Association (ASIA) score followed by patients with grade D (31.6%), grade A (15.2%), and grade E (14%), respectively, and also, a most common type of vertebral column injuries is burst fractures with a prevalence of 62%, followed by fracture–dislocation injury (25.3%) and compressed fracture (12.7%). Regarding the improvement of patients according to ASIA grade, the highest percentage of improvement is seen in grad grades D (84% and 77%), and grade A patients have improved to grade B by about 33.3%. In the study conducted, 5% of patients died during 24 months of follow-up, which means 75% of the deceased patients were grade A patients at the time of admission. Conclusion: As mentioned, the most important predictor of the patient's prognosis is the patient's initial condition.

Background: Post-stroke hemiplegic shoulder pain (HSP) is a common complication leading to significant activity limitation. Some approaches have been recommended for the management of HSP, and most of them have various adverse effects, while none were established to be effective. This study aimed to evaluate the effect of minimally invasive extracorporeal shockwave therapy (ESWT) on patients with HSP pain management. Materials and Methods: Using a single-blind, randomized clinical trial, 43 patients with HSP were randomly assigned to complete three focus ESWT sessions once a week and additional five radial ESWT sessions twice a week. Patients in the control arm received zero energy ESWT. Visual analog scale, passive range of motion (ROM), Fugl-Meyer upper extremity assessment (FMA-UE), and shoulder pain and disability scale (SPADI) were measured at baseline, at the end of the interventions, and within four and eight weeks' intervals to evaluate the pain, function, and ROM in the affected shoulder. Result: Both groups showed an improvement in pain scores on the fourth and eighth weeks visits (P-value <0.001). Intervention with ESWT could effectively lead to a less severe pain score compared to the control group (P-value <0.001). In the intervention group, the ROM improved in both passive abduction and forward flexion (P-value <0.05), but no significant change was observed in the control group (P-value >0.05). FMA-UE and SPADI did not differ significantly between groups. Conclusion: Based on the findings of this study, the combination of rESWT and focused ESWT can efficiently improve stroke-induced HSP.

Epidermoid and dermoid cysts are benign tumors lined by stratified squamous epithelium. Any region of the body that is covered by squamous epithelium has the potential ability to develop them. Herein, we reported two rare cases with benign cystic teratoma at unusual sites in the genital system. The first case was a 29-year-old G1P1L1 female admitted in our center with pelvic pain 2 months ago. Magnetic resonance imaging (MRI) showed a mass in the posterior cul-de-sac with severe fat content. The patient underwent laparoscopy. Histopathological study of the removed mass showed a dermoid cyst. The second patient was a 35-year-old G3L1Ab2 female who was admitted to our clinic with the chief complaint of abnormal uterine bleeding since one year ago. The ultrasonography represents a hyperecho 65 × 27 mm mass lesion in the endometrial canal progressing toward cervical canal. After laparotomy, a degenerated myoma was resected. Surprisingly, histopathological study of the removed mass showed a mature cystic teratoma. To the best of our knowledge, it is the first study which reports cystic teratomas in the cervix region.

Background: The aim of this study was to evaluate pelvic MRI accuracy for measurement of anatomical land marks in severe fecal incontinent (FI) children with high imperforate anus (IA). Materials and Methods: A total of 80 children (40 cases and 40 controls) aged more than 4 years with severe FI were assessed. Magnetic resonance imaging was performed by a radiologist with the same device. For pelvic anatomical land marks measurement, we measured the ano-rectal angel and hiatal/pc ratio. Results: The mean of ano-rectal angel was 118.67 ± 25.2 mm in cases and 132.07 ± 13.8 mm in control group (P = .004). H/PCR was 0.63 ± 0.05 in cases and 0.62 ± 0.45 in controls (P = NS). There was no significant correlation between [INSIDE:1] (r = 0.25, P = 0.36) or ano-rectal angle measurement (r = 0.16, P = 0.05) and FI score in patients with severe FI. Conclusions: Pelvic magnetic resonance imaging could be accurately used is measuring the ano-rectal angle is high IA children with severe FI which leads to selected patients who may have benefits of reoperation.

Background: The purpose of this study was to evaluate the effect of shields in imposed radiation dose to gonads in anterior-posterior (AP) and lateral views of lumbosacral radiography using digital radiography (DR) and computerized radiography (CR) methods. Materials and Methods: Sixty patients who were suspected to AP and lateral view of lumbosacral radiography were included in this study. The patients were exposed with and without shields which have 0.25 mm thickness. This study also compared the imposed dose to gonads for one and two plates of shields with none shields situation. Measurement of the radiation dose was performed using thermo luminescence dosimeters on the surface of the gonads. Furthermore, the absolute and excess relative risk (ERR) of biological abnormalities was estimated in the above-mentioned method using the BEIR VII model. Results: The mean dose of the DR method (10.14 ± 0.27) for the AP view was significantly lower than CR (32.43 ± 0.17) with and without shields. In addition, the imposed dose to gonads in the lateral view of DR (6.41 ± 0.47) was lower compared to CR (9.38 ± 0.14). Furthermore, the mean imposed dose to gonads for one and two pate shields of DR was lower than CR. Moreover, the excess relative risk to gonads in the AP for DR was lower compared to CR in all mentioned situations. Conclusion: Lumbosacral radiography is suggested to be performed by DR systems, due to the lower imposed dose and ERR to the gonads. Moreover, using shields may lead to decrease of scatter rays and also ERR of the gonads.

Background: One of the concerns after bariatric surgery is the lack of nutrients and vitamins due to anatomical and physiological changes that occur after the surgery. The aim of the present study is to evaluate the effect of laparoscopic sleeve gastrectomy on these nutrients and vitamins. Materials and Methods: This prospective study was performed in Tehran and all the patients who met the inclusion criteria before the surgery were tested for serum levels of vitamins A, B12, D, ferritin, serum iron, and TIBC. The patients were tested once again for the same micronutrients, one year after surgery. Results: A total of 120 patients had the inclusion criteria and all of them completed the follow-up period. Of the patients, 64.2% (77 patients) were female and 35.8% (43 patients) were male. The mean weight of the patients was 122.1 ± 14.8 kg and the mean BMI of patients before surgery was 43.6 ± 4.4 kg/m². Comparing these parameters before and after surgery showed that serum levels of vitamins A and B12, ferritin, and TIBC were not significantly different from before surgery. However, vitamin D levels after surgery were significantly higher than before (p < 0.001). Conclusion: The result of the present study demonstrated that laparoscopic sleeve gastrectomy is one of the most effective surgical methods for obesity treatment and does not cause a lack of nutrients and vitamins in long term and does not require supplementation. In addition, it promotes serum levels of vitamin D, which is effective in preventing the effects of vitamin D deficiency in obese patients.

Physical therapies such as electroconvulsive therapy (ECT) may result in higher response and recovery rates, especially in patients who have treatment-resistant depression. Various studies have reported different changes in heart rate variability (HRV) parameters before and after depression treatment with ECT. Therefore, the present study reviews systematically the evidence describing changes in HRV parameters and the cardiac autonomic nervous system associated with ECT. Scopus, Web of Science, PubMed, and Embase electronic databases were searched for papers published up to September 8, 2022, without any restriction on the year and language of the study. A total of 895 articles were reviewed by two independent groups and nine articles that met the inclusion criteria were selected. Time-domain and frequency-domain HRV parameters were assessed. In conclusion, the results of our systematic review provided limited evidence for the influence of ECT on HRV parameters. Despite studies suggesting depression results in a decrease in parasympathetic activity and ECT results in an increase in cardiac vagal activity, ECT seems to have no consistent effect on HRV parameters.

Background: Small bowel length measurements and estimation have high clinical importance, especially in bariatric surgeries to prevent postoperation malnutrition. This study aimed to investigate the possible correlation between demographic and anthropometric factors with small bowel length. Materials and Methods: This cross-sectional study was performed on 150 patients that were candidates of abdominal surgeries. Anthropometric factors including age, gender, weight, height, body mass index, right wrist and waist circumstance, length of the right hand 2^nd and 4^th fingers and 2^nd to 4^th finger ratio, and length of the right hemithorax were obtained. Whole length of the small bowel was measured during surgery from the ligament of Treitz to the ileocecal junction between the mesenteric and antimesenteric border of the intestine. Results: The mean small bowel length was 5.45 ± 1.62 meters and significantly lower in women compared to men (P = 0.003) and had a significant direct relationship with height (r = 0.3, P < 0.001), an inverse relationship to 2^nd to 4^th finger ratio (= −0.34, P < 0.001). There were the same correlations between small intestine length with height and the 2^nd to 4^th finger ratio in open surgeries (P < 0.05). There was a correlation between age (r = 0.33, P = 0.032), weight (r= −0.60, P, 0.001), waist circumstance (r = −0.43, P = 0.004), and length of the right hemithorax (r = −0.47, P = 0.001). Conclusions: Using demographic and anthropometric factors, we could predict the small bowel length. These results could be further used in bariatric surgeries to avoid possible malnutrition.

Background: The aim of this study was to assess the prevalence of insulin resistance (HOMA-IR) between patients with and without thyroid nodules. Materials and Methods: This case–control study was performed on 86 patients with normal Thyroid-stimulating hormone (TSH) level (0.5–4.5 mIU/L) with thyroid nodules, who referred to Imam Khomeini and Golestan Hospitals (Ahvaz, Iran). Furthermore, 43 nonnodule patients with normal TSH level and normal thyroid ultrasonography were recruited from the general population as control group. The insulin resistance was evaluated for them made and the HOMA-IR ≥2.5 was defined as insulin resistance. Results: The mean of HOMA-IR value was significantly higher in thyroid nodule patients compared to controls (3.02 ± 1.92 vs. 1.10 ± 1.55; P < 0.001). Insulin resistance was seen in 49 thyroid nodule patients (57.0%), and 4 patients (9.3%) in the control group (P < 0.0001). Waist circumference, body mass index, fasting blood sugar, triglyceride, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and insulin levels were significantly higher in the thyroid nodule group. Conclusions: Our study shows there is an association between insulin resistance and thyroid nodules. The patients with thyroid nodules have higher HOMA-IR value.

Background: The present study was performed to compare the effectiveness of propofol–remifentanil and propofol–hydralazine in inducing controlled hypotension in patients undergoing the dacryocystorhinostomy (DCR) surgery and reducing their bleeding volume during surgery. Materials and Methods: The present double-blind, randomized clinical trial was performed on 70 patients who were candidates for DCR surgery and divided into two groups. In both the groups, general anesthesia protocol was performed. Moreover, in the first group, a syringe containing 2 mg of remifentanil in 20 ml of distilled water (0.1 mg/ml) was infused at the rate of 0.15 μg/kg/min (P + R group). In the second group, a syringe containing 20 mg of hydralazine in 20 ml of distilled water (1 mg/ml) was infused at the rate of 0.5–10 mg/h (P + H group). Results: The hemodynamic parameters were not significantly different between the two groups in the studied times (P > 0.05). In contrast, the bleeding volume in the P + R group with the mean of 61.29 ± 50.06 ml was significantly lower than that of the P + H group with the mean of 152.31 ± 90.81 ml (P < 0.001). Moreover, the mean score of surgeon's satisfaction level in the P + R group was higher than that of the P + H group (5.91 ± 0.28 vs. 4.29 ± 0.65; P < 0.001). Conclusion: According to the results of this study, there was no significant difference between the P + H and P + R groups in terms of fluctuations in the hemodynamic parameters and the occurrence of complications. However, a reduction in the bleeding volume and a higher satisfaction level of the surgeon were observed in the P + R group compared with the P + H group.

Background: Tibial plateau fractures have become more frequent in recent years. The most prevalent Schatzker classification is type II, which is a lateral tibial plateau fracture with depression. Our null hypothesis was that the 3.5 T-plate and the 4.5 T-plate have no difference in the management of patients with Schatzker type II tibial plateau fractures. Materials and Methods: The current study is a clinical trial that was conducted on patients with tibial plateau fractures. The Knee Society Score (KSS) was this study's main outcome. Tourniquet time (TT) and patient quality of life using the 36-item Short Form Survey Instrument (SF-36) were secondary goals of the outcomes measurement study. VAS measured pain. Among 176 patients, 89 and 87 of cases underwent surgical treatment with 3.5-mm (group A) and 4.5-mm (group B) T-plate, respectively. The data were entered into SPSS software (version 25, IBM Corporation, Armonk, NY) and analyzed. Results: In our study, we evaluated 176 patients with a mean age of 34.8 ± 15.2 years. Functional and clinical KSS scores were similar between the two groups throughout follow-up (P > 0.05). Regarding the other variables of VAS, TT, SF-36 physical function, and SF-36 mental health, no significant difference was observed between the two groups, and the two groups had similar averages in terms of these indicators (P > 0.05). Conclusion: According to the results, both plates had the appropriate functional outcomes in patients with split depression tibial plateau fracture.

Background: Enterococci may develop resistance to linezolid through chromosomal mutations that involve specific linezolid resistance genes, such as cfr, optrA, and poxtA. The objective of this study was to evaluate the antibiotic susceptibility of enterococcal isolates and identify cfr, optrA, and poxtA genes in MDR isolates. Materials and Methods: Enterococcal isolates were collected from various clinical specimens at Al-Zahra, Amin, and Khorshid Hospitals in Isfahan. The Enterococcus isolates were identified as belonging to the E. faecalis and E. faecium species by using specific gene (D alanine D alanine ligase ddl) sets in PCR. To detect cfr, optrA, and poxtA genes among the species, a multiplex-PCR assay was performed. Results: Out of 175 isolates, E. faecalis predominated 129/175 (73.7%). Furthermore, the prevalence of vancomycin-resistant Enterococci (VRE) and linezolid-resistant Enterococci (LRE) was 29.7% and 4%, respectively. The overall prevalence of MDR was 91.1%, 68.9%, and 66.6% of E. faecium, E. faecalis, and other Enterococcus spp., respectively. Interestingly, the frequency of optrA (71.4%) in E. faecium and poxtA and crf (42.8%) in E. faecalis were detected among LRE species. A statistically significant relationship (P < 0.05) was found between the presence of the three genes and the occurrence of LRE. Conclusion: This is the first study to report the detection of linezolid resistance genes (cfr, optrA, and poxtA) in clinical Enterococcus spp. isolates from Iran, conducted at Isfahan University of Medical Sciences hospitals. The emergence of enterococcal strains that resist linezolid is concerning as it can lead to the spread of resistant strains among patients, resulting in treatment failure.

Background: To reduce the complications of orthopedic surgery, the desire for less invasive procedures, such as, knee arthroscopy to repair the anterior cruciate ligament, has increased. There are, currently, two common positions for limbs that are used during surgery depending on the surgeon's experience. Therefore, our aim was to investigate the effect of limb position on complications after anterior cruciate ligament reconstruction surgery. Materials and Methods: From April 2016 to July 2020 at our orthopedic-sports trauma center, 688 patients between the ages of 18 and 50 with anterior cruciate ligament rupture underwent reconstruction surgery with a hamstring graft. Patients were divided into two groups in terms of limb position at the time of surgery. For three months, patients were evaluated for surgical complications, basic demographic information, and information during surgery. Results: There was no statistically significant difference between the two groups in terms of demographic information, side of injury, preparation time, tourniquet time, operation time, and duration of hospitalization. At quarterly follow-up, there was no significant difference between the two groups in terms of postoperative complications (P = 0.976). Conclusions: There is no difference between compartment syndrome and deep vein thrombosis in different situations, therefore, the surgeon should operate in any position he is skilled in. Also, surgeons should always pay special attention to these complications and provide necessary training to patients in order to prevent them.

Background: To reduce the complications of orthopedic surgery, the desire for less invasive procedures, such as, knee arthroscopy to repair the anterior cruciate ligament, has increased. There are, currently, two common positions for limbs that are used during surgery depending on the surgeon's experience. Therefore, our aim was to investigate the effect of limb position on complications after anterior cruciate ligament reconstruction surgery. Materials and Methods: From April 2016 to July 2020 at our orthopedic-sports trauma center, 688 patients between the ages of 18 and 50 with anterior cruciate ligament rupture underwent reconstruction surgery with a hamstring graft. Patients were divided into two groups in terms of limb position at the time of surgery. For three months, patients were evaluated for surgical complications, basic demographic information, and information during surgery. Results: There was no statistically significant difference between the two groups in terms of demographic information, side of injury, preparation time, tourniquet time, operation time, and duration of hospitalization. At quarterly follow-up, there was no significant difference between the two groups in terms of postoperative complications (P = 0.976). Conclusions: There is no difference between compartment syndrome and deep vein thrombosis in different situations, therefore, the surgeon should operate in any position he is skilled in. Also, surgeons should always pay special attention to these complications and provide necessary training to patients in order to prevent them.

Background: Only 5 to 10% of cancers are hereditary, but they are particularly important since they can be passed down from generation to generation, and family members are at elevated risk. Although screening methods are one of the essential strategies for dealing with hereditary cancers, they do not have high specificity and sensitivity. The emergence of whole-exome sequencing (WES) causes a significant increase in the diagnostic rate of cancer-causing variants in at-risk families. Materials and Methods: We performed WES on the proband's DNA sample from an Iranian family with multiple cancer-affected members to identify potential causative variants. Multiple in silico tools were used to evaluate the candidate variants' pathogenicity and their effects on the protein's structure, function, and stability. Moreover, the candidate variants were co-segregated in the family with Sanger sequencing. Results: The WES data analysis identified two pathogenic variants (CHEK2: NM_007194.4: c.538C>T, p.Arg180Cys and MLH1: NM_000249.4, c.844G>A, p.Ala282Thr). Sanger sequencing data showed each of the variants was incompletely segregated with phenotype, but both of them explained the patient's phenotype together. Also, the structural analysis demonstrated that due to the variant (c.538C>T), a salt bridge between arginine 180 and glutamic acid 149 was lost. Indeed, several protein stability tools described both variants as destabilizing. Conclusion: Herein, we interestingly identify two distinct deleterious causative variants (CHEK2: NM_007194.4: c.538C>T, p.Arg180Cys and MLH1: NM_000249.4, c.844G>A, p.Ala282Thr) in a family with several cancer-affected members. Furthermore, this study's findings established the utility of WES in the genetic diagnostics of cancer.

Background: Only 5 to 10% of cancers are hereditary, but they are particularly important since they can be passed down from generation to generation, and family members are at elevated risk. Although screening methods are one of the essential strategies for dealing with hereditary cancers, they do not have high specificity and sensitivity. The emergence of whole-exome sequencing (WES) causes a significant increase in the diagnostic rate of cancer-causing variants in at-risk families. Materials and Methods: We performed WES on the proband's DNA sample from an Iranian family with multiple cancer-affected members to identify potential causative variants. Multiple in silico tools were used to evaluate the candidate variants' pathogenicity and their effects on the protein's structure, function, and stability. Moreover, the candidate variants were co-segregated in the family with Sanger sequencing. Results: The WES data analysis identified two pathogenic variants (CHEK2: NM_007194.4: c.538C>T, p.Arg180Cys and MLH1: NM_000249.4, c.844G>A, p.Ala282Thr). Sanger sequencing data showed each of the variants was incompletely segregated with phenotype, but both of them explained the patient's phenotype together. Also, the structural analysis demonstrated that due to the variant (c.538C>T), a salt bridge between arginine 180 and glutamic acid 149 was lost. Indeed, several protein stability tools described both variants as destabilizing. Conclusion: Herein, we interestingly identify two distinct deleterious causative variants (CHEK2: NM_007194.4: c.538C>T, p.Arg180Cys and MLH1: NM_000249.4, c.844G>A, p.Ala282Thr) in a family with several cancer-affected members. Furthermore, this study's findings established the utility of WES in the genetic diagnostics of cancer.

Background: Tonsillectomy, one of the most common otolaryngology surgeries, often results in postoperative complications such as pain and bleeding. Currently, there is no consensus on postoperative pain management. This study aimed to determine the efficacy of oral prednisolone on postoperative pain after tonsillectomy with sutures. Materials and Methods: This pilot, double-blind, randomized clinical trial was conducted at two tertiary care centers affiliated with Isfahan University of Medical Sciences. Patients who underwent tonsillectomy with sutures were included. Participants were randomly divided into experimental and control groups. In the experimental group, patients received oral prednisolone in addition to acetaminophen; in the control group, patients received acetaminophen and a placebo. Post-operative pain was evaluated by a visual analog scale daily for ten days. Results: Initially, 60 patients were enrolled in the study; however, four were excluded due to non-attendance at follow-up visits. The groups were similar in terms of age and sex (both P values >0.05). In the study, postoperative pain from 1^st day to the 10^th day was lower in the experimental group than in the control group (P value <0.05). Conclusion: Numerous studies have been conducted on the effect of intravenous corticosteroids on this pain. However, there is no consensus on the analgesic role of oral corticosteroids for post-tonsillectomy pain. The present study showed that oral prednisolone is effective on post-operative pain compared to a placebo.

Background: Toxocariasis is an acute or chronic disease caused by parasites of the Ascaridae family, especially Toxocara of dogs and cats. Eggs are excreted out by feces of these animals on soil. Infective eggs develop on soil which can be infective to human. In this study, infection rate of Toxocara spp. in dogs and cats of urban and rural areas of Isfahan province of Iran has been investigated. Materials and Methods: Three hundred and seventy-five stray dog feces and 230 stray cat feces were collected from the public environment (slaughterhouses, parks, children's playgrounds, student dormitories, university environment, streets and squares) in Isfahan province of Iran. At first, dogs' and cats' feces were examined for the presence of Toxocara spp. eggs using formalin ether method. In the second stage, by using molecular methods, Toxocara eggs spp. (Toxocara canis or Toxocara cati) were identified. Results: From 375 dog fecal samples, 39 (10.40%) and from 230 cat fecal samples, 38 (16.52%) were positive for presence of the Toxocara eggs. Conclusion: Dogs and cats in Isfahan province of Iran were infected with Toxocara parasite. These infections can be potential risk for human toxocariasis.

Background: Renal cell carcinoma (RCC) is among the top death-causing cancers. Medicinal herbs can also have beneficial effects on RCC treatment. In this project, we aimed to study the antitumor effect of dichloromethane and N-butanol fractions of hydroalcoholic extract of Nigella sativa (N. sativa) on the morphology, viability, and apoptosis of ACHN (human renal adenocarcinoma) and GP-293 (normal renal epithelial) cell lines. Materials and Methods: In this experimental study, N-butanol and dichloromethane fractions of N. sativa were obtained, and ACHN and GP293 cell lines were treated with various concentrations of dichloromethane (0–100 μg/mL) and N-butanol (0–12.5 μg/mL) fractions for 24, 48, and 72 hours. Then, morphological changes, viability, and apoptosis were investigated. Results: Our results indicated that dichloromethane and N-butanol fractions cause morphological changes and significant decreases in the percentage of live cells in the ACHN cell line, in a dose- and time-dependent manner. In the GP-293 cell line, however, a lower toxicity was observed in comparison with that found for ACHN. The results of flow cytometry showed an apoptotic effect of dichloromethane and N-butanol fractions on the ACHN cell line but a higher rate of apoptosis induction for the total extract compared to the two fractions in the renal cancer cell line compared to the normal cell line. Conclusion: Our findings demonstrated that these two fractions of N. sativa induce inhibitory effects on the ACHN cell line morphology and viability. These effects were lower than those induced by the total extract. In addition, the two fractions caused more marked effects in the renal cancer cell line compared with the GP-293 cell line.

Background: The goal of the current research was to further elucidate the role of adenosine triphosphate (ATP)-sensitive potassium (K_ATP) channels in the motility and contractility force of gastric smooth muscle of diabetic rats. Materials and Methods: Male Wistar rats (190–230 g) were grouped into control and streptozotocin (STZ)-induced diabetes (55 mg/kg) rats. Thirty days later, gastric muscle contractility was measured using a myograph and a force transducer of antral segments immersed in a tissue bath. Gastric emptying response was measured through feeding of standard pellet. Furthermore, the expression of K_ATP channel subunits in antral smooth muscle was determined by western blot technique. Results: The amplitude of KCl-evoked twitch contractions of diabetic antral strips was about 25% more than control (P < 0.05). Application of minoxidil, a K_ATP channel opener, dose dependently decreased the force of twitch contractions in both normal and diabetic antral strips. Application of 10 μM glibenclamide, a K_ATP channel blocker, did not antagonize the minoxidil-induced relaxation of antral strips. Diabetic gastric emptying was faster than normal, although not significant. Despite the relaxant effect of minoxidil on gastric emptying rate in normal rats (P < 0.05), this effect was not observed in diabetic rats. Also, glibenclamide increased gastric emptying and antagonized minoxidil-induced relaxation in normal rats (P < 0.05). Furthermore, the expression of K_ATP Kir6.1 and SUR2B subunits was substantially reduced in antral smooth muscle in diabetic condition (P < 0.01). Conclusion: These results propose that K_ATP channels may contribute to the development of gastric motility disorders in diabetes.

Background: To prove the position of aripiprazole as a preventive and safe agent in delirium in patients admitted to the intensive care unit (ICU), it is necessary to conduct randomized controlled clinical trials with appropriate design. Materials and Methods: In this study, 80 patients were randomly divided into two groups of 40. Group A received placebo mart for one week, and group B received 15 mg aripiprazole daily (dissolved in 10 cc) daily. As a criterion for assessing delirium, the Confusion Assessment methods for the ICU (CAM-ICUs) were evaluated daily for patients. At the end of the study, the trends of CAM-ICU and CAM-ICU changes on day 7 were compared between the two groups. All statistical tests were performed in two domains with a significance level of 5% using the t-test. Statistical Package for the Social Sciences (SPSS) 21 software was used to analyze the data. Results: The use of aripiprazole in the studied indices was not statistically significant (P > 0.05). The results related to the length of stay in the ICU, showed that although the use of aripiprazole has reduced the length of hospitalization of patients in the ICU, this rate of reduction, was not significant (P > 0.05). Conclusion: The use of aripiprazole with the approach of reducing the risk or controlling the occurrence of delirium on patients admitted to the intensive care unit, despite creating some beneficial effects such as reducing the length of hospital stay in the ICU, cannot be clearly and significantly effective.

Background: Hypertension (HTN) is a leading cause of cardiovascular diseases and its control is poor. There is heterogeneity in levels of blood pressure control among various population subgroups. The present study was conducted within the framework of the National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases, and Stroke (NPCDCS) in India. It aims to estimate the proportion of optimal blood pressure control and identify factors associated with uncontrolled HTN consequent to initial screening. Materials and Methods: We assembled a cohort of individuals with HTN confirmed in a baseline screening in sixteen urban slum clusters of Bhopal (2017–2018). Sixteen accredited social health activists were trained from within these slums. Individuals with HTN were linked to primary care providers and followed up for the next two years. Obtaining optimal blood pressure control (defined as SBP <140 and DBP <90 mm of Hg) was a key outcome. Results: Of a total of 6174 individuals, 1571 (25.4%) had HTN, of which 813 were previously known and 758 were newly detected during the baseline survey. Two-year follow-up was completed for 1177 (74.9%). Blood pressure was optimally controlled in 301 (26%) at baseline and in 442 (38%) individuals at two years (an absolute increase of 12%; 95% CI 10.2–13.9). Older age, physical inactivity, higher body mass index, and newly diagnosed HTN were significantly associated with uncontrolled blood pressure. Conclusion: We found about six of every ten individuals with HTN were on treatment, and about four were optimally controlled. These findings provide a benchmark for NPCDCS, in terms of achievable goals within short periods of follow-up.

Background: Enterococci, although remarked as harmless commensals of the intestinal tract of humans and animals, have become a significant source of infection in hospitalized patients worldwide.The present study aimed to isolate and identify enterococci from clinical samples and to determine the genotypic characteristics of vancomycin-resistant enterococcus isolates. Materials and Methods: A total of 774 isolates of enterococci from clinical samples were identified to the species level, and their anti-microbial susceptibility pattern was determined by Kirby Bauer Disk Diffusion method and Vitek 2 automated system. Screening for vancomycin resistance was performed by using brain heart infusion agar containing 6 micrograms/ml of vancomycin. The minimum inhibitory concentration (MIC) of vancomycin was determined by the agar dilution method and Epsilometer test (E test). Genotyping was carried out for resistant isolates by multiplex polymerase chain reaction. Results: Thirty (3.88%) isolates were resistant to vancomycin by agar screen method. Five isolates showed intermediate resistance with anMIC of 8–16 micrograms/ml for vancomycin by agar dilution. By the E test, two isolates displayed an MIC of ≥32 micrograms/ml for vancomycin and one isolate showed an MICof ≥32 micrograms/ml for teicoplanin.Van A was the common genotype isolated. The present study reports isolates of Enterococcus faecalis with a susceptible MIC for glycopeptide and the presence of the Van A gene. Conclusion: Heterogeneous resistance among clinical isolates of Enterococcus faecalis was observed in our study. The predominant phenotype and genotype detected among clinical isolates were Van A.

Marine organisms contain several natural products and bioactive compounds, including hydrolyzed proteins, antioxidant peptides, gelatin, collagen, ω-3 unsaturated fatty acids, vitamin A, vitamin D, calcium phosphate, hydroxyapatite, chitosan, lectin, and various toxins. They can inhibit diverse diseases, be used in pharmaceutical compounds, or as antibiotics and pigments. In this regard, these microorganisms are of crucial medicinal and economical importance. Thanks to new technologies and advanced laboratory methods, bioactive compounds can be extracted from aquatic organisms. In this review study, the cytotoxicity (IC₅₀) and antibacterial effect of various extracts from marine organisms of the Persian Gulf are explored, compiled, and compared. Due to their easy accessibility, most of the studies are green, red, and brown algae.

Background: Functional abdominal pain is a health concern with chronic abdominal discomfort without clear etiology. Several etiologic factors are raised in this regard, one related to environmental factors. This study aimed to compare blood lead levels between children and adolescents with and without functional abdominal pain. Materials and Methods: This case–control study was performed in 2019–2020 in Isfahan, Iran. The sample size was calculated as 70 cases and an equal number of controls. Cases were children and adolescents with functional gastrointestinal disorder (FGID), and controls were grouped age- and sex-matched. Controls were randomly selected from those referred for routine health screening. Both groups obtained blood lead, iron, and calcium levels. All participants completed the FFQ Food Consumption and Environmental Pollutants Questionnaire. Results: Participants were 139 children (68 cases and 71 controls). The mean (SD) age was 9.40 (3.91) years in the FGID group and 8.79 (3.46) years in the controls (P = 0.330). The mean (SD) blood lead level was not significantly different between the FGID group and the controls (3.98 ± 2.56 vs 3.81 ± 1.96 μg/dl, respectively, P = 0.670). We found that 55.3% of children with high lead levels had FGID, while 44.4% of children with lower lead levels had FGID, but the difference was not statistically significant (P = 0.33). Conclusion: We found that the lead level was higher in patients with FGID than in the controls; however, this difference was not significantly different. This might be because of elevated lead levels in both groups. Future ecological studies with a large sample size are necessary in this regard.

Background: Considering the high prevalence of tonsillectomy in children and concerns of postoperative management, this study was conducted with the aim of evaluating the effects of oxymetazoline on bleeding, cough, and sore throat in children undergoing tonsillectomy. Materials and Methods: The current double-blind clinical trial study was conducted on 88 tonsillectomy candidate patients. These patients were randomly divided into two groups. In the first group, oxymetazoline 0.05% nasal spray (OXY group) and in the second group, distilled water spray (Control group) was prescribed as one puff in each nostril immediately after anesthesia induction., the nasal spray was prescribed again in both nostrils at 12 h after tonsillectomy. Then the hemodynamic parameters, post-tonsillectomy hemorrhage (PTH) and sore throat were evaluated. Results: The mean of the sore throat of children was not significantly different between the two groups in any of the follow-up times (P value >0.05). PTH in recovery and in the ward in the OXY group with the mean of 57.60 ± 71.82 ml and 22.11 ± 22.50 ml, respectively, was significantly lower than the control group (83.50 ± 113.64 ml and 27.52 ± 35.11 ml) (P value < 0.05). Also, the frequency of cough in the ward in the OXY group with 27.3% was significantly lower than the control group with 56.8% (P value = 0.005). Conclusion: Regarding the results of the present study, sore throat and hemodynamic parameters did not change significantly with the administration of oxymetazoline. But this drug has played a significant role in reducing PTH and cough in children.

Background: The effect of bariatric surgery on weight loss (WL) of patients with severe obesity is an established finding. However, some studies have shown that other factors such as demographic characteristics can also be involved in the extent of success and relapse of obesity. Thus, this study was performed to determine the association of demographic characteristics with the rate of weight loss and changes in nutritional factors one year after one anastomosis gastric bypass (OAGB). Materials and Methods: In this cross-sectional study, 121 patients undergoing OAGB were investigated. Patients' body mass index (BMI), nutritional factors (including levels of albumin, vitamin D3, and serum ferritin), and demographic characteristics were measured one year after the surgery. Results: The BMI one year after surgery was significantly lower than before surgery (47.12 ± 5.08 kg/m² vs. 29.42 ± 3.86 kg/m²; P value <0.001). WL was 37.37 ± 6.70%. In addition, the serum level of vitamin D3 one year after surgery with the mean of 44.54 ± 17.25 was significantly higher than its level before surgery with the mean of 38.13 ± 14.42 (P value <0.001). WL in less than 50 years old and married patients was significantly higher than WL in over 50 years old and single patients (P value <0.05). Moreover, the decrease in serum ferritin level with the mean of 1.90 ± 0.56 ng/ml in women was significantly higher than its decrease with the mean of 3.02 ± 0.94 ng/ml in men (P value = 0.003). Conclusion: Some demographic characteristics such as age, gender, and marital status seem to affect the rate of weight loss or ferritin level one year after OAGB.

A case with an inflamed or damaged nerve root in the cervical spine is defined as cervical radiculopathy.The purpose of the current study is to recognize the most effective surgical procedures in cervical radiculopathy subjects. All related studies were taken using PubMed searching international databases, Scopus, ISI Web of Science (WoS), and Science direct with no limit of until November 20^th, 2021. Finally, based on the inclusion and exclusion criteria, after reviewing all randomized controlled trial studies which had the related data the researchers were looking for, they conducted meta-analysis with the seven remaining studies including eight different treatments. Heterogeneity was evaluated by Cochran's Q and Higgins I ² using R software for the network. In the results presented in this study, the neck disability index (NDI) changes as a result of taking cervical anterior discectomy without (ACD) and with fusion (ACDF) and ACD arthroplasty were -0.003, -1.659, and -1.656, respectively. According to the final diagram of the network, 11 comparisons were made in pairs. When each treatment group is compared with ACDF, it is shown that there was a significant mean effect among the patients who receive Mobi-C, Kineflx|C, and ADR, with mean differences of − 8.60 [CI 95% (− 12.75, − 4.45)], − 1.10 [CI 95% (− 5.22, 3.02)], and − 1.00 [CI 95% (− 7.18, 5.18)], respectively. The most effective surgical treatments for cervical radiculopathy were Mobi-c, Kineflx|C, and artificial disc replacement compared to ACDF treatment, respectively.

Background: Sexual desire and sexual activity are natural needs of human beings, which can be problematic and lead to various sexual disorders, if not used in the right way, including hypersexuality. The present study aimed to compare the effect of dialectical behavior therapy (DBT) and aripiprazole drug on marital instability in patients with hypersexuality. Materials and Methods: This experimental case--control Pretest--Posttest Control Group Design with follow up was done on 27 male and female patients with hypersexuality having at least a higher education degree selected from four hospitals and psychiatric centers including Khorshid Hospital, Asgariyeh Specialized Hospital, Farhangian Clinic and Imam Reza Medical Center in Isfahan and were randomly assigned to two groups of treatment (nine patients in every group) and one group of control (nine patients) after adjusting the age and gender. Pretest phase was done for both three groups using Marital Instability Index (MII). The first treatment group underwent DBT intervention for eight sessions of 2 hours (once a week), and the second experimental group was prescribed aripiprazole for 2 months. Afterwards, the posttest and follow-up were performed for all the three groups. The data were analyzed using SPSS 24 and multivariate analysis of covariance (MANCOVA). Results: The findings showed that DBT and aripiprazole had little effect on the problem of marital instability in patients with hypersexuality (p > 0.05); also, there was no significant difference between the effect of DBT and aripiprazole (p > 0.05). Conclusion: DBT and the drug aripiprazole cannot have a significant effect on the marital instability in patients.

Background: Poor sleep quality is a common issue among patients with end-stage renal disease (ESRD) who undergo dialysis. Nutritional habits are associated with sleep hygiene in patients undergoing dialysis. The objective of this study was to examine the potential correlation between nutritional status and sleep quality in individuals receiving hemodialysis treatment. Materials and Methods: This cross-sectional study included 160 hemodialysis patients. A food frequency questionnaire (FFQ) was used to measure food intake in participants. The Persian-validated version of the Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality. Patients were classified as poor or good sleepers with a PSQI score of <5 and >5, respectively. Results: Eighty-four percent of hemodialysis patients had bad sleep hygiene. There was a significant association between sleep quality and educational status and age (P < 0.001). Poor sleepers were older (61.65 years versus 51.12) and less educated (31.1% versus 4%). However, there was no significant difference in the intake of micro- and macronutrients between poor and good sleepers (P > 0.05). Conclusion: The results of this study suggest that sleep quality has no significant relationship with nutrient intake in hemodialysis patients. Demographic factors, such as age and educational status, have played a more effective role than nutritional factors in patients' sleep quality.

Background: Ultrasound is the selected technique for the detection of placenta accreta spectrum (PAS). This method can detect PAS in 80%-50% of cases. This study aimed to assess and compare the sensitivity and specificity of ultrasonography in the diagnosis of PAS after the first trimester. Materials and Methods: In this prospective study that was performed in 2020-2021 on 79 patients at high risk of PAS, all cases underwent ultrasonography in both 18-22 weeks of gestational age (GA) and 32-34 weeks of GA for evaluation of accreta. As per the risk factors, the delivery plan for all mothers was cesarean section. During the cesarean section, the placenta was examined for accreta, and if it was attached to the uterus, a diagnosis of placenta accreta was ascertained and a total abdominal hysterectomy was performed if the patient's bleeding was not controlled during the operation. The final diagnosis of PAS was made based on the pathology report. Results: Ultrasound evaluation for PAS in 18-22 weeks of GA had 79.17% specificity, 51.61% sensitivity, 61.54% positive predictive value, and 71.70% negative predictive value. Ultrasound imaging for PAS in 32-34 weeks of GA had 60.8% specificity, 90% sensitivity, 62.52% positive predictive value, and 90.33% negative predictive value. Conclusion: It should be concluded that PAS is a critical condition and if the patient is diagnosed in the second or third trimester, special strategies should be applied.

Given the increasing incidence of yeast infections and the presence of drug-resistant isolates, accurate identification of the pathogenic yeasts is essential for the management of yeast infections. In this review, we tried to introduce the routine and novel techniques applied for yeast identification. Laboratory identification methods of pathogenic yeast are classified into three categories; I. conventional methods, including microscopical and culture-base methods II. biochemical/physiological-processes methods III. molecular methods. While conventional and biochemical methods require more precautions and are not specific in some cases, molecular diagnostic methods are the optimum tools for diagnosing pathogenic yeasts in a short time with high accuracy and specificity, and having various methods that cover different purposes, and affordable costs for researchers. Nucleotide sequencing is a reference or gold standard for identifying pathogenic yeasts. Since it is an expensive method, it is not widely used in developing countries. However, novel identification techniques are constantly updated, and we recommend further studies in this field. The results of this study will guide researchers in finding more accurate diagnostic method(s) for their studies in a short period of time.

Background: Long non-coding RNAs (lncRNAs) have emerged as crucial regulators in various biological processes, including cancer development and progression. This study aimed to investigate the expression differences of the BRAF-activated non-coding RNA (BANCR) gene in GC tissues compared to adjacent normal tissues. The potential diagnostic significance of BANCR in GC was explored, with the aim of improving diagnostic and therapeutic approaches for this global health burden. Materials and Methods: Tissue samples from 100 gastric cancer (GC) patients were collected, and BANCR expression was analyzed using quantitative real-time PCR. Correlations between BANCR expression and clinicopathological features were assessed, and its biomarker potential was evaluated. Results: In individuals diagnosed with GC, the expression of BANCR was notably elevated in tumor tissues compared to adjacent normal tissues (P < 0.0001). However, the analysis of gene expression data did not demonstrate any statistically significant correlation between elevated BANCR expression and clinicopathological features. According to the ROC analysis, BANCR demonstrated an AUC of 0.6733 (P < 0.0001), with a sensitivity of 73% and a specificity of 45%. However, further evaluation is required to determine its potential as a biomarker (CI 95% = 0.5992 to 0.7473). Conclusions: The observed upregulation of BANCR in GC tissues implies its potential involvement as an oncogenic lncRNA in GC patients. Furthermore, BANCR may serve as a promising biomarker for identification and treatment of GC.

Background: Preoperative anxiety plays a critical role in post-operative pain response and other outcomes. Melatonin is a naturally secreted hormone which has anxiolytic, sedative, and analgesic properties. Pregabalin, analogue of gabapentin which has property of anxiolytic and analgesic effects. Materials and Methods: Total 96 patients undergoing total hip arthroplasty, divided into 3 groups of 32 each and were given placebo (group I), melatonin 6 mg (group II), and pregabalin 150 mg (group III). Anxiety level, postoperative pain score, sedation level and duration as well as characteristics of spinal anaesthesia were assessed with other vital parameters. Results: Group I showed an increment in the anxiety score from baseline whereas in group II and group III, there was a decline in pre-operative anxiety score from baseline at all the periods of observation and more significantly in group III. Visual analogue scale (VAS) score and total dose of rescue analgesia were highest in group I, but group II and group III were comparable to each other. However, the durations of spinal anaesthesia and motor blockade showed a statistically significant difference with maximum duration in group III followed by II and then I. The level of sedation among the three groups were comparable at all the periods of observation. Conclusions: Pregabalin was found better for perioperative anxiolysis, post-operative analgesia and for prolongation of duration of spinal anaesthesia when compared to melatonin.

Background: There is an emergency need in discovering an efficient profile of molecular biomarkers for early diagnosis of Non-small cell lung cancer (NSCLC). Transcription factors as important groups of regulators that are able to adjust the cell cycles have attracted the attention of most researchers recently. NFATc2 and PPARG are two important factors that have been selected for this project to assess their potential for being a biomarker for NSCLC. Materials and Methods: Here in this study, 50 NSCLC patients were included. During bronchoscopy, which was their routine diagnostic approach, we collected tumoral and marginal normal tissues. After the extraction of the total RNA from the tissues, cDNA was synthesized, and the transcriptional level of NFATc2 and PPARG was examined by quantitative real-time PCR. Subsequently, the data were analyzed by proper statistical analyses. Results: The mRNA expression of NFATc2 and PPARG were down-regulated in biopsy tissues of NSCLC patients compared with their pair marginal tissues (P_values were 0.0011 and <0.0001 respectively). Moreover, both of them had significant AUC (area under the curve) in the ROC curve analysis (0.65 for NFATc2 and 0.81 for PPARG, P_value <0.05). Conclusion: It appears that mRNA expression of NFATc2 and PPARG possesses the potential to be regarded as a diagnostic or prognostic biomarker for NSCLC.

Background: The current study is an attempt to register the alterations in the immunological and histological parameters in mice arising from the administration of Dietza maris (D. maris) in order to confirm its protective properties. Materials and Methods: Mice underwent 7 days of treatment with three doses of D. maris. Then, animals were scrutinized in terms of body weight, relative weight of organs, delayed type of hypersensitivity (DTH) response, and hemagglutination titer (HT). The determination of villus height, villus width, crypt depth, villus/crypt ratio (V/C), Goblet cells, and intestinal epithelial lymphocyte (IEL) density in villi was carried out. Results: A boosted DTH response was observed as a result of bacteria at medium dose. A variation was noted between the hemagglutinin titer of the control group and that of the high-dose group. Crypt depth, villus width, and villus height manifested alterations. High-dose-treated mice demonstrated proliferation of Goblet cells in the villi, whereas both in medium- and high-dose-treated mice, a distribution of IELs in the villus epithelium was noted. Overall, D. maris showed a stimulatory effect on immune functions in mice. Thus, thanks to improved cellular and humoral immunity and the increased quality of intestine function, we believe that D. maris promises novel therapeutic applications in the future. Conclusion: The attained findings lend credence to immuno-stimulatory effects arising from the capacity of D. maris to function as immunological adjuvants and to enhance humoral and cellular immunity as well as the intestinal structure and function.

Background: Hearing deterioration in hypothyroid subject was documented by Kemp. Cristiane et al. reported delayed waves latency in subclinical hypothyroid subjects. Recording of auditory brain stem evoked response in subclinical hypothyroid subjects at 80 dB and varying frequencies has been done. Materials and Methods: Case control study. Group 1, N = 30 control subjects, free T3, free T4, thyroid stimulating hormone (TSH) within normal range. Group 2, N = 30 subclinical hypothyroid subjects, TSH was between 4.6-8 microIU/L. Student Unpaired t test was done. Those on epileptic, neuroleptics, depression, psychosis drugs, inflammatory, proliferative, traumatic ear disorder, smokers, on tobacco, COVID-19 positive subjects, altered sensorium, drug abuse, diabetes mellitus, neuropathy, hypertension, cardiac arrhythmia, family history of hearing disorder, and furosemide drug were excluded. Auditory brainstem evoked response (ABER) done. Results: Mean ± SD of Brainstem evoked response auditory (BERA) waves III, V, interpeak latencies at 80 dB, 2, 4,6 KHz reported delay and significant in subclinical hypothyroid group as compared to control. Conclusion: BERA study at 6 KHz and 80 dB detects central neuropathy earlier in subclinical hypothyroid patients.

Background: The long-term use of pesticides can cause harmful consequences to both human health and the environment. In the present research, we aimed to compare biochemical, hematological, and plasmatic measurements of butyrylcholinesterase (BChE) between farmers and non-farmers. Materials and Methods: The study is cross-sectional and included 270 participants, with 135 farmers using pesticides and a control population of 135 non-farmers. The recruitment of the participants was conducted from August 2017 to the end of December 2019. Blood samples from participants were collected for the evaluation of biochemical markers of the function of the liver and determination of BChE activity. A whole blood sample with ethylenediamine tetraacetic anticoagulant (EDTA) was also taken for a complete blood count. Results: The results showed a statistically significant (P = 0.03) decrease in mean corpuscular hemoglobin (MCH) in the cases (28.45 ± 2.94 pg) as compared with controls (29.17 ± 2.54 pg). The statistical analysis of the renal parameters between the two groups determined that the uremia value was significantly higher in cases (34 ± 12 mg/dL) when compared to the control group (29 ± 8 mg/dL) P < 0.001. The cases recorded a significant increase in aspartate aminotransferase (AST) (26.22 ± 11.59 U/L) and alanine aminotransferase (ALT) (25.63 ± 13.47 U/L) enzyme activities among cases versus controls. The results obtained showed a significantly decreased BChE activity in the group of cases exposed to pesticides (7554.52 ± 2107 U/l) compared to the unexposed control group (10135.58 ± 1909 U/l) (t-test, P < 0.001). Conclusion: The education of the farmers on correct practices concerning phytosanitary use has the potential of reducing their exposure to these products.

Background: Scientists have believed that a number of risk factors, especially viral infectious agents, can be related to respiratory diseases. Due to the pandemics in 2019, Human Respiratory Syncytial Virus and Coronavirus have attracted the attention of different kinds of research. In this study, we attempted to evaluate the prevalence of these viruses. Materials and Methods: After extracting the RNA and DNA of these viruses, molecular tests were employed to report the rate of them in patients suffering from respiratory symptoms. Results: Our results demonstrated that 31 samples were COVID-19 positive. Furthermore, two cases had Respiratory syncytial virus (RSV) subgroup A infections. However, no cases showed a coinfection of both viruses. Conclusions: It seems that during the pandemic of COVID-19, RSV should not be ignored as it can be responsible for the respiratory syndrome.

Hydatid cyst is a common disease between humans and animals. Foods that are contaminated with eggs of echinococcal species are the cause of hydatid disease. Although this parasite affects different organs, the liver and lungs are very susceptible but the cardiac hydatid disease is very rare. We report the case of a 33-year-old man admitted because of chest pain. Echocardiography had shown suspected round cyst in the myocardium. More diagnostic managements had demonstrated cystic lesion in the liver, spleen and lungs. There were also multiple cystic lesions in both lungs. He refused surgery and was taken to medical therapy. Myocardial involvement by hydatid cysts occurs very rarely. The main treatment approach for cardiac hydatid disease in patients should be surgery. The alternative treatment was done to those who refused surgical removal, adjuvant therapy such as albendazole for at least 1–6 months. Because myocardial involvement by hydatid cysts is uncommon, we decided to report this rare case.

The facial artery is the main artery supplying the face occasionally. It gives three branches on the face, the inferior labial, the superior labial, and the lateral nasal, and terminates as the angular artery. Due to congenital vascular variations in the facial artery, it has been considered in the dissection of the head and neck region. During the dissection of a 65-year-old woman to expose this region, we discovered that the left facial artery is terminated by the superior labial artery after giving off the submental and inferior labial branches. At the level of the left oral commissure, the facial artery was attached to the buccinator muscle as connective tissue, with a noticeable decrease in diameter. The purpose of this study is to report a new variation of the facial artery that is particularly important for cadaver dissection, and head and neck surgeries, as well as for facial artery angiography.

Benign pneumoperitoneum can happen after colonoscopy, which shows itself as free air in the abdomen without symptoms or pneumoperitoneum without peritonitis. In this case, we reported a rare case of an elderly man who had acute abdominal stiffness after colonoscopy and observation of free air under the diaphragm that no perforation was observed in the intestine during laparoscopy and only one tiny intestinal tumor was randomly reported. There is no consensus on the treatment of pneumoperitoneum after colonoscopy. Patients with peritonitis benefit from laparoscopy but patients with micro perforation and asymptomatic patients benefit from intravenous antibiotic treatment and bowel rest.

Background: Opportunistic fungi are a constantly evolving group of pathogens that become active when the immune system is compromised, begin to multiply, and soon overwhelm the weakened immune system. This study was performed to evaluate the number of opportunistic fungi in bronchoalveolar lavage (BAL) samples of patients with pulmonary diseases. Materials and Methods: After receiving patients' consent and demographic forms, a total of 120 BAL samples were taken by a pulmonary physician. The etiologic agents were identified by standard morphological and molecular methods. Yeast cells were counted on culture media, and direct smears were precisely examined for the presence of yeasts elements, Pneumocystis, and filamentous fungi. Results: In this study, 29 (24.1%) patients showed positive direct smears for yeast elements in their BAL samples. The mean colony count of yeasts was 42,000 (CFU/mL) on culture media. Six (5%) species of filamentous fungi, including three (2.5%) isolates of Penicillium species (P. variabile, P. glabrum, and P. thomii), two (1.67%) Aspergillus species (A. flavus and A. fumigatus), 1 case (0.83%) Pseudallescheria boydii were detected. Seven cases (5.83%) of Pneumocystis cysts were observed in the direct smears stained with Giemsa. Identification of all fungi confirmed by molecular or sequencing methods. Conclusions: Due to the presence of a large number of fungi in the BAL samples and possible physical interference with the selected drugs for treatment, we draw the attention of pulmonologists to this important issue. Rapid diagnosis of fungal infections is essential to optimize treatments and outcomes.

Background: Hydatidosis is a serious and life-threatening disease that may lead to the death of the host if diagnosed and treated improperly. Apoptosis has been investigated as a mechanism of host innate immunity in suppressing parasites and also the survival of cysts in the human body. The present study investigates the process and role of apoptosis caused by a host cell or parasite in hydatid cysts. Materials and Methods: Survey cytotoxic effect and apoptotic mortality of hydatid-treated lymphocytes were investigated. Also, to determine the mechanism of apoptosis in host and parasite, the mean gene expressions of Bcl-2, Bax, Caspase 3 in hydatid-treated lymphocytes, and Fas-L gene in the laminated-germinal layer of fertile and infertile hydatid cysts were evaluated. Results: The viability of fertile and infertile hydatid fluid-treated lymphocytes was significantly different compared with the control group. Flow cytometry also showed apoptotic cells. Bax mean gene expression was significantly different between fertile and infertile treated lymphocytes. However, there was no significant difference in the mean expression of Caspase 3, and Bcl-2 genes in these two groups. Although the expression of the Fas-L gene in infertile cysts was higher than in fertile cysts, the result was not significant. Conclusion: It seems that hydatid cyst fluid may induce apoptosis in lymphocytes so that, hydatid cysts can escape from the immune system and stay alive. On the other hand, the results represent the possible immune path of host apoptosis against the parasite as one of the important routes in infertility of hydatid cysts.

Background: Several case-control studies have suggested that global and loci-specific deoxyribonucleic acid (DNA) methylation in peripheral blood mononuclear cells (PBMCs) of DNA might be potential biomarkers of cancer diagnosis and prognosis. In this study, for the first time, we intended to assess the diagnostic power of the methylation level of tumor suppressor candidate 3 (TUSC3) gene promoter in patients with colorectal cancer (CRC). Materials and Methods: In the current study, we quantitatively assessed the promoter methylation level of TUSC3 in PBMCs of 70 CRC cases and 75 non-cancerous subjects via methylation quantification of endonuclease-resistant DNA (MethyQESD) method. Results: The methylation level of the TUSC3 was meaningfully higher in CRC cases than in non-CRC subjects (43.55 ± 21.80% vs. 16.07 ± 13.63%, respectively; P < 0.001). The sensitivity and specificity of this gene for the detection of CRC were 88.6% and 76.0%, respectively. The receiver operating characteristic (ROC) curve examination discovered an area under the curve (AUC) of 0.880, representing a very high accuracy of the TUSC3 methylation marker in distinguishing CRC subjects from healthy individuals. However, there was no substantial diversity in methylation level between various CRC stages (P: 0.088). Conclusion: For CRC screening, PBMCs are a reliable source for DNA methylation analysis and TUSC3 promoter methylation can be utilized as a hopeful biomarker for early and non-invasive diagnosis of CRC.

Background: Rosacea is a multifactorial skin inflammatory disorder with an unknown cure. Genetics and environmental factors such as microorganisms are involved in the rosacea etiology, for example, Helicobacter pylori have been suggested in rosacea progression. The present study investigated the relationship between H. pylori eradication and rosacea patient's improvement. Materials and Methods: H. pylori infection was investigated in 60 rosacea patients and 65 sex- and age-matched healthy control through enzyme-linked immunosorbent assay (ELISA) and HpSag tests. After infection confirmation, randomly half of the rosacea patients were treated for H. pylori eradication (test), and others received standard treatment (control). HpSag and ELISA tests were repeated after infection eradication and disease flow was surveyed for 60 days. The groups were compared using the ANOVA (Analysis Of Variance) test at the significant level of P < 0.05. Results: At the baseline, the mean of immunoglobulin G (IgG) (59.27 ± 41.4 RU/mL) and immunoglobulin M (IgM) (11.55 ± 6.1 RU/mL) in rosacea patients was higher than the level of IgG (41.38 ± 54.33 RU/mL) and IgM (8.11 ± 8.91 RU/mL) in healthy control (P < 0.04) and (P < 0.01), respectively. Also, the values for H. pylori infection were positive in all patients and 10 healthy controls. The mean titer of IgM and IgG in the test and control patients groups were different at baseline and after treatment. Furthermore, in the test patients group, the mean of IgG was reduced in active rosacea after treatment, and 63.9% of active patients showed rosacea remission after H. pylori eradication. Conclusion: Data suggest the exacerbating role of H. pylori in rosacea, and its eradication along with other therapeutic methods causes rosacea improvement.

Background: Spontaneous pneumothorax is a potentially fatal condition with a high risk of recurrence. The purpose of this study is to compare two different approaches to SP management. In the first group, patients underwent only chemical pleurodesis; in the second group, CT-scan, VATS, and then chemical pleurodesis was performed. Materials and Methods: This study is a non-randomized clinical trial conducted on 65 patients admitted to Al-Zahra Hospital in Isfahan with a primary complaint of sudden dyspnea and a definitive diagnosis of spontaneous pneumothorax. Two studies compared the main outcomes of recurrence within six months and the time until recurrence. Results: Age, sex, and BMI were matched between the two study groups. The side of the pneumothorax, smoking history, and pulmonary disease history did not differ significantly (P > 0.05). Pneumothorax recurrence did not differ significantly between the two groups (P: 0.477). Conclusion: This study demonstrated no distinction between VATS and chemical pleurodesis when using only chemical pleurodesis. However, because numerous studies have suggested that one of these techniques may be beneficial for patients with SP, it is recommended to conduct additional randomized controlled trials (RCTs) with a more detailed plan and more comparable procedures, although it appears that meta-analysis design may be effective given the abundance of available RCT studies.

MicroRNAs are a large group of small, non-coding ssRNAs (miRNAs) that have an epigenetically pivotal role in gene expression and other biological processes in cells and can be regarded as capable biomarkers for the early detection and management of cancer. The aim of the present review article is to summarize the evidence for recognizing the molecular mechanism, target genes, and clinical significance of miR-647 in different cancers. Multiple studies have demonstrated that aberrant expression of miR-647 could be found in a variety of malignancies, such as bladder cancer, cervical cancer, colorectal cancer, gastric cancer, glioma, hepatocellular carcinoma, non-small cell lung cancer, ovarian cancer, and prostate cancer have reported, notably, increase or decrease in expression of miR-647 so that it can function as a tumorigenic (oncomiR) or tumor suppressor gene. MiR-647 is effective in the proliferation, migration, and invasion of cancer cells by playing a function in cell cycle pathways. MiR-647 can be a valuable potential biomarker for assessing the extent of cancer, prognosis, and response to therapy and shows great therapeutic efficacy in different solid tumors. Moreover, serum concentrations of miR-647 are directly effective in decreasing overall survival and disease progression. So, an efficient therapeutic target can be the effect on miR-647 expression by antitumor drugs.

Background: The hip joint's limitation causes lumbopelvic compensatory motions, accumulating tissue stress on the lumbar spines. It is essential and valuable to evaluate hip rotation range of motion (ROM) in different low back pain (LBP) classifications to understand them and plan the best exercise program. This study aimed to compare hip rotation ROM between subjects with and without LBP classified in movement system impairment (MSI). Materials and Methods: In this cross-sectional study, 100 subjects with LBP were classified into different MSI subgroups (mean age of 41.66 ± 7.82 years), and 100 healthy subjects (mean age of 38.96 ± 8.84 years) participated. Passive and active hip medial and lateral rotations ROM in prone and supine positions for dominant and non-dominant lower limbs were measured. Results: Generally, in the LBP group, minimal lateral rotation as compared to controls in movement tests measuring hip rotation ROM actively and passively, in prone and sitting positions, and for dominant and non-dominant limbs (P < 0.05). There were no significant differences among the LBP subgroups (P > 0.05). Conclusions: Due to LBP, regardless of the MSI categories, remarkably restricted hip lateral rotation ROM.

Background: High prevalence of pressure ulcers (PUs) and their complications are important dilemmas in the intensive care unit (ICU). Therefore this study was designed to evaluate the effectiveness of topical whey protein formulation in preventing PUs in patients admitted to the ICU. Materials and Methods: In this randomized placebo-controlled clinical trial under registration number [IRCTdeted for blinded article], 80 eligible ICU patients were randomly allocated to receive topical ointment of whey protein or placebo on the sacrum with a diameter of 15 cm twice daily for seven days, in addition to the routine care. The mean risk score for developing PUs was calculated at baseline using the Braden tool, and the PUSH score was used to assess PUs on days 4, 7, and 14. Patients' related demographic and clinical variables were also collected using a medical record for more evaluation. Results: Our results showed that demographic characteristics and the Braden scores' baseline mean were not significantly different between groups (P > 0.05). The repeated measures ANOVA test revealed that the mean scores of PUs at various times were markedly lower in the whey protein than in the placebo group (P < 0.001). Conclusion: This intervention can be routinely added as effective, safe, inexpensive, and accessible care to reduce the incidence of PUs for patients at risk of developing this injury.

Background: Elevated brain cholesterol increases the risk of Alzheimer's disease. Production of 24-hydroxycholesterol (24s-OHC) by neurons prevents cholesterol accumulation in the brain. In this study, we investigated the effect of 24s-OHC on the HMG-COA reductase and ABCA1 which are involved in the brain cholesterol homeostasis with or without β-amyloid in astrocytes. Methods and Materials: Astrocytes were treated with 24s-OHC with or without Aβ. Western blot and real-time polymerase chain reaction were done to detect protein and gene expression of β-hydroxy-3-methyl-glutaryl-coenzyme A reductase (HMGCR) and ABCA1, respectively. Cholesterol release was determined using a quantitation kit. Results: Protein levels of HMGCR and ABCA1 were significantly increased by Aβ; however, the 24s-OHC was able to restore their levels and diminish the effect of amyloid-β. Aβ did not have a significant effect on HMGCR expression, while 24s-OHC reduced it by 68%. Aβ-induced ABCA1 expression did not increase cholesterol efflux as the lower levels of cholesterol in conditioned medium of Aβ-treated cells were found. Conclusion: Our novel findings show that Aβ affects two key elements in the brain cholesterol homeostasis, HMGCR and ABCA1, which are crucial in cholesterol synthesis and efflux. Since 24s-OHC could suppress the Aβ effects on enhancement of HMGCR and ABCA1, therefore the cytochrome P450 46A1 (Cyp46A1), which is exclusively expressed in the central nervous system and responsible for producing of 24s-OHC, could consider as a therapeutic target in the cholesterol-related neurodegenerative diseases such as Alzheimer's disease.

Background: The aim of this study was to assess the effect of a training package based on the lived experience of substance abusers on sleep problems and mental health. Materials and Methods: The current study was performed on 70 subjects equally distributed into two groups of control and intervention, Data collection tools included the Pittsburgh Sleep Quality Index (PSQI), the General Health Questionnaire (GHQ), and the Basic Adlerian Scales for Interpersonal Success—Adult Form (BASIS-A) Inventory. Data analysis was administered using the independent t-test, paired t-test, and MANCOVA. Statistical significance was considered when the P value < 0.05. Results: A total of 70 subjects participated in this study; 7 (10.6%) were females and 59 (89.4%) were males, with a mean age of 36.29 ± 8.588 years. The total score of PSQI was 12.48 (±4.206) and 13.16 (±3.397) for control and intervention groups, respectively, and declined to 12.33 (±4.442) and 9.56 (±4.45) after the intervention. The intervention resulted in an improved score for scales of belonging, going along, taking charge, harshness, being liked by all, and striving for perfection. Whereas the total score of the GHQ is reduced for both groups, that in the intervention group showed a higher decrease, which was also statistically significant. Conclusion: The developed training package successfully improved participants' sleep quality, mental health, and lifestyle.

Background: COVID-19 is the leading cause of the recent pandemic in the globe. This disease might have different effects on the maternal and fetal outcomes in pregnancy. The aim of this study was to assess these outcomes in pregnant women with COVID-19 infections in different trimesters. Materials and Methods: This is a prospective cohort study that was performed in February 2020 to August 2021 in Isfahan on 430 pregnant women with definite diagnosis of COVID-19 infection admitted to our medical centers. The included cases were followed based on the gestational age in which they were diagnosed with COVID-19 infection. Patients were divided into three groups (first, second, and third trimesters) based on COVID-19 infection. Results: The frequency of requiring mechanical ventilation was higher in mothers with COVID-19 in the second trimester (P = 0.049) and the frequency of PIH was significantly higher in mothers with COVID-19 in the third trimester compared to other women (P = 0.009). Fetal growth restriction (FGR) was also observed in 22 patients (5.3%) that was mostly observed with COVID-19 in the third trimester (P = 0.012). Oligohydramnios and fetal distress leading to C/S were observed in 19 patients (4.6%) and 12 patients (2.9%), respectively. The majority of maternal mortality was among cases with COVID-19 infection in the third trimester (44.4%). Conclusion: We observed higher maternal and fetal complications in women especially those in the third trimester. Our results were in line with the findings of previous studies. Women with COVID-19 infection in the third trimester had highest frequencies of preterm labor and FGR.

Background: Pelvic floor disorders include urinary incontinence, fecal incontinence, and pelvic floor prolapse, which are common complaints in women. Patients that suffer from uterine prolapse could benefit from surgical procedures that stabilize pelvic ligaments. Here, we aimed to compare the high uterosacral and sacrospinous ligament suspension surgeries. Materials and Methods: This clinical trial was performed in 2019–2021 on 64 women with uterine prolapse. Demographic data of the patients, including age, body mass index (BMI), past medical diseases, history of delivery, type of delivery, and duration of hospitalization, were collected. We assessed their urinary symptoms, prolapse degree, and sexual symptoms using the Female Sexual Function Index (FSFI) and Pelvic Floor Disability Index (PFDI-20) questionnaires before surgical interventions. Patients were divided into two groups undergoing high uterosacral and sacrospinous ligament suspension. They were followed up 6 and 12 months after surgeries. Results: Patients treated with sacrospinous ligament suspension had higher frequencies of surgical complications (P = 0.039), and the most common complication was low back pain (15.6%). The uterine prolapse andC point degree improved significantly in all cases after 6 and 12 months (P < 0.001). The Pelvic Organ Prolapse Quantifications System (POP-Q) scores improved significantly in both groups 6 and 12 months after surgery (P < 0.001), and patients who underwent sacrospinous ligament suspension had significantly lower pain intensity compared to the other group (P = 0.003). FSFI scores improved significantly in patients treated in both groups (P < 0.001). Conclusion: Both high uterosacral and sacrospinous ligament suspension techniques significantly improved pain, uterine prolapse, and C point degree.

Background: Coronavirus disease 2019 (COVID-19) is an infectious disease that the physiological changes in pregnancy can make pregnant patients more susceptible to more severe forms of this infection. Hence, the treatment of COVID-19 in pregnant women can be challenging. This study was designed to evaluate the safety and efficacy of Remdesivir in pregnant women with COVID-19. Materials and Methods: This study was conducted on 150 pregnant women with moderate to severe COVID-19 infection. Remdesivir was prescribed and continued for 5 or 10 days according to the patient's condition. Maternal and pregnancy outcomes and also recovery rates were evaluated. Moreover, additional variables were examined: age, gestational age, symptoms, O2 saturation and laboratory tests at admission, the interval between symptom initiation and admission to hospital and Remdesivir prescription, hospitalization days, and ICU admission. Results: The mean age was 32.37 years. Cough and dyspnea were the most prevalent symptoms (74% and 68.7%, respectively). At the time of admission, 79 (52.7%) women needed low-flow oxygen support, 67 (44.7%) needed high-flow oxygen support, and 4 (2.7%) were intubated. Fifty-four (36%) patients required ICU care. In patients who died (12 women), Remdesivir was prescribed later than those discharged (P value, 0.04). Patients with favorable pregnancy outcomes received Remdesivir earlier than those with unfavorable pregnancy outcomes (P value: 0.008). The recovery rate was 70% (89.9% in the low-flow oxygen, 50.7% in the NIPPV/high flow oxygen, and 0% in the intubated women). Conclusion: The results suggest that the early prescription of Remdesivir in pregnant women with moderate COVID-19 can improve the outcomes.

Background: Osteoporosis is the most prevalent metabolic bone disease in postmenopausal women associated with reduced bone mass and increased bone fracture. Measuring bone density in the lumbar spine and hip is a reliable measure of bone mass and can therefore specify the risk of fracture. Dual-energy X-ray absorptiometry (DXA) is an accurate non-invasive system measuring bone density, with a low margin of error and no complications. The present study aimed to investigate the relationship between biochemical parameters with bone density in postmenopausal women. Materials and Methods: This cross-sectional study was conducted on 87 postmenopausal women referred to osteoporosis centers in Isfahan. Bone density was measured in the spine and hip area using the DXA system. Serum levels of calcium, phosphorus, alkaline phosphatase, and magnesium were measured by an autoanalyzer, and serum levels of vitamin D were measured by high-performance liquid chromatography (HPLC). Results: The mean parameters of calcium, phosphorus, alkaline phosphatase, vitamin D, and magnesium did not show a significant difference between the two groups (P-value > 0.05). In the control group, the relationship between alkaline phosphatase and bone mineral content (BMC) and bony area (BA) in the spine was significant with a correlation coefficient of − 0.402 and 0.258, respectively (P-value < 0.05) and BMD and T-score in the femoral neck area showed a direct and significant relationship with phosphorus (correlation = 0.368; P value = 0.038). There was a significant relationship between the Z-score with calcium (correlation = 0.358; P value = 0.044). Conclusion: There was no significant relationship between the values of calcium, phosphorus, alkaline phosphatase, vitamin D, and magnesium parameters and bone density (spine and hip) in postmenopausal women with osteopenia or osteoporosis.

Background: The involvement of lateral habenula and the ineffective dose of morphine on reward-related learning and memory is less well-known. This study looked into the effects of electrical stimulation, GABA_B receptor blockade, and a combination of both with morphine on conditioned place preference. Materials and Methods: In this experiment, male rats were anesthetized with ketamine/xylazine (six rats in each group). A 5-day biased conditioned place preference paradigm was used for the behavioral test. The effects of electrical stimulation and phaclofen plus a low dose of morphine on the acquisition and expression phases were examined during conditioning sessions and before the test phase, respectively. Results: The conditioning scores were reduced by antagonist injection during the acquisition phase. Interestingly, different intensities exhibited opposite effects on the acquisition phase. Conditioned place preference scores during the acquisition phase were significantly induced by 25 μA electrical stimulation, while conditioning scores were suppressed by electrical stimulation at 150 μA. Phaclofen (2 μg/rat) combined with high intensity induced aversion during the acquisition phase, while inhibiting expression. In contrast, high intensity with phaclofen (1 μg/rat) inhibited only the acquisition session. However, low intensity during the acquisition phase had an additive effect that was prevented by pretreatment with phaclofen (2 μg/rat), but this response was modified by the antagonist's low dose. Conclusions: A behavioral technique called conditioned place preference is frequently used to evaluate learning that is related to rewards. Therefore, lateral habenula electrical stimulation and phaclofen plus morphine could affect place preference through the involvement of the reward system.

Background: Neural tube defects (NTDs) are abnormalities of the brain and spinal cord, which occur as a result of failure in neural tube closure during embryogenesis. Causes of NTDs are complex and multiple, with hereditary, lifestyle, and environmental factors appearing to play a role. In spite of their impact on public health, the role genetics play on NTDs in Ethiopia is lacking. In this study, the role of polymorphisms in MTHFR 677C > T (rs1801133), MTHFR 1298A > C (rs1801131), MTRR 66A > G (rs1801394), RFC1 80A > G (rs1051266), and TCN2 776C > G (rs1801198) on the risk of having NTD-affected pregnancy was investigated. Materials and Methods: One hundred women with NTD-affected pregnancy and 100 women with normal pregnancy were included in the study. DNA was extracted from saliva and genotyping for five polymorphisms in four genes was analyzed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). The departure of the genotype's distribution from Hardy–Weinberg equilibrium (HWE) was evaluated using the x² goodness-of-fit test. Frequencies of genotypes and alleles in case and control mothers were determined and differences between relative frequencies were evaluated by the x² or the Fisher's exact test. Results: The statistically significant difference was absent in the genotype and allele frequencies for all the analyzed polymorphisms between cases and controls (P > 0.05). Conclusion: MTHFR 677C > T, MTHFR 1298A > C, MTRR 66A > G, RFC1 80A > G, and TCN2 776C > G polymorphisms lack association with the risk of having a pregnancy affected by NTD. The role of other genes or environmental factors in NTD etiology needs to be investigated.

Endometrial carcinoma is one of the most frequent gynecological cancers in developed countries. Lymphovascular space invasion (LVSI), histological grade, and myometrial invasion (MMI) are important prognostic factors of endometrial carcinoma. LVSI is considered an independent poor prognostic factor in endometrial carcinoma. Based on the importance of LVSI, this study aimed to discuss the association of LVSI with tumor grade and MMI. A search of PubMed, EMBASE, Web of Science, Scopus, Google Scholar, and Cochrane Library was carried out to collect related studies. Consequently, most studies showed that LVSI is significantly associated with higher histologic grade and deep MMI.

Background: In order to improve the complete recovery of nausea and vomiting, we conducted a study with the aim of preventing acute and delayed nausea and vomiting in children undergoing moderate emetogenic chemotherapy. Materials and Methods: A clinical trial study was done on 130 children received chemotherapy. Patients received olanzapine and placebo. All groups received granisetron along with dexamethasone (DEX). The severity of chemotherapy-induced nausea and vomiting (CINV) induced by chemotherapy was compared in two groups. Results: The severity of nausea on the first, second, third, and fourth days was not significantly different (P > .05) in two groups. The number of patients without vomiting was significantly different during the first 24 hours after chemotherapy between patients in the two groups (82.3% vs 64.5%; P = .016). Conclusion: This study showed that olanzapine, which acts as an inhibitor of neurotransmitters, had a favorable efficacy in controlling acute and delayed CINV. More studies with large sample size are needed to compare the effect of olanzapine with other agents including aprepitant and palonosetron in the prevention of CINV.

Background: Growing evidence strongly indicates pivotal roles of gender differences in the occurrence and survival rate of patients with bladder cancer, with a higher incidence in males and poorer prognosis in females. Nevertheless, the molecular basis underlying gender-specific differences in bladder cancer remains unknown. The current study has tried to detect key genes contributing to gender differences in bladder cancer patients. Materials and Methods: The gene expression profile of GSE13507 was firstly obtained from the Gene Expression Omnibus (GEO) database. Further, differentially expressed genes (DEGs) were screened between males and females using R software. Protein–protein interactive (PPI) network analysis, Kyoto Encyclopedia of Genes and Genomes (KEGG), Gene Ontology (GO), and Kaplan–Meier survival analyses were also performed. Results: We detected six hub genes contributing to gender differences in bladder cancer patients, containing IGF2, CCL5, ASPM, CDC20, BUB1B, and CCNB1. Our analyses demonstrated that CCNB1 and BUB1B were upregulated in tumor tissues of female subjects with bladder cancer. Other genes, such as IGF2 and CCL5, were associated with a poor outcome in male patients with bladder cancer. Additionally, three signaling pathways (focal adhesion, rheumatoid arthritis, and human T-cell leukemia virus infection) were identified to be differentially downregulated in bladder cancer versus normal samples in both genders. Conclusion: Our findings suggested that gender differences may modulate the expression of key genes that contributed to bladder cancer occurrence and prognosis.

Background: Evaluation of ovarian tumors based on tumor markers could have high clinical importance. In this study, we aimed to assess the predictive value of HE4 and Risk of Ovarian Malignancy Algorithm (ROMA) compared to CA-125 in the Malignancy of ovarian epithelial masses. Materials and Methods: This cross-sectional study was performed in 2020–2021 including 203 patients. Serum HE4 and CA-125 levels were checked before surgery. According to the pathology report (benign, borderline, or malignant epithelial mass), the predictive values of the three markers were evaluated. Results: About 146 cases were benign; 14 cases were borderline and 43 cases were malignant. Most patients (69.8%) in the malignant group were in stage 3. Significantly higher levels of all three markers (CA-125, HE4, and ROMA) were found in patients with malignant tumors compared to benign or borderline tumors (P < 0.001 for all). The sensitivity of CA-125 was the highest (90.7%) in pre- and post-menopausal patients but the specificity of HE4 and ROMA were higher than CA-125 (98.1% and 97.5%, respectively, versus 86.9% for CA-125). In post-menopausal patients, both sensitivities of HE4 and ROMA were 90.5% and the specificity and sensitivity of CA-125 were the highest (95.2% and 100%). In premenopausal patients, the sensitivity of ROMA (90.9%) and the specificity of HE4 (100%) were the highest. Conclusions: HE4 and ROMA are not necessary for postmenopausal patients in low-resource areas and a check of serum CA-125 will be enough. The higher-cost, ROMA, and HE4 checks are recommended in premenopausal people because they are more sensitive.

Background: Alagille syndrome (ALGS) is an autosomal dominant disease caused by JAG1 or NOTCH2 mutation. It is diagnosed by the presence of three out of five features: characteristic facies, posterior embryotoxon, peripheral pulmonary stenosis, vertebral defects, and interlobular bile duct paucity. This study aimed to review the prevalence, clinical presentations, diagnosis, treatment, and outcome of patients with ALGS. Materials and Methods: This is a retrospective review of patients with ALGS at the Pediatric Department, Salmaniya Medical Complex, Bahrain, between August 1994 and October 2022. The diagnosis was based on clinical, laboratory, radiological, histopathological, and genetic findings. Results: Five patients were found to have ALGS. The prevalence of ALGS in Bahrain was 1.04 patients per 100,000 (0.001%). Four were Bahraini and three were females. Median birth weight was 2.3 (2.3–2.5) kg. All patients presented at the time of birth with low birth weight, cholestatic jaundice, clay-colored stool, heart murmur, and dysmorphic facial features. All had congenital heart diseases, two had butterfly vertebrae, and one had posterior embryotoxon. All had elevated liver enzymes and normal abdominal ultrasound. Three had positive hepatobiliary iminodiacetic acid scan and one had bile duct paucity in liver biopsy. Three had intraoperative cholangiogram. Four were positive for JAG1 mutation. All received ursodeoxycholic acid and fat-soluble vitamins. Two required liver transplantation. Conclusion: ALGS is a rare disorder in Bahrain. Diagnosis is challenging as the disease can be associated with or misdiagnosed as biliary atresia. Patients with ALGS are at high risk of morbidity either by unnecessary intraoperative cholangiogram or unavoidable liver transplantation.

Background: p16 is a cyclin-dependent kinase inhibitor and a cardinal regulator of the cell cycle. The relationship between p16 overexpression and poor prognosis of breast cancer has been reported in some studies. This study aimed to evaluate p16 expression in breast cancer in comparison to normal breast tissue and determine the association between p16 expression and clinicopathological parameters in breast cancer. Materials and Methods: Paraffin blocks of 110 samples were studied. These included 40 invasive breast carcinoma (tumor group) and normal tissue adjacent to the tumor (tumor control), as well as 30 normal mammoplasty specimens (normal control). Samples were from the pathology archive of Alzahra Hospital, Isfahan, Iran, from 2016 to 2020. p16 expression was studied and compared in these three groups using the immunohistochemistry technique. Moreover, the relationship between p16 expression and age, tumor size, carcinoma subtype, tumor grade, and lymph node involvement was investigated in the tumor group. SPSS version 16 was used to analyze data. Results: p16 expression showed a significant difference between the tumor group and the two control groups with a significantly higher expression in the tumor group. There was a significant direct relationship between the intensity of p16 expression and the number of involved lymph nodes (P < 0.001). No significant relationship was detected between p16 expression and other clinicopathological factors. Conclusion: p16 seems to have a rather significant expression in breast cancer in comparison to normal breast parenchyma. However, among clinicopathological parameters, we found only a direct relationship between lymph node involvement and intensity of p16 expression.

Background: The spike surface glycoprotein of SARS-CoV-2 is the essential protein in virus attachment to the target cell and cell entrance. As this protein contains immunodominant epitopes and is the main target for immune recognition, it is the critical target for vaccine and therapeutics development. In the current research, we analyzed the variability and mutations of the spike glycoprotein isolated from 72 COVID-19–positive patients from Iran's first three waves of disease. Materials and Methods: The RNA was extracted from nasopharyngeal samples of confirmed COVID-19 cases and served as a template for cDNA synthesis and reverse transcriptase polymerase chain reaction. The reverse transcriptase polymerase chain reaction products of each sample were assembled and sequenced. Results: After analysis of 72 sequences, we obtained 46 single nucleotide polymorphisms, including 23 that produce amino acid changes. Our analysis showed that the most frequent mutation was the D614G (in the samples of the second and third waves). Conclusions: Our findings suggest that developing effective vaccines requires identifying the predominant variants of SARS-CoV-2 in each community.

The world has experienced a global medical and socioeconomic burden following the coronavirus disease 2019 (COVID-19) pandemic. COVID-19 is a systemic disease and may affect different organs including the kidneys. Current literature contains reports on COVID-19-related conditions such as acute kidney injury, and complications experienced by chronic kidney disease, end stage kidney disease, and kidney transplant patients. Here, we discuss the incidence of kidney allograft rejection, immunosuppression management and rejection risk, donor-specific antibodies and previous rejection episodes, and rejection outcomes in kidney transplant recipients with COVID-19 by reviewing current studies.

Background: One of the most debilitating symptoms in breast cancer survivors is cancer-related fatigue (CRF). CRF weakens patients' physical, cognitive, and occupational functions. It is associated with poorer quality of life and may reduce recurrence-free and overall survival. This study aimed to evaluate the efficacy of a group psychoeducational intervention in improving CRF in breast cancer patients. Materials and Methods: Fifty breast cancer patients who suffered from CRF were randomly assigned to receive a group psychoeducational intervention or control group. This study was designed as an eight weeks clinical trial. The psychoeducational intervention mainly consisted of concentrative movement therapy and energy conservation strategies. Primary outcome measures were the changes in the Fatigue Visual Analogue scale, Cancer Fatigue scale, and Piper Fatigue scale at the study endpoint. Measure assessments were made on four occasions: at baseline, after the intervention, one week, and four weeks post intervention. Statistical analysis was performed using SPSS26. Results: The intervention improved CRF significantly (P < 0.001). All subscales of the Cancer Fatigue scale and the sensory, affective, and cognitive subscales of the Piper Fatigue scale showed statistically significant effects (P < 0.001) at all time points. However, the behavioral subscale of the Piper Fatigue scale was different only at the end of the study (P < 0.001). Conclusions: The group psychoeducational intervention improved CRF significantly. All the sensory, behavioral, physical, affective, and cognitive subscales improved. Accessible and confirmatory treatment can help patients to cope with fatigue in communities.

Background:The phenotypic range of limb-girdle muscular dystrophies (LGMDs) varies significantly because of genetic heterogeneity ranging from very mild to severe forms. Molecular analysis of the DYSF gene is challenging due to the wide range of mutations and associated complications in interpretations of novel DYSF variants with uncertain significance. Thus, in the current study, we performed the NGS analysis and its results are confirmed with Sanger sequencing to find the plausible disease-causing variants in patients with muscular dystrophy and their relatives via segregation analysis. Materials and Methods: Nine patients with LGMD type 2B (LGMD2B) characteristics were screened for putative mutations by the whole-exome sequencing (WES) test. Either the patients themselves or their parents and first relatives were investigated in the segregation analysis through Sanger sequencing. The majority of variants were classified as pathogenic through American College of Medical Genetics and Genomics (ACMG) guidelines, segregation results, and in silico predictions. Results: Results revealed eight variants in DYSF gene, including three splicing (c.1149+4A>G, c.2864+1G>A, and c.5785-7G>A), two nonsense (p.Gln112Ter and p.Trp2084Ter), two missense (p.Thr1546Pro and p.Tyr1032Cys), and one frameshift (p.Asp1067Ilefs), among nine Iranian families. One of the eight identified variants was novel, including p.Asp1067Ilefs, which was predicted to be likely pathogenic based on the ACMG guidelines. Notably, prediction tools suggested the damaging effects of studied variants on dysferlin structure. Conclusion: Conclusively, the current report introduced eight variants including a novel frameshift in DYSF gene with noticeable pathogenic effects. This study significantly can broaden the diagnostic spectrum of LGMD2B in combination with previous reports about DYSF mutations and may pave the way for a rapidly high-ranked identification of the accurate type of dysferlinopathy.

Background: The Toll-like receptor 4 (TLR4) gene promotes migration in adenocarcinoma cells. Morphine is an agonist for TLR4 that has a dual role in cancer development. The promoter or inhibitor role of morphine in cancer progression remains controversial. This study aims to evaluate the effects of morphine on the TLR4, myeloid differentiation primary response protein 88-dependent (MyD88), and nuclear factor-kappa B (NF-κB) expressions in the human MDA-MB-231 breast cancer cell line. Materials and Methods: The cells were examined after 24 hours of incubation with morphine using the Boyden chamber system. TLR4, MyD88, and NF-κB mRNA expressions were assessed using quantitative real-time polymerase chain reaction (RT-PCR). The concentration of interleukin-2 beta was also measured using the ELISA assay. Results: According to the findings, three doses of morphine (0.25, 1.25, and 0.025 μM) increased the expression of the TLR4 and NF-κB genes, whereas no significant change was observed in the mRNA expression of MyD88. Furthermore, treatment with morphine and lipopolysaccharide (LPS) significantly decreased the expression of TLR4, MyD88, and NF-κB. However, no significant change was observed in interleukin 2 beta concentration. Conclusions: These findings confirmed the excitatory effects of morphine on TRL4 expression and the MYD88 signaling pathway in vitro.

Biotinidase deficiency is a rare autosomal recessive neurometabolic disorder resulting in biotin deficiency. Our patient presented with seizures and developmental delay since infancy and was started on megavitamin supplements. At 14 years, she presented with motor regression with encephalopathy after discontinuation of vitamins. There were no skin and hair changes. Magnetic resonance imaging (MRI) of the brain showed bilateral symmetrical posterior putamen signal changes. Tandem mass spectroscopy showed increased methyl malonyl carnitine and 3-OH isovaleryl carnitine. There was a low biotinidase level, and a pathogenic variant in the BTD gene in the next-generation sequencing was identified. Special importance is placed on the unusual symmetric posterior putamen involvement seen in MRI of the brain.

Background: The new coronavirus is an agent of respiratory infections associated with thrombosis in vital organs. This study aimed to propose a better diagnosis and treatment of coagulation disorders caused by the new coronavirus (Covid-19). Materials and Methods: Search in Cochrane central, Web of Science, PubMed, Scopus, and Ovid will be done. Also, according to the inclusion criteria, cross-sectional studies, cohort, clinical trial, and case-control will be included without gender and language restriction. Participants will also be Covid-19 patients with coagulation disorders. Any disagreement in the stages of screening, selection, and extraction of data between the two reviewers will be resolved by discussion, then if not resolved, the opinion of expert reviewers will be used. The risk of bias will be assessed using the NOS (Newcastle–Ottawa scale) tool for cross-sectional study, cohort and case-control, and the Cochrane checklist for clinical trials study. Metaanalysis of included studies that are similar based on the methodology will be done. Also, a fixed or random-effect model will be used for this it. Heterogeneity indices (I2), odds ratio (OR), risk ratio (RR), mean difference, and %95 confidence interval will also be calculated by Stata V.13.0 (Corporation, College Station TX). Results: Treatment with anticoagulants will reduce the severity of thrombosis and lung disease in patients. D-dimer measurement will also be a diagnosis indicator of thrombosis. Conclusions: Simultaneous study of coagulation disorders and thrombosis in patients and development of a Godliness based on it will play a treatment role in the follow-up of the coronavirus disease.

Background: The aim of this study was to investigate the effect of Lieberman community return program on reducing positive and negative symptoms and improving social skills in people with schizophrenia. Materials and Methods: In this clinical trial study, 58 patients with schizophrenia were randomly allocated into two groups of 29. The first group received 16 sessions of Lieberman community return training and the second group received routine care as a control group. All patients were evaluated before intervention and 1 and 3 months after intervention using the Matson Social Skills Questionnaire and Negative and Positive Symptoms Assessment Scale and compared between the two groups. Results: Evaluation of negative symptoms showed that the dimensions of affective flattening, avolition, anhedonia–asociality, attention, and alogia in the intervention group decreased significantly over time (P < 0.05), but no significant difference was seen in the control group. The mean score of positive symptoms such as hallucinations, delusion, inappropriate affect, and formal thinking disorder in the intervention group were decreased significantly (P < 0.05), but no significant difference was seen in the control group. Appropriate social skills and overall skill score were increased significantly in the intervention group over time (P < 0.05). Conclusion: Lieberman community return program is likely to reduce the symptoms of schizophrenia and increase patients' social skills.

Background: Prediabetes is an intermediate hyperglycemia in which the fasting blood glucose (FBG) level is greater than normal (100–125 mg/dl) but lower than diabetic levels (more than 125 mg/dl). The aim of the present study was to evaluate and correlate the impact of the combined approach of yoga therapy (CAYT) on carotid intima-media thickness (CIMT) and metabolic parameters including FBG, glycated hemoglobin (HbA1C), and lipid profile-like triglyceride (TG), total cholesterol (TC), and high-density lipoprotein (HDL). Materials and Methods: Experimental Interventional study was conducted on a total of 250 prediabetics divided into the control (n = 125) and study group (n = 125) at “RUHS College of Medical Sciences and associated hospitals.” Assessments were made at baseline and after six months of the CAYT. The study group (n = 125) was engaged in the CAYT, which consists of yoga, dietary modification, counseling, and follow-up. The control group not participated in CAYT. Result: Mean age of participants was 45.3 ± 5.4 years. Pearson correlation analysis of CIMT and metabolic parameters which were fasting blood sugar, HbA1C, and lipid parameters (TC, TG, and HDL) showed that significant positive correlation with FBG (r = .880), HbA1C (r = .514), TC (r = .523), TG (r = .832), and negative correlation with HDL (r = ˗0.591) after six months of CAYT. Conclusion: This study demonstrated that after six months of CAYT metabolic parameters, CIMT were significantly decreased. We have observed a significant correlation exists between CIMT and metabolic parameters. Therefore, regular CIMT measurement might be beneficial for the assessment of cardiovascular disease (CVD) risk and facilitate better use of treatment modalities in prediabetics.

Background: The role of the hematologic indicators in the identification of severe or critical patients requires further investigation. In this study, we focused on predicting Covid-19 patients at risk of progression using blood parameters. Materials and Methods: We performed a retrospective study including 444 patients with confirmed Covid-19. Hematological parameters were evaluated. The logistic regression analysis was performed with step-wise method with dependent variables such as intensive care units admission, partial pressure of oxygen saturation, and mortality. Also, independent variables such as hematological parameters, age and sex to assess variables that are likely to predict patients at risk of progression. Results: Patients in intensive care units had significantly higher mean absolute neutrophil count than outpatients (P < 0.001). There was a statistically significant difference in the mean absolute lymphocyte count between dead and survived patients (P = 0.015). Multivariate analysis confirmed the positive association of the white blood cells (P < 0.001), absolute neutrophil count (P < 0.004), red cell distribution width (P < 0.001), and lactate dehydrogenase (P = 0.007) to be positively associated with the admission of Covid-19 patients in the intensive care units and the absolute monocyte count (P = 0.012, Odds ratios = 0.100, CI95% = 0.066-0.605) to be negatively associated with mortality. Conclusion: Based on the results of our study, it is recommended to use hematological data to make clinical decisions and evaluate the patient's prognosis.

Background: The pandemic of Covid-19 resulted in significant morbidity and mortality, especially in those with pre-existing diseases like diabetes mellitus, cardiovascular diseases, etc., primarily due to extensive pulmonary involvement. The chest radiograph is the first imaging tool used in all Covid-19 patients. Hence, in this study, we attempt to understand and evaluate the role of the chest radiograph in Covid-19 patients with and without coexisting diseases. Materials and Methods: Our study included RTPCR-positive Covid-19 patients with comorbidities (560 cases) and without comorbidities (145 controls), viz. diabetes mellitus, hypertension, coronary artery disease, or thyroid disease. All controls and cases had chest radiographs with simple fractional zonal scores in a predesigned proforma. Statistical evaluation of chest radiograph scores was compared with and within groups. Results: Among the controls, approximately 63.5% revealed pulmonary findings on chest radiographs contrary to 77% among cases. No statistical differences were noted among controls and cases based on age and gender. The presence of pleural effusion was noted as a significant factor affecting the score and hence the prognosis in both controls and cases. Statistically significant differences were noted in SFZ scores between controls and various case groups. Conclusion: Chest radiograph scores in Covid-19 disease are higher in patients with comorbidities at the time of presentation, most marked in those with both hypertension and thyroid disease followed by those with hypertension and coronary artery disease. Lower zone predominance is seen in all patients including those with and without comorbidities. The chest radiograph scores become statistically significant with more than one existing comorbidity.

Background: There is no dedicated specific intensive care unit (ICU) for poisoning cases due to the small number of poisoned patients in some poisoning centers and patients may hospitalized in the general ICU. In this study, we compared the outcome of hospitalization in poisoning and general ICU, in matched patients to demographical and toxico-clinical factors. Materials and Methods: This historical cohort study was conducted from September 2020 to January 2022 in the general and poisoning ICUs of Khorshid Hospital affiliated to the University of Medical Sciences, Isfahan, Iran. Patient characteristics, clinical, and toxicological information as well as the therapeutic measures and outcome were collected from hospital medical records and analyzed. Results: Totally, 178 (60.1% male and 39.9% female) patients met inclusion criteria. Medicines (56.2%) and opioids (25.3%) followed by pesticides (14%) were the most common substances. Suicide was the type of exposure in 78.7% of the cases. Most patients suffered from lung (19.1%) and kidney (15.2%) injuries. The mortality rate was 23.6%. The median length of hospital stay (P-value < 0.001) and duration of ventilator usage was higher (P-value < 0.001) in general ICU compared to specific ICU for poisoning cases. No significant difference with respect to demographic, toxico-clinical variables and mortality rate was found between the two groups. Conclusion: Among poisoned patients admitted to ICU, reported mortality rate was relatively high. Patients who hospitalized in the specific ICU for poisoning cases have lower length of hospital stay and duration of mechanical ventilation compared to general ICU.

Background: Encephalitis is an uncommon, serious brain infection that can cause fatality among children. The cause of most encephalitis remained unknown, yet viruses are the most well-known infectious agents that cause encephalitis. This study aimed to determine varicella–zoster virus (VZV) and herpes simplex virus type 1, 2 (HSV1/2) among individuals who are under 5 years of age in Iran. Materials and Methods: In this study, 149 cerebrospinal fluid samples of suspected patients of encephalitis were analyzed with some symptoms, such as seizure, fever, nausea loss of consciousness, and dizziness from Mofid Children's Hospital in Tehran, Iran. Then, the molecular evaluation of samples was performed using multiplex Polymerase Chain Reaction (PCR) for detecting HSV1/2 and VZV. Results: The mean age of the patients was 1.8 years. Also, 63.4% of children were male and 36.6% were female. Out of 149 tested samples, 11 (7.3%) showed the viral DNA for one of the herpes viruses (7.3%). Nine samples were HSV1 positive (6.0%) and two samples were VZV positive (1.3%). Fever and vomiting were the most frequent symptoms. The mean ± standard deviation (SD) WBC and counts in cerebrospinal fluid (CSF)-positive samples, and all included samples were 298.8 ± 552.7 cells/μL and 131.1 ± 474.6 cells/μL, respectively. Conclusions: Although viral encephalitis is considered a threat to children's health, with accurate diagnosis and appropriate antiviral drugs, death and neurological complications in children can be prevented.

Background: Bariatric surgery is associated with significant risk reduction for obesity-related and hormone-mediated cancers; however, few studies report gastric or esophageal cancer development after bariatric surgery. This study evaluates the incidence of pre-cancerous mucosal lesions one year after bariatric surgery. Materials and Methods: Eligible patients for omega-loop gastric bypass and classic Roux-en-Y gastric bypass (RYGB) underwent upper endoscopy before bariatric surgery and one year after the procedure. Several biopsies were obtained from esophagogastric mucosa, all of which were evaluated by pathologists regarding the development of any pre-cancerous lesion. Results: A total of 108 patients were included in the study. Seventy-one underwent omega bypass and 37 classic RYGB. Follow-up endoscopy indicated no dysplastic changes in esophagogastric mucosa one year after the surgery. The number of patients with gastric intestinal metaplasia was 22 and 25 before and after the surgery, respectively, which was not a statistically significant increase. Conclusion: Bariatric surgeries might not increase the risk of developing pre-cancerous lesions in the esophagogastric mucosa. Further epidemiological studies may help to establish this finding.

Background: Pertrochanteric hip fractures are common and among serious injuries of the old population with considerable mortality and morbidity. The aim of this study was to evaluate long-term effects of recombinant human parathyroid hormone on postoperative clinical and radiologic outcomes in elderly patients with pertrochanteric hip fractures. Materials and Methods: Between 2016 and 2019, we prospectively assessed 80 patients with pertrochanteric hip fractures who underwent reduction and internal fixation with a dynamic hip screw. Patients were divided randomly into two groups. About 40 patients in the control group who received supplementary calcium (1000 mg/day) and vitamin D (800 UI/day), and 40 others who were treated additionally with 20–28 mg daily teriparatide for three months post-operatively. The functional and radiologic assessment was done using visual analog scale (VAS), Harris hip score (HSS), and standard radiographs of the hip. Results: At the final follow-up, there was a significant difference between the two groups regarding average HSS (68.38 in the control group versus 74.12 in the treatment group, P-value <0.001). VAS score was also significantly lower in the treatment group (P-value <0.001). Regarding radiographic evidence of union, the results were not statistically different between the two groups. Conclusions: The current study illustrated that short-term daily administration of teriparatide improves long-term functional outcome after pertrochanteric hip fracture fixation and can reduce the pain but does not affect union and callus formation.

Background: We aimed to better understand the outcomes/complications of pie-crusting technique using blade knife during total knee arthroplasty (TKA) in patients with knee genu varum deformity. Materials and Methods: A systematic search was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. English and Persian language articles were considered on the use of pie-crusting technique during TKA in patients with knee genu varum/varus deformity using related keywords and Medical Subject Headings terms with reported postoperative complications and outcomes. Results: Primary search resulted in 81 studies of them 9 included in our study (ages ranged: 19 years to 62 years). No perioperative complications and/or any significant differences between pie-crusting and control group were observed. Except for two studies that found no significant positive effect for the use of pie-crusting, other studies found pie-crusting a useful and promising technique. Four studies found significant improvement in pie-crusting group compared to control in terms of functional Knee Society Score (KSS), range of motion (ROM), medial gap, and the knee-specific KKS. Three records found no significant differences in terms of functional KSS, ROM; however, they reported fewer use of constrained inserts or a reasonable correction of femoral tibial angle. No serious complications were reported. Conclusions: Due to the inconsistency of the results on the efficiency and outcomes of pie-crusting, we cannot make a firm conclusion and more high-quality studies are needed in this regard. However, this method can be considered as a safe method which depends on the skill of surgeon.

Background: Several countries, including Iran, have been affected by the novel Coronavirus Disease 2019 (COVID-19) pandemic since December 2019. The aim of this study was to provide a comprehensive report on COVID-19 patients in Shiraz, Southern Iran. Materials and Methods: This study was performed on 311 hospitalized patients with COVID-19. The data on demographic, clinical, and paraclinical features were analyzed. Results: The median age of the patients was 58 years, with 42.1% of the patients being above 60 years of age. Upon admission, fever was detected in 28.2% of critically ill patients. At least one underlying disease or risk factor was also present in 75.6% of the patients. Shortness of breath was the most common clinical symptom (66.2%), dry cough (53.7%), and muscle pain (40.5%) was the second and third. Sneezing (0.3%), rhinorrhea (0.7%), and sore throat (3.09%) were observed only in non-critically ill patients. In addition, 26.9% of all patients had lymphocytopenia, 25.8% had raised C-reactive protein, and 79.9% had abnormal creatinine levels. Finally, death occurred in 39 patients (12.5%). Conclusions: Noncritically ill patients were younger than critically ill patients. The most common risk factors for getting critically ill were surgery, hypertension, diabetes mellitus, chronic heart disease, asthma, and chronic renal disease.

Background: We aimed to investigate the usefulness of intracranial arterial pulsatility index to assess the prognosis of lacunar infarcts. Materials and Methods: Forty-nine patients with confirmed acute lacunar infarct were enrolled in the study. A transcranial color-coded sonography was performed to assess the pulsatility index of bilateral middle cerebral, posterior cerebral, vertebral, and proximal internal carotid arteries. Patients' clinical status was assessed using a modified Rankin scale. Spearman correlation was used for reporting the relation between quantitative data. Statistical significance was defined as a two-tail p-value of less than 0.05. Results: The mean age ± standard deviation was 64.1 ± 9.07 years old, and 57.1% of the patients were male. Upon discharge, only 8.2% of the patients were ranked as 0 on the modified Rankin scale; however, after a 6-month follow-up period, this number increased to 49%. There were no significant differences between the left and right pulsatility index measurements in any of the assessed arteries. Patients with vertebral artery pulsatility indexes >1 on their primary assessment had significantly worse outcomes during the first, third, and sixth months follow-up (all r > 0.3, p-values < 0.01). Pulsatility indexes from other arteries did not predict the prognosis. Conclusion: Sonography-assisted assessment of the vertebral artery blood flow during the early stage of lacunar infarct provides a reliable reference for prognosis estimation.

Background: To evaluate atherosclerotic changes in carotid arteries (CCA) in uremic patients before and after 18 months of continuous ambulatory peritoneal dialysis (CAPD) treatment, and to evaluate the impact of dyslipidemia and CAPD treatment on vascular remodeling. Materials and Methods: We conducted a longitudinal, prospective study during 2020 and 2021 at the Clinic for Nephrology, Clinical Center University of Sarajevo. Patients with end-stage renal disease were included and were followed during 18 months of CAPD treatment. All patients were treated using commercially prepared biocompatible balanced dialysis solutions. Carotid intima-media thickness (IMT) and atherosclerotic plaques on the common carotid artery (CCA) were measured by echotomography. Results: A total of 50 patients were included and were followed during 18 months of CAPD treatment. Lipid values in the serum of patients with CAPD were significantly lower after 18 months of CAPD treatment compared to the values before treatment, while the value of high-density lipoprotein (HDL) was significantly increased after 18 months of CAPD treatment. The values of IMT and the diameter of the CCA compared to the basal values were significantly lower (P < 0.001). Conclusion: We demonstrated significantly lower lipid values and higher HDL levels following CAPD treatment. Correct selection of the targeted pharmacological intervention can substantially impact the regression of vascular changes in patients on peritoneal dialysis.

Background: Due to the increasing prevalence of candidiasis, early detection of the causative agents may pave the way for the management of this infection. The present study aimed to assess the discriminative power of the six isoenzymatic systems for differentiating the Candida species. Materials and Methods: Sixteen standard Candida albicans and Candida dubliniensis strains and 30 fluconazole-sensitive and fluconazole-resistant clinical strains of Candida albicans were analyzed using a Multilocus Enzyme Electrophoresis (MLEE) method, including six enzymatic systems consisting of malate dehydrogenase (MDH), phosphoglucomutase (PGM), glucose-phosphate isomerase (GPI), glucose-6-phosphate dehydrogenase (G6PDH), 6-phosphogluconate dehydrogenase (6PGD), and malic enzyme (ME). Results: Among the six enzymatic systems, ME showed no diagnostic activity, whereas MDH provided the best species-specific pattern for species discrimination. In addition, the MDH and G6PD systems provided a discriminatory pattern for differentiating C. dubliniensis from C. albicans isolates. The same isoenzymatic activity was detected in all 36 standard and clinical isolates. Moreover, the results showed no correlation between the isoenzymatic profiles and drug resistance. Conclusion: Among the investigated MLEE systems, MDH was able to differentiate between Candida albicans and Candida dubliniensis. Although no association was detected between isoenzyme patterns and fluconazole resistance in this investigation, isoenzyme patterns are likely correlated with virulence factors between species and even within species. To answer these questions, additional studies should be done on more strains.

Background: Chorionic villus sampling (CVS) is one of the invasive diagnostic methods used to diagnose chromosomal, genetic, and metabolic diseases in the embryonic period. The use of this method is associated with maternal and fetal consequences, the most serious of which is abortion. Therefore, the present study was conducted to investigate the incidence of these consequences and the factors affecting the incidence of abortion. Materials and Methods: A cross-sectional study was performed on 98 pregnant women with CVS indications. Maternal and fetal outcomes including abortion, vaginal bleeding, subchorionic hematoma, premature rupture of membrane (PROM), chorioamnionitis, preterm delivery, limb abnormality, fetal growth retardation, and preeclampsia were recorded. Results: The results of the present study showed that the incidence of fetal outcomes including fetal growth failure, premature rupture of membranes, abortion, and limb abnormalities was 4.1%, 7.1%, 3.1%, and 1%, and the incidence of maternal outcomes including preterm delivery, subchorionic hematoma, preeclampsia, and hemorrhage was 14.3%, 3.1%, 6.1%, and 10.2%, respectively. In addition, a decrease in free BHCG and an increase in NT were significantly associated with the occurrence of abortion (OR: 0.11 and 4.25, respectively, P value < 0.05). Conclusion: It should be noted that due to a long time between placental sampling and the occurrence of vaginal bleeding, premature rupture of membrane, and preterm delivery, it seems that placental sampling has no effect. In addition, only a decrease in free BHCG or an increase in NT significantly increased the chance of miscarriage.

Background: The quality of the luteal phase is the most important issue affecting pregnancy outcomes in assisted reproductive technology (ART). Luteal-phase support with the administration of gonadotropin-releasing hormone (GnRH) agonist or progesterone improves the likelihood of pregnancy in ART. Due to disagreements regarding the best pharmaceutical form of progesterone for success of in vitro fertilization (IVF) in ART methods, the present study aimed to compare the clinical efficacy of oral dydrogesterone with vaginal progesterone on the outcome of pregnancy in IVF. Materials and Methods: This unblinded randomized clinical trial was conducted at the Shahid Beheshti Hospital, Obstetrics and Gynecology Centre in Isfahan, Iran, between june 2021 and September 2021. In total, 126 couples were included in the study. All patients underwent controlled ovarian stimulation and IVF. Patients were randomly divided into two groups (n = 63 per group). After embryo transfer, group I was treated with Cyclogest 400 mg twice daily, and group II was treated with oral Duphaston 10 mg twice daily. Results: No significant differences were observed between the two groups in terms of the mean endometrial thickness (P = 0.613), the mean number of transferred embryos (P = 0.100), and the number of implanted embryos (P = 0.338). Additionally, no statistically significant differences in the pregnancy rate were detected between the two groups (P = 0.875). Conclusions: The evidence from this study indicates that Duphaston is as effective as Cyclogest for luteal-phase support.

Background: In the current age of diagnostic approaches in cancer, countless efforts have been allocated to identify novel and efficient biomarkers to detect cancer in its early stages. We focused on evaluating the correlation between the progression of gastrointestinal cancer, a leading cause of cancer death worldwide, and human endogenous retrovirus (HERV). Materials and Methods: In this study, we conducted a study on the peripheral blood mononuclear cells (PBMC) gathered from gastric and colon cancer patients. We focused on HERV-K rec, np9, gag expression analysis by quantitative real-time PCR, after extraction of RNA and synthesizing cDNA. Results: Unlike np9 whose expression increased significantly in the colon and gastric cancers, the mRNA level of the rec gene declined in both cancers. Moreover, our data illustrated that the over-expression of the gag gene was only observed in colon cancerous cells rather than gastric malignancy. Conclusions: Overall, given the correlation between the expression level of HERV-associated genes and gastrointestinal cancer, our study suggests that these genes could be considered beneficial markers for cancer diagnosis. However, researchers should conduct studies in future articles on whether these genes can be employed as biomarkers in gastrointestinal cancer.

Background: Congenital malformations are defined as “any defect in the structure of a person that exists from birth”. Among them, congenital heart malformations have the highest prevalence in the world. This study focuses on the development of a predictive model for congenital heart disease in Isfahan using support vector machine (SVM) and particle swarm intelligence. Materials and Methods: It consists of four parts: data collection, preprocessing, identify target features, and technique. The proposed technique is a combination of the SVM method and particle swarm optimization (PSO). Results: The data set includes 1389 patients and 399 features. The best performance in terms of accuracy, with 81.57%, is related to the PSO-SVM technique and the worst performance, with 78.62%, is related to the random forest technique. Congenital extra cardiac anomalies are considered as the most important factor with averages of 0.655. Conclusion: Congenital extra cardiac anomalies are considered as the most important factor. Detecting more important feature affecting congenital heart disease allows physicians to treat the variable risk factors associated with congenital heart disease progression. The use of a machine learning approach provides the ability to predict the presence of congenital heart disease with high accuracy and sensitivity.

Background: Increased intracranial pressure (ICP) is a modifiable secondary injury that is associated with poor outcomes in patients with traumatic brain injuries (TBIs). Therefore, the present study was conducted with the aim of determining the ICP of TBI patients by measuring the thickness of the optic nerve sheath diameter (ONSD). Materials and Methods: The present cross-sectional study was conducted on 220 patients with severe TBI that referred to Khatam-al-Anbya Hospital in Zahedan in 2021. The measurement of ONSD was performed by ultrasonography. Results: The results of this study revealed that 22.7% of TBI patients had high ICP. The mean of right and left ONSD in patients with normal ICP was 3.85 ± 0.83 and 3.85 ± 0.82 mm, respectively, and was significantly lower than that of patients with abnormal ICP (high ICP) with the mean of 3.85 ± 0.82 and 6.12 ± 0.84 mm, respectively (P value <.001). In addition, the right ONSD with the cutoff point of 5.13 mm, the sensitivity of 84%, and the specificity of 95.29% and the left ONSD with the cutoff point of 5.24 mm, the sensitivity of 90%, and the specificity of 95.88% had a significant diagnostic value in the diagnosis of high ICP (P value <.05). Conclusion: The findings of the present study indicated that the measurement of ONSD is a cost-effective and minimally invasive procedure with a higher accuracy in diagnosing high ICP in TBI patients.

Background: Trametes species possess remarkable immunomodulatory and anticancer effects which are mainly related to the activation of innate immune receptors by their polysaccharide constituents. In this study, we investigate the effect of Trametes gibbosa (Pers.) Fr. polysaccharide fraction (TGP) on activation of TLR-4 receptor and subsequent release of IL-8 in HEK-Blue™ hTLR4 cells. Materials and Methods: The polysaccharide fraction was purified using ethanol precipitation and dialysis methods. The total sugar content and monosaccharide composition were analyzed by phenol–sulfuric acid and chromatographic methods. FT-IR spectroscopy was also performed for structure characterization of the polysaccharide. The activation of TLR4 was determined by measuring the secreted embryonic alkaline phosphatase in the culture media. Results: The results indicated that the total sugar content of TGP was about 90%, which glucose was the major constituents. FT-IR analysis showed the characteristic bands of polysaccharides. TGP was able to activate the TLR-4 signaling pathway in a dose-dependent manner. Moreover, the significant increase of IL-8 was observed in cells treating with TGP. The HEK-Blue Null2™ reporter cells lacking TLR4, did not respond to LPS and TGP. Conclusion: The results suggest that TLR4 signaling cascade serve as targets for immunomodulatory activity of T. gibbosa which could address the anticancer properties of Trametes species.

Background: Nanotechnology has introduced valuable carriers for vaccine delivery. The success of vaccination depends on many factors, such as the intact and safe presentation of vaccine candidates to immune cells. We have conjugated branched PEI-2k and oleic acid (OL) as the building block of the cationic micelle. We aimed to introduce a novel carrier for vaccine candidates. Materials and Methods: We conjugated polyethyleneimine and OL (POA) to synthesize the building blocks of cationic micelles. The critical micelle concentration (CMC), size and zeta potential of micelles, and their stability in 60 days were determined. Loading, encapsulation efficiency, and in vitro release study were assessed using bovine serum albumin (BSA) as a protein model. Furthermore, the cytotoxicity and hemocompatibility of developed nanosized micelles were evaluated to ascertain the biocompatibility of fabricated micelles. Cell uptake of cationic micelles in the macrophage cell line was also followed up. Results: The conjugation of two polymer parts was confirmed by Fourier transform infrared spectroscopy and ¹H nuclear magnetic resonance techniques. The CMC of the developed micelles was around 5.62 × 10 ^{− 8} mg^/ml, whereas the loading and encapsulation efficiencies were 16.5% and 70%, respectively. The size and zeta potential of the cationic micelles were 96.53 ± 18.53 nm and 68.3 mV, respectively. The release of BSA from POA micelles after 8 and 72 hours was 8.5% and 82%, respectively. Finally, fluorescence microscopy showed that the prepared micelles were successfully and effectively taken up by RAW264.7 cells. Conclusion: These results may provide a cutting-edge vaccine delivery solution and open up a new avenue for future vaccine research.

Background: Cutaneous leishmaniasis (CL) is a common parasitic disorder that is endemic in many countries. There is no completely effective treatment for this condition, but pentavalent antimony compounds are regarded as the main treatment. Different laser types have been used for treatment of CL with variable success but to our best knowledge, there is no published paper regarding use of intense pulsed light (IPL) for treatment of CL. Materials and Methods: In this randomized, single-blind clinical trial study, we compared the efficacy of intralesional glucantime alone versus intralesional glucantime plus weekly IPL for treatment of 54 patients with confirmed cutaneous leishmaniasis for a maximum of eight weeks as a randomized, clinical trial. Results: Although it was not statistically significant, combination treatment was more effective than intralesional glucantime alone (P > 0.05). However, the velocity of healing was significantly higher in the IPL plus intralesional glucantime alone versus glucantime alone. No side effect was observed in both groups. Discussion: To better evaluate the efficacy of IPL, more studies with a higher number of patients and using various IPL filters are recommended.

The formation of new vessels from pre-existing vessels is known as angiogenesis. The process is controlled by stimuli and inhibitors. Angiogenesis starts as a result of the unbalance of these factors, where balance has a tendency toward the stimulus. One of the most important factors promoting angiogenesis is the vascular endothelial growth factor (VEGF). In addition to being involved in vascular regeneration in normal tissues, VEGF also takes part in tumor tissue angiogenesis. These factors affect endothelial cells (ECs) directly as well as differentiate tumor cells from endothelial cells and play an active role in tumor tissue angiogenesis. Angiogenesis partakes in the growth and proliferation of tumor tissue. Because anti-angiogenic treatment is favorable in existing cancer therapies, the potential benefits should be considered. One of these new therapies is cell therapy using mesenchymal stem cells (MSCs). Research on MSCs remains controversial because much of the earlier research on MSCs has shown their effectiveness, but more recent research has identified harmful effects of these cells. This article reviews the role of stem cells and their secretions in the angiogenesis of tumor tissues.

Background: One of the most common types of malignancies affecting the head and neck region is oral squamous cell carcinoma (OSCC). Little less is known about the role of myofibroblasts in the pathogenetic process of OSCC. Hence, we assessed the involvement of myofibroblasts in the invasive process of OSCC using α-SMA (α-smooth muscle actin) antibody. Materials and Methods: Four study groups in total were organized as follows: 40 cases each of well-differentiated OSCC (WDOSCC), moderately differentiated OSCC (MDOSCC), poorly differentiated OSCC (PDOSCC), and controls make up Group 1, Group 2, Group 3, and Group 4, respectively. The percentage of α-SMA immunopositive cells and staining intensity (A) multiplied together to determine the final staining score (B). The final staining index was produced by multiplying staining intensity (A) by the proportion of immunopositive cells that were stained with α-SMA (B) (FSI). Score Zero was graded as Index Zero by FSI while scores One and Two received an Index Low rating, scores Three and Four an Index Moderate rating, and scores Six and Nine an Index High rating. Results: Significantly higher expression of myofibroblast was observed in OSCC group in comparison with the control group. However; no significant difference in myofibroblast expression was observed while comparing different grades of OSCC. Conclusion: We recommend using myofibroblasts as a stromal marker to track the severity and development of OSCC.

Background: Early treatment of COVID-19 patients could reduce hospitalization and death. The effect of corticosteroids in the outpatient setting is still unknown. This study aimed to determine the effect of corticosteroids in the prevention of hospitalization of nonsevere cases. Materials and Methods: This study is a multicenter randomized controlled trial. Seventy five nonsevere COVID-19 patients presented between days 7 and 14 of their symptoms received either prednisolone or placebo. The primary outcome was hospitalization. The study protocol was registered in the Iranian Registry of Clinical Trials on December 2, 2020 (IRCT20171219037964N2). Results: Although the rate of hospitalization in the prednisolone group was higher than the placebo group (10.8% vs. 7.9%, respectively), it was not statistically significant (P value.,6). One patient in each group reported an adverse event and withdrew the medication. Conclusion: Considering the null effect of corticosteroids in the prevention of hospitalization in outpatient settings, it is suggested not to consider corticosteroids for outpatient treatment.

Background: According to the bioinformatics analyses and previous studies, bone morphogenetic protein receptor type 1B (BMPR1B) dysregulation could remarkably affect breast cancer (BC) status as a potential biomarker and tumor suppressor. Therefore, the analysis of the expression level of BMPR1B and other relevant biological factors such as microRNAs, long non-coding RNAs, downstream proteins in the relevant signaling pathways, and finding the accurate biological mechanism of BMPR1B could be helpful for a better understanding of BC pathogenicity and discovering the new treatment methods and drugs. Materials and Methods: R Studio software (4.0.2) was used for microarray data analyses. GSE31448 dataset was downloaded by GEOquery package and analyzed by limma package. STRING and miRWalk online databases and Cytoscape software were used for interaction analyses. Quantitative measurement of BMPR1B expression level was performed by qRT-PCR experiment. Result: Microarray and real-time PCR analysis revealed that BMPR1B has a significant downregulation in the transforming growth factor (TGF)-beta and bone morphogenic protein (BMP) signaling pathways in BC samples. BMPR1B is a potential diagnostic biomarker, regulated by hsa-miR-181a-5p. Also, BMPR1B regulates the function of BMP2, BMP6, SMAD4, SMAD5, and SMAD6 proteins. Discussion: BMPR1B have a significant role in the development of BC by regulating the potential proteins' function, playing the diagnostic biomarker role, and regulation of TGF-beta and BMP signaling pathways. The high amount of BMPR1B protein helps in increasing the survival rate of the patients.

Background: Post-dural puncture headache (PDPH) is one of the most common side effects of spinal anesthesia. Several strategies and drugs have been suggested for the treatment and/or prevention of this headache. The aim of this study is evaluating the effects of intravenous prescription of neostigmine plus atropine 15 minutes after dural puncture on incidence and severity of PDPH during 5 days of follow-up in the setting of lower limb orthopedic surgeries. Materials and Methods: In a randomized, controlled, double-blind clinical trial, 99 patients of lower limb orthopedic surgeries were randomized into study (49 patients) and control groups (50 patients). Fifteen minutes after dural puncture, participants in the two groups intravenously took neostigmine (40 μg/kg) plus atropine (20 μg/kg) and placebo (normal saline), respectively. Side effects of the studied drugs and incidence, severity, and duration of PDPH were evaluated 5 days after surgery. Results: A total of 20 patients in the study group and 31 in the control group showed a headache-with-PDPH profile during 5 days of follow-up (P-value = 0.035). The mean duration of PDPH was 1.15 ± 0.48 and 1.32 ± 0.54 days in the study and control groups, respectively (P-value = 0.254). Conclusion: Preventive administration of 40 μg/kg neostigmine plus 20 μg/kg of atropine may be effective in reducing the incidence and severity of PDPH after spinal anesthesia in lower limb orthopedic surgeries.

MicroRNAs are a group of short non-coding RNAs (miRNAs), which are epigenetically involved in gene expression and other cellular biological processes and can be considered as potential biomarkers for cancer detection and support for treatment management. This review aims to amass the evidence in order to reach the molecular mechanism and clinical significance of miR-877 in different types of cancer. Dysregulation of miR-877 level in various types of malignancies as bladder cancer, cervical cancer, cholangiocarcinoma, colorectal cancer (CRC), gastric cancer, glioblastoma, head and neck squamous cell carcinoma (HNSCC), hepatocellular carcinoma, laryngeal squamous cell carcinoma, melanoma, non-small cell lung cancer (NSCLC), oral squamous cell carcinoma, ovarian cancer (OC), pancreatic ductal adenocarcinoma, and renal cell carcinoma (RCC) have reported, significantly increase or decrease in its level, which can be indicated to its function as oncogene or tumor suppressor. MiR-877 is involved in cell proliferation, migration, and invasion through cell cycle pathways in cancer. MiR-877 could be potential a candidate as a valuable biomarker for prognosis in various cancers. Through this study, we proposed that miR-877 can potentially be a candidate as a prognostic marker for early detection of tumor development, progression, as well as metastasis.

Background: Stress and saffron seem to affect glucoregulation mechanisms and insulin resistance in different ways. Impacts of the aqueous saffron extract were investigated on serum glucose levels, serum insulin levels, the homeostatic model assessment of β-cell function (HOMA-B), the homeostatic model assessment of insulin resistance (HOMA-IR), adrenal weight, and hepatic gene expression of angiotensinogen (Agt) and tumor necrosis factor-α (TNF-α) in rats under sub-chronic stress. Materials and Methods: Forty-two male rats were divided into six groups: control, restraint stress (6h/day for seven days), saffron (30 and 60 mg/kg) treatments for seven days, and post-stress saffron (30 and 60 mg/kg) treatments for seven days. The serum glucose and insulin levels, hepatic gene expressions of Agt and TNF-α, HOMA-IR, HOMA-B, and adrenal gland weight were measured. Results: One-week recovery following sub-chronic stress led to non-significant hyperglycemia, hyperinsulinemia, and insulin resistance. The hepatic Agt and TNF-α mRNA levels increased significantly in this group. Saffron administration led to enhanced hepatic Agt mRNA in the non-stressed subjects. In addition, serum glucose levels, insulin resistance, and hepatic Agt gene expression significantly increased in stress-saffron groups. The hepatic TNF-α gene expression was reduced only in the stress-saffron 60 group. Conclusion: Saffron treatment after sub-chronic stress not only did not improve glucose tolerance but also enhanced insulin resistance. It indicated the interaction of saffron and sub-chronic stress to promote renin-angiotensin system activity. In addition, the saffron treatment decreased TNF-α gene expression after sub-chronic stress. The synergistic stimulating effect of saffron and sub-chronic stress on gene expression of hepatic Agt led to insulin resistance and hyperglycemia.

Background: Breast cancer is the most prevalent malignancy in females which needs chemotherapy treatment. Studies demonstrated that anti-cancer agents used for chemotherapy in cancer patient causes endothelium dysfunction. Several researches showed the efficacy of angiotensin-converting enzyme inhibitors, Carvedilol and Spironolactone on improving endothelial function. This study aimed to evaluate the effect of the combination of Spironolactone, Carvedilol, and Captopril on endothelial function in breast cancer patients. Materials and Methods: This study is a prospective Randomized Clinical Trial in breast cancer patients who underwent chemotherapy. Patients were divided into two groups who received the combination of Captopril, Spironolactone, and Carvedilol or standard regimen for 3 months during chemotherapy. Before and after intervention, ejection fraction (EF), E/A ratio and e' and flow-mediated dilation (FMD) properties were calculated and then compared. Results: Fifty-eight patients with a mean age of 47.57 ± 9.46 years were evaluated. The mean FMD after the intervention is statistically different in case and controls (<0.001). E/A ratio and e' are not statistically different between groups after intervention. The mean EF was not statistically different between the two groups after intervention. Conclusion: Prescribing combination of Carvedilol, Spironolactone, and Captopril in breast cancer patients undergoing chemotherapy can improve endothelial function and may have beneficial effects on diastolic function.

Background: Disease registration is an organized system for collecting, storing, retrieving, analyzing a particular disease or exposure to known substances in a specific population. The aim of this study was to assess the feasibility and design of the registration system for upper gastrointestinal bleeding patients based on patients referring to Al-Zahra and Khorshid hospitals, Isfahan, Iran. Materials and Methods: This study is a research action study in which the members of the registration system team are hospital triage physicians, internal residents in the Emergency department of hospital, subspecialty assistants and gastroenterologists, statisticians (epidemiologists and methodologists), and two trained persons were specified to collect medical information and documents. The data collection tool is a researcher-made checklist. Based on the available tools, the most important criteria related to gastrointestinal bleeding were selected. In the next step, the criteria selected in the council, including team members, were reviewed and a preliminary draft was prepared to record the information of patients. Results: The results indicated the final version of the checklist in three parts including demographic variables (age, sex, education, et al.), main variables (as the minimum data required by a person to register in the checklist (patient's clinical signs)), extended main variables (its information is designed to be used to diagnose, treat, and follow-up the patient in later stages). Conclusion: It seems to be predictable by establishing a system for recording gastrointestinal bleeding diseases, disease prevalence, monitoring services and treatment of patients, survival analysis and evaluation of clinical care outcomes, finding patients at higher risk for emergency treatment, reviewing drug interventions, and interventional activities.

Background: Weill–Marchesani syndrome (WMS) is a rare connective tissue disorder characterized by locus heterogeneity and variable expressivity. Patients suffering from WMS are described by short stature, brachydactyly, joint stiffness, congenital heart defects, and eye abnormalities. This disorder is inherited in two different modes; the autosomal dominant form of the disease occurs due to a mutation in FBN1, and the recessive form results from mutations in ADAMTS10, ADAMTS17, or LTP2 genes. Materials and Methods: The family recruited in this study was a consanguineous Iranian family with an intellectually disabled girl referred to the Sadra Genetics laboratory, Shahrekord, Iran. The clinical history of family members was investigated. Whole-Exome Sequencing (WES) for the proband was performed. Sanger sequencing was used to assess the segregation of candidate variants in the other family members. Results: Whole-exome sequencing analysis revealed a novel heterozygote mutation in the proband located at the third TGF-β-binding protein-like (TB) domain of the FBN1 gene (NM000138: c.2066A>G: (p. Glu689Gly), NP_000129.3, in exon 17 of the gene). Co-segregation analysis with Sanger sequencing confirmed this mutation in the affected members of the pedigree. Conclusion: Our findings represent an autosomal dominant form of specific WMS resulting from a substitution mutation in the FBN1 gene. In addition to the typical manifestations of the disorder, mild intellectual disability (ID) was identified in the 8-year-old proband. Given the fact that ID is primarily reported in ADAMTS10 mutated cases, this family was clinically and genetically a novel case.

Background: Bacteriocins are a type of antimicrobial peptide that are produced by probiotics. They have been studied as possible therapeutic drugs and have been used to suppress bacterial development in foods. Nisin is a potent bacteriocin having the anti-microbial and anti-cancer characteristics produced by Lactococcus lactis. The aim of the present paper is to evaluate the influence of Nisin on cell adhesion and its two related genes, mmp-2 and mmp-9, in the colorectal cancer cell line. Materials and Methods: For this purpose, HT-29 cells were treated with various concentrations of Nisin and the cell cytotoxicity, cell adhesion, and gene expression were evaluated using the MTT assay, cell adhesion assay, and real-time PCR. Results: Our findings showed that 32 to 1024 μg/ml of Nisin resulted in a significant reduction in cell viability (P < 0.05). Furthermore, 128 and 256 μg/ml of Nisin significantly reduced the cell adhesion, and mmp-2 and mmp-9 gene expressions (P < 0.05). Conclusion: Our findings suggested that Nisin could prevent metastasis and cancer progression.

Background: Bystander cardiopulmonary resuscitation is an important predictor of out-of-hospital arrest prognosis in the pediatric population. The purpose of this study was to assess the effectiveness of two educational methods, a video module and Peyton model with manikin, in parent's education. Materials and Methods: We enrolled 140 subjects, 70 in each group. We assess their knowledge, attitude, and practice about pediatric basic life support (BLS) before and after two different types of educational interventions. Results: Mean attitude, knowledge, and practice score were significantly higher after educational intervention in both groups. Knowledge and total practice score were significantly higher in the Peyton group compared with DVD group (P = 0.02 and 0.000, respectively). The rate of totally correct chest compression was 53% in Peyton/manikin group versus 24% in DVD/lecture group and the difference was meaningful statistically (P = 0.0003). Conclusion: Any educational intervention has a significant effect on the Iranian parent's knowledge and practice about child BLS, but education through manikin can increase this impact.

Background: Children suffer from a high prevalence of anxiety problems that require prompt treatment. It has been demonstrated that ketamine offers rapid anti-anxiety effects. This study aimed to evaluate ketamine's anti-anxiety impact in the treatment of children with school-refusal separation anxiety disorder. Materials and Methods: In this open-labeled randomized clinical trial, 71 children (6-10 years) diagnosed with school refusal separation anxiety disorder were randomly assigned to two groups; a case group, who received ketamine at a weekly rising dose of 0.1 to 1 mg/kg; the control group treated with Fluvoxamine (25 mg/day), which could increase to 200 mg/day if necessary. The SCARED and CATS questionnaires were used to assess anxiety before treatment, at the 8^th and 16^th weeks of intervention. The data were analyzed using repeated-measures analysis of covariance. Results: The mean anxiety scores in the eighth week (19.7 ± 16.1) were significantly lower in the ketamine group than before (31.5 ± 10.8). Until the sixteenth week (19.4 ± 14.6), there was no further decrease in scores in the ketamine group, in the fluvoxamine group, pre-treatment scores (36.3 ± 16.5) and eighth week (36.9 ± 16.6) were not significantly different, but scores decreased significantly in a sixteenth week (26.2 ± 12.5). Conclusion: In first eight weeks of treatment, ketamine was more successful than fluvoxamine at reducing anxiety disorder, considering the emergence of this disorder and the lack of major adverse effects of ketamine, it seems to be beneficial in early phases of treatment. Due to the quick onset of ketamine in future trials, their combination therapy is recommended during the initial weeks of treatment.

The elderly population is projected to increase from 8.5% in 2015 to 12% in 2030 and 16% in 2050. This growing demographic is chronically vulnerable to various age-related diseases and injuries like falling, leading to long-term pain, disability, or death. Thus, there is a need to use the potential of novel technologies to support the elderly regarding patient safety matters in particular. Internet of Things (IoT) has recently been introduced to improve the lifestyle of the elderly. This study aimed to evaluate the studies that have researched the use of the IoT for elderly patients' safety through performance metrics, accuracy, sensitivity, and specificity. We conducted a systematic review on the research question. To do this, we searched PubMed, EMBASE, Web of Science, Scopus, Google Scholar, and Science Direct databases by combining the related keywords. A data extraction form was used for data gathering through which English, full-text articles on the use of the IoT for the safety of elderly patients were included. The support vector machine technique has the most frequency of use compared to other techniques. Motion sensors were the most widely used type. The United States with four studies had the highest frequencies. The performance of IoT to ensure the elderly's safety was relatively good. It, however, needs to reach a stage of maturity for universal use.

Background: Bloodstream infections (BSIs) are one of the causes of morbidity and mortality in hospitalised patients. This study evaluated BSI's incidence, trend, antimicrobial susceptibility patterns and mortality in AL Zahra Hospital in Isfahan, Iran. Materials and Methods: This retrospective study was conducted in AL Zahra Hospital from March 2017 to March 2021. The Iranian nosocomial infection surveillance system was used for data gathering. The data included demographic and hospital data, type of bacteria, and antibiotic susceptibility findings and were analysed in SPSS-18 software. Results: The incidence of BSIs was 1.67% and 0.47%, and the mortality was 30% and 15.2% in the intensive care unit (ICU) and non-ICU wards, respectively. In the ICU, the mortality was correlated with the use of the catheter, type of organism and year of study, but in non-ICU, correlated with age, gender, use of the catheter, ward, year of study and duration between the incidence of BSIs and discharging/death. Staphylococcus epidermidis, Acinetobacter spp. and Klebsiella spp. were the most frequent germs isolated in all wards. Vancomycin (63.6%) and Gentamycin (37.7%) for ICU and Vancomycin (55.6%) and Meropenem (53.3) for other wards were the most sensitive antibiotics. Conclusion: Despite the few rate of BSI in the last four years in AL Zahra Hospital, our data showed that its incidence and mortality in the ICU ward are significantly more than in other hospital wards. We recommend prospective multicentre studies to know the total incidence of BSI, local risk factors and patterns of pathogens causing BSI.

Background: Scrophularia striata Boiss. (S. striata) is a flowering plant with several therapeutic properties including antiinflammatory, antioxidant, antimicrobial, and wound-healing activity. Regarding the side effects of drugs conventionally used for inflammatory bowel disease (IBD) treatment, we investigated the anticolitis properties of aqueous (SSAE) and hydroalcoholic (SSHE) extracts of S. striata on experimental colitis. Materials and Methods: The colitis was induced using acetic acid (3%) and 2 h before ulcer induction, each group of rats received orally three doses (150, 300, and 600 mg/kg, p.o.) of SSAE or SSHE for the next 5 days. Dexamethasone (1 mg/kg, i.p.) and mesalazine (100 mg/kg, p.o.) were used as reference drugs. Different parameters including weight of colon/height, ulcer index, total colitis index, levels of myeloperoxidase (MPO) and malondialdehyde (MDA) were investigated. Results: Total phenolic contents were 4.3 ± 0.2 and 7.1 ± 0.4 mg/g equivalent to gallic acid for SSAE and SSHE respectively. Three applied doses of SSHE and the highest dose of SSAE (600 mg/kg) could reduce all the macroscopic and pathologic indices of colitis and the levels of MPO and MDA. Two lesser doses of SSAE (150, 300 mg/kg) however, couldn't diminish the histopathologic features of colitis and the values of MPO and MDA. Conclusions: S. striata, especially SSHE, which also contained more phenolic compounds, had an ameliorating effect on ulcerative colitis and possibly exerts this effect through its antioxidant, antiinflammatory and wound healing properties. Further investigations are required to introduce this plant as a novel alternative herbal drug for colitis treatment.

Background: Previous evidence revealed an association between folate deficiency and non-alcoholic fatty liver disease (NAFLD). This study is the first one investigating the effects of folic acid on hepatic steatosis grade, liver enzymes, insulin resistance, and lipid profile in NAFLD cases. Materials and Methods: Sixty-six participants with NAFLD were allocated randomly to take either a placebo or one oral tablet of folic acid (1 mg) on a daily basis within eight weeks. Serum folate, homocysteine, glucose, aminotransferases, insulin, homeostasis model assessment of insulin resistance (HOMA-IR), and lipids were assessed. Ultrasonography was used for assessing the liver steatosis grade. Results: The serum alanine transaminase, grade of hepatic steatosis, and aspartate transaminase significantly were decreased within both study groups; however, the between-group comparison was not statistically significant. Of note, the decrease in ALT was more pronounced in folic acid compared with the placebo group (-5.45 ± 7.45 vs. -2.19 ± 8.6 IU/L). The serum homocysteine was decreased after receiving folic acid compared to the placebo (-0.58 ± 3.41 vs. +0.4 ± 3.56 μmol/L; adjusted P = 0.054). Other outcomes did not significantly change. Conclusion: Supplementation with folic acid (1 mg/d) for eight weeks among cases with NAFLD did not change significantly the serum levels of liver enzymes, the hepatic steatosis grade, insulin resistance and lipid profile. However, it was able to prevent the increase in homocysteine in comparison with the placebo. Conducting further research is suggested with the longer duration and different doses of folic acid, adjusted to the genotypes of methylenetetrahydrofolate reductase polymorphism, among NAFLD patients.

Background: Inflammatory cell death, PANoptosis, has been suggested to orchestrate the lymphocyte decrement among coronavirus disease-2019 (COVID-19) patients. The main aim of this study was to examine the differences in the expression of key genes related to inflammatory cell death and their correlation with lymphopenia in the mild and severe types of COVID-19 patients. Materials and Methods: Eighty-eight patients (36 to 60 years old) with mild (n = 44) and severe (n = 44) types of COVID-19 were enrolled. The expression of key genes related to apoptosis (FAS-associated death domain protein, FADD), pyroptosis (ASC (apoptosis-associated speck-like protein containing caspase activation and recruitment domains (CARD)), the adapter protein ASC binds directly to caspase-1 and is critical for caspase-1 activation in response to a broad range of stimuli), and necroptosis (mixed lineage kinase domain-like, MLKL) genes were examined by reverse transcription-quantitative polymerase chain reaction (RT-qPCR) assay, and compared between the groups. The serum levels of interleukin (IL)-6 were measured by enzyme-linked immunosorbent assay (ELISA) assay. Results: A major increase in the expression of FADD, ASC, and MLKL-related genes in the severe type of patients was compared to the mild type of patients. The serum levels of IL-6 similarly indicated a significant increase in the severe type of the patients. A significant negative correlation was detected between the three genes' expression and the levels of IL-6 with the lymphocyte counts in both types of COVID-19 patients. Conclusion: Overall, the main regulated cell-death pathways are likely to be involved in lymphopenia in COVID-19 patients, and the expression levels of these genes could potentially predict the patients' outcome.

Background: Endometriosis is a female reproductive system disease in which the endometrial tissue is found in other women's organs. Various factors are effective in the development of endometriosis, and because of the interaction of genetics and environmental factors, this disease is a multi-factorial disease. MAPK/ERK and PI3K/Akt/mTOR pathways are activated by growth factors and steroid hormones and are known as two important pathways involved in the processes of growth, proliferation, and survival of endometriosis cells. Raps, monomeric GTPase of the Ras family, are able to activate these pathways independent of Ras. The goal of our study was to evaluate the expression level of Rap1GAP and EPAC1 genes as two important RapGAPs (GTPase-activating proteins) and RapGEFs (guanine nucleotide exchange factors), respectively, in endometriosis tissues and normal endometrium tissues. Materials and Methods: In this study, 15 samples of women without signs of endometriosis were taken as control samples. Fifteen ectopic and 15 eutopic samples were taken from women with endometriosis using laparoscopic surgery. The expression of EPAC1 and Rap1GAP genes was investigated by the real-time polymerase chain reaction technique, and the results were analyzed by one-way ANOVA test. Results: EPAC1 upregulated significantly in ectopic tissues compared to eutopic and control tissues. Rap1GAP expression was lower in ectopic tissues compared to control and eutopic tissues. Conclusions: Based on these results, it may be concluded that changes in the expression of the Rap1GAP and Epca1 genes may play a role in the pathways involved in the pathogenesis, displacement, and migration of endometriosis cells.

Background: Anxiety is a common psychiatric condition in cardio-vascular diseases. Saffron appears to have a wide range of therapeutic effects on psychiatric conditions and cardio-vascular disorders. The aim of this study was to determine the effect of saffron on anxiety in hospitalized patients with acute coronary syndrome (ACS). Materials and Methods: In this clinical investigation, we selected 80 patients with ACS from Tohid Medical Center, Sanandaj. Patients were divided randomly into two groups, intervention group (n = 41), and control group (n = 39), based on how they received saffron and placebo every 12 hours for 4 days, respectively. The Spielberger Anxiety Inventory was completed before and after the intervention in both groups. Results: There was no significant difference between the intervention and control groups regarding the mean scores of the trait and state anxiety before and after the intervention (P > 0.05). Conclusion: The present study did not corroborate the therapeutic effects of saffron on reducing anxiety in patients with ACS.

Background: Bariatric surgery is a surgical procedure for patients with extreme obesity. Enhanced Recovery after Surgery (ERAS) is a method that provides special peri- and post-operation care. Here, we aimed to compare the effects of ERAS and standard recovery cares. Materials and Methods: This is a randomized clinical trial that was performed in 2020-2021 in Isfahan on 108 candidates for mini gastric bypass. Patients were then randomly divided into two equal groups receiving ERAS and standard recovery protocols. Patients were examined and visited after one month regarding the average number of hospitalization days, the average days required to return to normal activity or work, occurrence of pulmonary thromboemboli (PTE) and the rate of readmission. Results: Patients that received ERAS had significantly lower frequencies of nausea and vomiting (P = 0.032). Patients that received ERAS had significantly lower hospitalization duration (P < 0.001) compared to controls. No other significant differences were observed between two groups regarding surgery complication, re-admission rate and occurrence of PTE (P > 0.99 for all). Conclusion: Patients that received ERAS protocol after gastric bypass had significantly lower hospitalization duration and lower incidence of nausea and vomiting. They also had similar post-operative outcomes compared to the standard protocol.

Background: Non-alcoholic fatty liver disease (NAFLD) is one of the most common forms of chronic liver disease that affects about 25% of the general population. No definitive treatment for NAFLD has been identified yet. The aim was to determine the effect of atorvastatin (ATO) and flaxseed on related indicators of NAFLD-induced fat/fructose-enriched diet (FFD). Materials and Methods: Forty male Wistar rats were divided into five groups. NAFLD groups received FFD and carbon tetrachloride (CCl4) to induce NAFLD. After intervention with ATO (10 mg/kg/day) and/or flaxseed (7.5 g/kg/day), liver enzymes and lipid profiles in serum were determined at eight week of interventions. Results: Triglycerides (TG) and cholesterol (CHO) in FFD + ATO, FFD + flaxseed, and FFD + ATO + flaxseed had a significant decrease and low-density lipoprotein (LDL) level and LDL/high-density lipoprotein (HDL) ratio showed a significant increase in the FFD + flaxseed compared to the FFD. The levels of aspartate transaminase (AST), alanine transaminase (ALT), and gamma-glutamyltransferase (GGT) were significantly reduced in the FFD + ATO, FFD + flaxseed, and the FFD + ATO + flaxseed. In addition, Alkaline phosphatase (ALP) levels were significantly different between normal and FFD. Fasting blood sugar (FBS) levels were significantly different in the FFD + flaxseed and the FFD + ATO + flaxseed compared to the FFD. Conclusion: ATO therapy along with flaxseed controls NAFLD-related indices and FBS. Therefore, it can be stated with caution that ATO and flaxseed can be used to improve lipid profile and reduce the complications of NAFLD.

Background: Laryngeal mask airway (LMA) plays a crucial role in the field of modern anesthesia. There are different techniques to administer LMA. Here we aimed to compare the four methods of standard, 90° rotation, 180° rotation, and thumb placement in LMA mast placement. Materials and Methods: This is a clinical trial that was performed on 257 candidates of elective surgical operations requiring general anesthesia. All patients were categorized into four groups of LMA placement with index finger (standard method), mask placement with 90° rotation, 180° rotation method, and thumb finger group. We collected data regarding the success rates of LMA placement, the need for any manipulation when placing the mask, LMA placement time, failure of mask placement, presence of blood on the LMA, and laryngospasm and sore throats 1 hour after surgery in patients. Results: The 90° rotation method had a significantly higher first attempt success rate than that in the other three methods (98.4%, P = 0.02). Total success rate in 90° rotation method was also significantly higher than the other techniques (100%, P < 0.001). The need for any manipulation when placing the mask (1.6%, P = 0.01), presence of blood on the LMA mask (1.6%, P = 0.33), and frequency of sore throats 1 hour after surgery (21.9%, P = 0.14) were also lower in 90° rotation method than that in the other methods. Conclusion: The 90° rotation method had significantly higher success rate and lower failure rate regarding the mask placement compared to other three methods.

Background: Chitin and chitosan are utilized in many industries such as pharmacy, biotechnology, and medicine. The mealworm beetle, Tenebrio Molitor, is simply breaded and does not require a vast production space. Materials and Methods: In this study, we extracted chitin and chitosan using two different methods from Tenebrio Molitor adult beetles. Then we studied their physical and chemical properties along with their antibacterial effect. Results: Using two new methods we extracted 13, 3%, and 17.7% chitin from the dry mealworm beetle which was higher than in previous studies. The chitosan yield of the extracted chitin was 78.26% and 76.43%, respectively. The observed FTIR peaks for chitin and chitosan in this study were in accordance with the characteristic peaks. The degree of acetylation of chitin was 95.09% and 92.55% and the degree of deacetylation was 75.84%, and 72.6% from the first and second methods, respectively. The extracted chitosan also showed an antibacterial effect against Pseudomonas aeruginosa. Conclusions: Our study demonstrated that chitin and chitosan extracted from adult mealworm beetles could be considered as a replacement for commercial chitosan and needs further studies.

Primary central nervous system lymphoma (PCNSL) is uncommon with scarce cases having involvement of the spinal cord. Cauda equina is unique in its location and shows very rare involvement by diseases pathologies. When the same occur, they pose a lot of diagnostic difficulties as the location is difficult to access with overlapping radiologic abnormalities. It is an unusual location for lymphomas to occur with only few cases reported in literature. The cauda equina lymphomas may mimic other entities which occur at that site. Histopathology is the gold standard for the same. Here, we report an unusual case of cauda equina lymphoma mimicking a myxopapillary ependymoma in a 50-year-old male.

Background: Bacterial virulence factors may be influenced by sub-minimum inhibitory concentrations (sub-MICs) of antibiotics. The main purpose of this study was to investigate the effects of gentamicin at sub-MICs (0.5 MIC and 0.25 MIC) on alginate production of clinical isolates of Pseudomonas aeruginosa. Materials and Methods: The minimum inhibitory concentrations of gentamicin against 88 clinical isolates of P. aeruginosa were determined using the broth microdilution method. Alginate production of the isolates in the absence and presence of gentamicin at sub-MICs was assessed by the carbazole method. The presence of alginate in clinical isolates was confirmed by the detection of alginate genes (algD and algU) using the PCR method. Results: All the isolates had the ability of alginate production and were positive for algD and algU genes. sub-MICs of gentamicin significantly increased alginate production of 34 isolates (38.6%). On the other hand, in 49 isolates (55.7%), alginate production was significantly increased after treatment with sub-MICs of gentamicin. In five isolates (5.7%), the alginate production was reduced in exposure to 0.5 MIC of gentamicin while it was increased by gentamicin at 0.25 MIC. Conclusion: This study showed different effects of gentamicin at sub-MICs on the alginate production of clinical isolates of P. aeruginosa. Further research is highly recommended to understand the mechanism of different responses of P. aeruginosa isolates to the exposure of sub-MICs of gentamicin.

Background: Gynecomastia (GM) is the increased fibroglandular tissue in the male breast by more than 2 cm, which is palpated under the nipple and areola. An ideal surgical approach aims to reduce the breast size, reach an acceptable breast shape, resect excessive glandular tissue, fatty tissue, and skin fatty tissue and excess skin, relocate the nipple-areolar complex, and avoid scars. Based on its importance, we aimed to compare outcomes of liposuction with and without periareolar incision in patients with GM. Materials and Methods: This was a randomized clinical trial on patients referred for plastic surgery. Patients with GM were allocated into two treatment groups. Group A underwent liposuction without any areolar skin incision and group B had liposuction with the areolar skin incision. Patients were followed-up after surgery. Data were analyzed by Statistical Package for the Social Sciences (SPSS) version 20. Results: Sixty patients aged between 20 and 27 years old participated in this study. Three hematomas, two surgical site infections, one nipple hypopigmentation after surgery, and one seroma formation were noted in group B. On the other hand, one hematoma and one seroma formation were noted in group A. The patients in group A were highly satisfied after the liposuction without skin incision procedure compared with group B (P = 0.01). Conclusions: The management of GM by liposuction, either with the periareolar excision technique or without skin incision, allows the effective removal of fat and glandular tissue of the male breast. Although there was no significant difference regarding postoperation complications between groups, patients' satisfaction should be considered.

Background: Various studies have conducted to report the mortality rates and its risk factors in pediatric intensive care unit. This study aimed to determine the mortality prevalence and risk factors in PICU of Imam Hossein Children's Hospital in Isfahan, which is the main referral pediatric hospital in the center of Iran. Materials and Methods: This study was performed on 311 patients during a period of 9 months. The questionnaire which included age, gender, length of stay in the PICU and hospital, mortality, history of resuscitation in other wards and readmission, the causes and sources of hospitalization, pediatric risk of mortality (PRISM)-III score, respiratory supports, morbidities like nosocomial infections, acute kidney injury (AKI), multiple organ dysfunction syndrome (MODS) confirmed by pediatric sequential organ failure assessment score (P-SOFA) and glycemic disorders was filled out. Results: One hundred and seventy-seven (56.9%) were males and 103 (33%) were belonged to the age group of 12–59 months. The most prevalent causes of hospitalization were status epilepticus (12.9%) and pneumonia (11.2%). Mortality rate was 12.2%. The significant factors associated with mortality were readmission and history of resuscitation. PRISM-III index showed a significant difference between nonsurvivors and survivors (7.05 ± 6.36 vs. 3.36 ± 4.34, P = 0.001). Complications like AKI, hypoglycemia, MODS and disseminated intravascular coagulation (DIC), length of mechanical ventilation significantly correlated with mortality. Conclusions: Mortality rate was less than that of other developing countries (12.2%) and this was associated with some risk factors included readmission, history of resuscitation, PRISM-III Index; complications like AKI, acute respiratory distress syndrome (ARDS), DIC, mechanical ventilation duration, MODS, hypoglycemia, and P-SOFA index.

Background: In the current study, we aimed to evaluate the association between pregnancy-related plasma protein-A (PAPP-A) levels measured in the first trimester and pregnancy outcomes. Materials and Methods: This is a descriptive-analytical study that was performed in 2019--2021 on 1061 pregnant women in their first trimester. Demographic and basic information of all women were collected. These data included age, weight, parity, and date of delivery. Then the quantity of PAPP-A was recorded in three groups including less than 0.5 MOM, 0.5 to 2.5 MOM, and more than 2.5 MOM. Results: Data of 1061 women were analyzed. 900 women (84.8%) had term delivery and 155 women (14.6%) had pre-term deliveries. PAPP-A levels were normal in 83.4% of women. BMI and number of pregnancies had significant relationships with PAPP-A (p < 0.001, P = 0.03 respectively). The mean BMI in mothers with PAPP-A higher than 2.5 was significantly more than mothers with normal or lower PAPP-A levels (26.2 ± 31, P = 0.04). The frequency of term labor in mothers with normal PAPP-A was higher than other mothers (86.3%, P = 0.04). The frequency of preeclampsia in recent pregnancies in mothers with normal PAPP-A was significantly lower than other mothers (p < 0.001) and the frequency of abortions in recent pregnancies in mothers with PAPP-A less than 0.5 was significantly higher than mothers with normal or elevated PAPP-A (p < 0.001). Conclusion: Mothers with low PAPP-A levels are more likely to have poor pregnancy outcomes such as abortion, pre-term labor, and preeclampsia.

Background: Acne is a dermatologic condition with a high burden in terms of psychosocial consequences as a result of scars remaining on the skin. Its effects are severe in adolescence and finding treatments with short therapy courses, superior results, and fewer adverse effects are of high importance. Materials and Methods: We included 30 individuals with acne vulgaris scars in Al-Zahra academic training hospital from June 2018 to Jan 2019. Each individual received both fractional CO₂ and fractional Er:YAG lasers on right and left sides of the face, respectively. Three sessions of laser treatment were applied to each side with one-month intervals. Results were evaluated by patients according to subjective satisfaction and physicians' assessment and photo evaluation by two blinded dermatologists. Improvement was graded by a quartile grading scale: less than 25%: mild, 25% to 50%: moderate, 51% to 75%: good, and 76% to 100%: excellent response. Assessments were obtained at baseline and one month after the last visit. Results: Based on subjective satisfaction (p < 0.05) and physicians' assessment (p < 0.01), fractional CO₂ laser was significantly more effective than Erbium:YAG laser. Also, Post-treatment side effects were mild and transient in both groups. Conclusion: Laser therapies are common in the treatment of scars and each modality has special advantages and disadvantages. Choosing among them should be based on various criteria. Fractional CO₂ lasers have been revealed favorable results in most reports. Large comprehensive trials could help experts in choosing among alternatives for different subgroups.

Background: Multi-leaf collimator (MLC) is one of the efficient and cost-effective methods for protecting sensitive tissues around the target. This study aimed to evaluate the protective effect of MLC on the protection of sensitive organs in patients with left breast cancer. Materials and Methods: This study was performed on computed tomography (CT) scans of 45 patients with left breast cancer. Two treatment plans were completed for each patient. Only the heart and left lung were considered organs at risk in the first treatment plan, and in the second treatment plan, the left anterior descending artery (LAD) was also considered the organ at risk. It was covered as much as possible by the MLC. Dosimetric results of tumor and organ at risk (OARs) were extracted from the dose-volume histogram and compared. Results: The results showed that more LAD coverage by MLC leads to a significant reduction in the mean dose of OARs (P-value <0.05). The mean dose for heart, LAD, and left lung decreased by 11%, 7.4%, and 4.9%, respectively. The values of V₅ (volume received the dose of 5 Gy) and V₂₀ for the lung, V₁₀, V₂₅, and V30 for LAD, and V₅, V₂₀, V₂₅, and V₃₀ for the heart also decreased significantly (P-value <0.05). Conclusions: In general, better protection of LAD, heart, and lungs can be achieved by maximal shielding organs at risk by MLC in radiation therapy for patients with left breast cancer.

Background: A trigger finger is recognized as the most common hand tendinopathies that reduce functional ability. The present study compares the clinical outcomes of open classic release surgery with ultrasound-guided percutaneous surgery in cases of multiple finger involvement. Materials and Methods: A cohort study has been performed from March 2019 to December 2020 by participating 34 trigger finger patients with multiple involvements. These patients were treated using classical open release and ultrasound-guided percutaneous release methods and both methods were compared in patients. The pain severity and functional ability obtained from the quick disabilities of the arm, shoulder, and hand (Quick-DASH) test scores were compared. Results: The pain intensity in the classical open surgery patients was not significantly different from the ultrasound-guided group, and a one-month follow-up showed that the pain intensity in the ultrasound-guided patients was significantly less than in the other group (P = 0.02). Besides, no significant difference was observed between the functional abilities before and after the one-month follow-up. Indeed, the two groups had the same situations. Also, the recovery time in the ultrasound-guided percutaneous release group was significantly faster than in the other group. These cases had statistical differences as P = 0.001 and P < 0.001, respectively. The surgical release was 100% successful in both groups. The patients' satisfaction rates in the ultrasound-guided and open classic surgery treatment methods were 94.1 and 76.4%, respectively. Conclusions: Classical open release and ultrasound-guided percutaneous surgery could successfully treat multiple trigger fingers. However, ultrasound-guided percutaneous surgery provided faster recovery and less pain intensity than the other method.

Background: Cerebral palsy in children is considered a non-progressive brain injury due to abnormal brain development. The aim of this study was to investigate the effect of eight weeks of aquatic exercises on muscle strength in children with cerebral palsy. Materials and Methods: This study was performed on three boys with cerebral palsy with a mean age of 6.5 years. In this research, a single case study method with A1-B-A2 design has been used. After determining the position of the baseline, the intervention began and during 24 sessions of individual intervention, aquatic exercises were presented to the subjects and all three subjects were followed up for 2 consecutive weeks and one month after the end of the intervention. The strength of the flexor muscles of the arms and legs was measured by a power track dynamometer made by JTECK with a threshold of 4.4 N. Results: Based on the indicators of descriptive statistics and visual analysis, the intervention was effective for all three participants in muscle strength, and the strength of individuals after the intervention has improved compared to the baseline stage (percentage). Information overlap for the first and second participant in the strength of right thigh flexors was 75% and for the third participant was 100%. The strength of the upper and lower torso muscles improved after the end of the training compared to the basic stage. Conclusion: Aquatic exercises can increase the strength of children with cerebral palsy and provide a favorable environment for children with cerebral palsy.

Background: The surgery for a breast imaging-reporting and data system (BIRADS) IV lesions needs imaging or pathology supporting data. The roll of breast scintigraphy for this purpose is unclear. Materials and Methods: In a prospective design, 16 patients with 25 BIRADS IV lesions who were scheduled for surgery were included. Before the surgery, breast scintigraphy was done using a nondedicated dual head gamma camera in the prone position employing a shaped foam pad providing imaging at breast pendulous position. Twenty mCi ^{99 m}Tc methoxy-isobutyl-isonitrile was injected and two 15 and 60-min delayed imaging were done (anterior, bilateral, and single photon emission computed tomography [SPECT] projections). Pathology reports were collected and tumor to nontumor uptake ratio (T/NT) was analyzed, accordingly. Results: Out of all lesions, 12 were malignant (invasive ductal and lobular carcinoma ductal carcinoma in situ). At 15 min, T/NT was insignificantly higher in the malignant compared to benign lesions (22.8 ± 23.9 vs. 10.1 ± 10.1; P = 0.109). The optimal T/NT cutoff for discrimination of malignant and benign lesions was 20. Only 1 out of 13 benign lesions presented uptake >20 (7.7%; false-positive rate; P = 0.047). The diagnostic accuracy, sensitivity, and specificity for T/NT calculated at 0.68, 0.42, and 0.92, respectively. The T/NT at 60 min remained unchanged for either benign or malignant lesions (22.3 ± 30.2 vs. 11.7 ± 17.1; P = 0.296). Conclusions: Breast scintigraphy with general purpose gamma camera employing SPECT imaging may assist the selection of BIRADS IV lesions in need for surgery. All uptake positive cases should undergo surgery and decision for uptake negative cases should be made based on other data.

Background: Although laparoscopic total proctocolectomy with ileal pouch-anal anastomosis has recently been used for this group of patients, there are rare reports of its treatment outcomes and postoperative complications. For this purpose, the very aim of the present study was to evaluate the complications of this surgery after 6 months in patients with familial adenomatous polyposis (FAP) and ulcerative colitis (UC). Materials and Methods: The present cross-sectional study was performed on 20 patients undergoing restorative proctocolectomy with ileal pouch-anal anastomosis (RPC-IPAA) for FAP or UC during 2009–2014. Outcomes of patients were recorded 6 months after surgery for complications and satisfaction. Results: There were 11 (60%) males and 9 (40%) females with a mean age of 30.65 ± 9.59 years. There were 12 patients (60%) with FAP and eight patients (40%) with UC. The length of stay (LOS) ranged from 4 days to 10 days with the mean of 6.40 ± 1.76 days. The incidence of complications including leak, urinary retention, and wound infection were 10%, 5%, and 10%, respectively. Moreover, no postoperative mortalities occurred. Male patients had no problems during sexual activity or micturition. All patients were highly satisfied with the outcome of the surgery. Conclusion: According to the results of the present study, laparoscopic RPC-IPAA was a surgery with the least complications and the highest level of satisfaction for young patients with FAP and UC. Therefore, it seems that this surgery can be a suitable surgical method for the mentioned patients.

Background: Due to the very high and increasing prevalence, essential complications, and risk factors for psychiatric disorders, it is necessary to introduce screening tests for diagnosing and predicting mild traumatic brain injury (mTBI) prognosis. Materials and Methods: After completing the consent form and recording information and examination findings of patients with mild trauma, venous blood samples were taken from these patients. The samples were measured by observing the cold chain. After 3 months from mTBI, the post concussion symptoms questionnaire (PCSQ) and the short form 36 (SF-36) questionnaire for physical and mental evaluations were performed. Statistical tests analyzed the relationship between different variables and serum Creatine kinase BB (CKBB) levels. Results: Statistic analyses showed no relation between CKBB level of serum and age, gender, level of consciousness, PCSQ, and SF 36 scale, and the interval between trauma and arrival to the hospital. Further, there is a significant correlation between CK-BB levels and intracranial damage based on Fisher's exact test. Conclusion: This study and following more significant considerations can introduce a serum-based biomarker panel that can accurately differentiate patients with complicated mTBI from those with uncomplicated.

Background: Nonfunctioning pituitary adenomas (NFPAs) are the most common pituitary tumors and although they do not secrete hormones, they can have systemic effects. These tumors affect the function of other organs in the body by exerting pressure on the pituitary gland. There are differences between biomarkers NFPAs compared to healthy people. This study was conducted to show blood marker changes in adenomas compared to healthy people. Materials and Methods: This article compared the blood markers of NFPAs with healthy individuals retrospectively. The difference between blood markers in the two groups was statistically investigated where the predictive value of blood markers in the differentiation of the two groups was determined. An artificial neural network was also designed using the blood markers with its accuracy and predictive value determined. Results: A total of 96 NFPAs (nonfunctional pituitary adenoma) and 96 healthy individuals were evaluated. There was statistically a significant difference and positive correlation in platelet to lymphocyte ratio, neutrophil to lymphocyte ratio, and derived neutrophil to lymphocyte ratio between NFPAs and healthy individuals. There was a significant and negative correlation between red blood cell (RBC), lymphocyte, and monocyte between the two groups. RBC as an independent factor was associated with NFPAs. In this study, the artificial neural network was able to differentiate between NFPTs cases and healthy individuals with an accuracy of 81.2%. Conclusion: There are differences between blood markers in NFPAs relative to healthy people and the artificial neural network can accurately differentiate between them.

Despite the prevalence of hydatid cyst in humans, its occurrence in the heart is rare. The clinical signs of the mentioned cyst in the heart are diverse, which makes its diagnosis challenging. In addition, the cardiac hydatidosis is diagnosed late as this disease progresses gradually. In this report, the cases discussed of a case with intraventricular cardiac hydatid cyst with coronary artery disease and multiple hepatic hydatid cysts. After diagnosis, the patient underwent coronary artery bypass graft surgery, and the cyst was successfully removed. Considering the probability of heart involvement in endemic regions, devoting due attention to the disease as well as performing faster diagnosis of the disease can play a significant role in reducing its complications.

Background: Stem cells have been proposed to be one of the potent sources for treatment applications. Among diverse types of stem cells, stem cells derived from human exfoliated deciduous teeth (SHEDs) are known as the immature stem cell population, which are easily isolated, fast, and without ethical implications. SHEDs could induce pluripotent stem cells and show differentiation in chondrocytes, adipocytes, osteoblasts, neural cells, hepatocytes, myocytes, odontoblasts, and skin cells. Materials and Methods: In the current study, we investigated the effects of SHED on osteosarcoma cells (Saos-II) following 3 and 5 days indirect coculture. Results: Our results showed that indirect coculture of SHED with Saos-II cells could promote or inhibit Saos-II cells' growth in a concentration (the number of SHED vs. Saos-II cells) and time (days of indirect co-culture) dependent manner. Conclusion: Our findings suggested that, indirectly, SHED co-culture with the Soas-II cells might functions as a tumor suppressor where a higher number of SHEDs are used in the culture in comparison with the one cultured in the absence of/or fewer SHED incubation.

Background: Rheumatoid arthritis (RA) is a common chronic inflammatory disorder that can be associated with some hearing impairments. Hence, we aimed to evaluate the prevalence rate of hearing loss (HL) in RA patients. Materials and Methods: This study included 130 participants from February 2019 to March 2020 including 100 RA patients (78 females and 22 males) as RA group and 30 healthy cases (16 females and 14 males) as control group. All patients underwent pure tone audiometry, speech audiometry, tympanometry, acoustic reflex, and tone decay test by single operator and device. The rate of HL and contributing factors were then determined. Results: The mean age of RA group was 53.95 ± 7.6 years, and the mean duration of disease was 12.74 years. Rheumatoid factor was positive in 54% of patients, and the frequency rates of diabetes, chronic kidney disease, hypertension, and dyslipidemia among RA patients were 14%, 1%, 26%, and 19%, respectively. These values among RA patients with HL were 18%, 1.7%, 34%, and 27.5%, respectively. HL in RA patients was related to dyslipidemia (P = 0.011) and age (P = 0.0001). Frequency rate of conductive HL in left and right ears was 2% and 5%, respectively, and these rates for sensorineural hearing loss (SNHL) were 55% and 61%, respectively. In addition, the percent of HL in low, mid, and high frequency ranges was 18%, 19%, and 57%, respectively. Conclusions: The findings of the present research demonstrate that HL especially with SNHL and high-frequency types is common among RA patients.

Background: Endophthalmitis is a rare but a high morbid complication after cataract surgery, and a gold standard treatment is not recommended yet. In this study, we aim to evaluate the effect of early vitrectomy on the visual acuity of patients with postcataract endophthalmitis. Materials and Methods: This study was a single-arm clinical trial on 27 patients with postcataract surgery endophthalmitis. Early vitrectomy was the intervention. Visual acuity as the primary outcome was evaluated and compared at baseline, at discharge, and 1 and 3 months after the intervention. Results: From 27 patients who included in our study, six patients gain favorable visual acuity of 5/10 and above (success rate = 22%), and four of them have no improvement in their visual acuity. Retinal detachment was reported as a complication in just one case. Negative culture was a predictor for success in terms of visual acuity after the surgery. All patients who gain favorable results, presented in the first 15 days after the cataract surgery. Conclusion: The result of our study showed that, considering complete, early vitrectomy for the treatment of postcataract surgery endophthalmitis, especially for those who presented in the first 15 days of cataract surgery and for those who have negative culture is promising.

Background: This study compares the effect of vaginal administration of evening primrose oil with misoprostol on cervical preparation in prim gravid women at ≥40 weeks gestation. Materials and Methods: This was a double-blind randomized clinical trial conducted in Isfahan, Iran during 2019-2020 on 110 prim gravid pregnant women with a gestational age of 40 weeks and more and cephalic presentation of the fetus with the obstetrical indication for pregnancy termination. After obstetric examinations to rule out cephalo pelvic disproportion and calculation of the Bishop score by the researcher, patients were randomized to receive 25 μg misoprostol tablets (n = 55) or 1000 mg evening primrose oil Pearls (n = 55) administrated vaginally by a midwife. We compared Bishop's score before and after the intervention, time of cervical ripening, a dose of intervention for cervical ripening, need to induce labor, the interval between cervical preparation and induction of labor, duration of oxytocin use, need for cesarean section, and its cause, Apgar score at 5 and 10 minutes, neonatal birth weight. Results: Mean baseline Bishop Score was not significant between the groups (P = 0.45); after the intervention, it was significantly higher in the primrose oil group (P < .001). Significantly fewer patients required cesarean sections in the primrose oil group (P = 0.03). The other outcomes were. not significant between the groups (P > 0.05). Conclusion: Misoprostol and primrose oil administration appear to positively affect cervical readiness. Primrose oil resulted in significantly better Bishop Scores and fewer cesarean sections compared to misoprostol in pregnancy 40 weeks and more.

Background: Tumor recurrence as one of the main causes of cancer death is a big barrier to cancer complete treatment. Various studies denote the possible role of therapeutics in tumor relapse. Cisplatin as one of the generally used chemotherapy agents is supposed to be the source of therapy resistance through formation of polyploid giant cancer cells (PGCCs). Nevertheless, the mechanisms by which PGCCs promote tumor relapse are not fully understood. Materials and Methods: In this study, we performed experimental and bioinformatic investigations to recognize the mechanisms related to cisplatin resistance. A2780 and SCOV-3 cell lines were treated with cisplatin for 72 hours and were evaluated for their morphology by fluorescent microscopy and DNA content analysis. Furthermore, a microarray dataset of cisplatin-resistant ovarian cancer cells was re-analyzed to determine the significantly altered genes and signaling pathways. Results: Although cisplatin led to death of considerable fraction of cells in both cell lines, a significant number of survived cells became polyploid. On the other hand, our high throughput analysis determined significant change in expression of 1930 genes which mainly related to gene regulatory mechanisms and nuclear processes. Besides, mTOR, hypoxia, Hippo, and 14-3-3 signaling pathways previously shown to have role in PGCCs were determined. Conclusion: Taken together, results of this study demonstrated some key biological mechanisms related to cisplatin-resistant polyploid cancer cells.

Background: Hazelnut oil has a unique structure with a high oleic acid content, tocopherol, tocotrienols, and other bioactive compounds, such as phytosterols. These biochemical compounds have been widely studied because of their potential health properties. Understanding the process of apoptosis is the basis of new therapies contributing to cancer cells' death. Recently, the potential role of the evolutionary-reserved bcl-2 protein family in tumor progression and prognosis of some malignancies has been addressed in several studies. The present study is aimed at evaluating the effect of apoptotic properties of hazelnut oil on colorectal cancer cells through the major members of this family (bax and bcl-2). Materials and Methods: MTT assay, apoptotic cell staining (using Annexin V and propidium iodide), flow cytometry, and real-time PCR were used to evaluate the toxicity, percentage of apoptotic cells, and bax and bcl-2 genes' expression after exposing HT29 cells to hazelnut oil. Results: After hazelnut treatment, significant decreases in cell viability, and the gene expression of bax and bcl-2 were observed compared to the control group (P < 0.05). In addition, the total percentage of apoptotic cells after hazelnut oil treatment showed a significant increase in comparison with the negative control group (P < 0.05). Conclusion: Hazelnut oil appears to cause the death of cancerous cells through an apoptotic mechanism.

Background: Considering antioxidant effects of vitamin E (Vit E), in the present study, the effect of Vit E on liver and kidney functions and oxidative stress parameters in tissues of these organs of hypothyroid (Hypo) rats were reported. Materials and Methods: The animals were included in three groups:(1) control, (2) hypo, and (3) hypo-hypo-Vit E. Hypothyroidism was induced in rats by giving 0.05% propylthiouracil (PTU) in drinking water. Besides PTU, the rats in group 3 were daily injected with Vit E (20 mg/kg) for 42 days. The animals were deeply anesthetized and sacrificed, and the serum of the rats was immediately removed to measure thyroxin level and subsequent analysis. The liver and kidney tissues were also immediately removed for biochemical oxidative stress criteria. Results: PTU administration reduced serum thyroxin level and also thiol content, superoxide dismutase (SOD), and catalase (CAT) activities in the liver and kidney tissues while increasing malondialdehyde (MDA). Hypothyroidism also increased alanine aminotransferase (ALT), blood urea nitrogen (BUN), and creatinine while decreasing albumin. Vit E increased thiol, SOD, and CAT in the liver and kidney tissues while diminished MDA. Vit E also decreased ALT, BUN, and creatinine while increased albumin. Conclusion: The results of this study showed that Vit E prevented liver and renal tissue damage in hypothyroid rats.

Background: The aim of the present study was to evaluate the effect of ipratropium bromide with violet flower extract, ipratropium bromide with budesonide, and ipratropium bromide alone on the cuff-leak of the endotracheal tube and changes in hemodynamic parameters in intubated patients admitted to the intensive care unit. Materials and Methods: The present randomized clinical trial study was performed on 195 intubated patients in three groups of 65 patients. The first group received nebulized ipratropium bromide with budesonide (I + B group), the second group in addition to ipratropium bromide, received one tablespoon of the violet flower extract syrup every 8 hours (I + V group), and the third group received nebulized ipratropium bromide alone (I group). Hemodynamic parameters and the cuff-leak ratio (CLR) of patients were evaluated up to 72 hours after intubation. Results: The results of the present study revealed that 12 hours after intubation, the mean of CLR was significantly lower in group I (with a mean of 0.14 ± 0.02) as compared with that of the I + V and I + B groups (with the means of 0.16 ± 0.05 and 0.23 ± 0.05, respectively) (P < 0.001). In addition, 24 hours after intubation, the mean of CLR in group I + V was higher than that of I + B and I groups (P < 0.05). Conclusion: According to the results of this study, the use of violet extract syrup in patients under intubation can significantly improve patients' ratio of cuff-leak and SpO2. It seems that the use of violet extract syrup is effective to prevent unwanted complications during intubation and to facilitate patients' breathing.

Background: Considering the importance of weight disorders in childhood and its impact until adulthood, this study was conducted to assess the determinants of weight disorders in 2-year-old Iranian children. Materials and Methods: This cross-sectional study was conducted in 2020 among on 2300 children registered in Comprehensive Health Centers of Isfahan, Iran. Weight disorders, including underweight and overweight were defined according to the standardized National Center for Health Statistics (NCHS)/Centers for Disease Control (CDC) growth charts. Demographic data including gender, birth weight, maternal educational levels and occupation, duration of breastfeeding and the age of beginning complementary food were gathered. Results: In the present study, 750 children (i.e., 32.6%) had weight disorders. Among them, 53.6% were underweight, 26.3% were overweight, and 12.9% were obese, 7.2%had severe underweight. Female gender, university education of mothers and higher levels of socio-economic status significantly increased the chance of overweight by 14.79%, 22.28%, 27.33% and 24.48%, respectively. Although with the increase in the duration of breastfeeding and the increase of family members, overweight, respectively, decreased by 0.86 and 0.93 fold, but it was not statistically significant. There was an inverse, significant relationship between the duration of breastfeeding with overweight versus underweight. Conclusion: Underweight and overweight were the two most common weight disorders among 2-year- children, respectively. Control of modifiable risk factors for weight disorders in early life should be underscored in the primary health care system.

Background: Rosacea is a skin chronic inflammation with an unknown cause and cure. Environmental and genetic factors could not entirely explain the disease pathogenesis. Recently, infections like Chlamydia pneumoniae are of more attention in the rosacea progression. This study investigated the relationship between the C. pneumoniae seropositivity and the rosacea disorder. Materials and Methods: We aimed at a cohort of 100 patients with the rosacea disorder (60 active and 40 inactive) and from 100 sex- and age-matched healthy controls in Isfahan and determined the immunoglobulin M (IgM)/IgG antibodies titers to C. pneumoniae in the serum using the enzyme-linked immunosorbent assay method. The groups were compared using the analysis of variance procedure at the significant level of P < 0.05, statistically. Results: The mean of IgG in the controls was significantly higher than the levels in both the active and the inactive rosacea patients (p < 0.022). Also, the titer of serum IgM to C. pneumoniae in the controls was different, compared with the active (p < 0.019) and the inactive (p < 0.02) rosacea patients. In addition, the median titer of serum IgG (not IgM) to C. pneumoniae in the females with the inactive rosacea disorder was lower than the active rosacea disorder (p < 0.019) and controls women (p < 0.008). Furthermore, the serum level of IgG or IgM to C. pneumoniae in the controls males was higher than the males with the rosacea disorder (p < 0.05) and (p < 0.02), alternatively. Conclusion: C. pneumoniae seropositivity in the rosacea patients and controls was insignificant.

Background: Oral squamous cell carcinoma (OSCC) is one of the most common oral lesions and the tongue is one of the most common areas involved. The aim of this study was to evaluate the clinicopathologic feature of tongue SCCs based on its local distribution. Materials and Methods: In this cross-sectional study, clinical data such as age, gender, location, and clinical appearance were extracted from the archives of the Oral Pathology Department, Isfahan Dental School, registered with a definitive diagnosis of tongue SCC during 2005-2019. Then, 34 specimens were selected for histopathological evaluation in a simple random way. The histopathologic slides were examined to determine the grade of tumor malignancy. The data were entered into SPSS23 software and analyzed by Chi-square, Fisher exact, One-way ANOVA, and Non-parametric tests. P value <0.05 was considered significant. Results: Of the 275 OSCCs, 68 samples were tongue SCC. The mean age of patients was 61.7 ± 15 and 61.8% were women. The most common clinical manifestations were exophytic lesions (42.6%) and the most common site was the lateral border of the tongue (36.8%). The results did not show a significant relationship between the clinicopathologic feature including mean age (p = 0.766), gender (p = 0.338), clinical presentation (p = 0.434), grade of malignancy (p = 0.763) and location. But, among the histopathological parameters, the pattern of invasion (p = 0.047) was significantly associated with the local distribution. Conclusion: Given that most OSCCs had moderate differentiation of malignancy, identification of clinical features is needed. Attention to the pattern of invasion and location on the tongue can be effective in determining the therapeutic approach.

Background: Among various parameters used to predict the outcome of malignancy, nerve invasion has been widely considered as a sign of aggressive behavior in oral cancers. According to the importance of neural invasion in predicting the outcome of oral squamous cell carcinoma (OSCC), this study aimed to evaluate the prevalence of neural and vascular invasion in OSCC. Materials and Methods: In this descriptive, analytical, and cross-sectional study, paraffin-embedded tissues of 62 OSCC in the health center of surgery and pathology were evaluated (2013–2015). Patients' archives were evaluated and recorded in terms of their age and gender. Hematoxylin and eosin (H&E) slides were then examined by two oral pathologists and scrutinized for the presence of nerve involvement, tumor differentiation, vascular and lymph node invasion, and depth of invasion. Data were analyzed using SPSS version 23, t-test, and one-way ANOVA (P < 0.05). Results: Of 62 tumors, 12 patients showed only nerve invasion, 17 cases had only vascular invasion, and seven patients had both neural and vascular invasion, simultaneously, known as a neurovascular invasion. Furthermore, there was no vascular and neural invasion in 26 cases. There was a statistically significant correlation between vascular and neural invasion and the tumor site (P = 0.045). The highest frequency of neural invasion, as well as vascular invasion, was related to tongue tumors. Conclusion: The relation between neural and vascular invasion in OSCC with tumor's location was statistically significant. Lip and tongue carcinoma had shown more neurovascular invasion without relation to gender, age, and cell differentiation.

Background: This study aimed to investigate the relationship between maternal predisposing factors with the level of maternal serum pregnancy-associated plasma protein A and free subunit human chorionic gonadotropin and nuchal translucency. Materials and Methods: We performed a cross-sectional-analytical study on 762 pregnant women who referred to the Gene Azma Medical Genetics Laboratory in Isfahan for amniocentesis. All pregnant women at high risk of screening in the first trimester of pregnancy for trisomy 21 and other aneuploidy were referred to a gynecologist for amniotic fluid sampling (amniocentesis). Multiple of the means (MoM) of PAPPA ≤0.5, 0.5 ≥ MoM free β-hCG >2.5, and NT ≥3.5 mm were considered abnormal. We used Chi-square method and Mann–Whitney U-test to compare data qualitative and quantitative, respectively. Results: In individuals with less pregnancies and deliveries, the value of abnormal NT was higher (P < 0.01, P < 0.001, respectively). On the other hand, the highest abnormal rate of NT was observed in pregnant women under 35 years (21, 84%, P < 0.012). In addition, abnormal levels of free β-hCG are more common in women < 35 years of age (186, 66.9%, P < 0.02) and female fetuses (171, 58.8%) (P < 0.006). Conclusion: According to the results of this study, it can be said that considering the underlying factors of pregnant mothers in performing tests related to screening in the first trimester of pregnancy can lead to a reduction in false positive rates.

Background: This study investigated the impact of individual factors on the Health information-seeking behavior (HISB) of infertile couples undergoing Assisted Reproductive Technologies (ART). Materials and Methods: This applied study was done using the descriptive-analytical method. The population of the study remains to be infertile couples undergoing ART referred to a public Infertility Center and a private one in Bandar Abbas (capital of Hormozgan province, Southern Iran) in the summer of 2020. Using simple random sampling, 168 people were selected. The data collection tool was a questionnaire extracted from Longo HISB Model, used after validation and reliability. Data were analyzed by SPSS software using descriptive and inferential tests. Results: The results showed that individual factors (gender, education, income, age, and cause of infertility) affect the HISB of infertile couples. Based on the analysis of variance, there was a significant difference between infertile couples concerning Passive Information Receipt (F = 2.688 and P = 0.048) so the couples with a male cause used Passive Information Receipt more. Conclusions: Considering the results, it is necessary for the country's health system to take appropriate measures to provide an appropriate situation for better decision-making for infertile couples and improve the chances of fertility by reducing the existing inequalities to Active Information Receipt and quality health information.

Background: Cutaneous leishmaniasis (CL) is an ulcerative skin disease caused by some species of the genus Leishmania. Evidence shows that Perovskia abrotanoides is an important herbal medicine against Leishmania. This study was conducted to investigate the killing effect of terpenoid-rich fractions on promastigotes of L. major (MRHO/IR/75/ER). Material and Method: The eluates of reverse phased medium pressure liquid chromatography (RP-MPLC) of the extract were subjected to thin-layer chromatography (TLC) and categorized into six final fractions. Primary proton nuclear magnetic resonance (H-NMR) spectroscopy confirmed fractions' nature. Fractions 4, 5, and 6 (F4, F5, F6) were identified as terpenoid-rich content. Two concentrations of 50 and 100 μg/ml were prepared to test leishmanicidal activity. Followed by treating promastigotes of L. major by the fractions in incubation times of 12, 24, and 48 hours, their viability was determined using a cell proliferation MTS ((3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium) assay. Result: F4, F5, and F6 showed significant killing activity on promastigotes of L. major in a concentration-dependent manner. The viability of promastigotes was significantly reduced at a concentration of 100 μg/ml compared to 50 μg/ml (P-value <0.05). Also, over time a significant decreasing trend in the viability of promastigotes confirmed the time-dependent manner of the fractions (P-value <0.01). Furthermore, F5 had the highest leishmanicidal activity at the first incubation time compared with other fractions. Conclusion: Terpenoid-rich fractions of the P. abrotanoides have a leishmanicidal activity that depends on time and concentration. Among them, F5 has the highest potency that may contain potent terpenoid constituents.

Background: The aim of this study was to evaluate the expression pattern of tenascin in ameloblastoma, odontogenic keratocyst, and dentigerous cyst. Materials and Methods: The expression of tenascin was evaluated in microscopic slides of 42 paraffin blocks including 12 ameloblastomas, 15 odontogenic keratocysts, and 15 dentigerous cysts by immunohistochemistry. The expression of tenascin was examined in stroma, epithelium-connective tissue interface, and epithelium of the lesions by two pathologists semiquantitatively. Results: Stromal expression of tenascin was higher in ameloblastomas than other groups. All the paired groups showed significant differences except comparison of odontogenic keratocysts and dentigerous cysts. Epithelial-mesenchymal interface expression of tenascin was significantly higher in ameloblastomas and odontogenic keratocysts than dentigerous cysts. All the paired groups showed significant differences except comparison of odontogenic keratocysts and ameloblastomas. Expression of tenascin in epithelial cells of ameloblastomas was focal whereas in odontogenic keratocysts and dentigerous cysts negative immunoreactivity was reported. Conclusions: Expression of tenascin in these lesions suggests that it could play a role in epithelial-mesenchymal interaction. Higher expression of tenascin in ameloblastoma, can explain immaturity of its stroma and aggressive nature of this lesion compared with other studied groups. Moreover, higher expression of tenascin in epithelial-mesenchymal interface of odontogenic keratocyst compared with dentigerous cyst reveals its more immature and aggressive nature and high rate of recurrence.

Background: Self-care applications are effective in the control and treatment of disease symptoms. Today, the mobile phone is used as one of the tools that can help us in this regard. The present study attempts to develop and evaluate a functional self-care mobile-phone application for patients with skin and hair problems using treatment protocols of herbal medicine. Materials and Methods: This study is a descriptive-applied type. At first, a questionnaire was prepared for data need assessment and also to determine the data items and required capabilities of the application. Based on the results, an application was designed using the Java programing language in the Android software environment. In the next step, the application was installed on the mobile phones of several specialists and patients, and the necessary corrections were made. Then, the final version of the application was evaluated. Results: The most critical data elements of the mobile application for skin and hair patients included the application's functionality, temperament survey, and clinical information. After considering users' feedback, the screen functionality, the application's information and idiom, and overall functionality of the application were evaluated and approved by the users. Conclusion: By and large, the developed application could help the patients to receive the best and high-priority treatment protocols based on their own temperament.

Background: Ocular trauma is one of the most common causes of hospitalization in patients with ocular injuries. It imposes many direct and indirect physical and psychological costs on the patient and the community. Materials and Methods: The present descriptive cross-sectional and retrospective study includes all patients with ocular trauma who underwent surgery in the referral center's ophthalmic operating room for 10 years. A checklist was completed for each patient, including demographic information and the variables required for the study. A total of 927 patients who underwent eye surgery due to ocular trauma were eligible for the study. All descriptive data were reported as the mean plus standard deviation for quantitative variables and distribution tables and frequency percentage for qualitative variables. Inferential tests such as independent t-test and Chi-square test were used to evaluate the research questions. Results: This study showed that most ocular traumas occur at a young age and mostly in males. The types of trauma in the studied eyes were divided into penetrating and non-penetrating in different age groups. The results showed that the most common type of surgery was corneal laceration repair, and in all patients, visual acuity improved significantly after surgery. In this study, a total of 81% of patients underwent only one operation. Conclusions: Training and caring for children and adolescents about high-risk behaviors and educating industry professionals to wear goggles, and increase workplace safety can reduce these types of trauma.

Background: The aim of this study was to investigate the status of social support in people with drug abuse and its relationship with social health in patients referring to addiction treatment centers in Isfahan. Materials and Methods: This cross-sectional study was performed in Isfahan addiction treatment centers in 2019–2020. The study population was the total number of people with drug abuse in Isfahan addiction treatment centers that 300 people with substance abuse and 300 people as control group were included. Social support and social health questionnaires were distributed among the participants. The Keez Social Health Questionnaire, designed in the United States in 2004, is about daily life and the social environment and measures social health. Another questionnaire was the social support of Sherbon and Stewart (MOS). This scale was a self-report tool that measured the amount of social support received by the subject. Results: The results showed a positive, direct, and significant relationship between the dimensions of social support and social health in the group of patients with drug abuse (P < 0.05). Comparison of social support and its dimensions in the two control and affected groups showed that the scores in the healthy group were significantly higher than the affected group (P < 0.05). Conclusion: According to the results of this study, the level of social support and social health in people with substance abuse is less than other people in society, and to improve the social health of people with substance abuse, more social support should be provided.

Background: It is difficult to approach the Trigeminal Ganglion (TG) and Meckel's cave (MC) during surgeries. Therefore, the exact knowledge of the relationship of surgical landmarks to related anatomical structures is vital to reduce the associated postoperative morbidity. The aim of the present study was to enhance the knowledge of the surgical anatomy of structures that are present in the conduit of all surgical approaches to TG and MC, their distances from surrounding neurovascular structures, and their variations. Material and Methods: The study was carried out on 40 embalmed cadavers (Eight Female) of the anatomy department of a teaching hospital in Central India. Meticulous dissection of cranial fossae was done to locate TG, MC, and related anatomical structures. All distances from TG and MC were measured using an electronic digital calliper. Results: Length, width, and thickness of TG were 15.39 mm, 4.39 mm, and 2.54 mm, respectively. The distance from zygomatic arch, the lateral end of the petrous ridge, arcuate eminence, foramen ovale, and foramen spinosum to MC was 26.10 mm and 37.94 mm, 16.46 mm, 4.54 mm, and 11.23 mm, respectively. The sixth, fourth, and third cranial nerves were 6.26 mm, 4.94 mm, and 2.53 mm from MC, respectively. The MC was 42.72 mm and 33.87 mm anteromedial from posterior and anterior limits of the sigmoid sinus. Conclusion: Findings of the present study will aid surgical planning and decide the approach to TG and MC and avoid surgical complications.

Background: Many studies in the past have evaluated the role of immune system boosters in the treatment of leishmania major infection. Protein A (PA) is one of the structural components in peptidoglycan cell wall of gram-negative bacteria such as staphylococcus aurous which functions as a stimulator in the cellular immune system. The present study aims to evaluate the anti-inflammatory effect of PA on the recovery of leishmania major infection. Materials and Methods: This study was conducted on 24 female Balb/c-infected mice. The experimental group received PA at a dose of 60 mg/kg for four weeks. There was no intervention for the negative control group; the third group received the solvent of PA and sterile H2O; and the positive control group received Amphotericin B at a dose of 1 mg/kg body weight. At the end of the treatment period, a real-time polymerase chain reaction (PCR) assay was performed to determine parasitic burden, and the size of the lesions was measured by caliper with an accuracy of 0.01 mm. Results: Results showed that PA did slightly decrease the wound spread and growth but not to an extent that can be considered statistically significant. Also, differences in cycle threshold (Ct) values between the treated group and the untreated group was not impressive. Conclusions: Although findings showed that PA isn't such a good candidate for leishmania treatment, it may still be suitable for therapies that use multiple drugs in combination to speed up the healing of leishmaniosis, an issue that merits evaluation in future studies.

Background: Rosmarinus officinalis (rosemary) is a common household plant with needle-like leaves and white flowers that belongs to the family Lamiaceae and has various medicinal properties including ailments of hair and scalp, cardiovascular, nervous disorders, etc., In the current work, we have focused on formulation and evaluation of 1% hair lotion incorporated with methanolic extract of R. officinalis. Materials and Methods: The aerial parts of the plant were extracted with methanol and then the nature of phytochemicals were identified by chemical tests. It showed the presence of proteins, amino acids, fats and oils, steroids, glycosides, phenolic compounds, flavonoids, volatile oil, and vitamins. The extract was formulated to a suitable hair lotion and then evaluated for its various quality control parameters. Finally, the lotion was evaluated for hair growth promoting activity on C57BL/6 mice, using water as control and 2% minoxidil hair lotion as standard. Results: It was observed that the formulated 1% herbal hair lotion passed all the evaluation parameters and showed a significant hair growth promoting activity than the standard drug-treated animals. Conclusion: Although several researches have been carried out on the rosemary, an investigation on formulation of hair lotion adding the extract of the aerial part of the plant is for the first time. Since our formulation exhibited an excellent activity, it can be well thought out to be an alternative to the commercially available hair growth promoters with a lot of unwanted effects.

Background: Controversy remains about the positive role of music during general anesthesia and postoperative recovery. We, therefore, tested the hypothesis that intraoperative exposure to classical music reduces the propofol necessary to maintain the bispectral index (BIS) close to 50 during vitrectomy surgery. Materials and Methods: This double-blind clinical study is evaluating 50 patients undergoing vitrectomy surgery under general anesthesia. Patients were randomly assigned to music and white noise groups, and relevant sounds were played to patients after induction of anesthesia. The two groups were compared for the use of propofol as an anesthetic to maintain a BIS near 50 and for postoperative pain, anxiety, nausea, and vomiting. Results: Propofol consumption to maintain the set BIS score was much lower in the music group than in the white noise group (78.72 ± 25.76 microgram/kg/min and 117.91 ± 36.78 microgram/kg/min, respectively, P-value = 0.000). Postoperative pain scores were also much lower in the music group than in the white noise group (P-value = 0.000) and anxiety levels between these two groups did not differ (P-value = 0.870). No patient in the music group had complaints of postoperative nausea and vomiting (PONV) compared to six patients in the white noise group (P-value = 0.011). Conclusions: Listening to music during general anesthesia for vitrectomy surgery can reduce the use of anesthetics, postoperative pain, and PONV. Further, controlled studies are necessary to confirm our results.

Background: Shoulder pain is considered as the most important and relatively common postoperative cholecystectomy complications that often controls in recovery room by systemic narcotics that may have some side effects. The aim of this study was to evaluate the effect of premedication with oral tizanidine on shoulder pain relief after elective laparoscopic cholecystectomy. Materials and Methods: In this double-blinded clinical trial, 75 adults of American Society of Anesthesiologist physiologic state 1 and 2 scheduled for elective laparoscopic cholecystectomy under general anesthesia were selected and randomly divided in three groups of T, P, and control groups. Ninety minutes before the induction of anesthesia, patients received either 4 mg tizanidine (T group), 100 mg pregabalin (P group), or orally in 50cc or the same volume of plain water as a placebo (control group). Then, the vital signs, pain intensity, and the need for analgesic were measured during 24 hours and then compared in the groups. Results: There was no significant difference in patient characteristics, with respect to age, weight, gender, and duration of anesthesia and surgery between the groups (P > 0.05). The pain intensity and need for analgesic were significantly lower in tizanidine and pregabalin groups than the control group (P < 0.003) vs (P < 0.001). There was no significant difference in vital signs characteristics between the groups. Conclusion: Oral administration of 4 mg tizanidine and 100 mg pregabalin 90 minutes before laparoscopic cholecystectomy significantly relive postoperative shoulder pain and analgesic consumption without any complication.

Background: Emergence agitation (EA) is one of the complications following anesthesia in pediatric surgery. Various drugs are used to prevent this complication, and one of them is dexmedetomidine. Choosing the right dose of this drug for the best efficiency is an important issue due to this complication.The main purpose of this study is to evaluate the prophylactic effect of intravenous dexmedetomidine in different doses in preventing EA after tonsillectomy in children. Materials and Methods: Our study was a double-blind clinical trial performed on 75 children ASAI, II candidates for tonsillectomy. Patients were divided into three groups. The group 1 received a dose of 0.6 μg/kg per hour and group 2 received a dose of 0.3 μg/kg per hour and group 3 was the control group. Then vital signs and observational pain score (OPS) and pediatric anesthesia emergence delirium (PAEDS) criteria were measured in patients. The collected data were analyzed by using SPSS software version 23 and non-parametric tests such as Friedman, Mann-Whitney. Results: According to the data analysis, mean blood pressure, mean heart rate, OPS and PAEDS score in group 1 were lower than other groups. Also, the average time of staying in recovery and extubation in group 1 was less than other groups. Conclusion: A dose of 0.6 μg/kg dexmedetomidine has a better effect on reducing EA (emergence agitation) after pediatric tonsillectomy.

Acinetobacter baumannii (A. baumannii) is one of the most common bacteria in nosocomial infections. Inappropriate usage of antibiotics has led to expanding emergence resistance to A. baumannii as a multidrug-resistant (MDR) strain. Empirical antibiotic therapy is necessary to evaluate the resistant gene pattern of MDR A. baumannii. For this purpose, the present study evaluated the resistance genes pattern of MDR A. baumannii collected from hospitalized patients using a genotypic diagnostic technique. To find evidence related to the study objectives, databases were searched such as Google Scholar, Web of Science, Science Direct, PubMed, and Scopus from 2000 to 2022, with specified keywords in the title and text of the articles. Articles were included based on inclusion and exclusion criteria. The mentioned database displayed 284 articles. After screening, 65 eligible articles were included. The results showed that various b-lactamases genes, aminoglycoside-modifying enzymes (AMEs) genes, and pump-expressing genes are resistance gene patterns in MDR A. baumannii isolates. MDR A. baumannii has significantly become resistant to b-lactams, carbapenems, and aminoglycosides.

Background: Stationary cycling is the popular, preferred, and convenient form of exercise. During exercise, autonomic modulation is seen which can be assessed by heart rate variability (HRV). The aim of the study was to evaluate the changes in HRV during mild-intensity cycling exercise. Materials and Methods: An observational cross-sectional study was done on 20 healthy male volunteers with the age (35.44 ± 4.12), height (71.12 ± 11.98), and weight (161.23 ± 11.65), BMI (27.12 ± 3.49) attending various YOGA sessions in AYUSH OPD. Volunteers underwent an exercise program at the mild intensity of 30% to 50% of maximal heart rate on a stationary cycle for 20 min. HRV was recorded by the HRV mobile unit Dynamika Machine at rest, every 5 min (4×) over 20 min and during the recovery period. Repeated measures of analysis of variance with post-hoc analysis with Bonferroni and Holm's multiple comparisons. Results: Significant change was observed in mean heart rate and time domain parameters. Frequency domain parameters that showed significant change were total power, High Frequency- HF (ms²), Very Low Frequency -VLF (ms²), Low Frequency -LF (ms²), and Very Low Frequency %-VLF (%). Conclusions: The HRV parameters conclusively point towards cardiac parasympathetic withdrawal and sympathetic dominance at the initiation of exercise. With the progression of exercise, the sympathetic influence is retained. In the recovery period parasympathetic reactivation gains control over heart rate as well as HRV. The HRV response to exercise challenges may be helpful in designing exercise programs based on variations in the autonomic response.

Background: Ulcerative colitis (UC) and Crohn's disease (CD) are two major types of inflammatory bowel diseases (IBDs). Toll-like receptors (TLRs) are expressed in the innate immune system compartments, in charge of identifying a wide range of microorganisms. The aim of the present study was to evaluate the expression of TLR-2, -7, and -8 in peripheral blood mononuclear cells (PBMC) of UC patients as a novel non-invasive primary inflammation sensor for monitoring the clinical course of UC candidates. Materials and Methods: In this cross-sectional study, total RNA was extracted from the PBMC of 42 UC patients along with 20 healthy donors. The mRNA levels of TLR-2, -7, and -8 were assessed using the quantitative real-time polymerase chain (qRT-PCR) reaction. Results: The present research study demonstrated no significant changes in TLR-2 mRNA expression in UC patients in comparison with the control group (P = 0.1264), whereas significant elevation (P = 0.0008) was distinguished in the TLR-7 expression of UC participants specifically during the remission course compared with healthy donors and flareup patients (P = 0.0004 and P = 0.0063, respectively). The last selected TLR, TLR-8 was not shown remarkable changes either between UC patients and the control group or between clinical courses of the disease. Conclusion: Here, among three nominated TLRs for predicting UC patients, TLR-7 was potentially selected according to the significant difference in mRNA expression in flareup UC patients and control donors. TLR-7 could be used as a novel non-invasive biomarker for monitoring UC patients in the active course of the disease.

Background: Considering the global prevalence of cancers and the complications of common cancer treatments, there is growing interest in using medicinal herbs to complement cancer treatments and reduce treatment's side effects. Therefore, we investigate the effect of the extract of Nasturtium on the viability of oral cancer cells. Materials and Methods: In this experimental study, we prepared aqueous extract from Nasturtium leaves and human oral cancer cells (OCC-24) and normal fibroblast cells (HF2FF cell line) from a cell bank. Then the toxic effect of different concentrations of the extract on cell viability after 24–48 hours of exposure was investigated with the methylthiazol tetrazolium assay. Ultimately, the optical density was measured at 570 nm by an Elisa Reader. Analysis of inhibitory concentration 50 (IC50) was also performed. The data were analyzed by paired Student's t-test and one-way analysis of variance. Results: Data showed that the extract had statistically significant anticancer effects in concentrations above 0.125 mg/ml for 24-hour exposure and in concentrations above 0.5 mg/ml for 48-hour exposure (p-value <0.05). Also, this extract had an adverse effect on the viability of normal cells; however, this effect occurred in high doses of the extract (p-value <0.05). Analysis of IC50 criteria indicates that with increasing time, a higher concentration of the extract is required to inhibit the viability of cancer cells. Conclusion: Because of the results, this aqueous extract can be suggested as a potential therapeutic agent in oral cancer. The best concentration of the extract was found to be 1 mg/ml.

Background: Gastric cancer is a worldwide life-threatening cancer. The underlying cause of it is still unknown. We have noticed that some cancer/testis antigens (CTAs) are up-regulated in gastric cancer. The role of these genes in gastric cancer development is not fully understood. The main aim of the current study was to comprehensively investigate CTAs' expression and function in stomach adenocarcinoma (STAD). Materials and Methods: A comprehensive list of CTA genes was compiled from different databases. Transcriptome profiles of STAD were downloaded from the cancer genome atlas (TCGA) database and analyzed. Differentially-expressed CTAs were identified. Pathway enrichment analysis, weighted gene correlation network analysis (WGCNA), and overall survival (OS) analysis were performed on differentially-expressed CTA genes. Results: Pathway enrichment analysis indicates that CTA genes are involved in protein binding, ribonucleic acid processing, and reproductive tissues. WGCNA showed that six differentially-expressed CTA genes, namely Melanoma antigen gene (MAGE) family member A3, A6, A12 and chondrosarcoma associated gene (CSAG) 1, 2, and 3, were correlated. Up-regulation of MAGEA11, MAGEC3, Per ARNT SIM domain containing 1 (PASD1), placenta-specific protein 1 (PLAC1) and sperm protein associated with the nucleus X-linked family member (SPANXB1) were significantly associated with lower OS of patients. Conclusion: MAGEA11, MAGEC3, PASD1, PLAC1, and SPANXB1 can be investigated as prognostic biomarkers in basic and clinical studies. Further functional experiments are needed to understand the exact interaction mechanisms of these genes.

Background: Coronary artery disease (CAD) is known as the most common cardiovascular disease. The development of CAD is influenced by several risk factors. Diagnostic and therapeutic methods of this disease have many and costly side effects. Therefore, researchers are looking for cost-effective and accurate methods to diagnose this disease. Machine learning algorithms can help specialists diagnose the disease early. The aim of this study is to detect CAD using machine learning algorithms. Materials and Methods: In this study, three data mining algorithms support vector machine (SVM), artificial neural network (ANN), and random forest were used to predict CAD using the Isfahan Cohort Study dataset of Isfahan Cardiovascular Research Center. 19 features with 11495 records from this dataset were used for this research. Results: All three algorithms achieved relatively close results. However, the SVM had the highest accuracy compared to the other techniques. The accuracy was calculated as 89.73% for SVM. The ANN algorithm also obtained the high area under the curve, sensitivity and accuracy and provided acceptable performance. Age, sex, Sleep satisfaction, history of stroke, history of palpitations, and history of heart disease were most correlated with target class. Eleven rules were also extracted from this dataset with high confidence and support. Conclusion: In this study, it was shown that machine learning algorithms can be used with high accuracy to detect CAD. Thus, it allows physicians to perform timely preventive treatment in patients with CAD.

Background: Biofilm production is an important virulence factor in Staphylococcus aureus. Most of the infections associated with biofilms of this bacterium are very difficult to treat using antibiotics. The present research studied the effects of the two probiotic Lactobacillus species L. casei and L. rhamnosus on S. aureus biofilm. Materials and Methods: Cell-free supernatant (CFS) extracts of L. casei ATCC 39392 and L. rhamnosus ATCC 7469 culture were prepared. The effects of sub-minimum inhibitory concentrations of the CFS extracts on cell surface hydrophobicity (CSH), initial attachment, biofilm formation, and their ability in eradicating S. aureus ATCC 33591 biofilms were assessed. In addition, the effects of CFS extracts on expression of the genes involved in formation of S. aureus biofilms (cidA, hld, sarA, icaA, and icaR) were also evaluated through real-time polymerase chain reaction. Results: CFSs of both Lactobacillus spp. significantly reduced CSH, initial attachment, and biofilm formation and eradicated the biofilms. The above findings were supported by scanning electron microscopy results. These two Lactobacillus CFSs significantly changed the expression of all studied biofilm-related genes. Expression levels of cidA, hld, and icaR genes significantly increased by 4.4, 2.3, and 4.76 fold, respectively, but sarA and icaA genes were significantly downregulated by 3.12 and 2.3 fold. Conclusion: The results indicated that CFS extracts of L. casei and L. rhamnosus had desirable antagonistic and anti-biofilm effects against S. aureus. Consequently, carrying out further research enables us to prepare pharmaceuticals from these CFSs in order to prevent and treat infections caused by S. aureus biofilms.

Coronaviruses are important pathogens in humans and animals. Two years ago, a new coronavirus was identified as the cause of pneumonia and adult respiratory distress syndrome. These viruses have many clinical features, and new features are created daily. Bell's palsy is sporadic facial nerve palsy. The main reason of Bell's palsy is not recognized. Many viruses, such as herpes simplex or herpes zosters, have been previously identified as Bell's palsy. This case report seeks to explain the occurrence of Bell's palsy in a patient infected with coronavirus. The polymerase chain reaction test of a 60-year-old woman was positive for SARS-CoV-2. Bell's palsy happened on the 2^nd day of admission to intensive care unit and recovered by the 12^th day. After ruling out other etiologies of Bell's palsy, coronavirus appears to be one of the new etiologies of Bell's palsy.

Background: As the most common complication of endoscopic retrograde cholangiopancreatography (ERCP) is acute pancreatitis, researchers have paid due attention to minimize this complication using various drugs, one of which is epinephrine. Therefore, the present study aimed at evaluating the effectiveness of epinephrine spray on the papilla in preventing post-ERCP pancreatitis (PEP). Materials and Methods: The present double-blind clinical trial was performed on 164 patients undergoing ERCP. Patients in both groups received 50 mg rectal suppository as usual before ERCP. Then, during ERCP, epinephrine or normal saline was sprayed topically on the major papillae. After the intervention, patients were evaluated in terms of the incidence of PEP. Results: The results of the present study revealed that the incidence of PEP in the epinephrine and control groups was 2.4% and 4.9%, respectively (P > 0.05). There was no significant difference between the two groups in terms of the incidence of bleeding after ERCP, number of accidental pancreatic duct cannulation, the increase in vision during common bile duct cannulations, the need for precut sphincterotomy, and the number of hospitalization days (P > 0.05). In addition, the chance of developing PEP was lower and higher in patients with higher ages (odds ratio [OR]: 0.86; P = 0.030) and biliary sludge (OR: 4.97; P = 0.042), respectively. Conclusion: As compared with indomethacin alone (control group), it seems that the administration of epinephrine can be effective in reducing the incidence of PEP, although this relationship was not recognized to be significant in this study and only the age and the presence of sludge had a negative and positive relationship with the incidence of PEP, respectively.

Background: Due to the presence of platelet antigen polymorphisms, human platelet membrane glycoproteins can be identified as an alloantigen or autoantigen. The aim of this study was to determine the frequencies of human platelet antigens (HPAs)-1 to-5 and-15 in Turkmen blood donors and establish a panel of accredited HPAs negative donors as well as an HPA-typed platelet donor registry. Materials and Methods: HPA-1 to-5 and-15 typing was performed by the polymerase chain reaction-sequence-specific primer techniques on 80 unrelated Turkmen donors who were referred to Aq-Qala Blood Transfusion Center in Golestan Province from September 2018 to October 2019. Results: The frequencies of HPA phenotypes were determined as follows: HPA-1aa: 92.5%, HPA-1ab: 7.5%, HPA-2aa: 77.5%, HPA-2ab: 20.0%, HPA-2bb: 2.5%, HPA-3aa: 75.3%, HPA-3ab: 50%, HPA-3bb: 11.2%, HPA-4aa: 100%, HPA-5aa: 78.5%, HPA-5ab: 21.5%, HPA-15aa: 41.2%, HPA-15ab: 56.2% and HPA-15bb: 17.5%. Conclusion: Determining the genotype of HPAs that play an important role in platelet refractory can improve the management of alloimmunization due to the incompatibility of HPAs between the recipients and donors. Therefore, the registration process for national platelet donors can help patients accelerate and improve the quality of transfused platelets.

Background: It is important to synchrony the time, intensity, and respiratory signal of the phrenic nerve between the patient and the ventilator. This study aimed to evaluate the effect of switching from volume-controlled to pressure-controlled ventilation on respiratory distress and asynchrony index improvement. Materials and Methods: In this randomized controlled clinical trial, 70 patients admitted to the intensive care unit under mechanical ventilation were included. Asynchronous evaluation was performed by examining the patient and evaluating and analyzing the graphic flow curve and ventilator pressure, which included trigger and flow asynchronous and asynchronous cycling. In the intervention group, the mode of ventilation was switched to PSIMV such that peak inspiratory pressures would be equivalent to positive end-expiratory pressure (PEEP) in the volume-controlled mode. Finally, again at 60, 75, and 90 min, information about the ventilator and the patient's symptoms, and arterial carbon dioxide levels were sent by arterial gas sample. The asynchronous index was also recorded in both groups. Results: This study showed that the mean of variables such as height, ideal body weight, tidal volume, set rate; Sense, FiO₂, PEEP did not differ significantly between the two groups. The mean of asynchrony was significantly reduced in both control group (16.51 ± 3.35–14.51 ± 2.90; P < 0.001) and intervention group (18.26 ± 6.13–13.32 ± 5.53; P < 0.001). Conclusion: Regardless of the type and severity of the disease, switching the ventilation mode from volume-controlled to pressure-controlled can improve patient adaptation to the ventilator, especially in cases with frequent asynchrony.

Background: The present study aimed at comparing the effect of ketorolac and morphine on the pain control in patients with renal colic. Materials and Methods: The present clinical trial was performed on 272 patients with renal colic that were divided into two groups. Patients in the first and second groups intravenously received morphine at a dose of 1.0 mg/kg and ketorolac at a dose of 30 mg, respectively. Then, systolic blood pressure, diastolic blood pressure, heart rate, respiration rate (RR), and oxygen saturation percentage (SpO2) as well as patients' pain scores before and 5, 15, 30, 60, and 90 min after the intervention were recorded and evaluated. Results: The results of this study revealed that the mean pain scores of patients before and after the intervention were not significantly different between the two groups (P > 0.05). However, patients' pain significantly relieved over time in both groups (reduce: Morphine group = 9.4 and ketorolac group = 9.09; P < 0.001). In addition, nausea, dizziness, and a decreased SpO2 in the morphine group were 5.1%, 2.9%, and 1.5%, respectively, and in the ketorolac group only dizziness was 2.2% (P > 0.05). Conclusion: According to the results of this study, the efficacy of ketorolac in reducing patients' pain was not significantly different from that of morphine. Therefore, considering that the occurrence of complications in the ketorolac group was lower than that of the morphine group, it can be stated that ketorolac is a safer and more reliable drug than morphine in relieving pain in patients with renal colic.

Background: This study aims to evaluate the risk of hypothyroidism (HT) after radiotherapy (RT) of breast and supraclavicular in patients with breast cancer (BC). Materials and Methods: In a historical cohort study, the records of all patients with BC who had been referred to the Mahdieh radiotherapy Center of Hamadan from 2017 to 2019 were reviewed. Demographic characteristics, clinical information, previous and current used treatment methods (surgery, radiotherapy, chemotherapy), number of RT sessions and doses, and HT (TSH >5 mIU/L) were extracted from the patient's documents. Data were analyzed using SPSS software version 16. Results: Out of 304 patients referred to the Center, 266 patients were investigated. The mean TSH was 6.3 ± 7.9 ml/L (1.5 to 65.4). Approximately half of the patients were in Stage 2 of the disease. 37 (16.4%) patients were diagnosed with HT, of which 8.8% were clinical, and 7.5% were subclinical. The mean total dose of HT patients (5621.62 ± 491.67) was significantly higher than other patients (5304.76 ± 937.98). 21 patients (56.8%) in Stage 3 and 4 and 16 (43.2%) patients in Stages 1 and 2 had HT (P = 0.006). Spearman correlation coefficient showed that there was a significant relationship between total dose and TSH hormone (r = 0.624), the number of RT sessions with TSH hormone (r = 0.237), and total dose with T4 hormone (r = -0.232). Conclusion: The findings of this study showed that the risk of HT increases significantly in patients with BC who undergo RT of breast and supraclavicular. Patients with higher stage, more radiation, and more RT sessions are at higher risk of HT.

Background: Bacterial superinfections are one of the crucial challenges in patients with coronavirus disease 2019 (COVID-19) that are associated with a high mortality rate. The current study was designed to assess bacterial superinfections and antibiotic management in COVID-19 patients admitted to intensive care unit (ICU). Material and Methods: Seventy-three adult intubated patients with COVID-19 were included in a cross-sectional study. The lung aspirate samples were collected in two stages and assessed for bacterial growth by standard methods. Antimicrobial susceptibility testing was performed using the Kirby-Bauer method as recommended by the Clinical Laboratory Standard Institute guideline (2021 edition). Also, demographic and clinical data were collected. The statistical analysis was done by chisquare test and Student's t-test, and a P value <0.05 was considered significant. Results: Forty men and thirty-three women with a mean age of 64.78 ± 13.90 have included in our study. The mean length of hospitalization and stay in ICU were 18.77 ± 12.94 and 13.51 ± 9.83 days, respectively; 84.9% of cases died. Thirty-three patients had a bacterial superinfection mainly caused by Klebsiella spp and Acinetobacter spp; 21.2% of piperacillin/tazobactam consumers' patients survived that; the differences were significant (p = 0.034). A significant relationship was seen between superinfection and length of hospital stay until intubation (p = 0.033). Conclusion: Bacterial superinfection and mortality rates were relatively high in COVID-19 patients admitted to ICU. According to the results, using beta-lactam/beta-lactamase inhibitors antibiotics in hospitalized patients in ICU can effectively control superinfection.

Background: Immune checkpoints are molecules that act as regulators of immune system pathways. However, some tumor cells can express the ligands of immune checkpoints to escape from antitumor immune responses. Some agents, such as antibodies, can inhibit these checkpoints that prevent the immune system from targeting and killing cancer cells. The aim of this study was to express a novel bispecific tandem scFv in periplasmic space of Escherichia coli for simultaneous targeting of two immune checkpoints, cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) and programmed cell death protein 1 (PD-1). Materials and Methods: The bispecific tandem scFv was constructed based on the variable regions gene of anti-PD1 and anti-CTLA-4 antibodies. The optimum codon for expression in E. coli was chemically synthesized and subcloned in periplasmic expression plasmid. After transformation, the effect of cultivation conditions on periplasmic expression of the protein in E. coli BL21(DE3) was evaluated. Then, the bispecific tandem scFv was purified and its binding ability to cells expressing PD-1 and CTLA-4 was evaluated. Results: Expression of tandem scFv with a molecular weight of 55 kDa was verified by Sodium dodecyl sulfate-polyacrylamide gel electrophoresis and western blotting analysis. The best condition for soluble periplasmic expression was obtained to be incubation with 0.5 mM isopropyl β-D-1-thiogalactopyranoside at 23°C. The protein was successfully purified using affinity chromatography with a final yield of 4.5 mg/L. Binding analysis confirmed the bioactivity of purified the tandem scFv. Conclusion: This bispecific tandem scFv could be a potential candidate to cancer immunotherapy, although more biological activity assessments are still required to be carried out.

Background: Following personalized medicine and the development of e-publishing, a large number of case report–dedicated journals have emerged. But the lack of integrated guidelines is a major obstacle to the quality of this evidence. The purpose of this study is to analyze the reporting requirements of case report–dedicated journals to update and strengthen the CARE guidelines. Material and Methods: Quantitative and qualitative research approach has been done using the content analysis method. All case report–dedicated journals were selected from Scopus (54 out of a total of 68 journals). By referring to these journals' websites, all the contents of the authors' guideline section and two sample articles were examined as a unit of analysis. Quantitative data includes frequency and percentile; qualitative data was conducted through open coding, creating categories, and abstraction. Results: 51% of journals are related to Elsevier and Hindawi publications. 14.8% of journals have been launched in the form of companions. 52% of journals endorse the CARE guidelines. Among the CARE elements, title, consent form (100%), discussion, abstract (94.4%), and introduction (90.7%) had the most frequent elements, and timeline and patients' perspective had the least repetition in the authors' guideline. Also, 19 new reporting elements and 27 types of case reports were identified. Conclusions: Improving the reporting and content quality of case reports is very important to benefit from knowledge synthesis services. Medical journals publishing case reports should follow a more integrated process. An updated version of reporting guidelines needs to be available for publishers and editors of journals.

Background: Traumatic brain injury (TBI) is a leading cause of death among patients in developed countries. The patients' prognosis depends on the trauma-induced primary damage as well as the secondary brain damage, including electrolyte disturbances. Therefore, prevention, diagnosis, and timely treatment lead to better prognosis. Herein, the aim is to prognosticate about the mortality in patients with TBI through serum osmolarity at admission. Materials and Methods: In this cross-sectional study, 141 patients with TBI were assigned through convenience sampling. The level of serum osmolarity was examined once the patients were admitted to emergency department and later, the outcome was recorded. Finally, we analyzed the relationship between osmolarity level and patient outcome in age groups. Results: The mean serum osmolarity in the age group of under 18 years, 18 to 60 years, and more than 60 years was equal to 295.3 ± 10.02 mOsm/L, 297.2 ± 6.5 mOsm/L, and 301.6 ± 7.6 mOsm/L, respectively (P-value <0.001). Osmolarity with a cut-off point of more than 298.90 and sensitivity and specificity of 70.49 and 62.86, respectively, had appropriate diagnostic value for predicting mortality in these patients (P-value <0.001). Conclusion: According to the results of this study, serum osmolarity can have an appropriate diagnostic value in predicting mortality in patients with TBI. In addition, in different age categories, the osmolarity serum in the mortality of these patients was significantly different. Therefore, due to the high importance of serum osmolarity in the mortality of patients, careful monitoring of fluid therapy status of trauma patients should be implemented to prevent the development of hyperosmolarity for the patient with irreversible outcomes.

Background: Chronic kidney disease (CKD) is an important comorbidity in Coronavirus Disease 2019 (COVID-19) patients considering its high prevalence. We aimed to figure out the relationship between CKD and COVID-19 mortality in this study. Materials and Methods: In total, 116 CKD patients (estimated glomerular filtration rate [eGFR] lower than 60 mL/min/1.73 m²) and 147 control subjects confirmed with COVID-19 were studied. Data regarding demographics, sign and symptoms, laboratory findings, and chest computed tomography were collected. Association between CKD and in-hospital mortality were analyzed using logistic regression models adjusted for confounders. Results: Mortality rate was significantly higher in CKD than non-CKD (30.17 vs 4.76, P < 0.001) COVID-19 patients. Multivariate logistic regression showed that CKD was significantly correlated with in-hospital mortality in the total sample (Odds ratio (OR) = 8.64, confidence interval (CI): 3.67–20.35) and gender subgroups (females: OR = 4.77, CI: 1.38–16.40, males: OR = 13.43, CI: 3.85–46.87) (P < 0.05) of COVID-19 patients in the crude model. Whereas, the correlation did not remain significant in the fully adjusted model in the total sample (OR = 1.70, CI: 0.35–8.19) and gender subgroups (females: OR = 1.07 CI: 0.06–19.82, males: OR = 0.87, CI: 0.07–10.33) (P > 0.05) of COVID-19 patients. Conclusion: This study suggested an independent association between CKD and in-hospital mortality in COVID-19 patients. Therefore, more intensive surveillance of COVID-19 patients with CKD is to be warranted.

Background: The hypo-perfusion of the kidneys can lead to impairment in renal function and induce renal injury in case of delayed diagnosis and treatment. To date, laboratory markers are routinely used to determine the fluid volume status of the patients. The current study aims to evaluate the values of inferior vena cava (IVC) collapsibility index in hypovolemia diagnosis among critical patients admitted at the intensive care unit (ICU). Materials and Methods: This is a cross-sectional study performed on 67 patients admitted to the ICU due to acute kidney injury from May 2018 to October 2019. Hypovolemia was assessed assessing IVC collapsibility using ultrasonography. Laboratory data, including urine osmolality, urine-plasma creatinine ratio, sodium excretion fraction and urinary sodium level were checked. Afterward, IVC collapsibility index was measured for each patient using ultrasonography and the values of this index in accordance with the mentioned criteria was evaluated. Accordingly, reciever operating curve was depicted. Results: There was no significant asosociation between IVC collapsibility index with fractional excretion of sodium (P = 0.69), urine Na (P = 0.93) and urine osmolality ([P = 0.09]), while urine: Plasma creatinie ration revealed a significant association with IVC collapsibility index at cut point of 40.5% with sensitivity and specificity of 96% and 44% (P = 0.017, area under the curve: 0.67, 95% confidence interval: 0.551–0.804), respectively. Conclusion: According to the findings of this study, IVC collapsibility detected via ultrasonography was not an appropriate index to figure out hypovolemia in ICU patients. Furthermore, detailed studies are recommended.

Background: The seniors' lifestyle is an important public-health issue. Hence, assessing the association of cell phone use as a rapidly spreading technology on older adults' lifestyle can be useful for planning prevention and health-promotion policies. Materials and Methods: This cross-sectional study was conducted from March 2020 to March 2021 in Isfahan Comprehensive Health Care Centers to investigate the impact of cell phone use on the lifestyle of the elderly. The Cell-Phone Over-Use Scale and the lifestyle checklist were the assessment tools employed for this purpose. Results: Of the 300 participants with a mean age of 67.93 ± 5.14 years, 46% were male and 54% female. The average value of cell phone usage score was 47.88 ± 26.56, which was categorized into low 36%, moderate 41%, and overuse 23%. A positive and significant correlation was reported between the level of cell phone use in males (β =10.711, [0.95 confidence interval {CI} =4.262–17.160]) and people who have used a substance or opium in the past year (β =10.819, [0.95 CI = 3.677–17.961]). The present results found no significant association between cell phone use patterns and age, level of education, body mass index, television time, sports time, smoking in the past year, marital relationship, and living alone. Conclusion: In this study, we demonstrated a correlation between cell phone use and some demographic and lifestyle variables, namely sex and drug abuse.

Recently published researches show that 59% of all transmission came from asymptomatic transmission and at the time of diagnosis health-care workers (HCWs) tend to present without respiratory symptoms. These evidences have raised questions on whether an essential policy for use of personal protective equipment (PPE) is the best approach in HCW and other people or not. Therefore, this study conducted to investigate the effectiveness of using face masks and PPE in reducing the spread of COVID-19 in health-care and non-health-care settings. This systematic review and meta-analysis study was prepared according to the preferred reporting items for systematic review and meta-analysis statement and guided by meta-analysis of observational studies recommendations. Searches in databases were conducted from December 2019 to July 2021. Random-effects meta-analysis was performed to investigate the effect of using face masks and PPE on spread of COVID-19. Heterogeneity among studies was assessed using Cochran's Q test and the I² metrics. In total, 9920 individuals from 14 studies were included in this study. In all settings, application of PPE or any type of masks was associated with reduction in risk of COVID-19 (odds ratio [OR] = 0.44; 95% confidence interval [CI]: [0.29, 0.65]; I² = 85.21%). In the HCW subgroup, the protective effect had a combined OR of 0.33 (95% CI: (0.15,0.73), I² = 82.61%). Six studies were found protective effects of wearing mask in non-HCWs (OR = 0.58, 95% CI: (0.31, 1.06), I² = 85.63%). Results suggest that there is association between face mask/PPE use and reduction of COVID-19.

Background: Different techniques have been introduced to reduce the complications of nasotracheal intubation. The aim of this study was to compare the incidence of nasotracheal intubation complications in finger-guided and conventional methods. Materials and Methods: In this double-blind randomized trial study, 70 patients who were candidates for oral and maxillofacial surgery who required nasal intubation were included in the study finally of which 33 patients with conventional method and 35 patients with finger-guided tubes in the nasopharynx were analyzed at the end of the study. Variables such as success rate, hemodynamic response, and complications of intubation were compared between the two groups. Results: There was no significant difference between the two groups in terms of hemodynamic response to intubation (P > 0.05). There was a significant difference between the two groups in terms of success in tracheal intubation (P < 0.05). There was a significant difference between the two groups in terms of epistaxis immediately after intubation (P < 0.05). There was no significant difference between the two groups in terms of nasal turbine fractures (P > 0.05). However, the frequency of submucosal intubation in the conventional method was significantly higher than the other group (P = 0.02). Conclusion: Nasotracheal intubation using the finger guiding technique in the nasopharynx is associated with a higher success rate and less complications after intubation such as epistaxis and submucosal intubation compared to the conventional method.

Background: The roles of Epstein–Barr virus (EBV) in breast cancer and breast lymphoma by transfecting EBV DNA have been indicated in different studies, but few investigations have been conducted on its roles in recurrence of breast cancer. Here, we aimed to evaluate the roles of EBV in recurrent breast cancer tissue. Materials and Methods: This is a cross-sectional retrospective study that was performed in 2020–2021 in Isfahan on patients with breast cancer. The study population consisted of 30 tissue samples from recurrent breast cancer and 30 samples from nonrecurrent breast cancer. We collected demographic data of patients including age using a checklist. Other collected data were type of cancer, stages of cancer, tumor size in greatest dimension, lymph node involvements, and presence of metastasis. Furthermore, we evaluated all of the pathology samples from both groups for the presence of DNA of EBV and compared the data of both groups. Results: The DNA of EBV was positive in 8 patients of the relapsed group (26.6%) and 7 patients in the nonrelapsed patients (23.3%). There was no significant difference between two groups regarding positive DNA of EBV (P = 0.39). There were no significant differences between two groups of positive DNA of EBV with and without recurrent breast cancer regarding type of cancer (P = 0.63), stage of cancer (P = 0.19), tumor size in greatest dimension (P = 0.31), mean lymph node involvement (P = 0.27), number of lymph node involvement (P = 0.43), and metastasis (P = 0.69). Conclusion: EBV might have no significant role in recurrence of breast cancer.

The climatological parameters can be different in various geographical locations. Moreover, they have possible impacts on COVID-19 incidence. Therefore, the purpose of this systematic review article was to describe the effects of climatic variables on COVID-19 pandemic in different countries. Systematic literature search was performed in Scopus, ISI Web of Science, and PubMed databases using (“Climate” OR “Climate Change” OR “Global Warming” OR “Global Climate Change” OR “Meteorological Parameters” OR “Temperature” OR “Precipitation” OR “Relative Humidity” OR “Wind Speed” OR “Sunshine” OR “Climate Extremes” OR “Weather Extremes”) AND (“COVID” OR “Coronavirus disease 2019” OR “COVID-19” OR “SARS-CoV-2” OR “Novel Coronavirus”) keywords. From 5229 articles, 424 were screened and 149 were selected for further analysis. The relationship between meteorological parameters is variable in different geographical locations. The results indicate that among the climatic indicators, the temperature is the most significant factor that influences on COVID-19 pandemic in most countries. Some studies were proved that warm and wet climates can decrease COVID-19 incidence; however, the other studies represented that warm location can be a high risk of COVID-19 incidence. It could be suggested that all climate variables such as temperature, humidity, rainfall, precipitation, solar radiation, ultraviolet index, and wind speed could cause spread of COVID-19. Thus, it is recommended that future studies will survey the role of all meteorological variables and interaction between them on COVID-19 spread in specific small areas such as cities of each country and comparison between them.

Background: The present study aimed at investigating the topical effect of the combination of Plantago ovata and vinegar on the improvement of rural cutaneous leishmaniasis lesions. Materials and Methods: The present randomized double-blind controlled clinical trial was performed on 42 patients with rural skin leishmaniasis. In the case group, in addition to injecting glucantime into the lesion according to the latest national instructions, a combination of P. ovata and vinegar was applied topically twice a day for 8 weeks. In the control group, only glucantime injection into the lesion was performed for 8 weeks according to the latest national guidelines. At the end of the 1^st, 2^nd, 3^rd, 4^th, 8^th, and 12^th weeks after the intervention, the lesion area and improvement were evaluated and recorded. Results: The results of the present study indicated the lesion area in the case group with the mean of 0.35 ± 0.39 cm and 0.18 ± 0.27 cm in the 8^th and 12^th weeks, respectively was significantly less than that of the control group with the mean of 0.64 ± 0.78 cm and 0.56 ± 0.44, respectively (P < 0.05). Twelve weeks after the intervention, 84.1% of the lesions in the case group and 65.9% of the lesions in the control group were completely improved (P < 0.05). Conclusion: According to the results of the present study, the improvement of leishmaniasis lesion with the topical application of the combination of P. ovata and vinegar was significantly more than that of the control group in the 8^th and 12^th weeks after the intervention.

Background: Health-care workers (HCWs) are in the frontline for fighting the coronavirus disease 2019 (COVID-19) pandemic and are at higher risk of acquiring the infection. Therefore, the defining immunity status among HCWs helps mitigate the exposure risk. In this study, we investigated the anti-SARS-CoV-2 immunoglobulin G (IgG) and immunoglobulin M (IgM) and also the associated risk factors in the HCWs working in Isfahan University of Medical Sciences COVID-19 referral hospitals. Materials and Methods: In a cross-sectional study, demographics, COVID-19 symptoms during the past 2 weeks, and health-care details were collected from 200 consenting health workers of COVID-center-hospitals of Isfahan University of Medical Sciences from 23 October to 21 December 2020. The recombinant SARS-CoV2 nucleocapsid protein enzyme-linked immunosorbent assay-based IgM, and IgG antibody tests were evaluated. Data were analyzed using Chi-square and independent-t-student tests, and P < 0.05 was considered significant. Results: One hundred and forty-one women and 59 men with a mean age of 36.4 ± 7.77 years participated in the study. IgG Ab and IgM Ab were positive in 77 (38.5%) and 12 (6%) of samples, respectively, and both antibodies were detected in 9 (4.5%). Higher ages, direct contact with the patients with COVID-19, muscle pain, loss of taste and smell, fever, and cough were the factors associated with antibody seropositivity against SARS-CoV2. Conclusion: This study demonstrated that the prevalence of HCWs with antibodies against SARS-CoV-2 is relatively high in Isfahan University referral hospitals. The development of safety protocols and screening and vaccination strategies in the frontline HCWs must be implemented to reduce the burden of infection.

Background: Endotracheal intubation is employed to create a safe airway in patients requiring mechanical ventilation. The relatively high prevalence rate of unplanned displacement of the endotracheal tube (ETT) can be associated with serious complications. This study was conducted to evaluate the effectiveness of a newly designed tube holder in Iran (Irafit), the Thomas ETT holder and the traditional method using adhesive tape. Materials and Methods: The present manikin-based study was performed on the human mannequin. For this purpose, the mannequin was first subjected to oral intubation by a skilled emergency medicine specialist. Then, three methods of adhesive tape, Irafit-ETT holder, and Thomas-ETT holder were used. The mean of displacement in width of the mouth, length of the ETT, and depth as well as ETT removal was recorded. Results: The results of the present study revealed that the displacement in depth was significantly less in the Irafit-ETT holder as compared with the other two groups following the application of a tug (P < 0.001). The displacement in the length of the ETT with and without the application of a tug was significantly less in the Irafit-ETT holder and Thomas-ETT holder groups as compared with the adhesive tape group (P < 0.001). Conclusion: According to the results of the present study, it can be stated that both ETT holder devices (Thomas vs. Irafit) were not distinct in terms of displacements in length and width; however, the Iranian model was more successful in minimizing the displacement in depth.

Background: Nasal polyp (NP) is the most common benign tumor that can cause nasal obstruction and more annoying problems in patients. Recently, investigators have been focusing on complementary therapies alone or in conjunction with endoscopic nasal and sinus surgery. However, given the association of Vitamin D (VD) deficiency and chronic rhinosinusitis with nasal polyposis (CRSwNP) in previous studies, it may be possible to prevent the recurrence of NP and the development of rhinosinusitis by controlling serum levels of VD and maintaining it at a normal level. The current study aimed to investigate the efficacy of VD supplementation in preventing CRSwNP recurrence after endoscopic surgery. Materials and Methods: This clinical trial composed of vitamin D deficient patients with CRSwNP who were candidates for endoscopic sinus surgery in two groups of cases and controls. After endoscopic sinus surgery for all patients, we administered VD supplementation (50,000 IU) once a week for 8 weeks for cases and no further intervention for controls. The severity of symptoms was assessed using Sino-nasal outcome test (SNOT-22) and NP recurrence and recorded pre- and postintervention. Results: The findings indicated a higher mean change of SNOT-22 in the case group compared to that of the control group (36.03 ± 10.71 vs. 29.90 ± 11.99; P = 0.041). Moreover, the percentage of NP recurrence in cases was lower than controls; so that receiving VD supplementation has significantly reduced the chance of NP recurrence (odd ratio [95% confidence interval]: 0.298 [0.099–0.900]; P = 0.032). Conclusion: According to the result of the study, the administration of VD supplementation after endoscopic sinus surgery can reduce the severity of CRSwNP symptoms and NP recurrence significantly.

Background: The studies reported that chemokines Chemokine (C-C motif) ligand 2 (CCL2) and Chemokine (C-C motif) ligand 5 (CCL5) have tumor-promoting roles in breast cancer (BC). The aim of the present study was to evaluate the effect of 4 weeks of continuous aerobic exercise (AE) on chemokines CCL2 and CCL5 and their relative receptors in animal model of human BC. Materials and Methods: BALB/c mice were divided randomly into four groups included cancer control (CC) and three other groups. The total duration of the experiment was 14 weeks, including 2 weeks of familiarization of mice with treadmills and three of 4-week periods of experiment. Tumor inoculation and formation were performed in the second 4-week period. Group 1 received AE in the first 4-week, Group 2 received AE in the second 4-week and Group 3 in the third 4-week. Results: The CCL2 was reduced significantly in Groups 1, 2, and 3 compared to control (F_3,12 = 4705, P = 0.0001). In terms of CCL5, a significant decrease was seen only between Group 3 and control. Western blot results showed a significant reduction in C-C chemokine receptor Type 2 (CCR2) between Group 1 versus CC and Group 2 versus CC (F_3,20 = 1.812, P = 0.004). In terms of C-C chemokine receptor Type 5 (CCR5) a significant decrease was observed between Group 2 versus control and Group 3 versus control (F_3,20 = 273.3, P = 0.042), (P = 0.004). Conclusion: It can be concluded that 4-week AE significantly reduces the chemokines CCL2 and CCL5 and their respective receptors levels CCR5 and CCR2 in different stages, and it may have an inhibitory effect on tumor growth.

Background: Nonalcoholic fatty liver disease (NAFLD) is a common obesity-related disease. In this study, we aimed to investigate the effects of pioglitazone on NAFLD in morbid obese patients. Materials and Methods: This is a randomized controlled trial study that was performed in 2020–2021 on 44 patients who had grade 3 NAFLD. At the beginning of the study, we collected the following data: age, gender, body mass index (BMI), fasting blood glucose (FBS), lipid profile, aspartate aminotransferase, alanine aminotransferase (ALT), and the total size and volume of the liver and the left lobe of the liver. Patients in the control group were given a special diet. For patients in the treatment group, pioglitazone 15 mg tablets were administered twice daily for 4 months. Results: At the beginning of the study, all patients in both groups had grade 3 of NAFLD. After the treatments, 50% of the pioglitazone group had grade 1 NAFLD, and 50% of other patients had grade 2 that showed significant improvements in patients (P < 0.001). We also found significant improvements in the following items in the intervention group: liver size (P < 0.001), size of the left liver lobe (P < 0.001), FBS (P = 0.036), ALT (P = 0.011), and BMI (P < 0.001). No significant improvements were found in the control group (P > 0.05). Conclusion: The use of pioglitazone for 4 months resulted in improvements in fatty liver stage, liver size, BMI, FBS, and lipid profile. These data show the effectiveness of pioglitazone in NAFLD.

Background: Considering the importance of psychological interventions for adults who stutter (AWS), the present study compared the effectiveness of Cognitive Behavioral Group Therapy (CBGT) and Mindfulness and Acceptance Group Therapy (MAGT), in combination with Speech Therapy (ST) in AWS. Materials and Methods: A randomized clinical trial was conducted with 36 AWS in Tehran and Alborz provinces in Iran from September-2019 to September-2020. Participants were assigned to CBGT + ST and MAGT + ST groups. Outcomes variables, the fear of negative evaluation scale (FNE) and the social avoidance and distress scale (SAD), were measured at four stages: (1) pretest, (2) after MAGT/CBGT, (3) after ST, and (4) at 6-month follow-up. Results: The results of repetitive measure-analysis on variance showed that CBGT + ST and MAGT + ST were significantly effective (P = 0.001 and P = 0.003) on SAD. The same analysis showed that CBGT + ST was significantly effective (P = 0.001) on FNE. The results of Analysis of Covariance showed that there was no significant difference between CBGT + ST and MAGT + ST on SAD but CBGT + ST was more effective than MAGT + ST at stage 3 (P < 0.05) on FNE. Conclusion: Data indicated that CBGT + ST and MAGT + ST were both effective for SAD of AWS. Regarding FNE, unlike MAGT + ST, CBGT was effective either alone or in combination with ST for AWS. Further studies are needed to confirm the results of this study.

Delirium is a syndrome with an acute onset that is accompanied by fluctuation and is associated with behaviors that indicate impaired consciousness and cognition. It is common and costly and is associated with severe functional decline and distress in an adult. However, its detection and diagnosis are so challenging in children. Herein, we report a 2-year-old girl who was admitted in the pediatric intensive care unit (PICU) with pneumonia and was intubated because of respiratory failure. She needed a lot of benzodiazepine and opioid drugs to be sedated. During hospital course after extubation, she developed by agitation and restlessness and dissociation from environment. Electroencephalography was done and diffuse generalized slow wave was observed. Finally, by environmental factors' correction, benzodiazepine decreasing, and risperidone administering, she became well and discharged. Delirium should be considered as an important, underdiagnosed, and common condition in the PICU. It should be considered in altered cognition, consciousness, and circadian rhythm disturbance situation in children.

Background: Epigenetic mechanisms play an important role in the regulation of gene expression and genetic information. DNA methyltransferases are a family of enzymes that methylate DNA at the promoter region of the gene which can significantly contribute to gene silencing and carcinogenesis. In addition, histone deacetylation leads to gene silencing and tumorigenesis. Our previous work indicated that histone deacetylase (HDAC) inhibitors can induce its apoptotic role through down-regulation of HDACs. This study aimed to investigate the effect of 5'-fluoro-2'-deoxycytidine (FdCyd) and sodium butyrate on the genes of intrinsic apoptotic pathway (BAX, BAK and APAF1, Bcl-2, and Bcl-xL), p21, p27, and p53 gene expression, cell viability, and apoptosis in human hepatocellular carcinoma Hep3B, SMMC-7721, and HA22T/VGH cell lines. Materials and Methods: The Hep3B, SMMC-7721, and HA22T/VGH cells were cultured and treated with FdCyd and sodium butyrate. To determine cell viability, cell apoptosis, and the relative gene expression level, MTT assay, flow cytometry assay, and quantitative real-time polymerase chain reaction were done, respectively. Results: Both compounds induced significant cell growth inhibition and cell apoptosis significantly (P < 0.0001). Sodium butyrate up-regulated the BAX, BAK, APAF1, p21, p27, and p53 and down-regulated Bcl-2, and Bcl-xL significantly in all three cell lines. Similar results were observed in the Hep3B, and SMMC-7721 cell lines treated with FdCyd. It has no significant effect on p53 gene expression in HA22T/VGH. The expression of the other genes in this cell line was similar to other cell lines. Conclusion: Both compounds induced their roles through the intrinsic apoptotic pathway to induce cell apoptosis.