Background: The aim was to study the effectiveness and safety of a modified technique that employs a four-arm polypropylene (PP) mesh (NAZCA-TC) to treat pelvic organ prolapse (POP) and concurrent stress urinary incontinence (SUI) simultaneously. Materials and Methods: This prospective follow-up study was conducted on fifty SUI women with concurrent high-grade (greater than Stage 2) anterior vaginal wall and/or uterine prolapse who were referred to Al-Zahra and Noor Hospitals in Isfahan and underwent surgery using the NAZCA-TC, Promedon, Argantina kit. The POP-Quantification system was employed for staging POP before and after surgery. To evaluate lower urinary tract symptoms (LUTS) and patients' quality of life, a stress test and the short form of International Consultation on Incontinence Questionnaire of Female Lower Urinary Tract Symptom were used. Patients were followed up and assessed at 6 weeks, 6 months, and 1, 2, and 3 years after surgery. Results: The mean age of patients was 58.2 ± 10.2 years. There was a great reduction (88.6%) in POP staging after surgery. The success rate of SUI treatment was significantly high (83.5%). During 3 years of postoperative follow-up, mesh erosion occurred in 18%, 5 patients (10%) presented with mesh erosion in the first years after operation, 16% reported significant groin or pelvic pain, and 10% required sling release. Conclusion: A single vaginal incision and using two less percutaneous access sites with the PP meshes were effective for treating patients with concurrent POP and SUI but have a high rate of postsurgery erosion rate.

Sickle cell disease (SCD) is a hereditary blood disorder that can increase complications during pregnancy and in turn negatively influence pregnancy outcomes. In addition to patients with SCD are at a high risk of been infected with hepatitis C infection. Furthermore in this study, we reported the clinical status of a pregnant woman with SCD who had hepatitis C virus infection.

Background: Allergic rhinitis (AR) is one of the most common chronic diseases of childhood. Different studies have indicated an increasing prevalence of AR worldwide. The most common complaints of the patients are itching, tearing eyes, and rhinorrhea. The present study aims to assess the prevalence and risk factors of AR among 6–7-year-old children of Isfahan Province, Iran. Materials and Methods: This cross-sectional study conducted on 973 67-year-old primary school students of Isfahan Province in 2016. The study was conducted based on the International Study of Asthma and Allergies in Childhood questionnaire. Results: This study was conducted on 322 (33.1%) 6-year-old and 651 (66.9%) 7-year-old students. A total of 563 (57.9%) and 410 (42.1%) students were male and female, respectively. AR was diagnosed in 397 (40.8%) cases that 190 (47.8%) and 130 (32.7%) showed seasonal and permanent AR, respectively. A percentage of 44.7% of 6-year-old and 38.9% of 7-year-old (P = 0.04) students, 42.1% of males and 39% of females (P = 0.336), had AR; however, the percentages were not significant (P = 0.005). Exposure to smoking, plants, and domestic association with AR was not significant (P = 0.317, P = 0.863, and P = 0.253, respectively), but infancy breastfeeding association was significant (P = 0.015). Residence in the second area of Isfahan city was accompanied by higher prevalence of AR (P = 0.006). Conclusion: The prevalence of AR was considerably higher in Isfahan as one of the largest cities of Iran. It was significantly associated with age, infancy milk feeding, and area of residence but not with sex, smoking, plant, and domestic exposure.

Background: We report the effect of micropulse laser trabeculoplasty (MLT) in the intraocular pressure (IOP) of patients with uncontrolled open-angle glaucoma (OAG). Materials and Methods: In this retrospective review, 30 eyes with OAG were treated with a single session of MLT at the Vista Clinic in Lima Perú. We used a 532 nm frequency doubled Nd: YAG laser to 360° of the trabecular meshwork with a power of 1000 mW, 15% of the duty cycle, and 300 ms of exposure. The IOP was measured at baseline and at 1 day, 1 week, 3 months, and 6 months post-treatment and were followed up for one last control. Results: The mean baseline IOP was 15.6 mmHg and in the last control was 12.8 mmHg, mean follow-up time of 19 months (±10 standard deviation [SD]). The mean reduction of IOP in the 1^st day was 1.6 mmHg (±2.6 SD) and 1.2 mmHg (±3.3 SD) in the last follow-up. The mean percentage of IOP reduction was 17.9% and 7 eyes (40%) had IOP reduction >20%. No statistical significant difference in relation to demographic characteristics of the patients. The greatest reduction was achieved in the 1^st day with a median of 2.00 (P < 0.001). A tendency to achieve a higher reduction of IOP in patients with higher baseline IOP was found but was not statistically significant. No adverse reactions occurred. Conclusions: MLT slightly reduced the IOP in a few patients with uncontrolled OAG for a very short time and may not be suitable for these patients.

Background: Tracheal intubation is a common action in intensive care unit (ICU); however, it may cause laryngeal edema or laryngotracheal injury which leads to edema. The cuff-leak test is usually done to define the upper airway patency. Considering the point that laryngeal edema would be treated by anti-inflammatory agents, our aim was to evaluate the impact of nebulized budesonide on ICU patients' relief and comparison between nebulized budesonide efficacy and intravenous (IV) dexamethasone. Materials and Methods: In our clinical trial, 270 intubated patients from ICU were randomly selected and divided into three groups (each group was included 90 patients) as follows: IV dexamethasone, nebulized budesonide, and placebo group. All the patients were monitored at 0, 12, 24, 36, and 48 h of starting follow-up. Hemodynamic parameters and cuff-leak ratio were measured and data were analyzed using SPSS (ver. 20). Results: Our findings revealed that dexamethasone and budesonide treatment approaches were beneficial for an increase of cuff-leak volume (P < 0.001). Furthermore, the superiority of mentioned methods in patients' relief was significant compared with placebo group (P < 0.001). Moreover, hemodynamic parameters were not altered and were within the normal range in both dexamethasone and budesonide groups (P > 0.05). Conclusion: Our findings demonstrated that the use of budesonide and dexamethasone is beneficial in intubated ICU patients, and the above-mentioned approaches can reduce the complications of tracheal intubation. Furthermore, budesonide could be a trustworthy substitute treatment strategy instead of IV dexamethasone.

Background: Staphylococcus aureus is expressing a broad range of different hemolysins enhancing its ability to establish and maintain infection in humans. The aim of this study was to identify the types of hemolysins in different clinical isolates of S. aureus and their association with antibiotic resistance patterns. Materials and Methods: In this cross-sectional and descriptive study, clinical isolates of S. aureus were collected from Hamedan's hospitals during an 11-month period from June 2016 to January 2017 and identified by using biochemical tests. To determine the antibiotic resistance pattern, disk diffusion method and minimum inhibitory concentration (MIC) were conducted. Genomic DNA was extracted using extraction kit. The polymerase chain reaction was done with specific primers for identification of hla, hlb, hld, and hld genes. Results: Among a total of 389 clinical samples, 138 isolates (35.45%) of S. aureus were identified, which 87 isolates (63.04%) were cefoxitin MIC of >4 μg/ml and resistant to methicillin. The highest frequency of antibiotic resistance was observed against erythromycin in 108 isolates (78.26%) and penicillin in 133 isolates (96.37%) and the lowest resistance was against gatifloxacin in 50 isolates (36.23%) and Cefazolin in 11 isolates (97.7%). Furthermore, the hla, hlb, hld, and hlg genes were detected among 11 (7.97%), 7 (5.07%), 16 (11.59%), and 4 (2.89%) isolates, respectively. There was a significant relationship between the presence of alpha and delta hemolysin-encoding genes and the antibiotic resistance pattern of isolates (P < 0.05). Conclusion: The results exhibited that the association between the presence of the hemolysin genes and the antibiotic resistance pattern can be considered as a serious issue.

Background: Chronic obstructive pulmonary disease (COPD) is an increasing cause of morbidity and mortality worldwide. Anemia is seen as a common comorbidity in COPD patients associated with reduced functional capacity, impaired quality of life, greater likelihood of hospitalization, and early mortality. The aim is to study the prevalence of anemia in patients with COPD and to study its association with different parameters. Materials and Methods: In the present case–control study, 150 stable COPD patients were enrolled from the Outpatient Department of Respiratory Medicine, King George Medical University, Lucknow, from October 2015 to January 2017. GraphPad PRISM version 6.01 was used for the analysis of data. Chi-square test was used to compare between the groups. P < 0.05 was considered statistically significant. Results: The present study showed the prevalence of anemia in COPD patients to be 31.6%. The mean hemoglobin level in anemic group was 11.04 ± 1.1 g/dl, whereas in nonanemic group, it was 13.9 ± 0.8 g/dl. Anemia was significantly associated with increased dyspnea in our study which was assessed by modified Medical Research Council grade (P = 0.04). Conclusion: The prevalence of anemia in COPD patients was 31.6%. Anemia is present as comorbidity in COPD patients and is associated with poor quality of life and increased morbidity in the form of number of exacerbation and hospital admission. Identification and correction of anemia in COPD patients may improve their clinical outcome.

Background: Forced exercise can act as non-pharmacologic neuroprotective agent. In current study, we tried the involved molecular mechanisms of protective effects of forced exercise against methamphetamine induced neurodegeneration. Materials and Methods: Forty adult male rats were divided to Group 1 and 2 which received normal saline and methamphetamine (10 mg/kg) respectively for 30 days. Groups 3, 4 and 5 were treated with methamphetamine for first 15 days and then were treated by forced exercise, bupropion (20 mg/kg/day) or combination of them for the following 15 days. Between 26^th and 30^th days, Morris Water Maze (MWM) was used to evaluate the cognition. On day 31, hippocampus was isolated from each rat and oxidative, antioxidant and inflammatory factors also the level of total and phosphorylated forms of cAMP response element-binding protein (CREB) and brain derived neurotrophic factor (BDNF) proteins were also evaluated. Results: Chronic abuse of methamphetamine could decreases cognition and increase malondialdehyde (MDA), Tumor necrosis factor alpha (TNF-α) and interleukin-1 beta (IL-1β), while caused decreases in superoxide dismutase (SOD), glutathione peroxidase (GPx) and glutathione reductase (GR) activities all these changes was significant (P < 0.001) in compared to control group while treatment with bupropion, forced exercise and bupropion in combination with forced exercise could prevent all these malicious effects of methamphetamine (P < 0.001). Bupropion, forced exercise and bupropion in combination with forced exercise could activate CREB (both forms) and activates BDNF proteins' expression with P < 0.001 in methamphetamine treated rats. Conclusions: P-CREB/BDNF signaling pathways might have critical role in forced exercise protective effects against methamphetamine induced neurodegeneration.

Background: This study aimed to evaluate the impact of Vitamin D supplementation on prevention of recurrent urinary tract infections (UTIs) in the pediatrics. Materials and Methods: This randomized, triple-blind, placebo-controlled clinical trial was conducted in 2014 among 68 children and adolescents with recurrent UTI. They were randomly assigned to two groups, receiving either Vitamin D (1000 IU/daily) or placebo for 6 months. The serum concentration of Vitamin D before and after the study and the frequency of UTI during the study were recorded. Results: Overall 33 patients in the group of receiving Vitamin D and 32 in the placebo group completed the trial. The mean serum level of Vitamin D had a significant increase in the intervention group (15.80 ± 8.7 vs. 20.56 ± 8.30 ng/mL, P < 0.001) and significant decrease in the placebo group (20.43 ± 13.28 vs. 17.43 ± 9.99 ng/mL, P = 0.041). During the trial, the frequency of UTI was not significantly different between the two groups studied (P = 0.72). Both before and after the trial, the frequency of Vitamin D deficiency, insufficiency, and adequacy was not significantly different within and between groups (P > 0.05). Conclusion: The findings of this trial revealed that Vitamin D supplementation with the mentioned dose have not significant impact on preventing recurrent UTI. Future studies with higher doses of Vitamin D and longer follow-up are suggested.

Background: Ameloblastic carcinoma (ACA) is a malignant neoplasm with overlapping histopathological features of benign aggressive solid multicystic ameloblastoma (SMA). This often leads to misdiagnosis with direct implication on the management protocol. The need of the hour is to adopt reliable tissue biomarkers to differentiate these lesions accurately that will help to implement an appropriate treatment modality. Few studies to differentiate ACA and SMA in literature with a limitation of a single marker and lack of availability of cases have prompted us to undertake this study. Thereby, this study is aimed at resolving the diagnostic dilemma in differentiating ACA and aggressive SMA using SOX-2, OCT-4 and CD44. Materials and Methods: Tissue samples involved 40 archival cases of histopathologically confirmed cases of ACA (n = 20) and SMA (n = 20). The sections were subjected to immunohistochemical staining using antibodies to SOX-2, OCT-4 and CD44. Nuclear staining for SOX-2 and OCT-4 and membranous reactivity for CD44 was considered positive. Results: The expression of SOX-2 and OCT-4 in ACA was statistically significant when compared to SMA (P < 0.001). CD44 showed an insignificant statistical value of <0.077 in differentiating ACA and SMA. SOX-2 and OCT-4 expression in ACA showed a significant correlation coefficient of 0.616 at P < 0.004. Conclusions: SOX-2 and OCT-4 could serve as independent novel markers in resolving the diagnostic dilemma between ACA and aggressive SMA.

Background: This study aimed to evaluate the efficacy of memantine in the acute treatment of geriatric with bipolar disorder (BD) hospitalized for mania. Materials and Methods: This study conducted on 70 patients older than 60 years with BD in the acute phase of mania. Oral sodium valproate was prescribed in both groups. The intervention group received memantine tablet and the placebo group received a placebo tablet based on a same procedure. Severity of mania, cognitive changes, and quality of life (QoL) were assessed and recorded 4 and 8 weeks after the beginning of the study. The collected data were analyzed with SPSS (version 20) using independent samples t-test, analysis of variance in repeated observations, Chi-squared test, and Fisher's exact test. Results: Mania severity score had no significant difference at the beginning of the study, but 4 and 8 weeks after the intervention, it was reduced significantly in both groups (P < 0.001) that was higher in memantine group (P = 0.038). The mean increase in score of cognitive variations was 6.74 in the memantine group and 3.62 in the placebo group with a nonsignificant difference (P = 0.125). The scores of each dimension of QoL in the two groups showed that in all four dimensions, the patient's physical, psychological, social, and environmental status increased significantly by time (P < 0.001). Conclusions: According to the results of this study, memantine as an adjuvant to administration of sodium valproate may have a significant effect on decreasing the intensity of mania in the long run.

Background: Bipolar disorders (BD) in parents can have different effects on children and perhaps as a reason of the incidence of various psychiatric disorders in them and they may show a particular parenting style due to features of their disease. Given a crucial role of parenting style in upbringing children, this study aimed to evaluate different styles of parenting and its relationship with psychiatric disorders in children of parents with bipolar disorder (PBD) compared with controls. Materials and Methods: In this case–control study, 500 parents with children aged 6–17 years were included that 250 of them with BD were selected as the case group and 250 of them were healthy as control group. The parents were selected according to the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) by a physician. Psychiatric disorders in children were assessed by The Kiddie Schedule for Affective Disorders and Schizophrenia for school-age children (KSADS). The collected data were analyzed with SPSS (version 20). Results: According to KSADS, there was significant difference between two groups of children in depression, mania, attention-deficit hyperactivity disorder, and posttraumatic stress disorder (P < 0.05). In authoritative dimension, parenting styles were effective in the incidence of psychosis (odds ratio [OR] [95% confidence interval (CI)]: 0.775 [0.63–0.95]) and led to a decrease of 0.320 times in the chance of oppositional defiant disorder incidence (OR [95% CI]: 0.320 [0.21–0.74]; P = 0.043) but an increase of 1.129 times in the chance of cigarette/tobacco use (OR [95% CI]: 1.129 [1.02–1.25]; P = 0.016). Conclusion: The chance of psychiatric disorder's incidence in children of PBD was so far more than children of healthy parents. Hence, the incidence of some psychiatric disorders in children can be associated with parenting styles.

Background: This study aimed to evaluate and compare the therapeutic effects of ephedrine and lidocaine in treatment of intraoperative hiccups in gynecologic surgery under sedation. Materials and Methods: This randomized clinical trial in Isfahan was done on fifty female patients referring to Shahid Beheshti Hospital who needed to have sedation for medical interventions and they afflicted hiccups during surgery or sedation. Patients divided into two groups of 25 randomly assigned to one of the two groups of ephedrine or lidocaine. Ephedrine group received 5 mg/kg of medicine, while the lidocaine group was under treatment with 1 mg/kg lidocaine. Patients were monitored about systolic and diastolic blood pressure, MAP, heart rate, duration of hiccup, frequency of betterment, duration of intervention, and recovery at 15-min intervals of surgery and recovery. Results: Hiccups were resolved in 14 cases (56%) in the lidocaine group, while the improvement of such problem was achieved in 24 cases (96%) in ephedrine group (P < 0.001), so that the two groups did not have any significant difference in terms of the time of onset but the stop time of hiccups (relative to its start time) in the ephedrine group with the mean value of (2.40 ± 1.16) was significantly lower than the lidocaine group with the mean of 19.64 ± 22.76 min (P = 0.014). In addition, no complications were observed in the two groups. Conclusion: Ephedrine has been more successful than lidocaine as a stimulant in controlling hiccups, and it has been able to suppress hiccups in a higher percentage of patients at a shorter time.

Branchio-oculo-facial syndrome (BOFS), a rare, multiple-malformation congenital disorder, is characterized by facial anomalies, including associated cutaneous and ocular abnormalities. We report a new case of BOFS in an 11-year-old male child with bilateral cervical erythematous scaly linear plaque associated with scar formation and erosion. Although BOFS is very rare, physicians, especially dermatologists, should be aware of the cutaneous and histopathological features of BOFS due to impacts of the associated anomalies.

Background: Meniscus plays an important role in weight-bearing and energy absorption. Moreover, its function is optimal to maintain joint stability and congruous. Treatments for meniscus damage or meniscus tear include open or arthroscopic repair and meniscectomy. One of the most important factors that influence patients' recovery outcome is restoration technique. The purpose of this study was to compare the strength of recently new method of meniscus repair, submeniscal horizontal sutures, and single vertical loop suturing techniques in meniscus repair. Materials and Methods: An experimental study was conducted to study 12 ruptured medial meniscuses of bulls, which were divided into two groups of six meniscuses equally. In this study, submeniscal horizontal and vertical loop suturing techniques were compared based on their resistance to tensile forces and the stability of repaired gaps. Results: In this study, submeniscal horizontal and vertical loop knots were 104.3 ± 12.5 N and 110.7 ± 16.4 N, respectively. No significant difference was found between the two groups. To measure the stability of the gap, 95.4 ± 8.7 N tensile force was applied to submeniscal and 124.6 ± 11.7 N to vertical loop techniques. There was significantly different in gap stability between horizontal and vertical loop techniques in meniscal repair (P = 0.02). Conclusion: The results of this study indicate that knot resistance in submeniscal horizontal is similar to vertical loop resistance. The stability of the restored gap in vertical loop technique is more than submeniscal horizontal techniques. Vertical loop causes greater stability against tensile force.

Background: Epithelial–mesenchymal transition (EMT) is actively involved in tumor invasion. The main hallmark of EMT is downregulation of the adherens junction protein E-cadherin due to transcriptional repression. Candidate E-cadherin transcription repressors are members of ZEB family, ZEB2 belong to the ZEB family transcription factor that is pivotal for embryonic development and tumor progression. ZEB2 (zinc finger E-box binding homeobox 2) is most widely known as an inducer of EMT. Growing evidence have shown the involvement of microRNAs in cancer progression. In this study, we demonstrate that miR-30a is a potent suppressor of melanoma metastasis to the lung. Materials and Methods: In this study, miR-30a has been transfected into B16-F10 melanoma cells, and then cells were injected intravenously into C57BL/6 mice. Then, the mice were sacrificed and nodules in the lungs were enumerated. Results: Ectopic expression of miR-30a in melanoma cell line resulted in the suppression of pulmonary metastasis. We also found that transfected miR-30a into melanoma cells could increase E-cadherin and decrease ZEB2 expression. Conclusions: Our findings showed that increased expression of miR-30a in melanoma inhibited metastasis in vivo by targeting ZEB2 and E-cadherin.

Background: Sneezing transiently elevates cerebral blood flow. We speculated that induced sneezing, following embolism would restore arterial flow, thereby diminishing infarct volume and improving neurological deficits. Materials and Methods: Male rats were subjected to middle cerebral artery occlusion (MCAO) using prepared clots (embolization) and randomized into four equal groups as follows: (1) pre-MCAO-induced sneezing (PRMIS), (2) post-MCAO-induced sneezing (POMIS), and (3) pre- and POMIS (PRPOMIS) and the control group (eight rats per group). In the treatment groups, rats' sneezing episodes were induced before MCAO in PRMIS group or before regaining consciousness from surgical anesthesia in other treatment groups by cutting their whiskers during their anesthesia and subsequently inserted them into the rats' nostrils. Infarct volume was evaluated by 2, 3, 5-triphenyl tetrazolium chloride staining, and neurological deficits and brain edema were assessed by Bederson scale deficit scores 24-h post-MCAO. Results: The infarct volume and brain edema reduced and neurological deficits improved in the induced sneezing groups as compared with the MCAO control group. Compared to the control group, the highest improvements in the infarct volume and neurological deficits were seen in the PRPOMIS group, and POMIS group showed the most significant differences concerning the results of both ischemic and nonischemic brain edema. The highest protective effect was observed in the central region of the MCA territory. Conclusions: The reduction in ischemia-induced brain injury, brain edema, and neurological deficits by sneezing suggest that brief episodes of acute hypertension after stroke can increase blood flow to the ischemic area and improve recovery.

Background: Hearing loss (HL) is a highly prevalent heterogeneous deficiency of sensory-neural system with involvement of several dozen genes. Whole-exome sequencing (WES) is capable of discovering known and novel genes involved with HL. Materials and Methods: Two pedigrees with HL background from Khuzestan province of Iran were selected. Polymerase chain reaction-sequencing of GJB2 and homozygosity mapping of 16 DFNB loci were performed. One patient of the first and two affected individuals from the second pedigree were subjected to WES. The result files were analyzed using tools on Ubuntu 16.04. Short reads were mapped to reference genome (hg19, NCBI Build 37). Sorting and duplication removals were done. Variants were obtained and annotated by an online software tool. Variant filtration was performed. In the first family, ENDEAVOUR was applied to prioritize candidate genes. In the second family, a combination of shared variants, homozygosity mapping, and gene expression were implemented to launch the disease-causing gene. Results: GJB2 sequencing and linkage analysis established no homozygosity-by-descent at any DFNB loci. Utilizing ENDEAVOUR, BBX: C.C857G (P.A286G), and MYH15: C.C5557T (P.R1853C) were put forward, but none of the variants co-segregated with the phenotype. Two genes, UNC13B and TRAK1, were prioritized in the homozygous regions detected by HomozygosityMapper. Conclusion: WES is regarded a powerful approach to discover molecular etiology of Mendelian inherited disorders, but as it fails to enrich GC-rich regions, incapability of capturing noncoding regulatory regions and limited specificity and accuracy of copy number variations detection tools from exome data, it is assumed an insufficient procedure.

Background: Heat loss and core-to-peripheral redistribution of body heat occur in patients undergoing neuraxial anesthesia resulted to decrease of core temperature and early reach of shivering threshold. Because shivering has deleterious metabolic and cardiovascular effects, it should ideally be prevented by pharmacologic or other means. Tizanidine is an alpha-2 agonist. We evaluated the usefulness of oral tizanidine (TI) and tramadol in preventing of shivering in patients undergoing spinal anesthesia for transurethral resection of the prostate (TURP). Materials and Methods: Ninety patients, scheduled for TURP with spinal anesthesia, were prospectively enrolled. Patients were randomly assigned to 1 of 3 groups. 90 min before spinal anesthesia, 30 patients received 4 mg oral TI, 30 patients received 50 mg tramadol, and 30 patients received placebo as control group. Spinal anesthesia was induced at the L3–L4 or L4–L5 interspaces with 12.5 mg bupivacaine. An investigator blinded to the drugs recorded the frequency and degree of shivering. Results: The overall frequency and severity of shivering were significantly lower in patients treated with TI and tramadol compared to placebo (P = 0.04) (P = 0.001). There was not much difference in the nausea and vomiting of both the drugs (P = 026) (P = 011). There was no difference in hemodynamic parameters between three groups (P = 0.08) (P = 013). Conclusions: Oral TI and tramadol were comparable in respect to their effect in decreasing the incidence, intensity shivering when used prophylactically in patients who underwent TURP with spinal anesthesia.

Background: Women with breast cancer experience various challenges. Prescription of health information provides appropriate information at appropriate time to the appropriate person and plays a role in empowering self-care and improving health. The current research aims to evaluate the effect of health information prescription on self-care power of women with breast cancer. Materials and Methods: This semi-experimental quantitative study was done using pretest and posttest method in one group of 61 women with breast cancer selected from the Women's Cancer Center of Khatamolanbia Hospital using purposive sampling method. Data were collected by an author-made self-care questionnaire and patients' self-care score was calculated at the first visit (before health information prescription) and the second visit (after health information prescription). Data were analyzed using the SPSS version 23 software and analysis of variance at a statistical significance level of P < 0.05. Results: Total mean score of self-care in women with breast cancer was 40.97 and 115.3 before and after health information prescription, respectively. Increase of mean was observed in all subscales of self-care score from pretest to posttest so that change in posttest was higher in subscales of effective implementation of treatment and prevention from disabilities and personal functioning regulation (39.44), specialized knowledge on breast cancer (30.46), searching medical services and cooperation with treatment group (28.59), and awareness and attention to impacts and results of breast cancer (16.81). Conclusion: Health information prescription improves self-care power of women with breast cancer, and it is necessary to provide health information services in order to support women's self-care by the health authorities.

Background: Youth violence is an important public health challenge, and the literature on this problem in developing countries has been limited. The present study aims to determine the prevalence of violence its related risk factors in in a sample of students in Isfahan, Iran.Materials and Methods: In this cross-sectional study, 2800 middle and high school, aged 11–18 years in urban and rural areas selected in a multistage sampling procedure and were questioned using a self-administered questionnaire. Collected data included sociodemographic and family characteristics, students' knowledge, verbal and physical violence (as a perpetrator and/or victim), risk-taking behaviors (weapon carrying, threatening behaviors), family violent status, watching movies, and accessibility of sport facilities. Results: The prevalence of verbal and physical violence in studied students was 45% and 33.3%, respectively. The prevalence of verbal and physical victimization was 45.8% and 23.6%, respectively. The prevalence of physical violence was higher in middle school students than high school students (P = 0.0001) and in boys was higher than in girls (P = 0.0001). Being boy, carried a weapon out of home or in school, victimization, feel unsafe at school, and violence in the family are the significant related risk factors with students violence (P < 0.05). Conclusion: The prevalence of students' violence in Iranian students is similar to the most of other developing countries, although, high rate violence and related risk factors emphasize the need for comprehensive and interventional prevention programs to reduce and manage student violence and associated risk behaviors.

Background: Stress affects brain functions and induces psychological disorders. Previous studies have indicated different effects of crocin and exercise on the improvement of memory in some types of stress. The present study investigated the effect of crocin, exercise, and crocin-accompanied exercise on learning, memory, and memory consolidation in rats under chronic unpredictable stress (CUS). Materials and Methods: Male rats were randomly allocated to different groups: control, sham, stress, stress-exercise, stress-crocin, and stress-crocin-accompanied exercise groups. The CUS and treadmill running were applied 2 h/day and 1 h/day, respectively, for 21 days. Crocin (30 mg/kg) was daily intraperitoneally injected to the rats and their behavioral variables were evaluated as a brain function using the passive avoidance test. Results: Results showed that the CUS significantly decreased learning and memory compared to the control group, while crocin alone and crocin-accompanied exercise significantly improved learning and memory compared to the stressed group. It was found that exercise alone caused learning but did not improve memory in unpredictable stress rats. Conclusion: The data indicated that unpredictable stress had very destructive effects on the brain functions. Furthermore, unlike exercise, crocin improved memory under unpredictable stress conditions. Overall, it seems that the beneficial effects of crocin-accompanied exercise on learning and memory were probably because of crocin, but not exercise.

Background: There have been studies on the outcome of acute intoxication with antidepressants or antipsychotics. We performed outcome prediction analysis in acute poisoning patients with antidepressants/antipsychotics with or without combination with other drugs. Materials and Methods: A cross-sectional study was performed in Khorshid (PBUH) University Hospital affiliated with Isfahan University of Medical Sciences from March 2016 to May 2017. Patients with acute poisoning ingested antidepressants and antipsychotics with or without other drugs were included in the study. The outcome was categorized as survived without complications and complications/death. Binary regression analysis was performed for outcome prediction. Results: The data from 239 patients were analyzed. Most of the patients were female (68.2%), 5.9% of patients admitted to the Intensive Care Unit. About 94.99% of patients survived without complications. There was a significant difference between patients with and without complications with respect to the level of consciousness, hypotension, seizure, electrocardiography findings, pulse rate after 24 hours (h) of admission, and need to endotracheal intubation (P < 0.0001). Binary logistic regression analysis showed admission level of consciousness (stupor/coma) (odds ratio [OR] =8.07; P = 0,005), hypotension (OR = 12.16; P = 0.001), seizure (OR = 11.15; P = 0.009), tachycardia after 24 h of admission (OR = 22.50; P = 0.003), and need for endotracheal intubation (OR = 10.47; P = 0.002) were determinant factors in outcome prediction. Conclusions: Stupor/coma and hypotension were the predictive factors for outcome. Patients with seizure and tachycardia after 24 h of admission; and those intubated and received mechanical ventilation had a higher chance of complications.

Background: At workplaces, the workers exposed to several harmful agents such as physical, chemical, and biological pollutant that cause occupational diseases. There are a lot of jobs that not allow a certain pattern of exposure to this agent. In this article, we introduce a technology named radio-frequency identification (RFID) to estimate the exposure time of workers to harmful agent. Materials and Methods: This applied study was carried out experimentally in an industry in Isfahan province, Iran. Twenty-nine participants selected from the workers without a fixed pattern of exposure. Two methods used to measure the exposure time of them. The first method was based on a self-made RFID device and conducted by the workers. The second method performed by stopwatch, which was carried out by the occupational hygienist. The results were analyzed using SPSS 20 and descriptive statistics, Spearman correlation coefficient, and paired samples t-test. Results: The mean age of the participants was 36.48 ± 5.889 and job experience was 9.06 ± 6.316 years. Spearman correlation coefficient shows that there is a significant correlation between the exposure times measured by the workers and occupational hygienist (R in all zones was higher than 0.9, P < 0.05). Paired samples t-test shows that there are no significant differences between the mean exposure times measured by the workers and occupational hygienist in each zone and in all the zones (P > 0.05). Conclusion: RFID technology is an appropriate method to evaluate the exposure time of workers without fixed pattern of exposure to causative factors of occupational diseases. It can also be used in other fields of occupational health engineering.

Background: Breast lumpectomy is an integral part of the treatment of mammary masses in women. This study was conducted to evaluate and compare two-drug combinations of propofol–ketamine (PK) (ketofol) and propofol–fentanyl (PF) (fenofol) on quality of sedation and analgesia in lumpectomy. Materials and Methods: This was a randomized, double-blind, clinical trial performed on 64 patients aged 15–70 years with breast cancer lumpectomy referred to Isfahan's Seyed Al-Shohada Hospital. Consequently, patients were divided into two groups of 32 patients, each group receiving PF combination or PK combination during anesthesia. Results: The patients in two groups, PF and PK, were compared in their sedation levels, severity of pain, and other variables. The mean arterial blood pressure, systolic blood pressure, and heart rate (HR) did not show any significant difference at the beginning of the study in the two groups, but the fenofol (PF) group had a significantly lower oxygen saturation than the ketofol (PK) group. The sedation level was significantly lower in the fenofol group than the ketofol group (P < 0.001). The mean pain intensity was significantly lower in the PF group than the PK group (P < 0.001). Conclusion: The two combinations of ketofol and fenofol cause rapid, favorable, safe anesthetic with minimal side effects and hemodynamic effects but it may be a superior alternative to fenofol combination, in terms of respiratory depression.

Background: Preeclampsia (PE) is one of the main causes of maternal and perinatal mortality and morbidity. Evidence shows that oxidative stress plays an important role in the pathophysiology of the PE. As catalase is a key enzyme in antioxidant enzymatic defense which protects cell from oxidative damage, in this study, we aimed to investigate the relationship between CAT-21A/T (rs7943316) polymorphism and PE susceptibility. Materials and Methods: This case–control study was conducted on 155 PE women and 159 normotensive pregnant women. Polymerase chain reaction-restriction fragment length polymorphism method was used for genotyping. Results: There was no association between CAT-21AT and TT genotypes and PE susceptibility. However, the CAT-21A/T polymorphism was associated with 1.6-fold higher risk of PE in dominant model (AA vs. AT + TT) (odds ratio [OR] 1.6 [95% confidence interval [CI]: 0.9–2.9]; P = 0.04). However, the CAT-21A/T polymorphism was not associated with PE in recessive model (TT vs. AA + AT) (OR 1.3 [95% CI: 0.8–2.1]; P = 0.4). Conclusions: The CAT-21A/T polymorphism could be a risk factor for PE susceptibility in dominant model.

Background: Seidlitzia rosmarinus which is commonly called “Oshnan” or “Eshnan” in Persian belongs to Chenopodiaceae family. Conventionally, it is believed that this plant is toxic. This study was aimed to evaluate the cytotoxic effect of S. rosmarinus against HeLa and HepG₂ cell lines. Materials and Methods: S. rosmarinus was collected from the desert near Yazd, Iran. Hexane, chloroform, chloroform/methanol (9:1), and butanol extracts of aerial parts of S. rosmarinus were prepared. Doxorubicin and dimethyl sulfoxide 10% were used as positive and negative control, respectively. The cytotoxic activity was measured using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay. Results: All extracts significantly and concentration dependently reduced viability of HeLa and HepG2 cells. Hexane, chloroform, and butanol extracts at doses of 200, 500, 750, and 1000 μg/ml significantly reduced HeLa cell viability (P < 0.05). Chloroform/methanol extract at doses of 100–500 μg/ml significantly reduced HeLa cell viability (P < 0.05). Hexane, chloroform, and butanol extracts at doses of 500, 750, and 1000 μg/ml significantly reduced HepG2 cell viability (P < 0.05). Chloroform/methanol extract at doses of 200, 300, 400, and 500 μg/ml significantly reduced HepG cell viability (P < 0.05). The most cytotoxic extract was chloroform/methanol extract in both cell lines. Furthermore, in the both cell lines, the second potent extract was chloroform extract. Conclusions: It can be concluded from the findings of this study that S. rosmarinus is a good candidate for further study to find new cytotoxic agents. Phytochemical investigation on chloroform/methanol extract and their structures is recommended.

Background: Autism spectrum disorder (ASD) is a neurodevelopmental disorder with a recent increase in prevalence. A timely appropriate treatment for the disorder may play a crucial role in improvements in behaviors, interactions, and communications in an individual's life. It appears that evaluation of therapeutic approaches to the patients is essential and of importance. Thus, the aim of this study was to evaluate the efficacy of memantine as adjunct therapy in children with ASD. Materials and Methods: This randomized single-blind clinical trial included 60 children with ASD aged <14. The children undergoing applied behavior analysis (ABA) were divided into two groups of placebo and memantine (5 mg/day: a half of tablet in the morning and a half in the evening). After a 3-month course, improvements in symptoms of ASD were evaluated in both groups based on Gilliam autism rating scale. The collected data were analyzed with SPSS (version 20) using independent samples t-test, paired samples t-test, Chi-squared test and Fisher's exact test. Results: Both groups were similar in baseline characteristics including age, gender, and ASD symptoms (P > 0.05) but post intervention, total scores of ASD symptoms in both groups of memantine (mean score₁ =95.20 ± 14.49; mean score₂=73.50 ± 9.81) and control group (mean score_before = 91.50 ± 14.35; mean score_after = 89.63 ± 13.95) showed a decrease which was only significant in intervention group (P < 0.001). Conclusion: Accordingly, memantine administration as adjunct therapy can be more effective in improvement of ASD symptoms in children than ABA alone. Thus, it can be considered as a new selective adjunct therapy.

Primordial dwarfism (PD) is a group of rare genetically heterogeneous disorders consisted of disorders with intrauterine growth retardation continued through the life. SOFT syndrome with characteristics of short stature, onychodysplasia, facial dysmorphism, and hypotrichosis has been presented as a subtype of PD. Only 20 cases of SOFT syndrome have been reported in world to date, but none of them were not in Iran. Our case was 6.5-year-old girl with a complaint of growth retardation including height of 97 cm (Z = −4.6 standard deviation [SD]) and weight of 14 kg (Z = −4 SD) referred to growth clinic. She had a prominent forehead, triangular face, short limbs, malformed nails, and crowded teeth and her psychomotor function was normal. Laboratory and karyotype tests were normal while she was homozygous for c.G491A mutation of POC1A gene thus SOFT syndrome diagnosis was confirmed for her and recombinant growth hormone therapy was discontinued.

Background: Hypertension is one of the most common noncommunicable diseases in the world. One of the most effective factors on blood pressure (BP) is nutrition. The aim of this study was to examine the relationship between dietary patterns and BP among military staffs. Materials and Methods: The study was carried out among 405 military staffs between 22 and 51 years old. Demographic, anthropometric information, and BP of participants were evaluated by standard methods. The dietary intakes were collected using a food frequency questionnaire (FFQ). Dietary patterns were identified using a posteriori method, factor analysis, and based on the FFQ. To check the relationship between BP and dietary patterns, we used multivariate linear regression in different models, relationship were adjusted for Age, sex, marital, smoking, income, body mass index, waist-to-hip ratio, family history of hypertension, energy intake, and physical activity level. Results: Two dominant dietary patterns were identified in the participants: Healthy and western pattern. The association of dietary patterns with systolic BP (SBP) and diastolic BP (DBP) was exhibited in different models. There was no relationship between SBP and DBP with healthy pattern (P = 0.269 andP = 0.638, respectively) and western pattern (P = 0.648 and P = 0.315, respectively) after adjustments. Conclusion: Our findings indicated that dietary patterns did not have any significant relationship with SBP and DBP after adjustment for confounders in the healthy military. To identify the dietary patterns associated with BP in healthy military, more strong design studies and more participants should be conducted in the future.

Background: Many drugs have poor water solubility and so the oral delivery of such drugs is usually associated with limitation of low bioavailability and lack of dose proportionality. Lipid-based liquid crystal (LC) systems are excellent potential formulations for increasing dissolution and bioavailability of drugs. The aim of the present study was to formulate lipid-based LC containing fenofibrate (FFB) as a hydrophobic drug. Materials and Methods: The studied variables included lipid and stabilizer concentrations and the type of stabilizer. The LC formation was identified by the polarized optical microscopic method. The effects of variables on formulation characteristics such as particle size, drug release, and rheological behavior were evaluated. Results: The results showed that the prepared formulations had the particle size between 42 and 503 nm. The drug release profiles showed that FFB had the continuous release from the formulations and the highest dissolution efficiency was seen in formulation prepared by 1.5% of glyceryl monostearate and 0.5% of Pluronic F127 as the stabilizer. The change of stabilizer type from colloidal silica to Pluronic F127 increased the drug release, significantly. Conclusions: In the most formulations of FFB LCs, the DE% was more than the pure drug, and therefore, it seems that the liquid crystalline formulations can be effective for enhancing drug release. Furthermore, drug release rate depended on the stabilizer type so that the presence of colloidal silica caused slower drug release compared to Pluronic F127.

Background: Grape exosome-like nanovesicles (GELNs) have the advantage of inherent biocompatibility and biodegradability, the potential to be used as oral delivery vehicles. The objective of this research was to evaluate the efficiency of Syrah GELN purification and their effects on the intestinal stem cells when orally administrated to the rats. Materials and Methods: In this experimental study, Syrah GELN isolated by differential centrifugation and sucrose gradient ultracentrifugation method, then the concentration of protein, size, and zeta potential were measured as well as nanoparticles morphology. The stability of nanoparticles was investigated in the solution that mimicked the condition encountered in the stomach and intestine. To demonstrate transfection efficiency of intestinal stem cells, real-time PCR was carried out using rat leucine-rich repeat-containing G-protein-coupled receptor 5 (Lgr5)-specific primers on cDNA derived from total RNA extracted from the upper part of the small intestine of GELN-treated rats and their controls. Results: The mean size, zeta potential, and concentration of nanoparticles were 205.1 nm, −12.5 mV, and 250 μg/ml, respectively. The result of stability test demonstrated that Syrah GELN were resistant to the harsh environment of the stomach. Lgr5 gene expression was increased by tenfold in GELN-treated rats compared with the controls. Conclusions: As intestinal stem cells are poorly accessible by common exogenous agents in vivo, oral delivery of GELNs provides a new approach to modulate the stem cell microenvironment for intestinal remodeling. This novel and effective method would help to overcome conditions such as inflammatory bowel disease, colorectal cancer, and applicable in regenerative medicine.

Background: Cutaneous leishmaniasis is one of the most important public health problems in many developing countries. Sand flies, as vectors, transmit infectious forms of the parasite to the vertebrate hosts. Poldokhtar, South West of Iran, is one of the endemic foci of diseases with a little information about it. In this paper, we have tried to gather some useful information to control and to prevent this disease in this region. Materials and Methods: The present study was conducted to determine the vector(s), the parasite, and the species composition of sand flies in the Poldokhtar County during the months from July to September 2015. Sticky paper traps were used to collect sand flies from July to September. Species identification was done based on available diagnostic keys. Nested-polymerase chain reaction was performed to diagnosis the Leishmania infection of sand flies, and restriction fragment length polymorphism was used to identify the Leishmania species. Results: A total of 2000 specimens comprising 8 species of sand flies (6 Phlebotomus and 2 Sergentomyia) were identified. Phlebotomus papatasi was the dominant species outdoor and Sergentomyia sintoni was the dominant species indoor. Among the 163 specimens of female P. papatasi, just 10 of them (6.1%) were positive to Leishmania major parasites. Conclusion: This is the first report of Leishmania infection of P. papatasi to L. major in this region. The results revealed that the high density of P. papatasi in outdoor and their infection with L. major is attributed that this species can play a major role as a principle vector in this region.

Background: Methamphetamine-induced psychotic disorder (MIP) cannot be easily differentiated from other psychotic disorders. Some studies have reported that patients with MIP and schizophrenia have differences in their cognitive functioning. We hypothesized that their performance would be different on neuropsychological tests which assess executive functions and visual memory. Materials and Methods: In a cross-sectional study, 30 patients with MIP, 31 patients with schizophrenia, and 31 healthy controls were assessed by Rey–Osterrieth complex figure (ROCF) test and visual search and attention test (VSAT). One-way analysis of variance was performed to compare the mean scores of tests. Tukey's HSD test was used for post hoc analysis. Results: Three groups had significant differences according to ROCF test (F = 15.76, P < 0.0001), VSAT (F = 39.78, P < 0.0001), left VSAT (F = 37.96, P < 0.0001), right VSAT (F = 40.40, P < 0.0001), and the time of the test administration (F = 3.26, P = 0.04). The post hoc analysis showed that the mean score of ROCF test and VSAT (total, right, and left) was significantly higher in the control group than in the other two groups. The time of administering the test in the control group was significantly shorter than in the MIP group (P < 0.03) and nonsignificantly shorter than in the schizophrenia group (P = 0.54). The mean score of right side VSAT was significantly higher in the MIP group than in the schizophrenia group. Conclusion: ROCF could not differentiate MIP from schizophrenia. The better performance of patients with MIP on right side VSAT that is reported in this and in the previous study needs to be reevaluated in more controlled studies.

Background: Uncoupling protein-1 (UCP-1) is the index protein of the brown adipose tissue (BAT), used in the obesity studies. We evaluated the effects of thymoquinone (TQ), hydroalcoholic, and hexane extracts of Nigella sativa, on the UCP-1 gene expression in BAT, and also on the recovery from oxidative stress, due to a high-fat diet. Materials and Methods: Fifty mice were divided into five groups: the first group was fed with a usual diet and the second, third, fourth, and fifth groups with a high-fat diet, hydroalcoholic extract, hexane extract, and TQ, respectively. After completing the course, the lipid profile, paraoxonase 1 (PON1), serum total antioxidant capacity (TAC), and malondialdehyde (MDA) were measured. UCP-1 expression in BAT was evaluated at the gene and protein level. Results: The weight of mice, receiving TQ, hydroalcoholic, and hexane extracts, was decreased (P < 0.05), compared to the second group (P < 0.05). MDA was increased in the second group, compared to the first group (P < 0.05); however, TAC, liver catalase enzyme, and PON1 were decreased (P < 0.05). Furthermore, MDA of the third, fourth, and fifth groups had decreased, and the activity of PON1, liver catalase enzyme, and the amount of TAC was increased (P < 0.05). UCP-1 expression of the third and fourth groups was increased, compared to the second group (P < 0.05). Conclusion: The results suggest that TQ, hydroalcoholic, and hexane extracts of N. sativa have a protective and therapeutic role in the oxidative stress, caused by high-fat diets. The hydroalcoholic and hexane extracts can induce weight loss, by positively affecting UCP-1, at the gene and protein level.

Background: The aim of the study was to compare the serum zinc level and eating behaviors in 2–8-year-old children with and without arbitrarily zinc supplementation. Materials and Methods: This case–control study was conducted from December 2015 to December 2017 in Isfahan, Iran. The case group consisted of seventy children, aged 2–8 years, who have received zinc supplement without physician prescription; the controls were an equal number of age-matched children who did not receive any supplement. The serum zinc level was measured, and eating behaviors were identified using Children's Eating Behavior Questionnaire (CEBQ). Results: There was no significant difference in serum zinc level between two groups (P = 0.18). Some differences in CEBQ subscales were identified between the groups studied. In the control group, the subscale of enjoyment of food was higher than the case group (P < 0.001). In the case group, the subscales of food fussiness and satiety responsiveness were higher than controls (P < 0.001). Conclusion: In this study, serum zinc levels were not significantly different between the two groups, and arbitrarily zinc supplementation does not play an important role in improving anorexia subscales.

Background: One of the consequences of toxoplasmosis is the risk of passing it from mother to fetus and the onset of congenital toxoplasmosis during pregnancy. The purpose of this study was to evaluate the B1 gene of Toxoplasma gondii in the placental tissues of pregnant women with acute toxoplasmosis. Materials and Methods: The study was a cross-sectional study. Serum samples of pregnant women who attended to Fatemieh Hospital of Hamadan University of Medical Sciences were tested for immunoglobulin G (IgG) antibodies against T. gondii by enzyme-linked immunosorbent assay. Then, polymerase chain reaction was used to identify the specific B1 gene of T. gondii in IgG seropositive women. The placental tissues of the pregnant women with positive serum B1 gene examined for this gene. Anti-Toxoplasma immunoglobulin M (IgM) was performed on the umbilical cord and neonate blood. Results: Anti-Toxoplasma IgG was detected in 167 out of 653 (25.6%) pregnant women. T. gondii B1 gene was identified in 36 out of 167 (21.6%) of IgG seropositive women. After delivery, the B1 gene was evaluated in 15 out of 36 (41.7%) patients' placental tissues, 13 of which were positive for this gene (86.7%). Anti-Toxoplasma IgM was detected neither in any umbilical cord nor in neonatal blood samples. All newborns, with the exception of one case, were born with normal birth weight and in term birth. Conclusion: The B1 gene was detected in 86.7% of the placental tissue of women who were involved in acute toxoplasmosis during pregnancy.

Background: Exposure to psychological stresses can be a reason for obesity. Therefore, identifying the effective nutritional mechanisms such as feeding markers is of high necessity for the psychological stress conditions. Hence, the present study investigates the effects of subchronic isolation and social stresses on food intake, body weight differences (BWD), and levels of leptin, ghrelin, and glucose in rats. Materials and Methods: Eighteen male rats were randomly allocated into three groups: control (Co), isolation stress (IS), and social stress (SS) groups. Rats were under stresses for 7 days. The food intake (for three continuous hours after 16–18 h of food deprivation), BWD, levels of ghrelin, leptin, and glucose were measured. Results: The results showed that the food intake significantly (P < 0.05) reduced during the 1^st h in the SS group compared to the Co group. At the 2^nd h, the food intake significantly (P < 0.001 and P < 0.01, respectively) decreased in the IS group compared to the Co and SS groups. The cumulative food intake and body weight were significantly (P < 0.05) reduced in the IS group compared to the Co group. The serum ghrelin level significantly reduced in the IS group compared to the Co group. Conclusions: The subchronic psychological stresses led to a reduction in food intake by the reduction of serum ghrelin levels. It seems that ghrelin might have a more fundamental role in the food intake with respect to the leptin and glucose levels in subchronic stress condition. Furthermore, the decreased body weight justified the reduction of food intake, particularly in subchronic isolation stress.

Background: Tissue engineering and biomaterials have made it possible to innovate bone treatments for orthopedic and spine problems. The aim of this study is to develop a novel polyethylene oxide (PEO)/silicon-substituted hydroxyapatite (Si-HA) composite to be used as a scaffold for hard tissue engineering in orthopedic and spine procedures. Materials and Methods: The composite was fabricated through the electrospinning technique. The applied voltage (5 kV) and PEO concentration (5%) were fixed. Processing parameters such as the flow rates (20 μl/min and 50 μl/min), distances from capillary tube to the collector (130 mm and 180 mm), spinning time (10 min and 20 min), and concentration of Si-HA (0.2% and 0.6%) were explored to find the optimum conditions to produce fine composite fibers. Results: Scanning electron microscope images showed that 5% PEO, 5% PEO/0.2% Si-HA, and 5% PEO/0.6% Si-HA fibers were successively produced. Flow rates and working distances showed significant influence on the morphology of the polymeric and composite fibers. A high flow rate (50 μl/min) and a larger working distance (180 mm) resulted in larger fibers. The comparison between the mean fiber diameter of 5% PEO/0.2% Si-HA and 5% PEO/0.6% Si-HA showed to be significantly different. As the Si-HA concentration increased, certain fibers were having particles of Si-HA that were not properly integrated into the polymer matrix. Conclusions: Synthesis of a novel biomaterial for hard tissue scaffold through electrospinning was successful. In general, PEO/Si-HA fibers produced have the desired characteristics to mimic the extracellular matrix of bone.

Background: The attitude of research on addiction has been done on the key role of glutamate. As a regard, the prelimbic cortex (PrL) has an important role in addiction, learning, and memory. We tried to investigate the level of glutamate and aspartate concentration after glutamate receptors blockade in this region in the morphine-addicted rats. Materials and Methods: In this study, we examined the effects of local infusion of the N-methyl-D-aspartate receptor and α-amino-3-hydroxy-5-methylisoxazole-4-propionic acid receptor antagonists, 2-amino-5-phosphonovaleric acid (AP5), and 6-cyano-7-nitroquinoxaline-2, 3-dione (CNQX), into the PrL cortex on the level of excitatory amino acids (EAAs) and glycine. After 11 days of self-administration, the prelimbic area of the brain was taken out, and the EAAs and glycine concentration was measured by high-performance liquid chromatography. Results: Morphine resulted in the significant increase in the EAAs concentration within this area (P ≤ 0.001). Microinjection of AP5 into this region before using of morphine significantly decreased the morphine-induced glutamate and aspartate concentration (P ≤ 0.001). CNQX had the same effect and significantly reduced the EAAs concentration compared to the morphine group (P ≤ 0.001). In addition, microinjection of AP5 and CNQX simultaneously increased glycine concentration (P ≤ 0.001). Conclusions: These results show that morphine stimulates the EAAs release in the prelimbic area. It seems that microinjection of AP5 or CNQX in this region is effective in reducing morphine-induced EAA. It is suggested that EAA transmission in the PrL cortex may be a possible target for treatment of morphine addiction.

Background: Acute appendicitis is one of the most commonly diagnosed surgical diseases that its accurate diagnosis is still a problem, and there is no certainty. Ultrasound is recommended for diagnosis of appendicitis as an easy and noninvasive method. Therefore, due to the spread of disease and the urgent need to accurately diagnose in all educational centers, we decided to determine the diagnostic value of this inclusive method in identifying acute appendicitis. Materials and Methods: This is a descriptive cross-sectional research that was conducted on 540 patients referring to Educational Center of Ayatollah Kashani Hospital. All individuals suspected to appendicitis, and undergone ultrasound was included in the study, and then the result of ultrasound was compared to the obvious pathological results. Data were entered into statistical software of SPSS 20 and were analyzed. Results: According to the ultrasound findings, appendicitis was diagnosed as negative in 351 ones and positive in 189 ones. Ultrasound sensitivity in the diagnosis of appendicitis was 37.1%, while its specificity was 87.2%. The positive predictive value was 96.8% and the negative predictive value was only 11.7%. Conclusion: Considering very low-negative predictive value in educational centers, it is suggested that ultrasound is done for diagnosis of appendicitis only in complicated cases of appendicitis and differential diagnose (kidney stones, and ovarian cysts). In addition, it is recommended that routine ultrasound be avoided for all patients.

Background: Pelvic fracture (PF) is the second-most prevalent cause of mortality after brain trauma among multiple trauma patients. Our aim was to examine the reliability of suggestive criteria for having no PF (NPF) according to the common reported clinical signs and symptoms (CSSs). Materials and Methods: In the current prospective study, 3527 patients with multiple trauma were recruited according to the guideline of emergency medicine. Information on age, gender, pelvic pain or tenderness, sacrum and coccyx pain or tenderness, the ability to active straight leg raising (SLR), and distracting injury was collected, and PF was examined by either X-ray or computed tomography (CT) scan. Results: The CSS sensitivity of NPF was 39.75% and the specificity was 100%. The no distracting injury was not significantly different according to the CSS criteria and results of X-ray and CT scan (P = 0.269); however, the difference of other criteria was significant (P < 0.0001). No pelvic pain or tenderness and the ability to active SLR considerably affected the prediction of NPF (P < 0.0001). No distracting injury can be omitted from the criteria without any effect on specificity, but with increased sensitivity (60.8% with three criteria vs. 39.7% with four criteria). Conclusion: According to our results, it can be said that due to the high predictive value of our suggestive criteria, it could be applicable as the important criteria for defecting NPF among patients with the possibility of PF. This approach can reduce the necessity of imaging in these patients which helps to reduce the health cost and hazards of X-ray used for imaging and exhaustion of medical devices.

Background: Given the high prevalence of adverse perinatal outcome in the developing countries and the association between uterine artery (UtA) blood flow and fetal status in the uterine, in the current study, we assess the association between UtA pulsatility index (UtA-PI) at 30–34 week's gestation and adverse perinatal outcome. Materials and Methods: This cohort study included 100 pregnant women at 30–34 weeks' gestation. At baseline, UtA-PI was evaluated with color Doppler through abdominal ultrasound. Then, adverse perinatal outcomes including preterm labor, intrauterine fetal death, preeclampsia, low 5-min Apgar score (<7), low umbilical arterial cord blood pH, admitted to Intensive Care Unit in the first 3 days of birth, low birth weight, infant with low weight, death of newborns, cesarean section for respiratory distress, and meconial amniotic fluid were recorded. Ultimately, the collected data were analyzed using SPSS, version 20. Results: The presence of small-for-gestational-age fetuses indicated the highest prevalent adverse prenatal outcome with the incidence of 13.3% and 58.5%, respectively, among pregnancies with normal UtA-PI as well as those with high UtA-PI (P < 0.001). Overall, given that sensitivity and specificity of high UtA-PI were 37.5% and 73.3%, respectively, it could not properly predict adverse perinatal outcome (P = 0.360). Conclusion: According to the results, although the incidence of some of adverse perinatal outcomes in pregnant women with high UtA-PI was higher compared to those with normal UtA-PI, this factor alone cannot predict adverse perinatal outcome well. Therefore, this factor may predict these outcomes well, in the subgroups with high-risk pregnancies or with some blood factors or with pregnancy complications.

Background: Anthropometric indices are one of the ways to assess physical growth and nutritional status of children and adolescents considering the importance of nutrition in children and the role of healthy nutrition in preventing diabetes, obesity and other chronic diseases, the objective of this study is determine the relationship between nutritional knowledge and anthropometric indices in children and adolescents in Isfahan. Materials and Methods: This survey conducted using multistage cluster sampling on 1776 students aged 15–7 years old in Esfahan province in 2015. Nutritional knowledge was measured by questionnaire and height, weight, and body mass index (BMI) were measured as anthropometric index. Pearson and Spearman coefficients, regression, and T Independent were used to analyze the data; regression analysis was used to adjust the variables. Results: The mean age of students were 12.6 ± 1.9 years. About 50.3% of students were male, and most of them were studying in 5^th grade of elementary school (23.8%). Most of them had normal status in terms of BMI (60.6%) and height (77.8%). There was no significant relationship between the level of BMI and height of children and adolescents, and the total score of nutritional knowledge and its domains (P > 0.05), direct and significant relationship was found between nutritional knowledge in two domains of meals and food habits and age. Conclusion: As no relationship between nutritional knowledge and anthropometric index in our study, other factors are effective in this regard, and studies are required to be conducted to examine the nutritional attitude and performance, in addition to knowledge.

Background: Domperidone (DOM), a dopamine receptor antagonist, is used as antiemetic for the treatment of gastroparesis, vomiting, and nausea. The low water solubility of DOM leads to a low dissolution rate and variable bioavailability. The aim of this study was to enhance the solubility of DOM by the preparation of micron-sized particles. Materials and Methods: The in situ micronization process was carried out using solvent change method in the presence of Soluplus® or PEG₆₀₀₀as stabilizing agents. DOM was dissolved in appropriate solvent (acetone and methanol 1:1 v/v), and the stabilizing agent was dissolved in water (as nonsolvent). The nonsolvent was poured rapidly into the drug solution under stirring by a homogenizer, and the resultant was freeze dried. The crystalline shape and particle size of DOM and interaction of DOM with stabilizers were investigated by scanning electron microscopy (SEM), Fourier transform infrared spectroscopy (FTIR), X-ray diffraction (XRD), and differential scanning calorimetry (DSC), and then, dissolution test was carried out. Results: Optimum formulation was composed of DOM (0.5%) and PEG_{6000 (}0.1%) with the lowest particle size (3 μm) and the highest DE_60%(95.95%) as compared to pure DOM (particle size of 13.4 μm and DE_60%52.18%). Conclusion: SEM micrographs showed uniform and spherical shape of microcrystals. FTIR, XRD, and DSC studies indicated the micron size of the microcrystals and no interference between the drug and the stabilizer.

Background: Marine organisms produce a variety of compounds with pharmacological activities, including anticancer effects. They contain several secondary metabolites with interesting biological activities. This study attempted to find cytotoxicity of Hexane, Dichloromethane and Butanol partitions of Holothuria leucospilota and Echinometra mathaei. Materials and Methods: H. leucospilota and E. mathaei were collected from Persian Gulf. The animals were extracted by maceration with methanol-ethyl acetate (1:1). The H. leucospilota extract was partitioned by Kupchan method to hexane, dichloromethane, butanol, and water partitions. The cytotoxic activity of the extracts was investigated against HeLa (cervical cancer) and human umbilical vein endothelial cells cell lines by mitochondrial tetrazolium test assay after 72 h. Results: The cell survivals of HeLa cell were decreased by increasing the concentration of extracts. A significant reduction in cell viability at the doses of 30 (μg/ml) of dichloromethane (DCM) partition, 0.3, 3, and 30 (μg/ml) of ButOH partitions of sea cucumber, and 0.5 (μg/ml) of E. mathaei was observed. The median growth inhibitory concentration value of Hex, DCM, ButoH, and water partitions were 0.301, 0.21, 2.29, and 0.229 μg/ml, respectively. Conclusion: This study reveals that different partitions of H. leucospilota and total extract of E. mathaei have cytotoxic activity against cancer cell lines. More study is necessary to find the active metabolites in the more active partitions.

Background: The previously established methods for type 2 diabetes (T2D) have mainly concentrated on overt diabetes model development. Here, our intention was to create an animal model passing through distinct phases such as obesity with insulin resistance, prediabetes, and gradual progress to the overt diabetes stage. A high-fat high-carbohydrate diet formulation was prescribed combined with multiple low-dose streptozotocin (STZ) injections after obesity establishment. Materials and Methods: Sixteen male Wistar rats were separated randomly into two groups and fed a normal diet for 1 week after which the body weight and biochemical indices of each rat were measured and recorded. Subsequently, one group (n = 8) switched to the high-fat high-carbohydrate diet formulated by us for 10 weeks, whereas the other group (n = 8) continued with the normal diet. Body weight and biochemical indices of the rats in the high-fat diet (HFD) group were measured at the end of 10 weeks, and each rat received 30 mg/kg intraperitoneal STZ injections with 1-week intervals in two steps and was continued on a high-fat high-carbohydrate diet. The differences between the groups were analyzed using the Student's t-test or one-way analysis of variance and by post hoc multiple comparisons. Results: A significant change in weight, fasting blood glucose, and triglyceride was observed in rats fed with a HFD after 10 weeks. The HFD rats showed typical characteristics of T2D mellitus (T2DM) such as insulin resistance and hyperglycemia following 30 mg/kg STZ. Conclusions: The novel high-fat high-carbohydrate formulation we used, along with multiple low doses of STZ, can mimic peculiar characteristics of T2DM development.

Carnitine membrane transporter deficiency or primary carnitine deficiency (PCD) is an autosomal recessive disorder of fatty acid oxidation, in which the transport of carnitine into cells is impaired. Carnitine plays an important role in transporting fatty acids into the mitochondria and carnitine deficiency block oxidation of long-chain fatty acids in the mitochondria that leads to heart and hepatic disease, myopathy, nonketotic hypoglycemia, and neurological complications. PCD has a wide range of symptoms and can reveal itself as symptomatic cardiomyopathy or even asymptomatic. In this study, we reported twin brothers with PCD. One of them had symptoms of disease and cardiomyopathy and was under treatment with carnitine. Another twin was asymptomatic and was diagnosed during follow-up period of his brother.

Patient with refractory seizure may undergo awake craniotomy when the area to be resected is immediately adjacent to eloquent cortex. An awake craniotomy in a 30-year-old man was conducted using a scalp block, dexmedetomidine, and remifentanil infusion without any airway device throughout the procedure. Dexmedetomidine administered at a loading dose of 1 μg/kg and maintenance dose of 0.2–0.7 μg/kg/h. Remifentanil dose was 0.02 μg/kg/min. The patient remained comfortable and hemodynamically stable throughout the procedure. Cortical electrical stimulation revealed motor cortex overlapped with seizure focus. So that surgical procedure was limited to subpial resection of the epileptic focus. Dexmedetomidine with concurrent scalp block appears to be an useful sedation for awake craniotomy when sophisticated neurological test is required.

Langerhans cell histiocytosis (LCH) is characterized by idiopathic monoclonal infiltration of Langerhans cells in different organs such as the skeleton, skin, pituitary gland, liver, spleen, lungs, and the hematopoietic system. Skin lesions are common in LCH and affect about 40% of cases. It is reported that skin lesions are usually the first manifestation of LCH in 80% of patients. Usually, cutaneous presentations of LCH in adults are generalized or seborrhea-like lesions and it is often the first manifestation of disease. Here, we describe a 45-year old female who was known case of hypothyroidism, systemic lupus erythematosus, and diabetes insipidus. In our patient, cutaneous involvement was unusual. It was single and presented in unusual site (ankle) and before developing such lesion, she had diabetes insipidus for several years due to the involvement of pituitary gland.

Background: Infertility, as one of the most common gynecological disorders, affects many people worldwide. To choose the clinical treatment, correct assessment of tubal patency can provide an important clue; therefore, it is considered as one of the major steps in workup examinations of infertile women. In this study, we aimed to compare the results of transvaginal ultrasonography (TVS) after hysteroscopy (HSC) with laparoscopy, as a gold standard, for assessing the fallopian tubal patency in infertile women. Materials and Methods: This is a cross-sectional study which included 49 infertile women referred to Shahid Beheshti Hospital affiliated with Isfahan University of Medical Sciences during the years 2015 and 2016. At first, patients who met the inclusion criteria were examined through HSC in by a specialist in gynecology and obstetrics in operating room because laparoscopy was performed after TVS with HSC, but HSC was performed without anesthesia. TVS was performed before and after of HSC to observe fluid in the pouch of Douglas. The findings of TVS with HSC and laparoscopy were compared. Results: There was a strong agreement between TVS after HSC and laparoscopy (kappa coefficient = 0.935, 95% confidence interval [CI]: 0.81, 1.00). The sensitivity of TVS after HSC was 100% (95% CI: 66.37, 100) and specificity was 97.50% (95% CI: 86.84, 99.94) with a positive predictive value of 90% (95% CI: 55.50, 99.75) and negative predictive value of 100% (95% CI: 90.97, 100). Conclusion: TVS after HSC is an accurate diagnostic tool for examination of fallopian tubal patency in infertile women.

Background: This study was aimed to evaluate the influence of oral N-acetylcysteine (NAC) application as an adjuvant to letrozole on induced ovulation outcomes in patients with polycystic ovary syndrome (PCOS). Materials and Methods: This was a placebo-controlled double-blind randomized clinical trial with 130 PCOS patients who were infertile. First, patients were randomly divided into two groups. Patients in Group 1 were administered letrozole 5 mg/d plus NAC 1.2 g/d and patients in Group 2 were administered letrozole plus placebo for 5 days starting at the 3^rd day of the menstruation period. On the 12^th day of the cycle, ultrasound evaluation was performed, and in whom at least one follicle with an 18–20 mm diameter was found, 10,000 unit human chorionic gonadotropin (hCG) was prescribed, and 36 h after hCG injection, timed intercourse was advised. On the 16^th day, after hCG injection, serum β-hCG level was evaluated. Results: The number of follicles >18 mm was significantly higher in the letrozole + NAC group (P = 0.007). The ovulation and pregnancy rates were also significantly higher in the letrozole + NAC group (P = 0.045). No adverse side effects and no cases of ovarian hyperstimulation syndrome were observed in NAC group. Conclusion: NAC is demonstrated to be a safe and well-tolerated adjuvant to letrozole and can increase the pregnancy rates in PCOS patients.

Background: The aim of this study was radiobiological evaluation of different radiotherapy (RT) techniques, namely, combined photon-electron, two tangential photon beams, and electron therapy which are commonly used for treatment of mastectomy patients. Materials and Methods: The mentioned techniques were planned on the computed tomography (CT) images of a chest phantom, using TiGRT treatment planning system (TPS). The TPS dose calculations were verified using Thermo Luminescence dosimeters (TLD) measurements. Dose-volume histogram (DVH) of the plans was generated in the TPS, and also tumor control probability (TCP) and normal tissue complication probability (NTCP) values were calculated using DVH data for each technique. For TCP and NTCP modeling, Poisson Linear-Quadatric (PLQ) and Lyman-Kutcher-Burman (LKB) models were used, respectively. Results: The TCPs for the chest wall, internal mammary nodes, supraclavicular nodes, and axilla for the combined photon-electron was 90%, 90%, 90%, and 65%, respectively, which was higher compared to tangential beams (up to 11%, 11%, 5%, and 5%, respectively) and the electron therapy (up to 11%, 11%, 33%, and 23%, respectively) Whereas the NTCPs of the tangential beams for ipsilateral and contralateral lungs, heart, and chest wall–lung interface was 4%, 1%, 3%, and 5.6%, respectively. These NTCP values were considerably lower than electron therapy (up to 42%, 66%, and 40% and 30%, respectively) and combined photon-electron (up to 55%, 75%, 50%, and 20%, respectively) methods. Conclusion: Tangential beam is suggested for treating mastectomy patients, due to sufficient value of TCP, and also lower NTCP compared to the other techniques such as electron therapy and combined photon-electron.

Background: The type 2 diabetes is one of the most common autoimmune diseases. Due to a key role in the metabolism of unsaturated fatty acids such as arachidonic acid, one of the most important precursors of immunity mediators, fatty acid desaturase (FADS) genes could have an important impact in the development of type 2 diabetes. Materials and Methods: This study aimed to determine the relationship between polymorphisms rs174537 in FADS1 gene and rs174575 in FADS2 gene with type 2 diabetes in Iranian population. After extracting genomic DNA, the locations of mutations and allele types were identified with high-resolution melting (HRM)-polymerase chain reaction method. Then, association between these mutations with metabolic syndrome, dyslipidemia, and type 2 diabetes was investigated using χ² correlation coefficients for variables and logistic regression. Results: The results showed that among 50 diabetic participants, 68% of patients have the mutant allele for rs174537 in FADS1 gene. This rate is 26% for rs174575 in FADS2 gene. Based on the results, it seems that participants having rs174537 mutant allele are more prone to become diabetic but it has a beneficial effect on total and low-density lipoprotein cholesterol and participants having rs174575 mutant are less prone to become diabetic, and also, it leads to higher triglycerides and body mass index (obesity). Conclusions: Detecting FADS1 and FADS2, gene polymorphisms using HRM can be an anticipating tool for making decision on initiating lifestyle modifications to prevent type 2 diabetes.

Background: Hemodynamic monitoring is an essential part in the treatment of critically ill patients. Establishment of intravascular volume and creation of a normal systemic perfusion are the most important part to reduce the risk of organ failure and mortality. This study aimed to determine the correlation between the inferior vena cava (IVC) sonographic indices and the central venous pressure (CVP) to provide a useful guide for noninvasive intravascular volume status assessment in children. Materials and Methods: Target sample of children who were admitted to the pediatric critical care unit and required CVP monitoring were enrolled in this study. The collapsibility index (CI) and IVC/aorta (AO) ratio, from bedside ultrasonography measurement of the IVC, were calculated. Results: Of the 70 participants, 22 patients (31.4%) revealed a CVP of 8 mm/Hg or less and 48 patients (68.6%) revealed a CVP >8 mm/Hg. Fifty-six patients (80%) had an IVC-CI of 0.5 or greater and 17 patients (24.3%) had an IVC/AO of 0.8 or less. IVC-CI index is 45.5% sensitive and 91.7% specific with positive predictive value of 71.4 and negative predictive value of 78.6 to predict CVP <8, and the IVC/AO index is 50.8% sensitive and 87.5% specific with a positive predictive value of 64.7 and a negative predictive value of 79.2 to predict CVP <8. Conclusion: Based on the present finding, the IVC sonographic indices provide a useful guide for noninvasive intravascular volume status assessment in children.

Background: Sulfonylureas are important drugs of choice for treatment of type 2 diabetes mellitus (T2DM). It is suggested that differential response to sulfonylureas from T2DM patients is under influence of single nucleotide polymorphisms in some of the target genes. In spite of favorable therapeutic effects, sulfonylureas are associated with some adverse side effects such as microvascular complications and stroke, especially in older patients. Therefore, for T2DM patients who are getting less benefit, sulfonylureas should be avoided. Cyclin-dependent kinase 5 regulatory subunit-associated protein 1-like (CDKAL1) gene variation is reported to be associated with sulfonylureas effectiveness. Due to the inconsistency of available data regarding association of rs7754840 in CDKAL1 gene with sulfonylureas response in T2DM patients, the present study is conducted. Materials and Methods: Fifty-one diabetic patients sensitive to sulfonylureas and 51 patients resistant to sulfonylureas treatment were recruited to this study. After extraction of DNA from patients' peripheral blood samples, rs7754840 single-nucleotide polymorphism was genotyped by polymerase chain reaction-restriction fragment length polymorphism assay using MaeII (Tail) restriction enzyme. Results: Frequency of G allele in resistant group was more than sensitive group (71, 6% vs. 57, 8%). Regression analysis was shown significant association between GG genotype and higher risk of resistance to sulfonylureas treatment (odds ratio = 2.250 [95% confidential intervals: 1.010–5.012]; P = 0.046). Conclusion: Our data confirmed that genotypes of rs7754840 are significantly associated with sulfonylureas treatment response. rs7754840 in CDKAL1 gene in combination with other clinicopathological findings would help to move towards personalized therapy of T2DM patients.

Background: A secure airway and effective ventilation are key components of advanced life support, and misplacement of endotracheal tube (ETT) can lead to morbidity in multiple trauma patients. The purpose of this study was to investigate the accuracy of ultrasound in diagnosis of direction for tracheal intubation. Materials and Methods: This descriptive-analytical study was conducted on 100 traumatic patients requiring intubation in 2016 in the Emergency Department of Al-Zahra and Kashani Medical Education Centers in Isfahan. Surface probe was placed transversally in the front of the neck at the top of the suprasternal notch, and the position of trachea was specified by front of comet-tail artifact which is the contour between hyperechoic air–mucosa (A–M) and a posterior reverberation artifact. Intubation accuracy by capnography was investigated, and the results were recorded in each patient's profile. Tracheal sonography was done during placement, or as soon as, the ETT has been embedded. The scanning time was minimized and it was carried out in total time of 10 s. Results: The diagnosis of intubation accuracy indicated that it was successful in 94 individuals (94%) and unsuccessful in 6 ones (6%). Intubation accuracy in 93 people (93%) was confirmed, and inaccuracy of intubation in 7 people (7%) was diagnosed. Ultrasound sensitivity in diagnosis of intubation accuracy was 97.9% (92.94) with 83.3% (5.6%) specificity. The positive and negative predictive values were 98.9% (92.93) and 71.4% (5.7%) respectively. Conclusion: Ultrasound method has high sensitivity and specificity to determine the correct placement of the tracheal tube, and it can be implemented as a reliable method given the acceptable positive and negative predictive values.

Background: Irritable bowel syndrome (IBS) is one of the most common disorders among young adults. Various studies have demonstrated that the use of probiotics can reduce the overall symptom of IBS, and thus, our aim was to evaluate the efficacy of probiotic products in the reduction of IBS syndrome after colonoscopy. Materials and Methods: Our patients were divided among three groups, including immediate probiotic users, start use of probiotics 1 month after colonoscopy, and placebo group. All the patients were interviewed for having common IBS symptoms (stool consistency and frequency, gas, abdominal pain, and flatulence) at baseline, 3^rd month of follow-up, and 6^th month of follow-up. Results: The mean reduction in abdominal pain was 3.05 ± 1.21, 3.86 ± 0.94, and 3.82 ± 0.63 in the control group, immediate probiotic users, and 1 month after colonoscopy, respectively (P < 0.001). The symptoms of the disease, such as stool consistency, the frequency of defecation, and flatulence (except gas) in the first quarter, in the two treatment groups were significantly improved more than in the control group (P < 0.05). In contrast, the frequency of defecation was not significantly different in the treatment group receiving the probiotics month after colonoscopy compared to the placebo users (P > 0.05). Conclusion: According to our results, the use of probiotics had the beneficial effect on IBS symptoms. Furthermore, it can be said that reductions in symptoms and pain in the two treatment groups were not significantly different, but after 6 months of treatment, the effect of probiotics in patients who immediately use it after colonoscopy was more visible and more stable.

Background: The aim of this study was to evaluate the effect of dydrogesterone in the outcome of idiopathic intrauterine growth restriction (IUGR). Materials and Methods: It is a double-blind randomized control clinical trial study that was done in Shahid Beheshti hospital of Isfahan during 2015–2016. In this study, 89 pregnant women with idiopathic IUGR fetus were selected and randomly divided into two intervention and control groups. Intervention group was treated with dydrogesterone 10 mg every 12 h for 2 weeks, while the control group received conventional management and treatment of IUGR, which also has been performed in the intervention group. Results: After 2 weeks of intervention, fetal weight was significantly increased in dydrogesterone group as compared to control group (2053.15 vs. 1736.36 g, P = 0.001); furthermore, we observed significant differences in the term of fetal abdominal circumference between the groups (27.25 vs. 25.92 cm, P = 0.006). Middle cerebral artery resistance index (0.67 vs. 0.83, P < 0.001) and uterine artery (UA) resistance index (0.68 vs. 0.81, P < 0.001) were significantly decreased in dydrogesterone group as compared to control group. Conclusions: Our results showed that dydrogesterone reduces resistance index of uterine artery and middle cerebral and increased fetal weight, while no sign of toxicity was observed. Dydrogesterone supplementation would have the potentiality to become a simple and economic means to prevent IUGR.

Thyroid follicular cancers are one of the thyroid gland cancers. This cancer can lead to metastases to various areas of the body. We describe a patient with thyroid follicular carcinoma who after total thyroidectomy had severe hypercalcemia, increased creatinine, and thyrotoxicosis due to extensive bone metastases. The patient was a 52-year-old man who had femoral neck fracture as the first manifestation of thyroid cancer. He was hospitalized for some time after orthopedic measures because of thyrotoxicosis and deep-venous thrombosis. The study found that the origin of metastatic lesions was thyroid follicular cancer, leading to extensive bone metastases. After administering of methimazole and control of thyrotoxicosis, he was subjected to total thyroidectomy. Methimazole was discontinued immediately after surgery. One month after surgery, ultrasound confirmed that the thyroid was completely removed. However, T3 (triiodothyronine) remained high; besides the patient had hypercalcemia and increased creatinine due to dehydration. The patient was retreated with methimazole due to thyrotoxicosis, and for hypercalcemia fluid therapy, intravenous zoledronic acid was prescribed. These measures led to the normalization of creatinine and glomerular filtration rate. The purpose of introducing this case report was that these symptoms are a rare manifestation of functional metastases of follicular thyroid carcinoma after total thyroidectomy. Bone metastases of follicular thyroid carcinoma may be functional and are lytic that can lead to hypercalcemia and its complications.

Background: Painful diagnostic and therapeutic procedures performed for children are routine actions. Opioids and nonsteroidal anti-inflammatory drugs such as acetaminophens are among medications that can be used for this purpose. This study aimed to compare the onset and duration of action of intrabuccal (IB, submucosal) space and intramuscular (IM) injection of ketamine in pediatrics. Materials and Methods: This clinical trial study was carried out on 126 children of 1–15 years old referred to the emergency room of Al-Zahra and Kashani Hospitals in Isfahan and divided into two 63 populated groups of IM and IB. For one group randomly, 3 mg/kg IB ketamine was administered, and for another group, ketamine was injected intramuscularly at the dose of 5 mg/kg. The drug effect, surgeon satisfaction, and complications were evaluated. Data were analyzed using SPSS software. Results: The mean of time between injection and onset of drug effect in IM group was 5.71 min, whereas in IB group, it was 4.14 min (P < 0.0001). The mean of the duration of drug effect in IM group was 45.54 min, whereas in IB group, it was 24.63 min (P < 0.0001). Complications in IM group were significantly more reported than IB group (33.3% versus 11.1%, respectively, P = 003). The median of surgeon satisfaction in IM group was 3 and in IB group was 4 which was statistically significant (P = 0.007). Conclusions: IB method is preferred over IM method, and hence, it is recommended to use.

Background: Considering the effect of statins on the regulation of dopamine neurotransmitters and glutamates and importance of the treatment of obsessive-compulsive disorder (OCD) due to its relatively high prevalence and disability of available drugs in treatment of many patients, we came to the point to examine effectiveness of statins in patients with OCD. Materials and Methods: This study is a double-blind randomized clinical trial, which is done in OCD clinic of Isfahan Shariati in 2014 for 1 year. The target population consists of 64 patients with OCD; one group is given a daily 40 mg atorvastatin tablets and the other group receives placebo. At baseline, 4- and 8-week severities of obsessive-compulsive symptoms are measured using Yale–Brown scale and compared in the two groups. Results: The study results show a statistically significant difference between the two groups of intervention and control (P < 0.001). Furthermore, the results show the intervention effect at the end of the 4^th week and 8^th week (P < 0.001) that this change is evident in the 4^th week but remained almost constant in the 8^th week. Conclusion: Overall, the evidences obtained from the study declare the effects of adding statins to treat obsessive-compulsive symptoms.

Background: Laparoscopic bariatric surgeries in morbid obese patients may be associated with atelectasis, hypercapnia, and hypoxemia, intra and postoperatively. Several strategies are used for the prevention of these consequences. This study aimed to examine the effects of three different recruitment maneuvers comparatively during surgery and the influence of the maneuvers on some cardiopulmonary indices. Materials and Methods: In a clinical trial, ninety participants of laparoscopic surgery with body mass index higher than 40 were randomly divided into three equal groups. The first group was subject to 10 cmH₂O positive end-expiratory pressure (PEEP) during surgery, the second group, after venting the pneumoperitoneum, had 5 deep breaths with a positive pressure of 40 cmH₂O, and the third group was subject to both. Some pulmonary and hemodynamic parameters were measured every 15 min and compared between three groups. Results: The average of peak airway pressure, plateau airway pressure, and SpO₂static and dynamic compliance between the three groups had no meaningful differences (P > 0.05), but PaCO₂in the second group was statistically higher than the other two groups (P < 0.05). Conclusion: Multiple deep breaths alone are not as effective as PEEP or PEEP plus MDB in preventing adverse pulmonary effects in laparoscopic bariatric surgeries of morbid obese patients.

Background: Increasing use of different chemotherapy regimens, organ transplants, etc., has led to the increasing number of neutropenic patients. Overall, 10% of patients affected by cancer who are under treatment with anticancer drugs, regardless of the tumor type, are susceptible to febrile neutropenia. The study was performed to evaluate the frequency of bloodstream fungal infections in pediatric patients with febrile neutropenia in Sayed Al-Shohada Hospital (Cancer Referral Center in Isfahan) in 2010–2012. Materials and Methods: This cross-sectional study was performed on pediatric patients with febrile neutropenia who were referred to Sayed Al-Shohada Hospital (Cancer Referral Center in Isfahan) in 2010–2012. Blood samples were obtained from all the patients and were loaded into Bactec 9050 blood culture instruments (Bectone Dickinson, Baltimore, Md., USA), and organisms responsible for causing fever were detected. Results: Sixty-seven patients (51.3 males, 48.7 females) with a mean age of 12.3 ± 15.8 years were included. The blood cultures of 48 patients (71.6%) were negative. Seven samples of the isolates (10.4%) were fungi, and twelve of them (18%) were bacteria. Thus, the prevalence of fungal infection was 10.4%. Conclusion: Due to the high relative prevalence of fungal infections in our study, it is necessary to take precautions for fungal infection prevention and choose the best way management to obtain optimal results in these patients.

Background: Guillain-Barre syndrome (GBS) is an immune-mediated peripheral neuropathy. We compared clinical, laboratory characteristics, and disease course of GBS subtypes in a large group of Iranian patients in Isfahan. Materials and Methods: We collected data from patients who were admitted to Alzahra referral university Hospital, Isfahan, Iran with a diagnosis of GBS. In this population-based cross-sectional research, characteristic of 388 cases with GBS between 2010 and 2015 were studied. Results: The current study recruited 388 patients with GBS including 241 males (62.1%) and 147 females (37.9%) with a mean age of 42.78 ± 21.34. Patients with polyradiculopathy had the highest mean age of 55.12 ± 20.59 years, whereas the least age was seen in acute motor axonal neuropathy (AMAN) with the mean of 36.30 ± 18.71 years. The frequency of GBS witnessed the highest frequency in spring with 113 cases (29.1%) and winter with 101 cases (26%). Patients' electrodiagnostic findings indicated that the highest frequency pertained to AMSAN with 93 cases (24%), whereas the least frequent diagnosis was acute Polyradiculopathy with 8 cases (2.1%). Most of the patients did not have any infections (53.6%) and among patients with infections, AMSAN had the highest frequency (22.9%) and finally, patients with AMSAN and AMAN had a higher length of stay. Conclusion: The study demonstrated incidence, sex distribution, preceding infection, and surgery similar to previous studies. However, our data differs from a study in Tehran that showed acute inflammatory demyelinating polyradiculoneuropathy is more prevalent than other types and we found a seasonal preponderance in cold months, particularly in axonal types.

Suicide is one of the public health problems worldwide, but it lacks regular relevant reporting system. This issue is more important among women who play an influential role in the family and society. Therefore, the assessment of recent relevant studies is important to detect suicide-related factors and to help make the decisions about public health. The aim of the current study was to determine socioeconomic and psychological factors of suicide attempts in Iranian women using a descriptive meta-analysis method. All domestic scientific databases were searched using “suicide” keyword. A search was also done using keywords of corresponding to Medical Subject Headings including “Iran,” “suicide,” “psychosocial determinants,” “behavior,” “suicide commitment,” “suicide thoughts,” and “women.” Overall, 3061 articles were retrieved through the initial search. Finally, 69 studies from nine provinces were included for the analysis. All statistical analyses were performed using R software version 3.2.6 with Metafor package version 1.9-9. Using nine selected studies, frequency of urban family (prevalence = 85%, 95% confidence interval [CI] = 0.68–1.00), nonacademic education (prevalence = 53%, 95% CI = 0.45–0.61), and family problems (prevalence = 34%, 95% CI = 0.19–0.49) was identified as the most important related factor of suicide compared to any other related factors. According to the results, family problems and lower education are associated with suicide attempts. Thus, providing training programs and family consultant services are recommended to reduce the incidence of suicide attempts.

Background: As elongated styloid process is one of the causes of recurrent oropharyngeal pain and carotid nerve plexus compression called Eagle's syndrome and this length is not similar in different communities, the aim of the current study is to determine average length of styloid process by paranasal multidetector computed tomography. Materials and Methods: This is a retrospective cross-sectional study about 393 patients who underwent paranasal MDCT scan for trauma in Radiology Department without pathologic finding. Styloid length from temporal bone junction to tip of the process was measured using Workstation software. Demographic data including age, sex, and height were gathered from the patients' records, and patients were questioned about symptoms of Eagle's syndrome before trauma. Data were analyzed using SPSS version 20 with the methods of t-test, Chi-square, and ANOVA. P < 0.05 was considered statistically significant. Results: Two-hundred and sixteen males and 177 females underwent MDCT. The length of right, left, and mean length of both sides were 25.4 ± 7.3, 25.2 ± 7.8, 25.3 ± 7.1, respectively. The mean length of both sides' process was more among male that was statistically significant (P = 0.025 and 0.043, respectively). Right and left side styloid process' higher length was in correlation with patient's height (P = 0.002, r = 0.153, P = 0.029, r = 0.110, respectively) and number of symptoms (P < 0.001, r = 0.300, P < 0.001, r = 0.334, respectively). Conclusion: The mean length of styloid process was 25.3 ± 7.1 that was in accordance with some studies and different from others. Styloid process length is higher in males. The length of styloid process is in association with height and number of symptoms as well.

Background: Poly(methyl vinyl ether-maleic acid) (PMVEMA) is a water-soluble, biodegradable polymer used for drug delivery. The aim of the present study was to prepare nanofibers of this polymer as a fast-dissolving carrier for montelukast. Materials and Methods: Polymeric nanofibers were spun by electrospinning method using different ratios of biodegradable polymer of PMVEMA. The processing variables including voltage, distance of the needle to rotating screen, and flow rate of the solution were optimized based on the diameter of the nanofibers, drug content, and release efficiency by a Taguchi design. The morphology, diameter, and diameter distribution of the nanofibers were studied by scanning electron microscopy (SEM). Drug loading and its release rate from the nanofibers were analyzed spectrophotometrically. The possible molecular between the polymer and the drug was characterized with Fourier-transform-infrared spectroscopy. Results: The results showed the best situation for electrospinning of the polymer obtained at the polymer concentration of 37%, the distance of the needle to rotating screen of 19 cm, the voltage of 120 kV, and the rate of injection of 0.2 ml/h. In these situations, the fiber diameter and drug loading efficiency percentage were 273 nm and 83%, respectively. These nanofibers released the total loaded drug within 1–3 s with no residue in the dissolution medium. SEM results showed that the optimized nanofibers were quite smooth and without beads. Conclusions: The results indicated that the nanofibers of PMVEMA could dissolve the drug very rapidly and can be adopted for fast-dissolving dosage forms.

Subcorneal pustular dermatosis (SPD) or Sneddon-Wilkinson disease is a rare, benign, chronic, sterile pustular eruption which is associated with various systemic diseases including immunoglobinopathies, neoplasms, and autoimmune disorders. This paper reports a case of SPD in a patient with diffuse scleroderma in a 37-year-old woman. The hypothesis that immune dysregulation may play a role in the pathogenesis of SPD was supposed by the coexistence of diffuse scleroderma and SPD in our patient.

Background: Recent studies have shown that similar host glycan antigens are expressed by helminths such as Echinococcus granulosus hydatid cysts to evade from host immune system. In this work to investigate these antigens further, immunological cross-reactivity between human sera and hydatid cyst wall antigens has been investigated. Materials and Methods: Hydatid cyst wall antigens were used in enzyme-linked immunosorbent assay and Western immunoblotting and probed with pooled sera of hydatidosis patients and healthy controls. Sodium metaperiodate treatment was used to investigate glycan antigens. Results: A band with molecular weight about 53 KDa reacted with both hydatid patients' sera and also normal human sera. It has been shown that this band was a glycan antigen. Conclusions: A 53 KDa glycan antigen of hydatid cyst wall that reacted with all human sera may have an important role for evasion from host immune system.

Background: This study aimed to determine the effect of Hyper-Cyclophosphamide, Vincristine, Adriamycin, and Dexamethasone (CVAD) in the treatment of acute lymphoblastic leukemia (ALL) patients and remission duration. Materials and Methods: During a cross-sectional study in the Seyed Al-Shohada Hospital in Isfahan, patients with ALL who were admitted and treated from 2011 to 2015 because of the risk of ALL were selected and through the records investigation, demographic information, disease information, treatment, remission duration, current status, and duration of survival were collected in the form of data and are sick after going into remission, including the duration and recurrence remission survival time in treatment were analyzed and consequence, whether the patient is going into remission, remission and relapse and survival time based on the duration of treatment were analyzed. Results: Of the 62 patients, 13 patients after starting of treatment did not go to remission and died, but 49 patients (79%) went into complete remission. 21 of them of Hyper-CVAD group and 28 patients of classical treatment group (75/7% vs. 84%), but the difference was not significant (P = 0.43). Of the 48 patients who had a complete remission with the treatment regimen, ten patients relapsed after treatment with two of them of Hyper-CVAD group and eight patients were in the classical treatment group (9/5% vs. 29/6%), and the difference between the two groups was significant (P = 0.015). Conclusion: Hyper-CVAD regimen resulted in increased survival time of patients with ALL and less disease recurrence and therefore contraindications for use if the existing rules, and under the supervision of treatment, can be used.

Background: Due to depletion of fossil fuel reserves, global warming, and the need for energy efficiency, the new energy resource is required. For this purpose, hydrogen can be considered as clean and efficient energy carrier. In this study, biohydrogen production from physical pretreated mixed culture was investigated. Materials and Methods: In this study, the optimal conditions for physical pretreatment of mixed culture were investigated for the enrichment of hydrogen-producing bacteria (HPB). Three individual pretreatment processes, including thermal, ultraviolet (UV) radiation, and ultrasonication (US) were conducted in batch tests. The batch tests were carried out via 500 mL glass flasks with working volume 400 mL. Glucose was used as sole substrate, and other essential nutrient and trace elements were added. To agitation of substrate with HPB inoculum, the magnet stirrer was used at 60 rpm. Results: The results showed the production of H₂gas could be increased by appropriate pretreatment methods including thermal pretreatment at 100°C. At 100°C as a pretreatment, the volume of H₂gas was 112.25 mL and followed by US (97.46 mL), UV (89.11 mL), 80°C (72.72 mL), 90°C (53.95 mL), and 70°C (26.01 mL). In the pretreatment methods, the solution pH and effluent soluble chemical oxygen demand was 6.3–6.7 and 5100–8300 mg/L, respectively. Conclusions: The Gompertz model depicts that all R² values were more than 0.93, indicating that the fitted curves were best fitted with the experimental points.

Background: The relationship between dyslipidemia and type 2 diabetes mellitus (T2DM) has been frequently reported. Lipoprotein lipase (LPL) is considered to be an effective gene in regulating lipid profile. MicroRNAs (miRNAs) are small noncoding RNAs involved in posttranscriptional regulation of gene expression. In the present study, we have evaluated rs13702 (C/T) polymorphism located in miRNA-410 binding site of LPL gene in subset of Iranian T2DM patients and their normal counterparts. Materials and Methods: In this case–control study, 102 T2DM patients and 98 healthy controls were worked out for rs13702 single nucleotide polymorphism genotypes. High resolution meting (HRM) analysis was used for genotyping. Results: C allele of rs13702 C/T polymorphism located in miRNA-410 binding site in LPL gene was detected to be significantly associated with T2DM (C allele; odds ratios (OR) = 1.729 (95% confidential intervals (CI) = 1.184–2.523); P = 0.005) also its CC genotype (OR = 3.28 (95% CI 8.68–1.24); P = 0.010) showed the same association. Conclusion: Correlation of rs13702 C allele with susceptibility to T2DM may be due to the higher level of LPL that leads to increased plasma fatty acids and its entry into peripheral tissues such as skeletal muscle, liver, and adipocytes causing development of insulin resistance and ultimately T2DM.

Heterotopic bone formation is a rare event in gastrointestinal lesions, especially in the pediatric population. Osseous metaplasia is exceedingly rare in colonic polyps. We present a case of rectal juvenile polyp with stromal osseous metaplasia in a 10-year-old male child. This histologic finding is very rare in children with colorectal polyps.

In this paper, we will present a case of a 63-year-old female with bifrontal epidermoid tumor who has gone under bilateral craniotomy. In a case report study, a 63-year-old female with a chief complaint of progressive headache that has been admitted to Department of Neurosurgery was studied. Magnetic resonance imaging was performed for better evaluation. After detection of bifrontal epidermoid cyst, the patient underwent surgery, and following the surgery, a cut of the tumor has been excised, sent for pathology sampling and reviewed for detection of cyst. Microscopic review of the resected part reported normal brain tissue along with sections containing parts of cyst wall covered by squamous epithelium and huge amount of irregularly stratified keratin within its lumen, which clearly emphasizes on diagnosis of a typical epidermoid tumor. Bifrontal epidermoid cyst is rare, and according to our study, the clinical symptoms and patients imaging were consistent with other studies.

Background: A simple and sensitive reversed-phase high-performance liquid chromatography (HPLC) method based on liquid-liquid extraction was established and validated for determination of docetaxel (DTX) in plasma of rat. Materials and Methods: Samples were spiked with paclitaxel as the internal standard and the chromatographic separation was carried out using C18 HPLC column. The mobile phase consisted of a mixture of acetonitrile/water with the ratio of 60/40 v/v. The ultraviolet detector was operated at 230 nm, and the flow rate of mobile phase was 1 ml/min. The method was validated for linearity, precision, accuracy, recovery, and limit of quantification (LOQ). Then the method was applied to quantify DTX in the rat plasma after intravenous (IV) administration of the self-assembled micelles of folate-targeted Synpronic F127/cholesterol (FA-PF127-Chol) loaded with DTX and Taxotere^® as the reference marketed solution of DTX. The blood samples were taken from the ophthalmic vein at predetermined time intervals after treatment. Results: Calibration curve was linear between the concentration ranges of 0.1–7.5 μg/ml with the relative standard deviation % and evaluating error % ranged from 2.263 to 15.53 and −12.75 to 12.7 for intra- and inter-day validity, respectively. The mean recovery of the drug after plasma extraction was 95.67 ± 0.99% for the concentration of 1 μg/ml. The LOQ and the limit of detection for DTX in serum were 100 ng/ml and 30 ng/ml, respectively. Conclusions: The results indicated that the developed method could be adopted for pharmacokinetic studies of DTX-loaded FA-PF127-Chol micelles and Taxotere^® in rat.

Background: Health information-seeking behavior is a key concept in the empowerment of women with breast cancer after mastectomy for self-care management. Thus, a real understanding of their information needs and their information-seeking behavior may open up new opportunities for their postsurgery cares. The current research was conducted to identify the information needs and information-seeking motives of women with breast cancer after mastectomy. Materials and Methods: This is an applied qualitative research. Samples included 17 women with breast cancer after mastectomy selected from two hospitals of Shahid Mohammadi and Persian Gulf and Omid Central Chemotherapy in Bandar Abbas. Data were collected using semi-structured interview on winter 2014 and analyzed using qualitative content analysis method. Results: Three basic contents were extracted including information needs related to mental health, physical health related to disease and personal daily activities along with their subcategories, and representing common experience and perception of mastectomized women seeking for health information. Furthermore, hope, self-esteem, return to life, and available social support resources were expressed as the main information-seeking motives. Conclusion: Considering research findings, mastectomized women need to receive information in wide range of health and thus pursue purposeful behavior. Hence, it is necessary that required actions and measures are taken by health-care authorities, especially institutions responsible for women health, to support and meet information needs of the patients considering their information-seeking motives.

Background: The incidence of propofol injection pain during induction of general anesthesia varies from 28% to 90%. This prospective, randomized, double-blind, placebo-controlled study evaluated the effect of dexamethasone and granisetron for reducing the incidence and severity of propofol injection pain. Materials and Methods: A total of 227 female subjects received 5 mL of preservative-free saline, 1 mg granisetron (5 ml), or 0.15 mg/kg of dexamethasone (5 ml), intravenously, following exsanguination and occlusion of the veins of the arm. This was followed by a 0.5 mg/kg injection of propofol. Pain scores and intensity of pain recorded immediately following the injection of propofol. Hemodynamic parameters and O₂sat were recorded 1, 3, 5, and 10 min after propofol injection. Results: The incidence pain following the injection of propofol was significantly decreased with both granisetron and dexamethasone (50.7% and 49.4%). Mean pain score in granisetron group was 3.16 ± 1.23, dexamethasone was 2.73 ± 1.03, and in saline group was 4.82 ± 1.73 (P = 0.001). Mean pain intensity in granisetron group was 1.16 ± 0.18, dexamethasone was 1.26 ± 0.14, and in saline group was 2.2 ± 0.99 (P = 0.001). There were no differences in either mean arterial pressure or O₂Sate at any time point after drugs injection among the groups. There was a significant difference in pulse rate in third minutes between three groups and in the group who received granisetron was lesser (P = 0.04). Conclusion: Pretreatment with intravenous granisetron (1 mg) and dexamethasone (0.15 mg/kg) before injection of propofol is effective and safe in reducing the incidence and severity of pain due to propofol injection.

Background: Attention deficit hyperactivity disorder (ADHD) is the most common behavioral problems that cause hyperactivity, attention deficits, academic failure, and emotional and behavioral problems in preschool and elementary school that is often hidden from the parents' eyes. The aim of this study was to determine the effectiveness of parent-based cognitive-behavioral therapy (CBT) on ADHD symptoms (including attention deficit disorder, restlessness, and impulsivity), overweight and self-esteem of 6–11-year-old obese children with attention deficit hyperactivity in Isfahan. Materials and Methods: This quasi-experimental study was carried out on 40 children aged 6–11 years with ADHD and overweight or obesity (above the 85^th percentile in weight for age, height, and sex diagram) that their parents referred to Isfahan child and adolescent psychiatric clinic of Ali Asghar Hospital in 2015. For twenty patients, only ADHD treatment was applied, and they received no other intervention, but the others in experimental group participated in CBT sessions. Analysis tools were Coppersmith Self-Esteem Scale, ADHD conners' test, and the body mass index (BMI). Data were analyzed using analysis of variance with repeated measurements. Results: CBT by teaching parents had a significant effect on ADHD symptoms, the self-esteem of overweight and obese children with ADHD in posttest and follow-up. The results also showed that had a significant effect on ADHD symptoms, overweight and self-esteem of the obese children with ADHD (P < 0.001). Conclusions: Parents focused CBT can be considered as a complementary treatment for reducing ADHD symptoms and BMI and increased self-esteem in the obese ADHD children.

Background: Positive and negative emotional states are the most important factors in treatment and prevention process of psychosomatic diseases. This research aimed to investigate the effectiveness of emotional schemas' therapy on emotional schemas' modification and difficulties of emotion regulation in women with irritable bowel syndrome (IBS). Materials and Methods: This research was implemented in the framework of single-subject experimental design using step-wise multiple baselines plan. Five patients with IBS were selected as convenience sampling on the base of their willingness to participate and then they received emotional schema therapy (EST). Research tools included ROME III scale, SCID interview, emotional schemas questionnaire, and difficulties of emotional regulation. The analysis of data was done using visual analysis charts, recovery percentage, and reliable change index. Results: The results showed a decrease of scores in some maladaptive schemas and increase of some adaptive schemas than baseline in patients who received EST (P ≤ 0.05). Furthermore, this treatment decreased scores of some emotion regulation difficulty components (P ≤ 0.05). Conclusion: It seems that EST is an appropriate option for treatment of these patients because it is effective in improvement of emotional schemas and difficulties of emotional regulation.

Background: Exercise reverses retention deficit induced by morphine. The present study investigated the effect of aerobic exercise on tolerance to morphine usage and pain modulation. Materials and Methods: Male Wistar rats were divided into four groups as follows: (1) saline group (S), (2) morphine group (M), (3) saline + exercise (S + E), and (4) morphine + exercise group (M + E). The rats were initially trained to receive small pellets of food by pressing an active lever in the self-administration apparatus. The tail-flick and hot-plate tests were used for pain assessment. To perform the experiment, the jugular vein was exposed and cannulated. After recovery, the animals were placed in the self-administration apparatus and allowed to self-administer morphine in 2 h sessions over 11 consecutive days. Results: The morphine group was found to record a higher number of active lever pressings than did the saline one while this parameter decreased in the morphine + exercise group compared with the morphine one. Moreover, the morphine + exercise exhibited lowered pain sensitivity as evidenced to have reduced morphine use in the hot plate test. Conclusion: The exercise might be suggested to reduce using of morphine and modulate pain probably through the release of endogenous opioid.

Background: Nosocomial infections are one of the most leading causes of morbidity and mortality in patients with cancer. The emergence of multiple-drug-resistant (MDR) strains of Gram-negative bacteria causing nosocomial infection has become a serious concern in cancer patients. Therefore, the present study aimed to determine the spectrum and antibiotic resistance pattern of Gram-negative bacteria related nosocomial infections among Iranian cancer patients. Materials and Methods: This descriptive cross-sectional study was conducted during the 6 months from December 2015 to May 2016 in two tertiary care centers located in Isfahan and Arak Province. Gram-negative bacteria obtained from different clinical specimens from hospitalized patients with cancer and were identified using standard microbiological methods. Antibiotic susceptibility pattern was determined by the disk diffusion method according to the Clinical and Laboratory Standards Institute (CLSI) recommendation. Results: Of totally 259 culture positive cases, Escherichia coli showed the highest isolation rate (60.6%) followed by Klebsiella pneumoniae (26.6%) and Proteus spp (11.2%). The rate of MDR isolates were 91.5% (237/259). Overall, the most frequent source of bacterial isolation was urinary tract infection (65.6%) followed by skin and soft-tissue infection (23.6%). The antibiotic susceptibility results showed meropenem (MEN) and ceftazidime as the most effective antibiotics for E. coli, K. pneumoniae, and Proteus spp. isolates. Moreover, MEN was the most effective antibiotic against MDR isolates. Conclusion: The study findings showed a significant distribution of MDR Gram-negative bacteria which may increase the burden of healthcare-associated infections in cancer patients. Although, carbapenem can be considered as effective agents toward MDR strains for empirical antibiotic therapy in our region.

Neu–Laxova syndrome (NLS) is an autosomal recessive disorder characterized by central nervous system anomalies, facial dysmorphic features, anomalies of limb and genitalia, intrauterine growth retardation, skin disorders, and other congenital abnormalities. In this article, we present a newborn infant who was born with facial dysmorphic features, flat nose, ichthyosis, rocker bottom feet, and fixed flexion contractures. We believe that these clinical findings in this patient are consistent with features of NLS.

Background: Metadoxine (pyridoxine pyrrolidone carboxylate) is considered to be a beneficial agent for the treatment of experimental hepatotoxicity due to alcohol, CCl4, and bile duct ligation. Hence, the therapeutic effect of metadoxine and N-acetylcysteine (NAC) as reference drug was investigated in mice exposed to acute hepatotoxicity induced by a single oral toxic dose of acetaminophen (650 mg/kg). Materials and Methods: Metadoxine (200 and 400 mg/kg) and NAC (300 mg/kg) were given orally (p. o.), 2 h after acetaminophen administration. Serum aminotransferases, aspartate transaminase (AST), alanine transaminase (ALT), alkaline phosphatase (ALP), total bilirubin, hepatic glutathione (GSH), and malondialdehyde (MDA) levels were determined for evaluating the extent of hepatotoxicity due to acetaminophen and its protection by metadoxine. Results: Findings indicated that metadoxine significantly reduced the level of serum ALT, AST, and ALP but not total bilirubin which increased by acetaminophen intoxication. Administration of metadoxine also attenuated oxidative stress by suppressing lipid peroxidation (MDA) and prevented the depletion of reduced GSH level which caused by acetaminophen toxicity. Besides, metadoxine ameliorated histopathological hepatic tissue injury induced by acetaminophen. Conclusion: In most parameters examined, the effect of metadoxine was comparable to NAC. Hence, metadoxine could be considered as a beneficial therapeutic candidate to protect against acute acetaminophen hepatotoxicity.

Background: Candida dubliniensis is a newly diagnosed species very similar to Candida albicans phenotypically and first discovered in the mouth of people with AIDS in 1995. Among the different phenotypic and genotypic methods, a cost-effective method should be selected which makes it possible to differentiate these similar species. Materials and Methods: Polymerase chain reaction (PCR)-restriction fragment length polymorphism with MspI enzyme and the Duplex-PCR method were done by DNA extraction using boiling. The sequencing of the amplified ribosomal region was used to confirm the C. dubliniensis species. Direct examination and colony count of the yeasts were applied for bronchoalveolar lavage (BAL) samples and the growth rate of the yeasts were studied at 45°C. To understand the ability formation of chlamydoconidia in yeast isolates, they were separately cultured on the sunflower seed agar, wheat flour agar, and corn meal agar media. Results: Fifty-nine (49.2%) yeast colonies were identified from the total of 120 BAL specimens. Twenty-nine isolated yeasts; including 17 (58.6%) of C. albicans/dubliniensis complex and 12 (41.4%) of nonalbicans isolates produced pseudohypha or blastoconidia in direct smear with a mean colony count of 42000 CFU/mL. C. albicans with the frequency of 15 (42.9%) were the most common isolated yeasts, whereas C. dubliniensis was identified in two nonHIV patients. Conclusion: Sequencing of the replicated gene fragment is the best method for identifying the yeasts, but the determination of the species by phenotypic methods such as the creation of chlamydoconidia in sunflower seeds agar and wheat flour agar media can be cost-effective, have sensitivity and acceptable quality.

Background: The aim of this study was to evaluate the relation between normal values of extensor digitorum communis (EDC) Hoffmann-reflex (H-reflex) latency, upper limb length and age in normal participants, and to determine whether there is any regression equation between them. Materials and Methods: In this cross-sectional study, 120 upper limbs of 76 normal volunteers (55 limbs of 34 men and 65 limbs of 42 women) were participated in this study. The onset latency of EDC H-reflex was determined with standard electrodiagnostic techniques and was recorded. Results: The mean EDC H-reflex latency was 15.89 ± 1.41 ms. There was a positive significant correlation between EDC H-reflex latency and upper limb length (r = 0.749, P < 0.0001) and also arm length (r = 0.758, P < 0.0001), but there was a nonsignificant indirect correlation between age and EDC H-reflex latency (r = −0.111, P = 0.227). The relation between H-reflex and sex was not statistically significant (P = 0.46). Conclusion: According to our result, there are good predictive values between upper limb length and arm length for the estimation of normal EDC H-reflex latency.

Background: Today, leishmaniasis is a widespread, infectious parasitic disease caused by Leishmania spp. Natural-derived compounds are likely to provide a valuable source of new pharmaceuticals, and among them, quercetin derivatives may have antileishmanial effects. The antileishmanial activity of 3,5,7,3',4'-pentahydroxyflavonol (quercetin) derivatives is partly attributed to the position and pKa of phenolic or catechol hydroxyl groups. Therefore, to optimize their leishmanicidal effect, the structural features of quercetin and its derivatives were improved by acylation or alkylation of hydroxyl groups and changing their pKa and consequently their activities. Materials and Methods: In this study, during a regioselective method, quercetin derivatives were synthesized. The structures of synthesized compounds were confirmed by mass, IR, ¹H-, and ¹³C-NMR spectral data. The antileishmanial activities of compounds 1–6 were compared with glucantime as the standard drug against promastigotes of Leishmania major using standard cell-based leishmanicidal assay. Results: In this study, during a regioselective method, two 7-O-quercetin derivatives (5 and 6), and three quercetin acetate derivatives (2, 3, and 4) were synthesized. In detail, the IC₅₀values found against L. major were (1) 2.5 ± 0.92; (2) 2.85 ± 0.99; (3) 15.5 ± 1.95; (4) 13.5 ± 3.5; (5) 2.6 ± 0.57; and (6) 1.3 ± 0.35 μM while IC₅₀value of glucantime as the standard drug was 88.5 ± 9.47 μM. Conclusions: The present study showed an effective antileishmanial activity of quercetin semisynthetic compounds (1–6) against in vitro promastigotes of L. major. Among them, quercetin analogs with more lipophilic and iron-chelating activity showed more antiparasite activity.

Background: The purpose of this study is to report outcomes of total hip arthroplasty (THA) in patients under the age of 35 years regarding pain and joint function. Materials and Methods: This preliminary analytic-descriptive study was performed in prospective consecutive series of forty-three patients younger than 35 years old who had undergone unilateral THA during a 36-month period. As the primary outcome, the severity of pain using visual analog scale (VAS) of 1–10, and as the secondary outcomes, joint range of motion (ROM) and the Harris Hip Score (HHS) were assessed in the preoperative visit, 1, 6, and 18 months after operation for each patient. Complications were recorded at 6 months and 18 months after surgery. Results: The data of VAS showed the mean severity of pain was significant between preoperation measurements and postoperative assessments (P < 0.001). The means of HHS and hip ROM were also statistically significant before the operation in comparison with postoperative assessments (P < 0.001 for both means). A total of 19 patients had postoperative complications including periprosthetic fracture in two patients, infection in two patients, cup loosening in three patients, limb length discrepancy in 10 patients, and heterotopic ossification in two patients. Seven patients had been readmitted. Conclusion: We believe THA using uncemented prosthesis has a high survivorship with low rate osteolysis in young patients with good bone stock. It is necessary to have longer follow-up to have a better evaluation on outcomes.

Background: Chronic recalcitrant plantar fasciitis is a disabling condition. We presumed if shock wave could increase the permeability of skin and facilitate penetration of topical corticosteroid through the skin; the combinational therapeutic effect would be stronger than using shock wave alone. The study purpose was to utilize the synergistic effect of shock wave and topical corticosteroid in treatment of plantar fasciitis. Materials and Methods: Patients in both groups (n = 40) received four sessions of shock wave with the same protocol at weekly intervals. At 30 min before each session, we used an occlusive dressing of topical clobetasol for the intervention group and Vaseline oil for the control group. Pain severity was assessed with visual analog scale (VAS) and modified Roles and Maudsley score (RMS) at baseline and 1 month and 3 months after intervention. Plantar fascia (PF) thickness was measured with ultrasonography at baseline and 3 months after intervention. Results: One month after intervention, VAS morning showed significant improvement in intervention group (P = 0.006) and RMS showed better improvement in intervention group (P = 0.026). There was no significant difference between the two groups after 3 months in RMS or VAS score. PF thickness was decreased significantly in both groups, but it was not significant between the two groups (P = 0.292). Conclusions: This combinational therapy yielded earlier pain reduction and functional improvement than using shock wave alone; topical corticosteroid could enhance the effectiveness of shockwave in short-term in the treatment of recalcitrant plantar fasciitis.

Background: Pseudomonas aeruginosa is a biofilm-forming bacterium which can result in serious health problems, particularly in burn patients. Biofilm has been assumed to protect the bacteria from environmental fluctuations such as antimicrobial agent. Mucoid strains generate extensive levels of the alginate exopolysaccharide, which is an important factor of its biofilm. Materials and Methods: Totally, 100 isolates of P. aeruginosa has been gathered from wound infections of burn patients. Polymerase chain reaction of exoA gene has been carried out to confirm the bacteriologic identification of isolates. The biofilm-forming capacity has been specified by capsule staining and microtiter plate test as qualitative and quantitative determination, respectively. Antimicrobial susceptibility of the isolates has been specified by disk diffusion method. Results: All the isolates carried the exoA gene. The antibiotic resistance was imipenem (90%); levofloxacin (93%); aztreonam (87%); piperacillin-tazobactam (85%); tobramycin (92%); polymyxin b (PB) (2%); and ceftazidime (CAZ) (32%). Totally, multidrug-resistant (MDR) and extended drug-resistant (XDR) isolates were 19% and 75%, respectively. Fortunately, pan drug-resistant (PDR) strain has not been observed. The assessment of biofilm formation has shown that 7% of the isolates were nonbiofilm (N), weak (W) 67%, moderate (M) 22%, and strong (S) 4%. Conclusions: As a result, the findings of this survey indicated that PB and CAZ were the most effective antibiotics against P. aeruginosa, which of course indicate a serious problem about the emergence of the PDR strains. There was no relationship between the patterns of biofilm production and antibiotic susceptibility, but high frequency of MDR/XDR and biofilm producer strains has been detected.

Background: Allium genus with 750 species is the most diverse genus in the Amaryllidaceae family. Historically, Allium species have been used as medicinal plants, especially for prevention and treatment of cardiovascular diseases and considered as valuable sources of phytonutrients. Phytochemical investigation of Allium tripedale, locally called “Anashq,” which is an edible plant of the “Zagros” region (west of Iran) was conducted in the present study. Materials and Methods: Air-dried bulbs of the plant were extracted in a four-step extraction method with increasing polarity using hexane, chloroform, chloroform–methanol (9:1), and methanol. Chloroform-methanol (9:1) extract was fractionated by medium-pressure liquid chromatography on a RP-18 column using a linear gradient solvent system of H₂O to MeOH. Phenolic-rich fractions were subjected to the final isolation and purification of the constituents by reversed-phase high-performance liquid chromatography method. Structure elucidation of the compounds was performed through comprehensive methods including 1D-and 2D-NMR and mass spectroscopy. Results: Two cinnamic acid derivatives were isolated from the bulbs of A. tripedale; using spectroscopic methods, their chemical structures were determined as 6,7-dimethoxy N-trans-caffeoyltyramine (1) and N-trans-feruloyltyramine (2). Conclusion: Cinnamic acid derivatives are pharmacologically active phenolic compounds, which have been isolated from different Allium species. Isolation of these compounds from A. tripedale is reported for the first time in this study and could be used as a chemical basis for explanation of the plant biological and pharmacological activities.

Background: This randomized clinical trial was aimed to evaluate the effect of oral use of tamarind seed powder as an herbal product in patients affected by premature ejaculation (PE). Materials and Methods: In this study, 75 patients randomized in tamarind group (25 patients received daily 130 mg tamarind seed powder), paroxetine group (25 patients received daily 20 mg paroxetine), and placebo group (25 patients). Patients received the treatment regimen for 4 weeks. The primary outcome was intravaginal ejaculatory latency time (IELT). The secondary outcomes were PE diagnostic tool score, sexual function using International Index of Erectile Function (IIEF), and complications. Studied sexual functions include erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction. Results: The mean of IELT in tamarind, paroxetine, and placebo groups at baseline was 35.2 ± 26.5, 38 ± 27.6, and 44 ± 34.9 s and at the end of study was 49.5 ± 48.2, 147.4 ± 209.6, and 46.9 ± 37.6 s, respectively, which in paroxetine group significantly increased compared to other groups. IIEF scores for orgasmic function and intercourse satisfaction for paroxetine after treatment significantly increased than that of other groups. The differences between tamarind and placebo groups for studied variables were not statistically significant. The mean of increases in IELT for tamarind, paroxetine, and placebo groups was 14.35 ± 34.3, 109.4 ± 213.4, and 2.9 ± 9.3 s, respectively, which in paroxetine group was significantly higher than other groups and in tamarind group was significantly higher than placebo. Conclusions: Paroxetine was significantly better than tamarind seed powder and placebo although side effect in paroxetine was more frequent. IELT significantly more increased in tamarind group compared to placebo.

Background: The first cause of women mortality due to cancer is breast cancer. Mammography plays a central part in early detection of breast cancers. The screening methods can play a major role to reduce the morbidity and mortality rate due to this malignancy. We sought the basic data in this study on our population because knowing about the baseline data is apt and vital. Materials and Methods: In this study, data were collected from a questionnaire, contained baseline bio data information, and mammographic imaging of the patients came during 7 years. Breast imaging reporting and data system (BIRADS) score, breast composition, presence of axillary lymph nodes, microcalcifications, and other incidental positive findings were determined by a radiologist and analysis was performed by SPSS package. Results: The most common indication for mammography was annual screening. The mean age of participants to the study was 55 ± 7.9 years. The majority (80%) of the patients with known breast cancer (BIRADS 6) had the extremely dense breast. The most common incidental findings in mammogram studies were focal asymmetry, architectural distortion, intramammary lymph node and accessory breasts, respectively. Conclusion: The frequency distribution of BIRADS classification in our society was clarified. It seems that the breast cancer risk is higher in women with dense breasts. Architectural distortion was also correlated to BIRADS score.

Background: This study evaluated the clinical efficacy and tolerability of a 14-day course of bismuth-based quadruple therapy including tinidazole and levofloxacin in compare to a 14-day bismuth-based quadruple therapy including clarithromycin as first-line treatment for Helicobacter pylori infection in Iranian adults. Materials and Methods: The study was a prospective, parallel group, randomized controlled, clinical trial that conducted on 150 patients with H. pylori infection. Patients were randomly assigned to the two groups as follows: first group received pantoprazole 40 mg, bismuth subcitrate 240 mg, amoxicillin 1 g, and clarithromycin 500 mg (PBAC group), and other group received pantoprazole 40 mg, bismuth subcitrate 240 mg, amoxicillin 1 g, tinidazole 500 mg for 7 days, followed by levofloxacin 500 mg for the second 7 days (PBATL group). Main outcomes were eradication rate, tolerance of treatment, and dyspepsia severity. Results: The eradication rates for PBAC regimen was 81.1% (95% confidence interval [CI]: 71.9–90.2) and for PBATL regimen was 70.8% (95% CI: 60.1–81.6), which was not significantly different (P = 0.147). Tolerance of treatment was similar between groups. The median of severity of dyspeptic after treatment in PBAC group was 10 [9–14.75], which was similar to PBATL group 10 [9–13.5] (P = 0.690). Conclusion: There is no significant difference between PBAC and PBATL regimen, and efficacy was similar in both groups. The overall rate of treatment failure suggests that up to 18%–30% of patients will fail bismuth-based quadruple therapy and require retreatment for the infection.

Background: Nephrotoxicity is one of the side effects of cisplatin (CP) therapy which is gender related. CP disturbs renal function through glomerular filtration rate and electrolytes transport disturbances. This study was designed to compare some markers related to renal function in two protocols of CP treatment in rats. Materials and Methods: Male and female rats were subjected to receive single (treat 1; 7.5 mg/kg) and continues doses (treat 2; 3 mg/kg/day for 5 days) of CP, and the measurements were compared with control animals. Results: The serum level of blood urea nitrogen (BUN) and creatinine (Cr), and Cr-clearance, kidney tissue damage score, kidney weight, body weight change, and Na excretion was altered significantly (P < 0.05) in animals treated with continuous dose of CP (treat 2), while alteration of BUN and Cr was gender related. The kidney levels of malondialdehyde and nitrite were significantly different between male and female in two protocols of treatments. Conclusion: Renal function after CP therapy alters in rats' gender dependently, and it is related to protocol of treatment.

Background: Antirrhinum majus contains aurone with excellent antibacterial and antifungal activities. In addition, visible light activates the endogenous porphyrins of Propionibacterium acne, which results in bacterial death. Therefore, considering the above-mentioned facts, the aim of the present study was to prepare a topical herbal gel of A. majus hydroalcoholic extract and to evaluate its antiacne effects with or without blue light combination as an activator of the porphyrins. Materials and Methods: Antibacterial activity of the shoot or petal extracts was evaluated by disc diffusion method and the minimum inhibitory concentration (MIC) was calculated. Various gel formulations were developed by the Experimental Design software. The obtained gel formulations were prepared and tested for pharmaceutical parameters including organoleptic features, pH, viscosity, drug content, and release studies. Finally, the antibacterial activity was evaluated against (P. acnes) with or without blue light. Results: The MIC of the extracts showed to be 0.25 μg/ml. Evaluation of the gel formulation showed acceptable properties of the best formulation in comparison to a gel in the market. Pharmaceutical parameters were also in accordance with the standard parameters of the marketed gel. Furthermore, statistical analyses showed significant antibacterial effect for gel when compared to negative control. However, combination of blue light with gel did not show any significant difference on the observed antibacterial effect. Conclusion: Because of the statistically significant in vitro antiacne effects of the formulated gel, further clinical studies for evaluation of the healing effects of the prepared gel formulation on acne lesions must be performed.

Background: The role of renin-angiotensin system (RAS) in communication between renal system and cardiovascular system is extremely important. Baroreflex sensitivity (BRS) index defines as heart rate (HR) alteration versus mean arterial pressure (MAP) change ratio (ΔHR/ΔMAP) . Sympathetic nerve is arm of the baroreflexes and any change in its activity will lead to change in the BRS. The role of angiotensin II (Ang II) infusion in systemic circulation accompanied with bilateral renal denervation (RDN) on BRS index and renal function was studied. Materials and Methods: Seventy-two male and female Wistar rats in 12 groups were anesthetized and catheterized. The alteration of MAP and HR responses to phenylephrine infusion compared to control groups was determined in bilateral RDN rats subjected to treat with Ang II (300 or 1000 ng/kg/min) administration. Results: The BRS index was elevated in Ang II-treated non-RDN (normal) male rats gradually and dose dependently (P < 0.05), while this index was significantly different when compared with RDN male rats (P < 0.05). Accordingly, the BRS index was significantly lower in RDN than non-RDN male rats, and such observation was not observed in female rats. The creatinine clearance (insignificantly) and urine flow (significantly; P < 0.05) were decreased in both non-RDN and RDN male and female rats treated with Ang II. In RDN model, the serum nitrite levels were decreased in male and increased in female by Ang II infusion when compared with vehicle infusion. Conclusion: The Ang II infusion could increase the BRS index in non-RDN (normal) male rats which is significantly greater than BRS index in RDN rats.

Cellular therapy is being actively pursued as a therapeutic modality in many of the neurological diseases. A variety of stem cells from diverse sources have been studied in detail and have been shown to exhibit angiogenetic and immunomodulatory properties in addition to other neuroprotective effects. Published clinical data have shown bone marrow mononuclear cell (BMMNC) injection in neurological disorders is safe and possesses regenerative potential. We illustrate a case of 27-year-old male with traumatic brachial plexus injury, administered with autologous BMMNCs intrathecally and intramuscularly, followed by multidisciplinary rehabilitation. At the follow-up assessment of 3 and 7 months after first cell transplantation, improvements were recorded in muscle strength and movements. Electromyography (EMG) performed after the intervention showed a response in biceps and deltoid muscles suggesting the process of reinnervation at the site of injury. In view of the improvements observed after the treatment, the patient underwent second cell transplantation 8 months after the first transplantation. Muscle wasting had completely stopped with an increase in the muscle girth. No adverse effects were noted. Improvements were maintained for 4 years. A comprehensive randomized study for this type of injury is needed to establish the therapeutic benefits of cellular therapy.

Primary muscular hydatidosis is a very rare condition with an incidence of 1%–4% in endemic regions. This case report describes an unusual location of hydatid cyst in the sartorius muscle and the application of imaging in its preoperative diagnosis, choosing a treatment strategy, and monitoring.

Background: Several methods have been used in wound closure for traumatic wounds, but it is not clear that which of these methods has more safety and efficacy. This study aimed to compare scar width due to standard and current treatments in wound repair by suturing and method of wound restoration using wound tape in patients with traumatic ulcers. Materials and Methods: This randomized clinical trial was done in ninety patients with wounds in the facial area. They were divided randomly into two groups of 45. The wounds in the first group were sutured, and wound tapes were used to wound closure in the second group. After 2 months, length and width of scar and results of life-size photography were recorded in a list, especially prepared for this purpose. Results: The mean age of the patients was 22.7 ± 12.9 years with 46 males (56.1%) and 36 females (43.9%). After 2 months, scars width in suture wound group was 2.9 mm and in wound tape group was 2.5 mm, with no statistically significant difference (P = 0.07). In patients with wound length of >20 mm, scars width was similar between groups and no significant differences was noted (P = 0.27), but in patients with wound length of <20 mm, scars width in wound tape group was significantly less than suture wound group (1.7 vs. 2.5 mm, respectively, P = 0.01). Wound complications were not significantly different between the two groups. Conclusion: Findings revealed that scar formation in wounds lower than 20 mm treated using wound tape was lower than suture, but for wounds between 20 and 50 mm were similar between wound tape and suture.

Background: Damage to ethmoid skull base (ESB) and lateral lamella (LL) during endoscopic sinus surgery (ESS) causes penetration into the brain. This study is aimed to determine the relationship between the height of ESB and length of LL by sectional coronal computed tomography (CT) scans before ESS. Materials and Methods: In a cross-sectional study, 100 patients admitted to ENT clinic of Al-Zahra Hospital, filled the consents regarding the use of CT scan stereotype. Each stereotype was evaluated and using the software on two sides the height of ESB and the length of LL were measured, investigated and recorded. Next, the maximum and minimum height and length in the two sides was measured, and its mean calculated. Then, the relationship between the length of LL and the height of ESB was investigated. Results: There was a direct correlation, with the rate of 0.25 between the length of right LL and height of right ESB that was significant according to Pearson test (P = 0.013). Also, the rate of correlation between the left LL and height of left ESB was 0.15 that was not significant according to Pearson test (P = 0.15). Conclusion: Based on this study there was a direct correlation between height of the right ESB and the length of LL, but this correlation is very low, about 0.25 and even this correlation was lower in the case of left, about 0.15, which both of them are not significant. This may be due to other affecting factors, such as length, slope and angle of fovea ethmoidallis from the horizontal line.

Background: Given the high prevalence rate of ulnar neuropathy and importance of its proper management, to have a baseline information about the normative value of motor nerve conduction of first dorsal interosseous (FDI) muscle and abductor digiti minimi muscle (ADM) and their differences as well as their relation with different demographic characteristics of our population, we aimed to determine and compare the mean value of motor conduction velocity of FDI and ADM at forearm and across the elbow among the normal population. Materials and Methods: In this cross-sectional study, healthy participants were enrolled in the study. Ulnar nerve motor nerve conduction velocity (MNCV) was recorded from the ADM and the FDI at forearm and across the elbow. Mean MNCV of the ulnar nerve recorded from ADM and FDI was compared. In addition, MNCV of the ulnar nerve measured at the forearm and across the elbow was compared also. Results: During this study, 165 healthy volunteers selected and participated in the study. Mean of ulnar nerve MNCV for ADM was significantly lower than FDI, both at forearm and across the elbow (P < 0.001). Mean of ulnar nerve MNCV was significantly lower at forearm comparing than elbow level for both ADM and FDI (P < 0.001). Conclusion: The findings of the current study provide us a baseline data regarding the normative mean value of ulnar nerve MNCV in different locations, which could be used for providing an appropriate diagnostic protocol for ulnar nerve neuropathy. However, further studies among patients suspected with ulnar nerve neuropathy are needed.

Background: Epilepsy is a chronic neurological disorder characterized by seizure recurrence in patients. Electroencephalogram (EEG) has a diagnostic and prognostic role in the management of patients. Studies have shown a significant relation between seizure recurrence and abnormal EEG in newly diagnosed epileptic patients, and people with first episode of unprovoked seizure. The aim of this study is to evaluate seizure frequency in chronic epileptic patients on drug therapy based on normal or abnormal EEG. Materials and Methods: This prospective cohort study examined seizure recurrence in 59 epileptic patients (50.8% generalized, 49.2% focal) with normal and abnormal EEG. Data were recorded in patient medical file, and patients were followed by telephone call or visiting by neurologist. Results: In this study, 59 patients with a mean age of 29.58 ± 10.37 years were assessed that 42.4% of them were males and 57.6% were females. Seizure frequency in patient with specific abnormal EEG was significantly more than other patients (specific abnormal: 78.9%, nonspecific abnormal: 45.5%, and normal: 31%, P = 0.005). Seizure recurrence in patients on polytherapy was significantly higher than others (polytherapy: 76.9% and monotherapy: 27.3%, P < 0.001). In patient with abnormal imaging seizure, frequency was more than other patients which was nearly significant (P = 0.054). Conclusion: Abnormal EEG and number of anticonvulsant drugs have a role in seizure recurrence in epileptic patients.

Background: Inflammatory bowel disease (IBD) might be an immunodeficiency rather than an excessive inflammatory reaction. IBD, suspected to primary immunodeficiency diseases biobank (IBDSPIDB) as a resource for researches can help improve the prevention, diagnosis, and illness treatment and the health promotion throughout the society. Therefore, we launched the biobank of IBDSPID for the first time in Iran. Materials and Methods: This study was designed to provide the IBDSPIDB to have a high-quality DNA, RNA, and cDNA. Among of 365 patients, 39 have inclusion criteria that were as below: (1) IBD diagnosis before 5 years of age. (2) Resistance to conventional therapy of IBD. (3) Severe IBD. (4) Signs of SPID (including ear infections or pneumonia or recurrent sinus within the 1-year period; failure to thrive; poor response to the prolonged use of antibiotics; persistent thrush or skin abscesses; or a family history of PID). Results: Out of 39 patients, 51.3% were males. The mean age was 32.92 ± 15.90 years old. Ulcerative colitis (79.5%) was more than Crohn's disease. The majority of patients (50.0%) had severe IBDSPID. Resistance to drugs and consanguinity was 12.9% and 47.4%, respectively. Age at onset in 65.8% of patients was after 17 years old. Patients with autoimmune, allergy, and immunodeficiency disease history were 33.3%, 33.3%, and 10.36%, respectively. RNA and cDNA yields large quantities of high-quality DNA obtained and stored. Conclusion: Our biobank would be valuable for future genetic and molecular study to be more about the relation between IBD and PID.

Background: Reconstruction of nervous system is a great challenge in the therapeutic medical field. Nerve tissue engineering is a novel method to regenerate nervous system in human health care. Tissue engineering has introduced novel approaches to promote and guide peripheral nerve regeneration using submicron and nanoscale fibrous scaffolds. Materials and Methods: In this study, 9 wt% poly(3-hydroxybutyrate) (PHB) solutions with two different ratios of chitosan (CTS) (15%, and 20%) were mixed in trifluoroacetic acid as a cosolvent. Thereafter, random and aligned PHB/CTS scaffolds were fabricated by electrospinning method in an appropriate condition. Results: Average diameters for aligned PHB, PHB/CTS 85:15 and PHB/CTS 80:20 were obtained as 675 nm, 740.3 nm, and 870.74 nm, which was lesser than random fibers. The solution components entity authenticity was approved by Fourier transform infrared. The addition of CTS decreased both water droplet contact angle from 124.79° to 43.14° in random and 110.87° to 33.49° in aligned PHB/CTS fibrous scaffold. Moreover, alignment of fibers causes tremendous increase in hydrophilicity of fibrous PHB/CTS substrate. Tensile strength increased from 6.41 MPa for random to 8.73 MPa for aligned PHB/CTS 85:15. Conclusions: Our results indicated that aligned PHB/CTS 85:15 nanofibers are the desired scaffold than the random PHB/CTS nanofibers for application in nerve tissue regeneration.

Background: Marine organisms produce a variety of compounds with pharmacological activities including anticancer effects. This study attempt to find cytotoxicity of hexane (HEX), dichloromethane (DCM), and butanol (BUTOH) partitions of Sargassum angustifolium. Materials and Methods: S. angustifolium was collected from Bushehr, a Southwest coastline of Persian Gulf. The plant was extracted by maceration with methanol-ethyl acetate. The extract was evaporated under vacuum and partitioned by Kupchan method to yield HEX, DCM, and BUTOH partitions. The cytotoxic activity of the extract (150, 450, and 900 μg/ml) was investigated against MCF-7 (breast cancer), HeLa (cervical cancer), and human umbilical vein endothelial cells cell lines by mitochondrial tetrazolium test assay after 72 h. Results: The cell survivals of HeLa and MCF-7 cell were decreased by increasing the concentration of extracts from 150 μg/ml to 900 μg/ml. The median growth inhibitory concentration value of HEX partition was 71 and 77 μg/ml against HeLa and MCF-7, dichloromethane partition was 36 and 88 μg/ml against HeLa and MCF-7, respectively. BUTOH partition was 25 μg/ml against MCF-7. Conclusion: This study reveals that different partitions of S. angustifolium have cytotoxic activity against cancer cell lines.

Background: Cancer is the second cause of death after cardiovascular diseases worldwide. Tumor metastasis is the main cause of death in patients with cancer; therefore, unraveling the molecular mechanisms involved in metastasis is critical. Epithelial-mesenchymal transition (EMT) is believed to promote tumor metastasis. Based on the critical roles of long noncoding RNA-ATB (lncRNA-ATB) and SETD8 genes in cancer pathogenesis and EMT, in this study, we aimed to assess expression profile and clinicopathological relevance of these two genes in human gastric cancer. Materials and Methods: Quantitative real-time polymerase chain reaction was performed to assess these gene expressions in gastric cancer tissues and various cell lines. The associations between these gene expressions and clinicopathological characteristics were also analyzed. Results: Insignificant downregulation of lncRNA-ATB and significant upregulation of SETD8 in cancerous versus noncancerous gastric tissues were observed. Among different examined cell lines, all displayed both genes expression. Except for a significant inverse correlation between the expression levels of lncRNA-ATB and depth of invasion (T) and a direct association between SETD8 levels and advanced tumor grades, no significant association was found with other clinicopathological characteristics. Conclusion: lncRNA-ATB and SETD8 genes may play a critical role in gastric cancer progression and may serve as potential diagnostic/prognostic biomarkers in cancer patients.

Background: Despite conducting wide-ranging of pharmacotherapy for bipolar adolescents, many of them are showing a deficit in functioning with high relapse rate. The aim of the current study was to develop a manual and investigate the efficacy of group cognitive–behavioral therapy (G-CBT) for female bipolar adolescents. Materials and Methods: During the first qualitative phase of a mixed-methods study, a manual of G-CBT was developed. Then, 32 female bipolar adolescents aged 12–19 years old, receiving usual maintenance medications (UMM), were selected. Participants were randomized to the control (UMM) and intervention group (5, 2 h weekly sessions based on G-CBT manual with UMM). The parents in intervention group participated in three parallel sessions. All participants filled the following questionnaires before 1, 3, and 6 months after the initiation of the study: Young Mania Rating Scale, Children Depression Inventory and Global Assessment of Functioning. The results were analyzed using SPSS 21 software. The concurrent qualitative phase was analyzed through thematic analysis. Results: The results showed no significant differences in all questionnaires' scores through intervention and follow-up sessions (P > 0.05). However, using cutoff point of CDI, G-CBT was effective for intervention group (relapse rate: 25% vs. 44.4%). Two themes were extracted from the second qualitative phase: emotion recognition and emotion regulation, especially in anger control. Conclusions: The results showed that the addition of G-CBT to UMM leads to decrease in the depressive scores but has no effect on manic symptoms and relapse rate.

Background: Escherichia coli is a Gram-negative, opportunistic human pathogen in which increasing antibiotic resistance is a great concern for continued human survival. Although biofilm formation is a mechanism that helps E. coli to survive in unfavorable conditions, according to the importance of biofilm formation in developing the antibiotic resistance here, we studied the relation between antibiotic resistance and in vitro qualitative rating method biofilm formation in E. coli isolated from patients with urinary tract infection (UTI). Materials and Methods: The clinical isolates of E. coli (n = 100) were collected from urine of patients with UTI attending Isfahan Alzahra hospital. The strains were confirmed as E. coli using biochemical tests and molecular method. The Kirby-Bauer disk diffusion tests were done according to the Clinical and Laboratory Standards Institute protocol, and the biofilm synthesis was performed by microplate method. The binary logistic test was applied and P < 0.05 was considered statistically significant. Results: Our results showed a high outbreak of multidrug-resistant (MDR) E. coli strains (73%) and the highest resistance was observed toward ampicillin. The prevalence of biofilm producer isolates was 80% that 29% produced strong biofilm. The distribution of non-MDR isolates was high among strong biofilm producers, which shows a significant negative correlation between biofilm production and MDR pattern (P < 0.001). Conclusions: We found a negative correlation between MDR phenotype and biofilm formation capacity. This transmits the concept that more antibiotic susceptibility of strong biofilm producers may be due to the reduced exposure to multiple antibiotics.

Background: The present study has been designed to compare the effect of magnesium sulfate with mannitol on reducing intraocular pressure (IOP). Materials and Methods: During the phacoemulsification surgery, 105 patients randomly divided into three groups receiving 20% mannitol at a dose of 0.3 g/kg, 50% magnesium sulfate at a dose of 20 mg/kg, and placebo (normal saline), with the same volume (100 ml) and infusion time (10 min), were used for the first, second, and third groups, respectively. The IOP was measured before and immediately after the injection and 5 min after the end of the surgery and compared between the groups. Results: The mean IOP immediately after the injection had a significant difference in three groups (mannitol: 15.2 ± 2.5, magnesium sulfate: 14.7 ± 1.9, and normal saline: 13.8 ± 2.8; P = 0.044), and the IOP had a significant difference between normal saline and mannitol groups (0.027) while there was no significant difference between mannitol and magnesium sulfate groups (P = 0.34) and also between magnesium sulfate and normal saline groups (P = 0.2). Conclusion: Using magnesium sulfate had no effect on changes in the IOP and hemodynamic of patients during the surgery. Using mannitol may be effective in reducing IOP while no effect of magnesium sulfate on IOP was found.

Treatment based on traditional medicine is very popular in developing world due to inexpensive properties. Nowadays, several types of preparations based on medicinal plants at different dose have been extensively recognized in the diseases prevention and treatment. In this vista, latest findings support the effect of Curcuma longa and its chief constituents curcumin in a broad range of diseases cure via modulation of physiological and biochemical process. In addition, various studies based on animal mode and clinical trials showed that curcumin does not cause any adverse complications on liver and kidney function and it is safe at high dose. This review article aims at gathering information predominantly on pharmacological activities such as anti-diabetic, anti-microbial, hepato-protective activity, anti-inflammatory, and neurodegenerative diseases.

Background: Familial hypercholesterolemia (FH) is a disorder that is inherited by autosomal dominant pattern. The main cause of FH disease is the occurrence of mutations in low-density lipoprotein receptor (LDLR) gene sequence, as well as apolipoprotein B and proprotein convertase subtilisin/kexin type 9 genes, located in the next ranks, respectively. Materials and Methods: Forty-five unrelated Iranian patients with FH were screened using a high-resolution melting (HRM) method for exon 9 along with intron/exon boundaries of LDLR gene. Samples with shift in resultant HRM curves were compared to normal ones, sequenced, and analyzed. Results: Our findings revealed a missense mutation c. 1246C>T and a known variant IVS9-30C>T (rs1003723) that was recognized in 71% of the patients (22%: homozygous and 49%: heterozygous genotypes). In silico analysis, predicted the pathological effect of the c. 1246C>T mutation in LDLR protein structure, but IVS9-30C>T variant had no predicted effect on splice site and branch point function. Conclusion: FH is a hereditary type of hypercholesterolemia that leads to premature cardiovascular disease and atherosclerosis, and early diagnosis is needed. We detected a rare missense mutation (1246C>T) and a common single nucleotide polymorphism (SNP) in the Iranian population. These reports could help in the genetic diagnosis and counseling of FH patients.

Background: Nowadays, cartilage tissue engineering is the best candidate for regeneration of cartilage defects. This study evaluates the function of herbal extracts icariin (ICA), the major pharmacological constituent of herba Epimedium, compared with transforming growth factor β3 (TGFβ3) to prove its potential effect for cartilage tissue engineering. Materials and Methods: ICA, TGFβ3, and TGFβ3 + ICA were added fibrin-cell constructions derived from adipose tissue stem cells. After 14 days, cell viability analyzed by 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2H- tetrazolium bromide assay and the expression of cartilage genes was evaluated with real-time polymerase chain reaction (RT-PCR). Results: The results showed ICA, TGFβ3, and TGFβ3 + ICA increased the rate of proliferation and viability of cells; but there were no significant differences between them (P > 0.05). Furthermore, quantitative RT-PCR analysis demonstrated that cooperation of ICA with TGFβ3 showed a better effect in expression of cartilaginous specific genes and increased Sox9, type II collagen, and aggrecan expression significantly. Furthermore, the results of the expression of type I and X collagens revealed that TGFβ3 increased the expression of them (P < 0.01); However, treatment with ICA + TGFβ3 down regulated the expression of these genes significantly. Conclusion: The results indicated ICA could be a potential factor for chondrogenesis and in cooperation with TGFβ3 could reduce its hypertrophic effects and it is a promising factor for cartilage tissue engineering.

Background: Proteinuria is a well-known indicator of renal dysfunction. In this study, we evaluated the frequency of proteinuria in a sample of healthy Iranian elementary school students using both dipsticks and urine albumin-to-creatinine ratio (UACR) methods. Materials and Methods: This cross-sectional study was performed on 478 school students aged 7–9 years who were selected by multistage random cluster sampling from Isfahan city, Iran. A clean midstream first-morning urine sample was obtained from each subject. Urine samples were examined by dipstick method, and accordingly, they were reported as negative; trace; 1+; 2+; 3+; and 4+. UACR was determined in samples with positive dipstick proteinuria (defined as trace or greater). Results: This study included 478 students (42.8% boys), with mean age of 7.0 ± 0.4 years. Positive dipstick was detected in 124 (25.9%) cases. The frequency of positive dipstick proteinuria was significantly higher in the girls than boys (29.6% vs. 20.9%, respectively; P = 0.04). In cases with a positive dipstick, 10 (2.1%) cases had UACR 30–300 mg/g. The frequency of UACR of 30–300 mg/g was 1.4% and 2.5% in boys and girls, respectively. There was no significant difference in the frequency of UACR 30–300 mg/g in terms of gender (P = 0.4). None of the subjects had UACR above 300 mg/g. Conclusion: While the frequency of asymptomatic proteinuria varies widely across different studies, we found a higher rate of proteinuria in Iranian children. Cost-effectiveness analyses are needed to justify large screening program for detecting asymptomatic proteinuria, as a cardinal manifestation of kidney disease, in Iranian children.

Background: The most common neurodegenerative disease is dementia. Family of dementia patients says that their lives have been changed extensively after happening of dementia to their patients. One of the problems of family and caregivers is depression of the caregiver. In this study, we aimed to find the prevalence of depression and factors can affect depression in the dementia caregivers. Materials and Methods: This study was cross-sectional study with convenient sampling method. Our society was 96 main caregivers of dementia patients in the year 2015 in Iran. We had two questionnaires, a demographic and Beck Depression Inventory (BDI). BDI Cronbach's alpha is 0.86 for psychiatric patients and 0.81 for nonpsychiatric persons, and Beck's scores are between 0 and 64. We used SPSS version 22 for statistical analysis. Results: According to Beck depression test, 69.8% (n = 67 out of 96) of all caregivers had scores in the range of depression. In bivariate analysis, we found higher dementia severity and lower support of other family members from the caregiver can predict higher depression in the caregiver. As well, in regression analysis using GLM model, we found higher age and lower educational level of the caregiver can predict higher depression in the caregiver. Moreover, regression analysis approved findings about severity and support of other family members in bivariate analysis. Conclusion: High-level depression is found in caregivers of dementia patients. It needs special attention from healthcare managers, clinicians and all of health-care personnel who deals with dementia patients and their caregivers.

Thrombotic thrombocytopenic purpura (TTP) secondary to diabetic ketoacidosis has been rarely reported and is considered as a rare complication. If left untreated, this condition could be life threatening with considerable morbidity and mortality. Herein, we report a 6-year-old girl with reduced consciousness and respiratory distress with a history of polydipsia and polyuria in the 2 weeks before hospitalization. The patient was initially diagnosed as diabetic ketoacidosis based on clinical and laboratory findings and treated accordingly. After treatment and during hospitalization although she had gained relative consciousness, she experienced seizure and reduced consciousness again. Considering laboratory and clinical findings and the patient's underlying conditions (thrombocytopenia, renal failure, and high lactate dehydrogenase), TTP was suspected although ADAMTS13 test could not be done. Treatment with plasmapheresis was initiated, and after 48 h, the patient was conscious, and laboratory indices became normal within a few days. The patient was discharged after full recovery. TTP should be considered as a rare complication of diabetic ketoacidosis in patients with thrombocytopenia, renal failure, and reduced consciousness and should be immediately treated.

In this paper, a novel model of clinical teachers with social and emotional competency which is emphasized on the importance of clinical teacher's social and emotional competence is presented. In this model, we supposed that a teacher with social and emotional competence can manage her/his emotions and has the ability to personal development and well-being. Such teacher has the competency of empathy, communication with the patients, teamwork, and collaboration to provide successful patient-centered care and relationship-centered care. He/she will be success in clinical supervision, role modeling, and mentoring by providing appropriate relationship with students. This teacher can influence and build bonds that will be effective for clinical management and leadership. In addition, it will affect the hidden and informal curriculum with the awareness of the context. These factors establish an appropriate learning environment to achieve students' academic, professional, social, and emotional outcomes and create an appropriate health care environment that influences the successful care of patient and patient's satisfaction. We reviewed a broad body of research to support our proposed model and finally proposed agendas for future research.

Background: Neutropenic fever and mucositis with 70% outbreak average is one of the major reasons of death in the acute leukemia adult patients. The aim of this study was to determine the relationship of serum zinc level with neutropenic fever and mucositis prevalence in acute leukemia adult patients and comparison of the effects of therapeutic intervention with the serum zinc correct level in the group of patients with zinc deficiency. Materials and Methods: From May 2012 to May 2013 in a double-blind, randomized, placebo-controlled study, on the basis of zinc serum level, 40 acute leukemia adult patients were divided into two groups of normal and deficiency zinc, and neutropenic fever and mucositis prevalence were taken into consideration in each and every group. The deficiency zinc patients were randomly allocated to zinc or control group in a blocked randomization schedule. The data analysis was performed by SPSS software 20 and with the aid of variance analysis statistical method, logistic regression, and X²statistical test. Results: Serum zinc level was higher in acute leukemia adult patients without mucositis and neutropenic fever than others but was not statistically significant. There is a positive relation between receiving zinc with recovery; although the relationship has not become statistically significant. Conclusion: These data, although preliminary, suggest that zinc therapy could be a valid therapeutic adjuvant to improve the quality-of-life of acute leukemia adult patients.

Background: A period of starvation after colorectal anastomosis to permit for resolution of the clinical evidence of ileus has been an unchallenged surgical dogma until recent years. We intended to determine the safety and feasibility of an unconventional postoperative oral intake protocol in patients experiencing colorectal anastomosis. Materials and Methods: Between 2013 and 2015, sixty consecutive patients underwent colorectal anastomosis and they were randomized into two groups. The early feeding group began fluids on the first postoperative day while the regular feeding group was managed in the traditional way - nothing by mouth until the complete resolution of ileus. Results: The majority of patients (93%) tolerated the early feeding. The times to first passage of flatus (2.66 ± 0.71 days vs. 3.9 ± 0.071 days) and stool (3.9 ± 0.92 days vs. 5.4 ± 0.77 days) were significantly quicker in early feeding group. Hospital stay was also significantly shorter in the early feeding group (4 ± 0.64 days vs. 6.1 ± 0.84 days). Anastomosis leakage and abscess formation were not seen in early feeding group. The patient's satisfaction (visual analog scale) in the early feeding group was higher than delayed feeding group (8.56 ± 1.16 vs. 7.06 ± 1.59, P < 0.001). Conclusions: Early oral feeding after colorectal surgeries is safe and tolerated by the majority of patients.

Background: The standard treatment for cervical disc herniation is open discectomy surgery but some of techniques, such as nucleoplasty were applied by neurosurgeons in recent decade. The aim of this study was to compare the postoperation results of open discectomy and nucleoplasty methods in people suffering from single cervical disc herniation. Materials and Methods: In a clinical trial study that performed during 2012–2013, 70 patients who candidate for neck surgery were selected and randomly divided into two groups. The first group was operated with standard discectomia and the second group was operated with nucleoplasty method. All patients were followed neck pain, upper limb pain and common complications included discitis, infection and hematoma in 2 weak, 1, 2, 3, and 6 months after operation. All data were analyzed using SPSS software. Results: Cervical pain mean from before the operation to 6 months after operation had no significant difference between two groups, but radicular pain had significant difference in 2 and 3 months after operation (P < 0.05). It is notable that after operation it is not observed any discitis, infection and hematoma of operated place. Conclusion: Doing nucleoplasty surgery in patients suffering from single cervical disc herniation causes decrease in cervical and radicular pain, at least as the same as discectomy method. Since now it is possible in our country to apply this method and on the other hand, in this method, time of surgery, postoperation complications, hospital costs, and period of convalescence is low, it is preferred in patients suffering from cervical disc and its application is advised.

Microsatellite instability (MSI) is a molecular hallmark for some colorectal cancers (CRCs) in which short tandem repeats are prone to mutations along with DNA sequences. It is due to DNA-mismatch-repair system deficiency because of a germline/somatic mutation in mismatch-repair (MMR) genes. The germline mutations lead to Lynch syndrome (LS) while epigenetic gene silencing results in sporadic CRC tumors. We discuss in our paper the most important clinical aspects of MSI testing in CRCs. We reviewed the most reliable relevant studies and clinical trials according to their high-quality methods, particularly within two recent decades. MSI testing is used to classify CRC tumors as MSI-high (MSI-H), MSI-low, and microsatellite stable tumors. MSI-H or MMR deficient tumors have shown the best prognosis among all CRCs, so MSI testing is considered as a good prognostic marker. Moreover, it is used to identify LS among familial CRC patients. There is a diagnostic mutation in BRAF gene (V600E) by which sporadic CRCs could be distinguished from LS associated CRCs, due to its concordance with sporadic CRCs not LS. Although, some previous studies had demonstrated a predictive role for MSI testing in chemotherapy process, emerging some controversial findings in recent studies has not convinced many authors to recommend it as a routine examination to evaluate therapeutic response. Though emerging new molecular findings have opened novel windows to develop clinical management of CRC, MSI testing has remained as an excellent prognostic and diagnostic tool for CRC tumors.

Background: Nasal corticosteroids are the main drug class for the treatment of allergic rhinitis, and their long-term continuous use can be problematic. The current study aimed to compare the use of Nasaleze and mometasone nasal spray in patients with allergic rhinitis. Materials and Methods: In this study, 64 patients were studied in two groups of 32 patients. Nasaleze was used for the first group and mometasone for the second group for 4 weeks. The severity of sneezing, runny nose, tearing, nasal congestion, itchy eyes, and scratchy throat were evaluated at the onset of the study, and also 14 and 28 days after treatment in the form of a single-blind study. Statistical analysis was performed using SPSS Software (SPSS Inc., Chicago, IL, USA, Version 20). Results: The severity of allergic rhinitis symptoms had a significant difference in both groups of Nasaleze and mometasone at three times. Furthermore, in the Nasaleze group, the intensity of tearing significantly reduced 14 and 28 days after treatment compared to the mometasone group. In addition, the mean pretreatment score of allergic had no significant difference in the two groups neither14 days nor 28 days after the treatment. Conclusion: The efficacy of Nasaleze nasal spray is very similar to that of mometasone nasal spray to control the symptoms of allergic rhinitis. Therefore, Nasaleze nasal spray can be a suitable alternative for nasal corticosteroids in children older than 18 months, pregnant and lactating women.

Background: Radicular pain is one of the most common forms of chronic pain in the world, which has challenges about effective medical therapy. The aim of this study was to evaluate the effect of pregabalin (PGB) and metformin (Met) on subacute and chronic radiculopathy. Materials and Methods: This double-blind prospective clinical trial was performed on 71 patients with subacute and chronic cervical and lumbosacral radiculopathy. Group A was treated with PGB 75 mg daily while Group B was treated with PGB 75 mg daily and Met 500 mg daily for 3 months. Finally, the pain score in both groups was evaluated based on visual analog scale (VAS) and numerical scale pain. Results: The results showed a significant reduction in VAS and pain severity in both groups but this reduction in the terms of VAS (47.79% vs. 46.48%, P = 0.125) and pain severity (47.1% vs. 39.2%, P = 0.264) was more in treated patients with PGB and Met as compared to PGB group while total pain experience (53.5% vs. 49.1%, P = 0.464) and interference with daily function (57.1% vs. 50.61%, P = 0.726) were more in patients treated with PGB alone. Conclusion: Our results showed that PGB and PGB + Met reduced pain intensity and interference with daily function while we did not observe significant differences between two groups. PGB alone would have the potentiality to become a simple and economic means to decrease radicular pain.

Background: Nitric oxide (NO) as a vasodilator factor has renoprotective effect against renal ischemia. The balance between angiotensin II (Ang II) and NO can affect kidney homeostasis. The aim of this study was to determine NO alteration in response to renin–Ang system vasodilator receptors antagonists (PD123319; Ang II type 2 receptor antagonist and A779; Mas receptor antagonist) in renal ischemia/reperfusion injury (IRI) in rats. Materials and Methods: Sixty-three Wistar male and female rats were used. Animals from each gender were divided into four groups received saline, Ang II, PD123319 + Ang II, and A779 + Ang II after renal IRI. Renal IRI induced with an adjustable hook. Blood pressure and renal blood flow (RBF) measured continuously. The nitrite levels were measured in serum, kidney, and urine samples. Results: In female rats, the serum and kidney nitrite levels increased significantly by Ang II (P < 0.05) and decreased significantly (P < 0.05) when PD123319 was accompanied with Ang II. Such observation was not seen in male. Ang II decreased RBF significantly in all groups (P < 0.05), while PD + Ang II group showed significant decrease in RBF in comparison with the other groups in female rats (P < 0.05). Conclusion: Males show more sensibility to Ang II infusion; in fact, it is suggested that there is gender dimorphism in the Ang II and NO production associated with vasodilator receptors.

Background: Ganoderma lucidum from Ganodermataceae family is a kind of mushroom known to have various therapeutic properties such as lowering high blood sugar and high blood pressure, boosting the immune system as well as its antibacterial and antioxidant effects. Materials and Methods: this study investigated the oxidative stability, microbial and sensory properties of sausage at three different treatments; (i) 1% w/w Ganoderma lucidum powder (GLP) without nitrite as a food preservative (P), (ii) 0.5% w/w GLP with 80 ppm nitrite (N + P), and (iii) sausage with 120 ppm nitrate (N). Lipid oxidation was evaluated using peroxide value (PV) and thiobarbituric acid reactive species. Antimicrobial properties were assessed by total plate count (TPC), yeasts and molds, coliforms, Clostridium perfringens, and Staphylococcus aureus. Sensory assessment was evaluated by nine-point hedonic procedure. Results: Samples in N + P treatment showed lower PV than other treatments at the storage period with no significant difference in 2-thiobarbituric acid (TBA) between N and N + P. The P group showed the highest TBA value (P < 0.01). TPC remained below maximal permissible limit recommended by ISIRI during 30 days of storage in all sausage formulations (6.9798 log CFU). There was not found any coliforms bacteria, Clostridium perfringens, and S. aureus. The sensory evaluation indicated that there is no significant difference between samples in texture, taste, and smell. The color and overall acceptability of N group were higher and N + P group was closer to N group. Conclusion: The results suggest that G. lucidum powder might be considered as a potential natural preservative for meat products.

Background: Increasing drug resistance is an important factor in the complexity of tuberculosis (TB) control. The identification of disease transmission type, recurrence of a previous infection, or new transmission of the disease is the key factor in the control of TB. In this study, we aimed to identify the genetic diversity of drug-resistant Mycobacterium tuberculosis isolates in Isfahan province of Iran through the mycobacterial interspersed repetitive unit-variable number tandem repeat (MIRU-VNTR) typing method based on 24 loci. Materials and Methods: Of 300 isolates obtained from a variety of clinical specimens, 18 drug-resistance M. tuberculosis clinical isolates (resistant to a single drug to more than one drug) were collected between 2013 and 2015 from regional TB reference laboratory in Isfahan. All drug-resistance M. tuberculosis isolates were typed by 24-locus MIRU-VNTR typing. Results: The highest percentage of isolates, 38.8%, belonged to the East-Asian lineage (lineage 2), while the lineages Indo-Oceanic (lineage 1), East-African–Indian (lineage 3), and Euro-American (lineage 4) represented 5.5%, 22.2%, and 33.3%, respectively. Among the 33.3% (6/18) Euro-American strains, the Latin American– Mediterranean and Ural sub-lineage were 22.2% (4/18) and 11.1% (2/18), respectively. Conclusion: The results of this study show that the lineages of drug-resistant M. tuberculosis isolates in Isfahan province of Iran are similar to those reported in the Eastern Mediterranean region (indicative of the epidemiological relationship between the countries in the region). Continued molecular monitoring is important as it has been proposed that the genetics and evolutionary backgrounds of drug-resistant M. tuberculosis strains may have an impact on the transmissibility profile.

Background: The aim of this study is to determine the predictive value of ultrasonography for results of local steroid injection in patients with carpal tunnel syndrome (CTS). Materials and Methods: This prospective cohort study was conducted during a 1-year period in outpatient clinics of rehabilitation and physical medicine including 35 patients with moderate and severe CTS who receive ultrasonography-guided local steroid injection. The Boston self-assessment questionnaire and electrodiagnosis parameters were recorded at baseline, 1 month, and 3 months after therapy. We also recorded the baseline ultrasonography parameters to determine the predictors of outcome. Results: The sensory severity score and functional status scale along with electrodiagnosis parameters decreased significantly at 1 month (P < 0.001) and remained unchanged after 3 months. Volar bulging was negatively associated with sensory nerve action potential latency (r = −0.392; P = 0.020). Cross-sectional area (CSA) of maximal swelling (MS; r = 0.409; P = 0.015), CSA at 2-cm of MS (r = 0.563; P < 0.001), and CSA at 12-cm of MS (r = 0.521; P = 0.001) correlated positively with compound muscle action potential (CMAP) amplitude while maximal swelling/12-cm MS ratio (r = −0.439; P = 0.008) and maximal swelling/2-cm MS ratio (r = −0.342; P = 0.045) correlated negatively. CSA at 12-cm of MS also correlated positively with CMAP amplitude nerve conduction velocity (r = 0.436; P = 0.010). Conclusion: Volar bulging, CSA of maximal swelling, CSA of MS at 2-cm, and CSA of MS at 12-cm are among the ultrasonographic predictors of response to local steroid injection in patients with CTS.

Background: L7/L12 is a protective antigen conserved in main Brucella pathogens and is considered as potential vaccine candidate. Outer membrane protein 2b is an immunogen conserved in all Brucella pathogens. Materials and Methods: The purpose of the current study was to in silico design a L7/L12-SOmp2b fusion protein and in vitro production of the chimera. Two possible fusion forms, L7/L12-SOmp2b and SOmp2b-L7/L12, were subjected to in silico modeling and analysis. Cloning and expression of the fusion protein has been done in the pET28a vector and Escherichia coli Bl21 (DE3), respectively. Results: Analysis and validation of the fusion proteins three-dimensional models showed that both models are in the range of native proteins. However, L7/L12-SOmp2b structure was more valid than the SOmp2b-L7/L12 model and subjected to in vitro production. The major histocompatibility complex II (MHC-II) epitope mapping using Immune Epitope DataBase indicated that the model contained good MHC-II binders. The L7/L12-Omp2b coding sequence was cloned in pET28a vector. The fusion was successfully expressed in E. coli BL21 by induction with isopropyl-β-d-thiogalactopyranoside. The rL7/L12-SOmp2b was purified with Ni-NTA column. The yield of the purified rL7/L12-SOmp2b was estimated by Bradford method to be 240 μg/ml of the culture. Western blot analysis revealed a specific reactivity with purified rL7/L12-SOmp2b produced in E. coli cells and showed the expression in the prokaryotic system. Conclusions: Our data indicates that L7/L12-SOmp2b fusion protein has a potential to induce both B- and T-cell-mediated immune responses and it can be evaluated as a new subunit vaccine candidate against brucellosis.

Background: Population aging and more prevalent westernized lifestyle would be expected to result in a markedly rising burden of colorectal cancer (CRC) in the future years. The aim of this study is to estimate the limited-time prevalence of CRC in Iran between 2015 and 2020. Materials and Methods: Aggregated CRC incidence data were extracted from the Iranian national cancer registry (IR.NCR) reports for 2003–2009 and from GLOBOCAN-2012 database for 2012. Incidence trends were analyzed by age groups, genders, histopathologic, and topographic subtypes to estimate annual percentage changes. Incidence was projected for 2020. The prevalence was estimated applying an adopted version of a previously introduced equation to estimate limited–time prevalence based on the incidence and survival data. Monte Carlo sensitivity analyses were applied to estimate 95% uncertainty levels (ULs). In each scenario, incidence, survival, annual percentage changes, and completeness of case ascertainment at IR.NCR were replaced under pre-assumed distributions. Results: Number of estimated within 1, 2-3 and 4-5-year CRC patients in 2015 were 13676 (95% UL: 10051–18807), 20964 (15835–28268), and 14485 (11188–19293), respectively. Estimated 5-year prevalence for 2020 (99463; 75150–134744) was 2.03 times of that for 2015. Highest 5-year prevalence was estimated in ages 55–59 for females and 75 + for males. Adenocarcinoma (41376; 31227 55898) was the most prevalent histologic subtype. The most prevalent tumor location was colon (30822, 23262–41638). Conclusion: A substantial growth in the prevalence of CRC survivors is highly expected for future years in Iran. Establishment of specialized institutes is highly recommended to provide medical and especially social supports for Iranian CRC survivors.

Background: The present study was designed to evaluate the effectiveness of magnesium sulfate (MgSO₄) in procedural sedation and analgesia (PSA) when combined with ketamine in patients with fractures in emergency departments and required short and painful emergency procedures. Materials and Methods: In this study, 100 patients with fractures and dislocations who were presented to the emergency departments and required PSA for short and painful emergency procedures were randomly allocated to groups of ketamine plus MgSO₄or ketamine alone. Train of four (TOF) stimulation pattern was assessed using nerve stimulator machine and compared between groups. Results: The mean age of studied patients was 46.9 ± 9.3 years old. 48% were male and 52% were female. No significant differences were noted between groups in demographic variables. The status of TOF, 2 min after the injection of ketamine (1.5 mg/kg), in both groups was similar. After the injection of the second dose of ketamine (1 mg/kg) the status of TOF in four patients in ketamine plus MgSO₄ (0.45 mg/kg) group changed, it was three quarters but in ketamine group, the status of TOF in all patients was four quarters. The difference between groups was not statistically significant (P = 0.12). Conclusion: The findings revealed that for muscle relaxation during medical procedures in the emergency department, ketamine in combination with MgSO₄with this dose was not effective for muscle relaxation during procedures.

Background: Thymoquinone as the main active component of Nigella sativa might have a various pharmacological effects such as antiapoptotic and antioxidant. Morphine is commonly used for the treatment of severe pain that can increase the generation of free radicals and affects the spermatogenesis. This study was designed to evaluate protective effects of thymoquinone against morphine-induced damages, sperm viability, count, motility, morphology and testis histology, and nitric oxide and testosterone hormone of the mice. Materials and Methods: In this experimental study, we divided 48 mice into eight groups (n = 6); various doses of thymoquinone (2, 10, and 20 mg/kg) and morphine (20 mg/kg) plus thymoquinone (2, 10, and 20 mg/kg) were administered intraperitoneally to 48 male mice for 30 consequent days. Male reproductive parameters including testis weight, testosterone hormone, serum nitric oxide, germinal thickness, sperm morphology, count, viability, and motility were analyzed and compared. Results: The results indicated that morphine administration significantly decreased germinal thickness, testis weight, testosterone level, viability, morphology, count, and motility of sperm and increased nitric oxide as compared to saline group (P < 0.05). However, increasing the dose of thymoquinone in the thymoquinone and thymoquinone plus morphine groups significantly decreases nitric oxide level (P < 0.05) while significantly boosted motility, morphology, count, viability of sperm cells, germinal thickness, and testosterone hormone in all groups as compared to morphine group (P < 0.05). Conclusion: It seems that thymoquinone administration could increase the quality some of spermatozoa and improves morphine-induced adverse effects on reproductive parameters in male mice

Background: Twine-arginine translocation (TAT) system is one of the exporting systems in Escherichia coli which could transport fully/semi-correctly folded proteins outside the reductive cytoplasmic space. In combination with co-expression with a chaperone system, the correctly folded proteins could be transported to oxidative periplasmic space and culture media to pass the main limitations in E. coli expression system such as misfolding and inclusion body formation. Materials and Methods: To study the effectiveness of signaling sequences and chaperone co-expression on the translocation of expressed protein, somatropin was selected as the target. Two common signal sequences in TAT system (TorA and SufI) were added at the N-terminal of somatropin and the cassettes were co-expressed in E. coli BL21 (DE3) by a chaperone team including DnaK/J-GrpeE. Results: The expression pattern studies including Western blotting and sodium dodecyl sulfate polyacrylamide gel electrophoresis confirmed that somatropin is expressed in two cassettes. However, the pattern was different for two signaling sequences. Conclusion: The results confirmed that the approach of using TAT-signaling sequences and co-expression with the chaperone team could enhance translocation of protein to periplasmic space and culture media compared to control groups. Western blotting results showed that the signal sequence TorA could transport more expressed proteins to the periplasmic space and culture media in comparison with SufI. However, there was a considerable amount of human growth hormone in the cytoplasm which could not be transported outside the cytoplasmic space.

Background: Intra-abdominal adhesions after surgery are usually in the form of bands and can annoy the patient throughout life causing repeated surgical procedures. Therefore, any action to prevent adhesions after surgery can increase longevity and quality of life. For this aim, this study investigates the effect of streptokinase and normal saline on the 7^th day and 1 month after laparotomy. Materials and Methods: Experimental study was conducted on thirty healthy male Wistar rats weighing 200–250 g with age of 3 months divided into three groups of 10. Group I: No treatment, Group II: Received normal saline, and Group III: Received normal saline and streptokinase at the same time. One week and 1 month after laparotomy, the frequency of the presence or absence of adhesion bands was performed by a person who was unaware of the sample grouping. The collected information was analyzed with the SPSS software (version 16; SPSS Inc., Chicago, IL, USA). Results: Adhesion frequency was found to be 20% on the 7^th day (early) and 1 month after laparotomy (late) for Group 1, and it was 40% on early and late for Group II, while 0% on the early and late for Group III. Hence, in the group receiving streptokinase, no early or late adhesion was observed; therefore, it had a significant role in the prevention of intra-abdominal adhesions (P < 0.05). However, adhesions in the group receiving normal saline had no remarkable difference with the group receiving no drug (P > 0.05). Conclusion: According to the results of our study, we believe that streptokinase could be a good antiadhesive agent considering its effectiveness.

Background: The deleterious effect of oxidative stress on myocardial ischemia–reperfusion (I/R) has already been shown in previous studies. Since Teucrium polium has anti-oxidative and cardio-protective properties, the aim of this study was to investigate the effects of this plant on I/R injuries in the isolated rat heart. Materials and Methods: The myocardial I/R injury of rat was created by Langendorff retrograde perfusion technology. The heart was preperfused with Krebs–Henseleit (K-H) solution containing T. polium extract for 20 min before 20 min global ischemia, and then the reperfusion with K-H bicarbonate buffer was conducted for 40 min. The left ventricular developed pressure and the maximum up/down rate of the left ventricular pressure (±dp/dt_max) were recorded by physiological recorder as the myocardial function. Lactate dehydrogenase (LDH) and creatine kinase (CK) activities in the effluent were measured to determine the myocardial injury degree. Thiobarbituric acid reactive substances (TBARS), total thiol groups (−SH), superoxide anion dismutase (SOD), and catalase (CAT) in myocardial tissue were detected to determine the oxidative stress degree. Results: The results showed that the pretreatment with T. polium significantly enhanced cardiac parameters and the coronary artery flow, decreased the LDH, CK activities, and TBARS level, whereas it increased − SH groups, SOD and CAT activities. Conclusions: Our findings indicated that T. polium could provide protection for heart against the I/R injury which may be related to the improvement of myocardial oxidative stress states.

Background: Both microRNAs (miRNAs) and long noncoding RNAs (lncRNAs) have been shown to have a critical role in the regulation of cellular processes such as cell growth and apoptosis, as well as cancer progression and metastasis. lncRNAs are aberrantly expressed in many diseases including cancer. Although it is well known that miRNAs can target a large number of protein-coding genes, little is known whether miRNAs can also target lncRNAs. In the present study, we determine whether miR-21 can regulate lncRNA cancer susceptibility candidate 2 (CASC2) in colorectal cancer. Materials and Methods: LS174T cells were transfected with locked nucleic acid (LNA)-anti-miR-21 and scrambled LNA for 24, 48 and 72 h. The expression of miR-21 and lncCASC2 was evaluated by quantitative reverse transcriptase polymerase chain reaction. Results: However, contrary to what we expected and reported by others, lncCASC2 quantity was significantly reduced in LNA treated LS174T cells compared to the scrambled treated and normal untreated cells (P < 0.05). Conclusion: The interaction of miRNA and lncRNA are not as simple as suggested by other reports. Moreover, it could be complex molecular mechanisms underlying the communication of various noncoding RNA elements.

Background: The prevalence of anxiety disorders among children and adolescents are found to be approximately between 8–12 and 5–10, respectively, and the long-lasting effects of such disorders can expose the sufferers to impairment and dysfunction in several areas of life the examples of which are poor educational performance, low self-esteem, and depression. The present study aims to evaluate the efficacy of internet-based, cognitive-behavioral therapy (ICBT) in treating the anxiety disorders among adolescent females. Materials and Methods: The sample included thirty girls aged between 10 and 18 years suffering from a variety of anxiety disorders, under pharmaceutical therapy and referred to clinics of child and adolescent psychiatry specialists in Isfahan. The sample was selected through diagnostic interviews by psychiatrists based on the Diagnostic and Statistical Manual of Mental Disorders, 4^th Edition, Text Revision; afterward, they were randomly assigned to either the experimental or the control groups. To evaluate the efficacy of an ICBT in reducing anxiety disorder symptoms, Screen for Child Anxiety Related Emotional Disorders questionnaire was administered among the patients both before and 4 weeks after the treatment. Results: The covariance analysis results aimed to compare the anxiety disorder score variations between the two groups which demonstrate the fact that anxiety disorder scores in these two groups differ from one another (P < 0.001). Conclusions: This study is comprised of two Conclusions.the significant reduction in the mean of anxiety disorders scores in the experimental group compared to those in control group can be indicative of the efficacy of ICBT. In addition the significant reduction in the average of anxiety disorders symptoms' scores according to the type of anxiety disorders in the experimental group, compared to those in control group, can be indicative of the efficacy of ICBT.

Background: Unilateral ureteral obstruction (UUO) alters the expression of renin-angiotensin system (RAS) components and angiotensin 1-7 (Ang 1-7) as a main arm of RAS is affected by UUO. The role of Mas receptor antagonist (A779) was examined in renal hemodynamic responses to Ang 1-7 in 3-day UUO and UUO removal (RUUO) in rats. Materials and Methods: Forty-five male Wistar rats were randomly divided into three groups of sham operated, UUO, and RUUO, while each group was divided into two subgroups treated with vehicle or A779. Renal blood flow (RBF) and renal vascular resistance (RVR) responses to graded Ang 1-7 infusion were measured at controlled renal perfusion pressure. Results: Mean arterial pressure response to Ang 1-7 was increased in vehicle-treated subgroup significantly (P < 0.05) when compared with A779-treated subgroup. However, such observation was not seen in UUO and RUUO rats. The graded Ang 1-7 infusion increased RBF and decreased RVR significantly in vehicle-treated rats (P < 0.005). Furthermore, a significant difference was found between vehicle and A779-treated subgroups in sham, UUO, and RUUO groups (P < 0.005). Conclusion: Ang 1-7 could alter the kidney hemodynamics responses in ureteral obstruction models.

Background: Ulcerative colitis (UC) is an idiopathic inflammatory disorder. Currently, the final treatment is colectomy. The aim of this study was to investigate the outcomes of proctocolectomy in patients that used a high dose of prednisolone. Materials and Methods: Seventy-five patients presenting for surgical management of histopathologically proven UC. All patients were offered total proctocolectomy (TPC) with ileal pouch-anal anastomosis (IPAA). Patients were divided into two groups: low dose of steroids (Group A) and high dose of steroid (Group B) consumers. Data from these patients after 2 years were reviewed and analyzed. Results: From total patients, 34 of them were male and 34 ones were female and seven patients underwent laparatomy. Overall incontinence rate was 8.8%; dysplasia was 22%, pouchitis was 18.9% while mortality was nil. The length of hospital stay was 6.76 days in Group A and 9.21 days in Group B (P = 0.399). Leakage was observed in nine of the patients after surgery (P = 0.589). Fecal incontinence between two groups was not statistically different (P = 0.063). Conclusions: Laparoscopic TPC-IPAA is feasible in patients needing surgical management of UC. Preoperative treatment with high-dose corticosteroids is associated with an increased risk of complications and reoperations.

Background: Extended-spectrum β-lactamase (ESBL)-producing is a significant resistant mechanism to β-lactams in Enterobacteriaceae, especially in Klebsiella pneumoniae. The main objectives of this study were to genetically characterize urinary clinical isolates of K. pneumoniae through the investigating of blaTEM, blaCTX-M and using molecular typing by Enterobacterial repetitive intergenic consensus polymerase chain reaction (ERIC-PCR) method. We also determined the frequency of antibiotic resistance of K. pneumoniae strains to characterize the β-lactamases included. Materials and Methods: A cross-sectional study was carried out to evaluate 98 strains of K. pneumoniae isolated from urine culture of outpatients referred to Al-Zahra Hospital, Isfahan, Iran. Antibiotic susceptibility testing was performed using Kirby–Bauer's method. Screening of ESBLs was carried out using double-disk screening test. PCR technique was performed to detect TEM and CTX-M genes. The total DNA of each strain was tested by ERIC-PCR. Results: In 98 K. pneumoniae studied clinical isolates, 25.5% were ESBL producing and 44.9% multidrug-resistant (MDR). From 25 ESBL isolates, 23 (92%) cases showed MDR phenotype. In ESBL producing isolates, 23 (92%) were blaCTX-M and 19 (76%) blaTEM positive. The antimicrobial drug susceptibilities of ESBL isolates indicated high resistant rates for cefotaxime and ceftazidime. All 25 ESBL producing isolates were resistant to cefotaxime. Complex patterns of fingerprints isolates showed that 36% of the isolates were belonged to the cluster no 5. Conclusion: This study revealed high antimicrobial resistance rates among ESBL isolates which can lead to various health difficulties. Epidemiological data collection from patients is recommended to develop the strategies to manage antibiotic resistance.

Background: Anterior knee pain is a major problem in total knee arthroplasty (TKA). It is accepted that anterior knee pain (AKP) often contributes to a patellofemoral etiology; however, its etiology or treatment is not understood completely. Disabling pain receptors by electrocautery could theoretically lead to anterior knee area denervation. The present study aimed to evaluate the pain post-patellar denervation (PD) with electrocautery in TKA. Materials and Methods: Clinical results for 92 patients who underwent TKA (58 women, 34 men; mean age 67.5 years) were analyzed. In addition to removal of all osteophytes, PD by electrocautery was performed on patella of treatment group (n = 46) and debridement alone including removing of all osteophytes was performed on the control group (n = 46). Knee Society System (KSS) score, patella score (PS), and visual analog scale (VAS) were used to determine pre- and post-operative AKP. Results: The follow-up duration was 10 months. No revision or reoperations were performed. There were no patellar fractures. On all parameters (KSS score, PS, and VAS), there was a statistically significant pre- to post-operative difference in favor of the denervation group only 3 weeks after operation; however, there was no statistically difference postoperation on other follow-ups (3, 6, and 10 months). Conclusions: PD with electrocautery could reduce AKP in TKA without patellar resurfacing only in a short-term period postoperation.

Background: Superparamagnetic iron oxide nanoparticles (SPION) have been largely considered for numerous applications in biomedicine such as magnetic resonance imaging, hyperthermia, cell tracking, anticancer treatment, and targeted delivery of drugs or genes. However, they may have side effects such body weight loss. Quercetin (QT), a strong antioxidant and free radical scavenger and a natural flavonoid, has a wide range of biological and therapeutic effects. In this study, the effect of QT on prevention of weight loss due to the using of SPION has been investigated. Materials and Methods: SPION and QT-SPION were administered orally at 50 and 100 mg/kg for 7 days. Then, the body weight was measured at the beginning and the end of the study. Results: Rats fed with 50 and 100 mg/kg SPION showed a significant weight loss, whereas those that fed with 50 mg/kg QT-SPION did not. A weight loss was observed in rats treated with 100 mg/kg of QT-SPION. Conclusions: The results of this study showed that quercetin could prevent weight loss due to the SPION.

Tyrosinemia type III is an autosomal recessive disorder caused by the deficiency of 4- hydroxyphenylpyruvate dioxygenase (4-HPPD). It is characterized by elevated levels of blood tyrosine and massive excretion of its derivatives into the urine. Clinical findings of tyrosinemia type III include neurological symptoms and mental retardation. Only a few patients presenting with this disease have been described, and the clinical phenotype remains variable and unclear. We present a case, who was admitted to the hospital at the age of 4 months for recurrent seizures. Two months later, she was admitted again with status epilepticus. Laboratory data showed increased level of tyrosine in the blood. She was treated with a diet low in tyrosine and phenylalanine and anamix formula that leading to catch-up growth and improvement of her symptoms. Plasma tyrosine level dropped to normal values. In any child who presents with the neurologic symptom, some rare diagnosis like tyrosinemia type III should be considered.

Background: Cerebral aneurysms are a kind of cardiovascular diseases which are accompanied with high morbidity and mortality due to rupturing and causing subarachnoid hemorrhages. The current study aimed to determine epidemiologic and demographic features and prognosis of patients with cerebral aneurysms. Materials and Methods: In this cross-sectional study, 465 patients with cerebral aneurysms hospitalized in Al-Zahra Hospital were studied. The required information including demographic, epidemiologic, and clinical features of the disease were extracted from their records. The obtained data were analyzed using SPSS software and the factors associated with the prognosis of the disease were determined. Results: Four hundred and sixty-five cases with cerebral aneurysm undergoing surgery were investigated. The mean age of the patients was 48 ± 14 years whereas 216 cases (46.5%) were male and 249 (53.5%) were female. Two hundred and thirty-seven patients (51%) remitted completely while the disease caused moderate disability in 84 cases (18.1%), severe disability in 24 ones (5.2%) and vegetative state in 9 cases (1.9%) and mortality in 57 ones while it was unknown in 54 cases (11.6%). In terms of the age of patient, WFNS index, anatomical position of aneurysm, type of aneurysm lesion, the incidence season of the disease, type of postoperative complications, family history and operative approach, the disease outcome had a significant difference while gender, ethnicity, and risk factors had no significant effect on the disease outcome. Conclusions: According to the type of aneurysm, the incidence position of the aneurysm and other epidemiologic, demographic, and clinical features, providing the prevention and treatment strategies is necessary.

Background: Respiratory infections are a frequent cause of fever in neutropenic patients, whereas respiratory viral infections are not frequently considered as a diagnosis, which causes high morbidity and mortality in these patients. Materials and Methods: This prospective study was performed on 36 patients with neutropenia who admitted to hospital were eligible for inclusion with fever (single temperature of >38.3°C or a sustained temperature of >38°C for more than 1 h), upper and lower respiratory symptoms. Sampling was performed from the throat of the patient by the sterile swab. All materials were analyzed by quantitative real-time multiplex polymerase chain reaction covering the following viruses; influenza, parainfluenza virus (PIV), rhinovirus (RV), human metapneumovirus, and respiratory syncytial virus (RSV). Results: RV was the most frequently detected virus and then RSV was the most. PIV was not present in any of the tested samples. Furthermore, no substantial differences in the distribution of specific viral species were observed based on age, sex, neutropenia duration, hematological disorder, and respiratory tract symptoms and signs (P > 0.05). Conclusion: Our prospective study supports the hypothesis that respiratory viruses play an important role in the development of neutropenic fever, and thus has the potential to individualize infection treatment and to reduce the extensive use of antibiotics in immunocompromised patients with neutropenia.

Background: Although the role of self-rated health (SRH) on all-cause mortality is known, we still do not know whether SRH predicts death due to specific causes (e.g., kidney disease). The current study aimed to compare Blacks and Whites on the association between SRH and mortality due to kidney diseases. A nationally representative sample of adults in the United States was used to provide generalizable results to the United States population. Materials and Methods: The Americans' Changing Lives study is a nationally representative cohort, conducted from 1986–2011. The study followed 3361 Blacks (n = 1156) and Whites (n = 2205) for up to 25 years. The outcome was time to death due to kidney diseases, derived from death certificates and the National Death Index. Cox proportional hazards models were used to test whether race and baseline SRH interact on mortality due to kidney diseases. Results: In the pooled sample, poor SRH (odds ratio [OR] = 2.29, 95% confidence interval [CI] = 1.24–4.24) was associated with an increased risk of death due to kidney diseases over the follow-up period. Baseline SRH also showed a significant interaction with race on the outcome (OR = 0.49, 95% CI = 0.25–0.96), suggesting a stronger effect of SRH on deaths due to kidney diseases for Whites compared to Blacks. In race-specific models, poor SRH at baseline increased risk of death due to kidney diseases among Whites (OR = 2.23, 95% CI = 1.14–4.34) but not Blacks (OR = 1.14, 95% CI = 0.54–2.41). Conclusions: Blacks and Whites differ regarding the predictive role of baseline SRH on death due to kidney diseases over time. Factors such as SRH better predict risk of mortality for Whites than for Blacks.

Background: In this study, functional state of patients with Type C distal humerus fractures undergone surgical plating was evaluated 6 and 12 months after the surgery in order to record postsurgical factors such as pain level and job/performance satisfaction. Materials and Methods: In this cross-sectional study, 46 patients with humerus fractures were recruited and their ability to do daily tasks, presence of degenerative changes, stability of elbow joint, and range of motion was evaluated. For assessment of response to surgery, Mayo score was used. Results: Among 46 patients, 45 (97.8%) of them had joint stability. Evaluation of postsurgical complications showed that six subjects (13%) had no complications, but superficial infection was observed in 12 (26.1%) subjects. Neuromuscular disorders in ulnar nerve were present in 11 subjects (23.9%), recurrent articular bursitis of elbow joint in 6 subjects (13%), stiffness of elbow joint in 29 subjects (63%), nonunion of fracture in 3 subjects (6.5%), and myositis ossification in 4 (8.7%) subjects. Furthermore, 18 (39.1%) patients presented with more than one (2–4) complications. Conclusion: Open reduction and internal fixation surgery with dual plating is the method of choice for treatment of Type C distal humeral fractures. Evaluation of long-term outcomes of this surgery could be done via several different questionnaires as many studies suggest. This study demonstrated that the outcomes of this surgery in Isfahan, Iran, have been noticeably inferior compared to results of the studies in other parts of the world.

Background: As marcaine is administered to a great extent due to minor complications and reasonable expenses and as discectomy is prevalently used in Iran, this study makes a comparison between effect of marcaine alone, lidocaine alone, and marcaine plus lidocaine on pain relief of patients undergoing lumbar disc open surgery. Materials and Methods: In a clinical trial study, 192 patients were selected and randomly divided into four groups. Patients in Groups 1–4 received 0.5 ml marcaine during surgery, 5 ml lidocaine 2% before incision, 5 ml lidocaine 2% before incision plus 5 ml marcaine during surgey and normal saline, respectively. After patients gained knowledge of visual analog scale (VAS) criteria, their severity of pain was measured and was recorded in their profiles, along with demographic details and history of diseases. After surgery and their transfer to their rooms, their severity of pain was measured and recorded again by using VAS criteria. Finally, difference between the four groups was compared by SPSS software. Results: The mean (±standard deviation) of postoperative pain in marcaine + lidocaine, marcaine, lidocaine, and normal saline was 3.5 ± 1.3, 3.5 ± 1.6, 36.1.9, and 4.2 ± 1.8, respectively, and we did not observe any significant difference in severity of pain after surgery in these groups (P = 0.15). The highest and lowest degree of satisfaction occurred in marcaine-lidocaine group and control group, respectively, (40 patients [83.3%] vs. 25 patients [52.1%]). Conclusion: Lidocaine-marcaine treatment reduces the need to opiates in cases of postoperative pain relief of discectomy and provides patients with great satisfaction.

Background: Due to the prevalence of autoimmune hypothyroidism and its effects on physical and mental health it is necessary to provide a treatment which is also effective in preventing the progression of sub-clinical hypothyroidism in these patients. This study aims to investigate the effect of selenium supplementation on of anti-thyroid hormone antibodies in these patients. Materials and Methods: In a randomized clinical trial, 70 patients with autoimmune hypothyroidism randomly divided into two groups of 35 each, the first group was treated with oral selenium treatment with levothyroxine (LT4) and to the second group along with LT4, placebo was also prescribed. Serum selenium level, thyroid hormones and anti-thyroid hormone antibodies before and after 3 months of treatment in both groups, were determined, and the results were analyzed using SPSS software. Results: The mean of the serum anti-thyroid peroxidase serum level in the intervention group before and after treatment was 682.18 ± 87.25 and 522.96 ± 47.21 and the difference before and after treatment was statistically significant (P = 0.021). The level of this antibody before and after treatment in the control group was 441 ± 53.54 and 501.18 ± 77.68, and no significant differences between two groups were observed before and after treatment (P = 0.42). Conclusion: Selenium supplementation may help to reduce the levels of antibodies in patients with autoimmune hypothyroidism.