Background: Syncope is an important and common clinical condition, and the neurally mediated syncope is the most frequent type of syncope. Tilt testing is considered as a first-line diagnostic test. Materials and Methods: We conducted the conventional and modified tilt test on 200 subjects in the age range of 5-20 years. In conventional protocol, the patient was tilted for up to 15 min without medication. If syncope did not develop, the patient received 0.1 mg/kg sublingual isosorbide dinitrate. Then, the patient was continued to be tilted for another 15 min. In modified tilt test, before starting the test, the patient received 0.1 mg/kg isosorbide dinitrate sublingually in supine position. Then, the table was tilted for a maximum of 25 min or until the test became positive. Results: In conventional tilt test group 79.13% and in modified tilt test group 87.06% of subjects showed positive results. In conventional tilt test, the mean of response time was 17.67 ± 4.74 min. The mean of the total time of conventional tilt test was 49.81 ± 5.57 min. In modified tilt test, the mean of response time was 7.24 ± 4.83 min. The mean of the total time of modified tilt test was 35.09 ± 7.58 min. Furthermore, the means of both response and total times between two groups were significantly different (P < 0.001). Conclusions: Our study showed that we can save about 15-20 min in total test time which may increase the cooperation and compliance of young patients and decrease their anxiety with this new protocol.

Background: The objective of the present study was to assess the major immediate outcomes of eptifibatide therapy during intracoronary stent implantation. Materials and Methods: In an interventional study, patients undergoing percutaneous coronary intervention (PCI) were randomized into either the eptifibatide (n = 100) or the control (n = 107) group. In each group, demographic and clinical characteristics such as cardiac death, stent thrombosis (ST), myocardial infarction (MI), rates of target lesion and vessel revascularization, cerebral vascular accident (CVA), and emergency coronary artery bypass grafting (CABG) were recorded. Results: The overall rates of major adverse events such as mortality, Stent thrombosis (ST), Myocardial Infarction (MI), target lesion revascularization (TLR), target vessel revascularization (TVR), CVA, and emergency CABG within 24 h after stent implantation were low and comparable between the two groups; P > 0.05 considered significant for all comparisons. Conclusion: There were no statistical differences between the clinical outcomes of groups administered with single-dose intracoronary eptifibatide and control groups among patients undergoing PCI during stent implantation.

Background: 22q11.2 microdeletion syndrome is the most common multiple genetic disorder associated with learning disabilities, developmental delays, immune deficiency, hypocalcemia, and cleft palate. Finding some valid criteria for screening of 22q11.2 deletion syndromes in infants would be very helpful in early diagnosis and treatment. Materials and Methods: Since 69% of individuals with 22q11.2 deletion have a palatal abnormality, we studied the prevalence of 22q11.2 deletion syndrome in 378 Iranian patients during a 5-year period, including 291 patients affected with cleft palate only without cleft lip (CPO) and 87 patients affected with velopharyngeal incompetence (VPI) and/or submucous cleft palate (SMCP). DNA copy number was analyzed with multiplex ligation-dependent probe amplification (MLPA) technique. Results: In our study, 15/378 (3.97%) patients with palatal anomalies showed 22q11.2 deletion. Interestingly, this prevalence between syndromic patients was 15/104 (14.42%). Conclusion: It seems that SMCP or VPI, in addition to one or more another features of 22q11.2 deletions, especially developmental delay, may be good criteria for molecular investigation of 22q11.2 region.

Background: Degenerative changes and inflammation in the rotator cuff (RC) are the most important causes of shoulder pain. The aim of the present study was to determine the effectiveness of platelet-rich plasma (PRP) in patients with chronic RC tendinopathy. Materials and Methods: This study was an open-label study performed at Kashani Hospital between April 2012 and June 2014. Patients with a <1 cm partial tearing of the bursal side of RC with no or little response to conservative management were included. PRP injection was done using ultrasonography guide via posterior subacromial approach. Demographic data were obtained in all patient before the study, and shoulder function was evaluated using Constant shoulder score (CSS) before and 3 months after PRP injection. Results: A total number of 17 patients were enrolled. The mean of CSS before and after intervention was 37.05 ± 11.03 and 61.76 ± 14.75, respectively (P < 0.001). There was no statistically significant correlation between the pain score before the study and the improvement in CSS (P = 0.45, r = 0.03). Significant relation was observed between the individuals' age and improvement of CSS (P = 0.02, r = −0.49). There was no significant difference in CSS improvement between genders (P = 0.23). Conclusion: Single injection of PRP is effective to reduce pain and improve range of motion in patients with bursal side partial tearing of RC who failed to respond to conservative treatments.

Background: Dorema aucheri is a plant of Apiaceae family which is used widely in some states of Iran. Different extracts and essential oil of Dorema species contain flavonoids and cumarin compounds which have anti-hypertensive, cholesterol- and triglycerides-lowering properties. This study was undertaken to evaluate the genotoxic properties of hydroalcoholic and aqueous extracts of D. aucheri on human hepatoma cells using the comet assay method for safety evaluation. Materials and Methods: In this method, after incubation of cells with different concentrations of extracts, cell suspensions were added to pre-coated normal agarose slides. After lysis, electrophoresis and neutralization process, staining was done by ethidium bromide and comets were observed using a fluorescence microscope. Tail length, percentage of DNA in tail and tail moment parameters were measured. Results: Statistical analysis of the results demonstrated that concentrations more than 500 μg/ml of hydroalcoholic and aqueous extract of D. aucheri were genotoxic. Conclusion: It can be concluded from the results that taking the concentrations less than these dosages of extracts are safe but more studies are required to determine genotoxic mechanisms of this plant.

Background: Patients with functional dyspepsia (FD) may use specific coping strategies. Hence, the aim of the present study was to compare cognitive emotion regulation strategies in FD patients and healthy controls. Materials and Methods: This was a descriptive observational study. The sample consisted of 86 individuals, 43 of whom were patients diagnosed with FD. The patients referred to the psychosomatic disorders clinic, Isfahan, Iran. The comparative sample included 43 healthy controls (without digestive diagnoses) matched with the patients by age and gender. Subjects completed data on demographic factors and cognitive emotion regulation questionnaire. Results: The results indicated that there are significant differences between patients with FD and healthy controls according to using cognitive strategies. Scores of healthy controls in positive reappraisal and acceptance were significantly more than FD patients, and inversely, scores of FD patients in rumination and other-blame were meaningfully more than healthy controls. Conclusion: FD patients apply less adaptive strategies and more maladaptive strategies. It is seemed psychological interventions that focus on reducing maladaptive strategies and increasing adaptive strategies could be effective for FD patients.

Background: Current studies have indicated a high ratio of psychological problems in functional dyspepsia (FD) which causes disturbance in its management, so recognition these problems help the process of treatment. Materials and Methods: This was a cross-sectional study with a sample size of 4763 carried out in Isfahan University of Medical Sciences in 2011. Modified ROME III questionnaire was used to evaluate FD symptoms. Hospital anxiety and depression scale and 12-item General Health Questionnaire-12 was used to assess the psychological issue. Logistic regression analysis was used to assess the association of psychological problems and FD. Results: We showed that overly 654 (13.7%), 1338 (28.1%), and 1067 (22.4%) of participants, respectively had anxiety, depression, and of psychological distress. Seven hundred and ten (15.5%) participants were diagnosed with FD. Of all participants Mean scores of anxiety (P < 0.001), depression (P < 0.001), and psychological distress (P < 0.001) in participants with FD were significantly more than those with no FD. Multivariate logistic regression analysis showed that psychological problems, whether in the form of psychological distress odds ratio (OR): 2 (95% confidence interval [CI]: 1.3–3) and OR: 1.3 (95% CI: 1.1–1.7) in males and females, respectively, anxiety OR: 2.4 (95% CI: 1.5–3.9) and OR: 2.3 (95% CI: 1.7–3.2) in males and females, respectively) or depression OR: 2.2 (95% CI: 1.5–3.3) and OR: 1.7 (95% CI: 1.3–2.3) in males and females, respectively) were significantly linked to FD in both genders. Conclusions: The prevalence of FD is less in males than females, but psychological links were stronger in males. Thus, it is essential to consider and detect the psychological distress in these patients.

Background: To evaluate effectiveness of collagen crosslinking in pellucid marginal degeneration patients. Materials and Methods: Twenty-one eyes of 15 patients treated by collagen crosslinking were enrolled in our non-controlled clinical trial study. After evaluation of patients about inclusion and exclusion criteria, preoperative examination was done and then patients underwent CXL procedure and seen 6 months after surgery for postoperative examinations. Results: Mean preoperative LogMar uncorrected visual acuity (UCVA) was 0.63 (SE = 0.08), and mean preoperative LogMar BCVA was 0.26 (SE = 0.04). At 6 months postoperative, mean LogMar UCVA was 0.59 (SE = 0.06) and mean LogMar BCVA was 0.19 (SE = 0.02). The non-parametric test (Wilcoxon) showed reduction of LogMar BCVA was significant (P value = 0.02), but reduction of LogMar UCVA was not significant (P value = 0.5). Mean preoperative K1 was 42.23 ± 2.85 and mean postoperative K1 significantly decreased to 41.68 ± 2.44 (P value = 0.008). Also, mean preoperative K2 was 48.39 ± 2.37 and mean postoperative K2 significantly reduced to 47.64 ± 2.16 (P value = 0.002). Conclusion: Most remarkable findings of our study were improvement of visual acuity and reduction K1 and K2 parameters. Stability of other values and absence of detectable change after study period implies halting of the progression of the disease. We suggest CXL can be useful for management of PMD, but we need more studies with larger sample size and longer follow up.

Background: One of the standard equipment in medical linear accelerators is multi-leaf collimators (MLCs); which is used as a replacement for lead shielding. MLC's advantages are a reduction of the treatment time, the simplicity of treatment, and better dose distribution. The main disadvantage of MLC is the radiation leakages from the edges and between the leaves. The purpose of this study was to determine the effect of various treatment parameters in the magnitude of MLC leakage in linear accelerators. Materials and Methods: This project was performed with ONCOR Siemens linear accelerators. The amount of radiation leakage was determined by film dosimetry method. The films were Kodak-extended dose range-2, and the beams were 6 MV and 18 MV photons. In another part of the experiment, the fluctuation of the leakage was measured at various depths and fields. Results: The amount of leakage was generally up to 1.5 ± 0.2% for both energies. The results showed that the level of the leakage and the amount of dose fluctuation depends on the field size and depth of measurement. The amount of the leakage fluctuations in all energies was decreased with increasing of field size. The variation of the leakage versus field size was similar to the inverse of scattering collimator factor. Conclusions: The amount of leakage was more for 18 MV compare to 6 MV The percentage of the leakage for both energies is less than the 5% value which is recommended by protocols. The fluctuation of the MLC leakage reduced by increasing the field size and depth.

Background: Folic acid supplementation had previously mentioned as a protective factor against the onset of preeclampsia (PE). In this study, we aimed to compare the effect of high dose (5 mg daily) and low dose (1 mg daily) of folic acid supplementation on prevalence, onset and severity of PE. Materials and Methods: Pregnant women who were in the first trimester and referred to prenatal care university hospitals of Isfahan, Iran during October 2013–May 2015 were included in this study, then they were randomly divided into two groups of 5 mg and 1 mg (treated with daily 5 mg and 1 mg of folic acid, respectively), both groups received folic acid from the first trimester of pregnancy to 42 days after termination. Blood pressure, body mass index (BMI), and some urine and blood biochemistry parameters were measured. SPSS-22 used for statistical analysis. Results: A total of 943 pregnant women participated in the study (450 women in 1 mg group and 450 women in 5 mg group). Incidence rate of PE was 3.8% in 1 mg group and 2.4% in 5 mg group. In a comparison of preeclamptic patients in 1 mg and 5 mg group, no significant differences were seen regarding age, BMI, laboratory data, the severity of the disease, and onset (early or late) (P > 0.05). Conclusion: Although our findings support that administration of high dose folic acid may decrease the prevalence of PE, there is not enough data to support that higher amount of folic acid administration can reduce the severity of presentation's signs or ameliorate the laboratory data and the onset of PE.