Background: Ectopic pregnancy (EP) occurs in 1% of pregnancies, and may seriously effects on women's health and future fertility so this study aimed to compare the results of hysterosalpingography (HSG) after treatment of EP by laparoscopy, laparotomy, and methotrexate (MTX) therapy. Materials and Methods: This was a clinical trial study was done on 112 EP women with treatment indication referred to Isfahan Al-Zahran and Shahid Beheshti Hospitals from 2017 to 2018. They were divided into 33 populated groups of laparoscopic salpingostomy, laparotomy and MTX. Then patients of three groups underwent HSG 3 months after intervention. The factors such beta human chorionic gonadotropin (β–hCG) (mIU/mL), size of EP (mm), infection, hospital length of stay (LOS), and tubal patency were recorded and compared between the groups. Results: There were no significant differences between groups for age, body mass index, β–hCG, Size of EP, and hospital LOS (P > 0.05). The infection was more frequent in laparotomy group with no significant difference among three groups. The infection rates were 9%, 12%, and 6% for MTX, laparotomy, and laparoscopy arms, respectively. Between the three groups tubal patency as primary outcome had higher frequency than laparoscopy group, although, the difference was not statistically significant (P = 0.595). Conclusion: Although infection was more in laparotomy and that tubal patency was more within 3 months in laparoscopy and MTX, there were no statistically significant differences in the results of laparoscopy, laparotomy, and MTX in HSG results.

Background: CA1, as a major structure involved in learning and memory, has been shown to be affected by tramadol addiction. Both orexin and endocannabinoid receptors express in CA1 and play an important role in drug dependency. The aim of this study was to evaluate the modulatory effects of orexin-2 (OX2R) and endocannabinoid-1 (CB1R) receptors on neuronal activity in CA1, in response to tramadol in rats. Materials and Methods: Male Wistar rats were divided into 8 groups (n = 6–7); saline-dimethyl sulfoxide (DMSO), tramadol-DMSO, saline-TCS-OX2-29, saline-AM251, tramadol-TCS-OX2-29, tramadol-AM251, saline-TCS-OX2-29-AM251, tramadol-TCS-OX2-29-AM251. Tramadol was injected intraperitoneally, and then, AM251 (1 nmol/0.3 μL), CB1R antagonist and TCS-OX2-29 (1 nmol/0.3 μL), OX2R antagonist, were microinjected individually or concurrently into the CA1. Using in vivo extracellular single-unit recording, the firing of CA1 pyramidal neurons was investigated. Results: Tramadol decreased neuronal activity in CA1 (P < 0.01) but increased it after micro-injection of DMSO. TCS-OX2-29 increased neuronal activity in saline group (P < 0.05) but decreased it in tramadol group. AM251 had no effect on saline group but decreased neuronal activity in tramadol group (P < 0.05). Concurrent micro-injection of TCS-OX2-29 and AM251 had no effect on saline group but decreased neuronal activity in tramadol group (P < 0.05). Conclusions: Our findings suggest that neural activity in CA1 is rapidly affected by acute use of tramadol, and some of these effects may be induced through the endocannabinoid and orexin systems. Thus, the function of endocannabinoid and orexin systems in CA1 may play a role in tramadol addiction.

Background: The present study investigated the plasma level of fibrinogen before and after removing the pump in coronary artery bypass graft (CABG) surgery and its relationship with the need for blood products. Materials and Methods: The present study was performed on 60 patients who were candidates for CABG surgery. The fibrinogen level of these patients was assessed and recorded before surgery and immediately after removing the pump. In addition, their hemoglobin level was recorded before the operation and 2 h after. In addition, the number and type of blood products transfusion were recorded intraoperatively and postoperatively and also at the intensive care unit. Results: Patients' fibrinogen level after removing the pump with the mean of 130.53 ± 122.01 mg/dl decreased significantly compared to before surgery with the mean of mg/dl 224.95 ± 132.88 mg/dl (P < 0.001). In addition, the prognostic value of fibrinogen after removing the pump in determining the postoperative need of blood transfusion showed that the cut-off value of fibrinogen was < 196 mg/dl with a sensitivity of 16.82% and specificity of 80%, but it was not statistically significant (area under the curve [95% confidence interval]: 0.519 [0.350–0.689]; P = 0.825). Conclusion: According to the results of the present study, due to significant changes in fibrinogen levels after removing the pump compared to preoperation, it seems that this factor can play an important role in prognosis of the need to postoperative blood transfusion, although the prognostic value and the critical point mentioned in our study was not significant and it is required to do further studies.

Background: Tramadol is an opioid analgesic with monoamine reuptake inhibitory effects. Although tramadol has been widely used to control pain, there is controversy about the risk of abuse. Therefore, in the present study, the acute effects of tramadol on neuronal activity in the medial prefrontal cortex (mPFC), which is one of the important centers of the reward system, were investigated electrophysiologically. Materials and Methods: Tramadol was injected interperitoneally (12.5 and 25 mk/kg) or subcutaneously (40 mg/kg) and its effect on the firing of mPFC neurons was investigated, using in vivo extracellular single unit recording. Results: Tramadol could not significantly affect neural activity in mPFC, suggesting no acute and rapid effect on mPFC. Conclusions: The present results showed that neural activity in mPFC was not rapidly affected by acute application of tramadol. Since the role of mPFC in tramadol addiction has been elucidated, it can be concluded that these effects may be due to delayed responses or chronic use of tramadol.

Introduction: The aim of this study was to assess the effect of a community-based intervention on social capital, quality of life, self-care, and health literacy among elderly. Materials and Methods: This quasi-experimental trial was conducted at two health-care centers in Isfahan, Iran, which assigned to the intervention and control groups. A total of 86 elderly (60 years or above) enrolled in the study. The intervention program consisted of 12 weekly group sessions with various health topics. Nine sessions held in the health-care center and three local tours in different locations of the neighborhood. The control group received routine care of health centers. Social capital, quality of life, self-care, and health literacy were assessed at baseline and 1 month after the intervention in two groups. Results: Mental component of quality of life (P = 0.026), self-care, and health literacy (P < 0.001) showed a significant increase in the intervention group compared to the control group at 1 month after the intervention. The total score of social capital and the dimensions of local community participation, social agency, feelings of security and trust, interactions with neighbors, and interactions with family and friends improved in the intervention group (P < 0.001). However, there was no significant difference in the dimensions of tolerance of diversity (P = 0.241) and value of life (P = 0.928). Conclusions: This community-based interventions with a variety of diverse and participatory components can be used as a strategy to promote the health of the elderly in primary health care.

Background: Altered heart rate variability (HRV) has been associated with a number of disorders affecting autonomic tone, including recent myocardial infarction, congestive heart failure, and diabetic neuropathy. Furthermore, obstructive sleep apnea (OSA) has been shown to be associated with characteristic disturbances in heart rhythm. In this study, using HRV frequency analysis, an attempt has been made to diagnose or possibly diagnose OSA. Materials and Methods: Using Somnologica version 3.3.1 software (Medcare-Embla), polysomnographic recordings were done. Electrocardiographic signals were digitalized with a sampling rate of 250 Hz. Using the HRV analysis report of this software, low-frequency (LF) and high- frequency (HF) information and LF to HF ratio (LF/HF) were obtained at 5-min intervals, then at cutting points 30, 35, 40, 45, and 50, which indicate the intensity of the apnea and hypopnea index (AHI), were analyzed with mean and standard deviation of HRV frequencies. Results: According to the results reported in this study, comparison of mild, moderate, and severe cases led to no significant differences, while frequency-domain analysis displayed significant LF/HF increase in more severe AHI cases. This can probably be applied in screening high-risk patients, reducing the application of PSG in high probable cases, and providing an estimate of prognosis of potentials patients for the physicians. Conclusions: In the study of frequency-domain analysis, LF/HF increases in more severe AHI cases. These can probably be applied in screening high-risk patients, reducing the application of PSG in high probable cases.

Background: Spatial disease mapping is a widespread tool in ecological analysis to obtain accurate estimates for incidence, relative risks (RRs), prevalence, or mortality rates regarding to increase the incidence of gastrointestinal (GI) cancer in Isfahan in recent years. This study aimed to inspect the RR of GI cancer in Isfahan counties using empirical and full Bayesian model. Materials and Methods: Data of this ecological study were GI cancer cases which registered in health-care system of Isfahan University of Sciences during 2005–2010. We applied shared component model to model the spatial variation incidence rates of the GI cancers. We compared three models such as Gamma–Poisson, lognormal, and Besag, York, and Mollie (BYM) Bayesian. WinBUGS and GIS 10.1 software were used. Results: According to the fitted model, BYM model had best fit to the data. However, in general, ranks of RRs in most counties are identical; counties with higher RR in one map have higher RR in other maps. Geographical maps for three cancers in women were smoother than men. Isfahan has high RR in women, whereas this point is slightly different in men. Daran, FreidoonShahr, and Isfahan are cities which have high RR in esophagus, stomach, and colon cancer, respectively. Conclusions: Lognormal and BYM maps had very similar results. Despite some differences in estimation values, in nearly all maps arias Isfahan had high RR in GI cancer. It is recommended to promote the use of screening programs and increase awareness of people in high RR areas to reduce the incidence of GI cancer.

Background: The present study aims to evaluate the diagnostic exactitude of the intraoperative Chertsey test in tibiofibular syndesmotic injuries in patients with malleolar fractures, in comparison with a computed tomography (CT) scan. Materials and Methods: In this study, patients with malleolar fractures operated between 2018 and 2020 were examined. Thirty-nine patients were enrolled in the study. A three-dimensional preoperative CT scan was obtained. The opposite unfractured ankle was also scanned and considered as the control group. The Chertsey test was performed during the operation to assess the syndesmosis injury. Then, patients were partitioned into two distinct groups, considering the condition of their ankle, namely the Chertsey positive (unstable syndesmosis) group and the Chertsey negative (stable syndesmosis) group. Results: The outcomes of the present survey illustrated that the Chertsey test was positive in 16 patients (41.03%) and negative in 23 patients (59.07%). The median of all CT scan parameters (anterior tibiofibular distances (TFD), middle TFD, posterior TFD, and maximal TFD and volume) before surgery in the group of patients with a positive Chertsey test was significantly higher, measured against the unfractured control group (P < 0.001 for all parameters). Furthermore, a comparison of CT scan parameters and syndesmosis space volume before surgery between the two groups of patients with positive and negative Chertsey test results showed that the measurement of parameters in Chertsey-positive patients was significantly higher than the Chertsey-negative patients (P < 0.001). Conclusion: Chertsey test could be used to diagnose syndesmosis injuries in patients with malleolar fractures due to its high importance in the outcome of patients.